Chiropractic + Naturopathic Doctor

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

Anthony Lombardi   

Features Business Management

After part 1 of this article was published, I received a very kind e-mail from a fellow colleague who wrote this: “Anthony, I am deeply touched by reading your article. Not everyone is willing to help others and openly discuss the inside of their business and techniques.”

After part 1 of this article was published, I received a very kind e-mail from a fellow colleague who wrote this: “Anthony, I am deeply touched by reading your article. Not everyone is willing to help others and openly discuss the inside of their business and techniques.”

This short note made me feel very special. I feel that willingness to share valuable information with one another is an attribute that enhances our profession.


Some may feel that sharing such things gives “secrets” away, which can hurt our own practice, but that is simply untrue. I once read somewhere that by teaching we learn and by learning we teach. At the best of times the utilization rate of chiropractic services in Canada is about 15 per cent. That leaves a pool of over 24 million potential chiropractic patients. With prospects like that, helpful tips, or “secrets,” will not endanger the future of their practices.

So let’s continue where we left off from last issue, identifying some of the things I didn’t learn in school that have revolutionized my practice today. The first five things were discussed last issue. What follows are the remaining five points.

6. Understanding trophic changes
Many of us have probably heard the terms “trophic changes in soft tissue” or “trophic soft tissue changes,” but very few of us have a firm grasp on the clinical meaning and the mechanism of the concept. On a surface level, trophic changes are simply changes in soft tissue (skin, fascia, muscle), resulting from interruption of nerve supplyThis interruption does not have to be a discal lesion, nerve compression or axonometis. It can simply be an interruption caused by microcirculatory changes at autonomic spinal levels (T1-T5, T10-L2), overuse of a particular muscle or group of muscles, or effects of degenerating joints, which contribute to the neurogenic inflammation that triggers trophic changes in segmental and local tissue.

For example, in musculoskeletal cases we may notice clinical signs such as knots or tight bands in subcutaneous tissue over an injured muscle as a result of a combination of motor inhibition and changes in capillary circulation to that region.

I’ve learned the key to clinical treatment is to reverse the stimuli that trigger the noxious chemical and the mechanical stimuli that cause the neurogenic inflammatory response. Manipulation of joints, manual muscle treatments and interventions that directly target the nervous system, such as acupuncture and electro-stimulation, are key allies in the minimization of trophic changes and the acceleration of soft tissue healing.

7. You never get a second chance to make a first (clinical) impression
The world today is moving at a fast pace with countless stimuli occupying the attention of your potential patients. So, making a habit of creating a positive, lasting first impression on your new patients is the most important factor that will determine how many new patients they refer to your care.

New York University researcher Daniela Schiller examined the neuroscience of how people form impressions of others. She studied the amygdala, which controls and moderates our motivations – telling us where to go and why – and the posterior cingular cortex (PCC), which helps us assess the value of objects and possible choices. Together, the PCC and amygdala help us compute first impressions of others.

Based on Schiller’s work, one of the best ways to take advantage of a first impression is to give people a reason to trust and value you. This is why the importance of what you do on the patients’ initial visit will reflect how quickly your practice grows. On the initial visit, being able to assess the patient’s problem, provide a focused functional assessment and provide an indicated treatment in which the patient sees immediate results (that day) is the best way to make a lasting impression. I have made it a point to do this and I now see 12 new patients per week.

Andy Sernovitz, author of Word of Mouth Marketing, says new patients will refer new people to you within the first three visits. So, if you cannot make a valuable impression on your new patients, you won’t be getting any more referrals from them.

8. The meaning response
Meaning response is the brain’s perception of the surrounding environment, which elicits a physiological response that decreases sympathetic tone. Basically, it’s when a patient walks into the doctor’s office and, instead of feeling nervous, feels relaxed. This gives the therapist an advantage because the sympathetic nervous system, which is active during pain and times of anxiety, becomes submissive when actual relaxation occurs in the mind and body.

For example, when a patient with post-traumatic stress disorder walks into my clinic and is greeted by Nitro, our nine-pound toy poodle therapy dog, a physiological transformation takes place within the patient’s body. Dr. David Neuman, a medical doctor who studies the meaning response, says, “A neurohumoral reaction takes place in response to the patients’ surroundings when they perceive and infuse meaning in activities around them that impact their brain and improve treatment results.”

So, this means the colour of your walls, your waiting room furniture, the way you shake your patients’ hands, how often your patients come in for treatment, and almost every other aspect of your office influences an untapped reservoir of healing capacity that can easily be accessed by our patients on every visit.

9. Goodwill hunting
Since I started my practice in 2002 I have made it a point to be a continuous part of my community. I have learned that investing time, money and resources into self-driven community initiatives not only enhances the state of the community but provides your practice with more benefits than any paid advertisement. Your community is the place where the majority of your patients and patient referrals will come from. So naturally, it makes sense to reciprocate the support by creating practical programs everyone can rally around.

Consistently supporting your community through initiatives you generate will build goodwill in your practice, which will be rewarded over time as the community sends referrals your way.

Since 2004, my clinic has run a citywide winter coat drive that has collected and distributed over 7,000 coats to those in need. In 2008, I created an annual academic scholarship open to high school students in our community that gives eligible students $1,000 for post-secondary education.

10. How to invent money
In the book, Rich Dad, Poor Dad, by Robert Kiyosaki, there is a chapter that resonated with me and helped me understand the concept of creating and inventing money. The secret to inventing money is to take how you do things and change it slightly in a manner that yields more money in your profit column. Let me show you some of the ways you can invent money.

Owning versus renting
I touched on this in part 1 of this series, but it is worth mentioning again. Using your savings as a down payment on ownership will reduce your monthly expenses by hundreds or thousands of dollars, and your investment is protected because the value of your asset will appreciate. I recently mentored a chiropractor who was paying $3,000 per month in rent. After he purchased a property for his practice, the mortgage payment was $1,800 per month. He invented $1,200 per month.

Understanding that saving is earning
Find areas in your practice where you can do without. Look over your credit card and debit statements as you ask yourself this question: What do I need to run my practice? Common expenses that can be reduced with a simple phone call include cellphone bills, insurance premiums, point-of-sale fees, changing banks and switching from traditional telephone providers to voice-over-Internet companies. For example, last year I created money by switching from a big bank to a credit union as I paid $900 less in annual service fees.

Being creative
This past summer while on vacation at the cottage, I wanted to see if I could generate income from my deck chair. Using Paypal, I created a promotional sale that allowed my patients to purchase gift certificates for clinic services at a modestly reduced rate. My staff e-mailed the offer to my patients and by the end of the week I had invented over $4,000 in online sales. Statistics tell us that 30 per cent of gift certificates never get redeemed, and in this case, nearly half are still unused. If you do something like this, remember to keep your pricing competitive and connect it to a time of year when people need gifts – like Christmas or Valentine’s Day.

The longer you practice, the more you will learn about people, business and life in general. I feel it is important that, as chiropractors, we take the time to help one another become better at clinical and business practice. This way, we can enjoy more fruitful lives as our profession grows into the future with stability and self-assurance.

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 for information.

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