Business Talk – 10 things I didn’t learn in school, part 1 of 2

Conventional curriculums teach concepts and principles that are within the traditional realm of the profession.

Conventional curriculums teach concepts and principles that are within the traditional realm of the profession. Consequently, academia is unable to keep up with the continually changing clinical and economic climates that today’s chiropractors practice in. School, for the most part, teaches us the basics – but I’ve learned that it’s those individuals who go beyond what is taught in school who make the biggest impact as their careers move forward.

Fortunately, I have had some very good clinical mentors and have followed sound business advice. These two, when merged together, have produced some very fruitful results for my practice. In this two-part article, I will share 10 things I didn’t learn in school that have forever revolutionized my practice and allowed me to provide innovative ways to make every visit a patient experience.

1. Assess for success
Over time, studies have demonstrated there is a lack of research to support conventional orthopedic testing. Research has been telling us that conventional assessment approaches often lead to incorrect interpretations of diagnostic imaging and conventional orthopedic testing (Jensen, 1994, Cadogan, 2011, Contant, 2003). As clinicians, we are presented with injuries and different clinical presentations that challenge the way we assess our patients.

Functional assessment
Functional assessment is changing the way chiropractors assess their patients. It is a contemporary term that focuses on locating biomechanical dysfunction so that our assessment can specifically direct where treatment will occur. I use a functional assessment system (EXSTORE) with favourable results because it provides patients with tangible perspective in the progression of their treatment. If the initial assessment reveals a weak gluteus minimus, and if on the following visits that muscle tests strong, then patients may observe and appreciate the differences even if they still experience pain. Functional assessment constitutes the majority of referrals to my practice.

2. Getting to the (motor) point
The concept of the motor point has dramatically improved my treatment results and I did not learn the clinical significance of it until after I left school. The motor point is the junction where the motor nerve innervates the skeletal muscle. It’s the end point of all motor neural processes, which culminates in the desired contraction of skeletal muscle. The most popular factors that influence this clinical phenomenon are nociception and joint changes. Nociception is the processing of noxious stimuli by the peripheral sensory system, which can adversely affect the motor neuron, causing a weaker muscle contraction. Changes in spinal and peripheral joints cause nociception which projects sensory information via interneurons onto alpha motoneurons in the spinal cord,  triggering peripheral muscle inhibition (Lund 1999, Svennson 1996, Nijs 2012, Hurley 1997, Horre 2006).  

Restoring motor inhibition
The work of several researchers has built the foundation for the growing use of Functional Motor Point Acupuncture and Acupressure to restore motor inhibition. Take the example of a patient with low-back pain who has a weak gluteus maximus muscle brought on by an old ankle sprain. In this case, locating and stimulating the neuromuscular junction or “motor point” of the inhibited tissue will help restore dysfunction. This dysfunction can be restored by using an acupuncture needle or manual compression directly on the motor point, with or without the use of electricity (Jensen, 1994, Cadogan, 2011, Contant, 2003). When done correctly, the clinical results astound most patients, leading them to come back and talk to other people about your clinic.

3. Doctors really don’t fix anything
Many clinicians feel their treatments help their patients by “fixing” the problem, much like an auto mechanic corrects the function of a car. The reality is that clinicians who treat human conditions never actually “fix” anything; they merely help the ever changing human organism to adapt from one day to the next. Three years ago, I interviewed Dr. Alejandro Elorriaga, who has trained thousands of successful practitioners as the director of the McMaster Contemporary Medical Acupuncture Program.

Elorriaga said the biological reality of any clinical dysfunction of the musculoskeletal system is that the underlying problem most likely has been present for the better part of the person’s life, before it reaches the point of becoming part of a pain experience. The biological reality is that no therapeutic intervention will ever be able to fully correct the very complex underlying elemental dysfunctions associated to the presenting biomechanical clinical problem. However, therapeutic interventions such as electro-acupuncture, manual techniques and manipulation can restore part of the lost adaptive potential relevant to musculoskeletal function in such a way that the pain experience greatly subsides or disappears altogether.

4. Stop paying rent – own it
Let’s look at two chiropractors and analyze their chosen paths:

Dr. A pays an average rent of $3,000 per month for 25 years and then he retires with little equity and no assets.

Dr. B pays rent for eight years then takes her savings ($125,000) to use as a down payment to purchase a property that costs $500,000. Instead of paying $3,000 per month, her mortgage payment is $2,181.02. This saves her $818.98 per month for the next 17 years, which totals $167,071.92 plus interest. In addition, the value of Dr. B’s property has increased to $1.2 million.

Windfall
I once interviewed veteran real estate agent and developer Frank Lostrocco, who discussed with me the benefits of ownership. I learned that in the majority of Canadian urban and suburban markets the value of real estate has doubled in the last 10 to 12 years. There are short-term accounting advantages to leasing over owning in terms of yearly expenses, but for a practitioner, I find the advantages of owning greatly outweigh leasing. Also, it is easier to sell the practice when you control the location and building, which provides a huge windfall for your retirement years.

5. The King’s Speech
If there’s one thing audiences should take away from The King’s Speech, the Oscar-winning account of King George VI’s struggle to overcome a debilitating stammer, it’s that practice makes perfect. Every time we see a patient we are essentially engaging in public speaking – to an audience of one. In addition to assessment and treatment, the majority of the time spent with our patient is spent communicating through conversation. Whether the topic is the patient’s sore back, or their plans for the weekend, we must carry the conversation during patient visits.

Benefits of public speaking
Paul Argenti, from Tuck Business School in Dartmouth, N.S., teaches students and professionals communication skills and recommends that public speakers develop the ability to lock eyes with their audience, making them feel like they are the only ones in the room. Many of us may avoid public speaking, but it is never too late to start and become proficient – much like King George VI, who, by the end of his career, was an outstanding communicator. Public speaking allows you to address groups, schools and patient education events that promote your craft and build your practice. Personally, my public speaking skills have created opportunities for me and for my business. Currently, I have two television commercials, which run on networks in Hamilton, Ont., after I was asked to be a spokesperson for a cable company and for a credit union.

The main thing chiropractors and chiropractic students should take from this is that school provides a good foundation for success but our potential for clinical and business growth is boundless and often comes from untraditional sources.

Five more things I didn’t learn in school that have made a difference in my practice shall be revealed next issue.

Anthony Lombardi, DC, is consultant to athletes in the NFL, CFL and NHL, and founder of the Hamilton Back Clinic in Hamilton, Ont. He teaches his fundamental EXSTORE Assessment System and conducts practice-building workshops to health professionals. Visit www.exstore.ca for information.