E 169 Shared Decision Making in Patient Centred Care Chris Chippendale DC

a doctors perspective e 169 chris chippendale patient centered care
Chris Chippendale, DC talks to Dr. Justin Trosclair, DC on A Doctor's Perspective Podcast

Learn to communicate what you do and goals for the patient based on what they want. Patient centered evidence based care evolves and Chris Chippendale DC talks shared decision making and much more.

Chris Chippendale, MChiro DC PgCert MRCC (Pain)  and I just briefly talk about qualifications and differences of a UK vs USA trained chiropractor.

Most chiropractors in the UK are cash based. He talks about how he set up his fees and we touch on membership practices, charge per hour and flat fees. What is the biggest determining factor on the price per visit?

When is it appropriate to do a double charge, how to handle flare ups if you do a membership plan and what about case fees instead of per visit?

Do case fee patients vs per visit change how you recommend care?

What is Patient Centered Care versus Doctor Centered Care?

Follow the doctor orders and what I think is appropriate. The doctor will ride in and save the patient. This type of model is normal. Patient care is about the hero journey. The doctor is the guide to the patient so the patient can reach their health goals. It’s about shared decision making, giving the patient a choice.

How do you handle the patients who say, You are the Doctor, You tell me the Best option?

I’m here to help you get what you want out of care. I want us to work together and for you to be an active part of care.

When trying to get patients to do exercise or make changes, it’s easier to meet them where they are than to steer them in a direction they don’t desire to go. Understand they may have a ton of things going on in their life so to do 3 exercises is the best they can handle at the present time. This could be the essence of patient centered care.

What do you, Patient, want from care so that when we are done you would say this was a good use of time and money? Patient may think they coming from pain but really that was there for 3 years, what has the pain taken from their life that they want back.

Link their words that they described their issue as, during your report of findings. We are grabbing, cracking, stretching and pushing so that area can move better and working better.

Bone out of place is obviously not something he would say, but when do you correct a patient’s wrong beliefs and when do you just let it go?

Ask for a referral when a patient is expressing enthusiasm but before they get better.

Intimate Time With Yourself – not what it sounds like

BOOKS

David Allen Getting Things Done, Jonathan Haidt The Righteous Mind 5 Love Languages

facebook.com/patientcentred
patientcentred.co.uk

Show notes can be found at https://adoctorsperspective.net/169 here you can also find links to things mentioned and the full transcript.

a doctors perspective e 169 chris chippendale patient centered care w Trosclair
Full Transcript of the Interview (it will have grammatical errors and mistakes). Just Click to expand. Thanks audioburst!

00:00:05 – 00:05:00

Episode one hundred and sixty nine shared decision. Making in patient centered care. I'm justin trust player. Today we dr chris. Chippendales perspective starring. Twenty seventeen and eighteen podcast. Awards nominated toast invest. Sally often on amazon as we get a behind the curtain. Look at all types of doctor and specialties. Let's hear a doctor's perspective looking back to the podcast who merry christmas. Merry holidays because it is upon us be similar was a fun month so far. I got interviewed on the modern carpeting. Marketing show as well as the chiropractic philanthropies for the when sheets and revisions. That i can do so i was super pumped about that. I'm sure they'll be released sometime in january february of twenty twenty one. So that's a good way to start the year. One last little plug. Those trilingual animal. Coloring books are still around there on amazon. The five and one book is the one i'd recommend is less than ten bucks makes great christmas gifts stocking stuffers and order. Soon you can still get it before the big day all right. Nothing that today's show we're going to discuss. Patient centered care evidence based how to speak not like a scripted report of findings or anything that although we do get a sample what that might look like but we want to know things like what does a patient centered care versus. A doctor centered care. Looks like what are the differences there. How do you meet the patient where they are you like. They need to do all these exercises. And all this stuff and the patient might be like. I don't care about the exercise. I just want to be headache free. Okay what does that look like. How do you wrestle with that. Divide between well. This is what you should do and this is what you want is their way to bridge that we're going to discuss all those types of things. So that's exciting. Well even discuss fees because he is from the united kingdom and he discusses win is a good time to ask for referral and near the end when we talk about the relationship advice. He has a special intimate time with yourself. It's not what you think. All right the books he recommended the show notes and the transcripts can be found at a doctor's perspective dot net slash one six nine. Let's go hashtag behind. The curtain live from germany and seven oaks united kingdom which is just outside london that end the show. We have a special guest that really focuses on. Patient centered care. No it's a buzz word but we'll find out what that means to him effective communication building trust and rapport and all of those types of things. That is so important. And he's been at it since twenty thirteen. He'd graduate from the royal college of chiropractic. Just happened to have him on. So please welcome. That's a chris. Chippendale me very exciting. I always love the accents so for those. Who don't know chiropractic is a real thing in the united kingdom like you to get school classes. There's boards just like america. Australia i think. Yeah yeah okay. We have qualifications and everything germany. It's kind of a little. There's a reciprocal licenses. But at the same time. We're not called doctors here. We always have to put usa at the back and then you raw germany yard. It's a little bit grayer every country in europe. How's it going rules. While i think maybe the netherlands too so you can kinda have to retake borcelino about you. But if you wanted to practice in america even if that's allowed i don't know it's a lot of effort to retake boards and there's not a lot of good Reciprocal licensing so it makes it tough. Yeah we're by. Well we make everybody to train making trump your age. I remember China go to ireland one time when i was exiting china's like oh yeah ireland or scotland. That'd be great and then you start looking into like oh man. Seok case studies that you can do instead of taking the boards. I was like wow. I don't even know where to begin with that. And it's a lot of money wanna feel on you'll notes from previous patients Yeah china that's not gonna work colorado the notes much better back then seller like america. Everything has to be documented. Proof that you did. Yeah yeah so. I guess the biggest difference that when mainly cash practices Insurance isn't really initially a lot of take insurance. But the i take it from most insurance Way the patients payoff in cash. And then they get reimbursed by the insurance. There are a couple of insurance that that you do that but more and more of the saying. We're not going to work with them now. I'd say for me at least ninety decided are A painting out of pocket. Now is that good or bad. It's good it's we.

00:05:00 – 00:10:02

Don't yeah if basically if the patient agrees to pay for it. I'm paying for c. i. Amazes me erin about how it is in the sites how you do all this work and then you hope the insurers are going to say yes. We'll pay you for that. And all these codes that you have to keep goes through a lot of wet you used the wrong code. And they'll say no. We're not gonna pay you for the treatment. Yeah i'm envious about us. Probably whilst the you can think a maybe unethical chiropractors at some point where they would always bundle these two things together and it's like well wait on every patient so they're like okay when our just going to say this and this together in the same region. That's happened though. Yeah that's on. Just the idea that the charge higher prices then are you still kind of charged around that forty to fifty five range. I mean it depends in way you walk in central london you could. You could probably be paying. I think probably guys that he chomped seventy pounds for a fraternity. Where i'm i'm fifty for treatment and ninety for the initial consultation place in the uk money off of that. It varies quite a lot geographically. Because it's not insurance based on what the people in your area a willing to buy so it can be quite local with that you have to up charge for rehab and everything or is it just fifty and you just sort of. Yeah you pay for the treatment. It's a bit different. The thanks british people. Expect the if you the. I'm gonna get everything so i if i showed them some rehab them. I'm included Some you might shaw for equipment if we sell. Thera- abounds tax separately and things. But i saw more. If i'm gonna use some acupuncture as well. Or if i'm gonna these trucks it's Yeah you'd probably for that visit and you get whatever you need on that okay so you really had to think about that price like what's kind of thing so you don't shortchange yourself on the hard cases and everything else. Although i mean some will bite on time and most practicians it'll be. You'll have it that get you century time and you might need a double treatment. But you'll pay for that i. I'm a little bit of an outline that don't do that. I just i feel like. I'm selling my time. And i don't i i'm punishing somebody if they need a bit more about diet and then you know. Why am i getting another twenty minutes this today. Making thirty man stopped talking. Show me get it done. I'm not paying twice. Yeah that's the thing is to do it and to it. It's like well. They need to know ahead of on what they're going to buy. You either decided a unique to pay double each time and we're going to spend double off that i'd rather than say. Yeah that's what you thought what it cost to come and see me today and i'm gonna give you everything that you need on that It's it's easy for me. These patients on what about like membership stuff where they pay you. Know whatever seventy bucks a month and then some places will do Yeah tends to be. It's more the. I don't know that it's more of the high volume places but places already gear around maintenance cat that whole thing again. People in regular maintenance might do that. I i liked the idea a little bit and saying you know what pay this much time. I'm angie covered and we e. I just think it's too much variation you just call predicts when somebody's going to have a flare up many guy you know. That's your wool. Maintenance is in this month's outset Or do you got i. If you have one flare up every three multiple companies three you know you gotta get into this whole calculating the patients that just looking at a guy like actually. Yeah it's like a and insurance products here So i just they can. They can buy block a treatment for discount. I ha i did. Dabble nothing misalignment did dabble with doing a case fee. Little note for everybody. But if i felt i can't we're gonna need to work together for a little bit of time. It's going to be like at least three months. I might say let you can pay a visit. And this is what the average patient like you would cost with winning the pain or you can buy a lump sum now. You can pay it in two installments and this is what have you need meeting more. That's fine it's coming. Sounds like a josh wagner style right there yeah yeah it's It's and it's nice in the when it suitable for the right people while and some patients loved it We didn't get any negative feedback. Actually but it's just. It's trying to couch that yeah and then kind of having a truck and i could like there's some people gonna work out without fee is going to be I we stopped doing it like when we opened back up after the lockdown. Yeah i already track. He came in one week and shut down for four. Yeah we had a. We had a few. I've just said. I just said we're hitting poles on this and then when you come back we'll see where you're at and I think most of them doing pretty.

00:10:02 – 00:15:05

Okay okay let's just pick it up. When we were a couple we were like look. It's going back okay. So we'll refund you the stuff. You haven't usable square it also I like that. Yeah yeah so it's It's a different way practicing. I like a show me. It was interesting. Actually realize for some people where i i was a bit more luck into space them out when i knew that money was no object to that point about me and you know there was still a few people who run. As if you're paying per visit. I probably would have tried quicker because i know you. You know it's going to help them financially little bit whereas when it was no object objects like. Let's just come back next week. You might be a two weeks but let's transit so it was still. It was interesting to see. I kinda got one guy. But it's like they're a little bit sway does still come back in does. Stop trying to read the patient in the moment and you like you can kind of feel in your gut could read the room. You're like ooh they ready to finish. Yeah interesting experiment. I'm not sure. I'll go back to it but it was good to try definitely. I think it'd be great if every car try not once like a year and then see what he learned from it could adapting told me if you think about how i managed by. She might may be changed a little bit. You know when when. I was talking membership before i always looked at it like at some point. You know when they were just maintenance once or twice a month you can come in or not come in. You're not gonna you know it's not going to bank to the next month but it has to be some kind of upfront fee. You kinda like jim like. Hey there's a three fifty signing fee and then after that it's only whatever at least i'm getting covered for that initial busy month. Yeah yeah. I never really experimented. I think it could be something. I think the clinics wax. It's sort of like okay now that you doing well. Yo gotti occupied you functioning a lot that we have membership option. If you want to the things amazing always like as a patient. I would always look at that and you see your bank young people paying for that and coming in of course because when you have five hundred people on it yeah yeah. Every plus with jim members attend up the gin you wouldn't be able to use single medicare. Don't come in that's terrible. Yeah so Yeah i hear you look at it like that. And i'll tell you when feeling need that. It seems they're doing very well. I think that's a good start. We've come out with the money part which was not intended. It's how it played out because this is gonna be about a building trust and rapport and a patient centered care but it's also a business and so i guess we kind of covered that part which is nice. So you've done things your guest lecturing. You're a two thousand seventeen year award a pg cert- in advance professional practice. Not sure what that means a few other. What that post-graduates it's on the way to a mouth is michael even if not okay. So you've got this experience. You've had some lectures. You're you're trying to give back and you're trying to create this patient. Centered care model that i think the profession definitely needs and it sounds like you could use that as well. Let's dive into that. What what is it. What's going on so i mean patient-centered guy is it your gut me right. It's a buzzword. And i. I got a little frustrated when i hear writing around now i i hear a lotta people talk about how patients sentences and then seconds later. We'll show you. You don't really understand what i mean. They've got the easiest way. I explain it. The opposite of the doctor sends model. Yeah which is where traditional medical doctors. You follow doctor's orders you turn up. They diagnoses they. Tell you what to do you. You coming to seize then dad. Doing treatments of life incorporates all about the dumpster in their expertise. It's like that heroin. They're gonna write it on that that white knight and say you the the head of the predecessor down distress from the theme today and it's all about them And the the opposite for me so about making the patient. Harry so we're talking about in seminal is the heroes johnny familiar with that. Of course the council that that whole that whole off of the janney of the hair right. That's how i see the patient that going through dog and it's about positioning yourself as the guide you'll the men so your rb one. Can i be your dumbledore. You're you know you're the past things helping than complete this johnny. So it's all about them and they're all. Can you'll data help you as you but knowledge a ton of experience is a lot you can provide for this past and but it's really making sure they remain center. Plus shed decision making is a is a big thing. The i don't tell my patients. This is what you're going to do. This is what you have today. I'll give them my advice that it's very clear that we're treating them as an equal on both going to decide as a team where we're gonna go from here.

00:15:06 – 00:20:05

I'm playing devil's advocate. A little bit. But i'm also curious because i had the same mentality and sometimes you get the people that are just like You i'm paying you. you're the doctor. Like i don't know if i need acupuncture. I don't know if i need this exercise or that exercise. So how are. How do you approach those patients are. Do you get that often. Yeah you do on fine without. I think it depends on the sometimes. They'll say well. Let i'm the expert in slowing on the expert and the musculoskeletal system. You'll the expert. Yea i don't know about your life. You know that really well. If we're gonna make this work for you and your life and your buddy. We need both sets of expertise. So if i think we need to ban encouragement and it will help relax. Oh i can maybe have an opinion on this. Maybe i'm going to bring to the table and my side like that. Sometimes i think not just and it might not be okay something. We could do today some acupuncture. Do you think accupuncture would be beneficial. The they're gonna guy will you tell me But i might just say something. That was really helpful. In these cases have some acupuncture. And how do you feel about that and see. I'm still presenting against. This is my expert opinion. That but i'm making sure they have that opportunity to say. Yeah sounds good. Oh i really don't like needles. I sounds a bit about nile. Turned their another option except that. Yeah yeah and it's Much more about. I think the vibe in the atmosphere and the relationship that you said of the star is i want it to be play right from the start that you're human being human being. I'm here to help you get what you want. Have a cat. And i want us to work together and i want you to be in that thought process and i respect your opinion. I respect your take on things. And i'm not gonna make you do anything already. One day i might give you a nudge. I just want them to feel relaxed. And feel but it's okay for them to say. Oh i'm not sure about that or a. Why you doing that. Stewing or how come they won't be able to ask questions and find out more because if they don't learn anything by the end harris jenny. What was the point you know. Especially the whole thing gets back and just live with this for the rest of his life and hasn't done anything. Nobody's watching the so. What do you think about rehab rehab have to be in. The patient centered care. Is that a mandatory aspect of it because people can be like. I wanna go back to the gym. I wanna do a marathon. I just need to do thera- bands as all at the level. I want extent rotation stuff. Yeah can fix shoulder from I it's very rarely wouldn't give some sort of active or somebody. I think you've got to meet them. Weather out. some people can get into. The ten camels was the day. Like i'm happy with that. That's a victory. They they took thirty seconds to help themselves great. I love what. They're so honest. Unlike him do those that. Yeah i love that as well i think when when they tell me i haven't done is done for that. It's like great. They feel okay. Tell me about that. I feel the line to me. And i just come back on friday. Yeah some people. I'm happy if not so that we can do us a step forward for them. Great other people. It's about common him down by the next fifty thousand excellent do by next week. It's like whoa. Let's plus at this one game. Not guys you got too often. They're big into crawfish all of sudden schools so some people have to bring them back a bit. But i like to give him as much as i think. They can read in the to right now to help themselves as there's a navajo saying if he i love it says Easiest to write a hole in the direction that is going. And that's not the approach. I type with patients that heading this way. It's much easier for me to jump on that point then maybe stadium trying to grab them in guy. I know you wanna go hit. But i'm going to unravel you the other way. I find that very very rainy wax and you end up with the frustration. Don't turn a frustrated by she vital listrik chiropractors. Like how hard. You just banging on people's heads about this innate intelligence and all this type of stuff because i was like man to get people to do exercise as much less change their entire viewpoint on the medical model and all of that. I'm having said i in. I don't think it's a little. I don't think that's listed problem. Okay i mean that is that is definitely part of it but i think the evidence by side we have just as much problem it looks very and we use science and you know we embrace him. We'll medical model degree and we. You know we're not trying to change that whole paradigm and kinda. Give them this honi philosophy but we still fall into that trap. It's like balakow to me. And i think you have extremes on both ends that i you know. I don't descended chiropractice equally on the spectrum. We like to say evidence based on all they stopped voice practice and the extreme high-volume going back at him on the head.

00:20:05 – 00:25:02

Yeah ever wanna practice. I see it on also. Well i hear the way people talk and had the way they you know they set up and i think that's it's better. I think in that you're not trying to sell about. But they can still use the eve. They can still use a long quite fierce nice language they can still eat. Certainly quiet launch guild I think we're all guilty of question. Sometimes is sort of guilting patients in that and you know we might say well this is. There was a phrase. I was in the ftc grape at if he is a guy on i've put it on a slide. I haven't put that stock me so much. We're talking about like empathy. And like i well up. Then forget him. That doesn't sit with being empathic. Your way all the empathy in the world for them when they're in my office but if they don't call them my vice they're on their own away. I know what you mean. I think it's things like not worth. I'm not trying to excuse the stuff that happens in the other. Yeah we we have that problem by sides. I think yeah but spent africa trying to bangladesh with stuff. I try that. I don't think it works very well. It worked for some that you end up. And then that's when they got a how do i. This is what i find when people if they were there questions in front of a seminar things like that and room face. How do i explain it. So patients get it. How do i say this. Like one of the words i need. He's won't see especially in. What do you do for your report of findings. And they want me to give them look script but like a freight they wanna scrip. But i want the framework. And i wanna be able to fit my was into that script and i have to kind of bring them back. And you think communication's talking like that step to step one. You gotta listen and if you don't listen then don't gonna listen to you. One of these really useful. We could really help people and we wanna win paul but we stopped in guys. How can they even here on voice on rather than thinking. I can picture in my head to the best possible outcome for this. I'm going to try and push them up that hill. Yeah i try to think okay. What's the realistically what's the best outcome right. Now for this pass and bearing in mind there. You're in the fact that they've Sick parents and then. I got three kids and businesses struggling to the longtime. Yes like a giving forty minutes of rehab probably do better that i can do another get stumped or i can give him ten camels and they'll get not done maybe every other day like to me. That's the better outcome. It's about being realistic. I is there any case. I think we don't do that. Very easily. initiatives. Often 'cause we may have an experience that life all selves or know this stuff we know about spa. We know about the muscular skeletal system. We studied and we studied it. Because it's so cool. It's like you really interesting and that's why we study. We spent the whole time and money. Memorize stuff textbook from going into you. Don't go into that. You'd become a clinician if you're really interested in the body and then we come out with a long these patients. They really yeah. I had this with One of our when she fest off it out. She was just getting frustrated. She's like why don't they care. This is that body. It's so important. I said so far. Yeah but to them like it's it's a call it's a vehicle gets like when i'm not a car guy. I know interesting if it gets me from eight b. and it doesn't cost money. I'm happy like my wife's the petrograd she eat into that I take my cottam mechanic. 'cause something's acting up and he he looks at it you still ten of it. Yeah this and the carburetor backing up to the pistole. I don't even know what he's usually jog him. And i don't wanna look like an idiot. So oh yeah yeah oh yeah oh yeah the carbonate. Yeah cool That would be. Why thing with yes absolutely. Oh that makes total smiling. No what he means the headline lewis. It's just tell me how much it's gonna cost man like can you fix it cannot mccollum. That's all i care about. And maybe if he said you know when you change gear do this tiny little thing and it might be a better. I'm might do that. Maybe i'm not gonna completely change your driving habits. But he might give me one little take on board. But it's just a call. I just don't care about for some people that stash on bobby. Fish and chips are better than eating clean and healthy exactly. Well they care about the ins and outs yeah. That's that's where especially new guidelines as the way we teach them over here.

00:25:02 – 00:30:16

Report findings a fifteen minute anatomy lecture. I am pointing out join on the spine model right in front of them and like dishes what gets inflamed great to the five percent. You're interrupted because they don't want to steepening from outgoing. I don't remember things. I just said to embarrassed about on that follows up with two questions for you now then is there. Wording are some analogies that you've been able to. What is a chiropractor. Do you snapping my neck and whatnot and then before you answer that one. One of the things you mentioned was i was going to ask you about asking their goals meeting them where they are. Is that part of your process. Asking what do you want from this. Yeah that's me. That's a pro a ripoll point of view that's when number one objective in the history. Just find out what's missing from this doesn't watson 'cause they never come in with pain relief. They think they d and we think they do but they never come in because the pain not explains why you have the people who had it for five years. Why they now now five years ago and it's because this pain or symptoms or whatever is it's taken something from their life and they won't back and not story cycle. you know the hammers jenny. They have a need and that's all they come. And if i can find that out then i can show them. I know what you want. Which makes a great okay. I trust this person. I know what. I will then trying to sell me. That goals me. You know whether that's a subway station. Free spoiling or strong core of kind of the ideal back when don't have to sell them and take them all go for them. It's all about right. You really want to be able to get back to getting in the gym. 'cause you want to lose ten pounds 'cause your way you get into the older and you're worried that you spouses and finding you attractive. That's a really populated motivator. And then i can hayes how we're gonna do that. you know. And every recommendation is getting tools out rather than coming into the back pain. But i really want you to have this really strong cohen. I really wanted to let hinge properly in paris by like it's just so which could still be the same goal you i have to do this but we're going to frame it. You want to get in the gym. Is louise white right we. We've gotta get you strengthening fine because you wanna get dead lifting all that and you haven't done squat for ten years we'll go somewhat today but suddenly it's not do these dog exercises because it'll make you strong and it will make me happier all i'm going do this and you know it's good for my back. It's like i'm eating healthy. 'cause it's good for my health. It's like no. I'm doing this. So i can get back to the jim in a few weeks time. That's way way more powerful and exactly exactly the same voice. But they get it and grail b that and it's yeah that's already ready teasing me finding that goal and usually prices of discovery dan. 'cause i often derail until we have the conversation quite quite often will have that conversation the history within a few minutes going he. Actually that is what's really bothering me. But it's not the back pain. The fact that i call relax in the evenings and i'm canada irritable with my kids. I don't like that. I feel letting them down to the fall. He doesn't necessarily go that deep with everybody's trying to song you'll never get that like cry into the emotion boxy type plays off very stomach kind of but But yeah the the key thing to me If i know what thank goal is by the end of the consultation. I can sit about failure to your radio. Connect with them and it's going to make the law going forward so i already trying to make sure we got that. So let's say we have a thirty six year old female. Deputy worker hand goes numb. Also goes at night suspect an disbelieves also scaling tightness. You know you're gonna do some stretches from cracking some exercises. How do you explain what's going on. I keep it really simple now. I say a lot less way less than i graduated point slugged. Yeah i've i've had some colleagues be like can you. Is that informed consent. You haven't got a model out you know. What a facet joined they. Stick around because it on. Can they want to know that you know. They like to hear a diagnosis. They do definitely liked to have. This thing hasn't name. There will always a thing that exists. Great people know about it But i just keep it only about language. I'm easy doing it during the examination. liked it. I'll often Talk about what. I think i'm gonna find festivals. We have the history sounds to me. Like you've got a bit of a dispose in the neck might show you the picture easy. I'm google pretty easily just so they can see what that is not going to look for in the examination. But we're going to check everything else. And then if we find out right. See how that been as painful. That's what i was talking about reading. Flame those nerves are unhappy and that explains why when you head to the right. You're gonna tingling running down the i'm linking and i'm using the words that he got me it's always about what they said linking by vasan to be it's thoughts during the examination explaining what we're finding how that starting to fit this picture together in terms of Cracking and snapping instruction and moving around.

00:30:16 – 00:35:02

I'm gonna get area meeting but we're gonna get it working better. Thought can be. It's that it they want to know for. Most people are going to let the best thing we can do for. This right now is to get these stuck. Aries freed up. Get some more blood flow in their start together. As man's coming down most effective way to do that in my opinion would be to use what we call an adjustment already. Paul stretchy might popping noises bubble. The joint that's on. And then i'll i'll show them what we're gonna do some hands on so they know as much as possible to experience by saying that that that's not working. I'm gonna do a thing. That's going to get that working properly. It's going to feel like this and for quite a few people thousand and then usually they'll come second visit. So what are you actually doing that. And then i can my little anthony You wanna know a great. And i can just a moment an my eyes glaze over. Yeah but that was where i struggled. With the my. I loved the teaching paul. I love getting patients to understand more about that body. I think the better they know about the can. They can take it better. They're going to say. But i was full on everybody because you know that i'm not some version of don't incentive practice. I wanted them to norwich so trying to make they did most. I'm cat you mean you didn't make him come to class on the first visit and bring their spouse. Yeah but it wasn't about anatomy hero's janney and entrepot much different than. Oh yeah. it's i. I love that stuff. And if they give me an inkling but they're into that okay great can start to something maybe even a little bit more but yeah ninety seven people you know. It's like the old school report. Findings went wrong. Can you fix it. How long it take yeah. That's radio tonight. So i try and get out as quick as possible and i try to give them the information i need in. His fee was as possible and as simple as possible with absolutely nothing unnecessary. At that moment they should be able to tell the personnel side. What would they just had experience. I what karen. I sullivan is when he cited right so when you get hired when you're offset what did they say. What are you gonna tell them so really good question whilst right the end and then you find out. Oh no they think a was a of place. I can see why characters said it. It was so easy so easy to explain what happened our in place. I probably wouldn't surprise. Twenty five percent of my patients go on despite me telling him about melting in very bad. And there's you cracking noise. They feel and they feel better. How could that not be about that place to them. Yeah we can heads on the wall too much about that. I crack and neck because there's so many people said at anyway. I just kind of joke with it. And that's what you think we're doing. I mean there's a crack noise that's great whatever. I'm not like funny things. Meeting the weather is writing the wholesome the direction that it's going if it's cooling a big problems in that passing i feel i have to counter every known accurate beliefs. They have about my movie right right. Yeah that's what that's the likes would probably tell me up against the for that one but i believe every time passing has a belief. Not totally factually accurate. It's gonna make them a chronic mass and it's gonna make them defend it does happen. I definitely think that happens a lot more than it should. But some patients just won't may believe in if i try and correct that belief. I'm just gonna end up destroying the ripple somebody else. He might may be reinforced at episode. One hundred sixty six that larry bins. He's a physical therapist. Got his doctorate in a lot of the stuff that you're talking about. He kind of chats about not exactly the same way but definitely has a placebo. But that's the one. He stopped amazing. I love that. I rarely incorporated law. Come out with titan signs revelation. And he is. I think he's every clinician should know about that stuff. 'cause it's so important i think it can become dogma like l like how you word it that people matters like keypunch is going to be painful. Guess what it will be painful for them. You're going to shop scratch. You've just guarantee that yeah good well. Let's switch gears a little bit. We've got two gears to shift into. There's usually four maybe six depending on the car. We're in about four now. A marketing era cast practice in a small town What are you doing to get patients.

00:35:02 – 00:40:02

We'll wait quite lucky. The practice itself has been established for about thirty five years say the voss majority of people now coming mouth which is really great. We don't do a ton of extent among we have a facebook page. I think any professional boxer would look at facebook page. What are you doing. That makes a difference. Yeah rebranded or what are. Y'all doing Now when not really to be honest we that's something. I've been thinking for why we should do. More of the clinic is to benefit. Move but to be honest. We it's a lot of it comes through. Google reviews been helpful. Huge on thing we got that upcoming we may not focus celsius up to about sixty. I think which is hadn't shown above the ones in the area and that makes a big difference knots and to me. I love that free and his cabinet. You know the nice thing is we sort of encourage patients to do that. I think the key to oskoui's when they're expressing them before they get better. Yeah 'cause well like this. I find this like we find that goal. Sirri powerful emotions goal. Right it's gonna take probably three months but we're going to get you back to being able to play with your kids on the floor again and have that great time feel like a good parent and he's going to be meaningful and you're gonna you're gonna thank me every state she gets in the rest of your life. It's going to be amazing. Life changing and there like yeah. But if they're getting they're feeling amazing and then they get that and you seem like a week off like yeah. I'm like well how we can. Yeah yeah play with. They completely forgot how bad they watch. This is a life changing that you know. It's not the analogy is a bit like you just throwing a bowl for dog like i don't treat my dogs. People don't like this metaphor the when you look a dog and his running really happy. It's not when it's at your feet with the bull. It's not what it's trucking back to you. It's going so the bowl or would it can see it's gaining on it. That's one that dogs like it's in the zairean. It's really really happy. So when the ethic dick 'cause it's about to get the go out a society with patients when they can see making tangible progress and i'm gonna get my goal and not it doesn't have to go with me not could be somebody you know. They're about to get that com. They saved up about to get some ocean. You're about to go into some as holiday and then within a couple of weeks off to the next and it's totally jump down. So that's the time. I think to all these before they get that we just send them a little email just to make it super easy for them. Just reduce the friction. Here's the link to practice. We'd love it if you just a couple. Yeah couple of sentences what you came in with. What your experience in the clinic and the differences by if you might be too and it's telling them what right because if you just say hey would. You need us a review. People that have rights locking Don't wanna say so having that would use. That frictions definitely helps i. I've been networking with A few gyms as well because my ideal patients. I like more. The athletes sporting types. Which i never used to when i graduated i hated that the loss of years become a more of an interesting line. So i've been working with those people who see base people coming in and there's a couple of lakewood gyms. I know a few trains. They know what i'm about. And so they referring pretty steadily. I think that's a good thing to do. Is a particular share off to is fine. The people who see those people on the network with that rather than you know. It's good to put out. And i'm sure we could be a benadryl. Putting facebook. ads targeting amateur athletes and things like that but Yeah we're that we're well established enough and we've got a busy enough know enough patients. Coming in that we can afford to be pocketing really. That's a nice nice advantage. One of the things we we tend to do is we have these goals we fight to get them and then once you get them you never celebrate them is one thing the next thing we never just pause and look in the rear view mirror and just acknowledged where we were and where we are now. It's huge thing to do and those that do it. They don't burn out and they just have more purpose. Research has shown that so one of the little reminders for everybody. I know why. I haven't looked at it but i kinda do that with patients like holiday that when we have best reviewed flat right. Let's reset way. You were you ahead. He was saying you couldn't be this. You couldn't be remembering your examination. I found this and this and that and that we've done faster view that you'll feel better. You'll meeting you're starting to get back into the jin your next moving a lot. Better your shoulders feeding these sort of. It's even like that. Before and after comparison. I find people really responding to that and then doing that towards the end to cameras. Well recapping like say. Remember the rabi merit look at where you look at where you are now was great. Celebrate the absolutely yeah all right fifth year we. We typically have busy schedules. Were not able to take vacation like we want to. We have spouses and things like that. So the question is how you to take more time off. And how do you keep the love alive in a divorced. Yeah that's an ongoing area.

00:40:02 – 00:45:00

If i to me. I am a definite hollick in recovery. You know always taking them more and more stuff and So me and my wife has been really instrumental in helping me see that in helping to might change sometimes with the carrot. Sometimes it's sick. She's great because she. It's not worth when you love it and she's she's been great because she's really good at seeing when i'm kidding myself she'll just cold she's greek. She's very blunt. She says she doesn't play if i upset. She doesn't do the whole anti. I'm fine tells me why she upset. Exactly what will they did. So that's been very 'cause she's thoughts to me a lot of. How did you think you're doing the right. But you're really bunny fans and you know we'll see news much as we'd like to. She's been already instrumental in for me. I'm really focusing now on making sure i've got not freed in the diary loss. Okay that's free time. But i'm going to put patients into or i'm going to work on the website there or i'm going to build any seminar or i'm gonna. I'm not looking to fill. I'm trying to get the mt space that i can keep. Mt cool comes up but sometimes something cool might come up when i put it that. I'd like to keep that. I think is really important to have that. Switch off time where you'll know doing something or planning something like for me. I love paul's books and normally i. You know i'm driving anywhere. I've got one on walking anywhere. Go on. I'm doing any of the tools around the house or got one on an recently It was an audio but the suggested this san. Yeah take some time to unplug the headphones in and that's been a bit of a game changer. 'cause it's like oh it's just me my old said yeah. Just distract from maybe. I'm overdoing made him. A bit stressed out. But i can distract drive to strike to track. I'm ready gonna kidding myself. And that's been a really nice guy. Okay maybe i'll put some musical. But maybe i'll just have that What am my coaches to intimate time. We sell which Yeah i like that phrase and the only to people and they chuckled and it sounds bit different. That's a good point. Like when i was in china had way more free time. I didn't have a kid so like you have a kid. You'll let ballantyne of again exactly you don't have to worry about it. So it was. I was always walk in. But anytime i would travel. You got more time on the subway. You're doing all these different things. But i wanna hear. I wanna hear the sounds of japan. I want to hear them talking. Horns i want to. I want to experience everything. I don't have to be plugged in so much and even here my commute. I just ride my bike. like what. what and a half kilometers and that worked. So there's not a lot of time even if you take the train to really plug into anything by the time you're ready already. The train is anyway. So i've learned to let myself feel guilty about always doing something for a podcast. Episode mini sold or something to put up big right now like i'm wasting time otherwise. Yeah yeah yeah so i just. I found some music podcast. And i just enjoy that because every every week. It's new music that you've never heard and yeah i think that anything for me. It was it was a book on being a said that one of the key things. It's just trying to be a little time. 'cause if i it's like training like you want to go and get strong right. You call spend five hours in the gym every night. You've got you got stronger. Wendy rest is when you're not using the muscle and he'll wasn't get stronger. It's it's the same thing with brian. Not yeah that's something. I've been definitely funding ones better now. But it's very much. I wouldn't claim to be. Yes i have got. The most of the went blank balance thing. It's a it's an ongoing project not very good last piece any books podcasts or resources that we should check out. yeah so i in. I've been ready getting into getting done by david. Allen which is it's been a really good system for just getting a bit. we're going to the whole idea. Who's by you so that you get everything out of your head. You don't rely on your brains. Remember anything somewhere fanny complicated but really comprehensive system but making sure that you're trying stuff out of your head on radio for me it made. I made a rookie mistake. I was getting stuff. I need to get done in about half the time so like being twice as productive so i took on twice as And that's where like. I'm gonna strip project on now i had this It's got derek. Seven article he says. I have a hell yet will know approach to things or if somebody says something hell yet and then slowly. Yeah that could be cool thing. So that's been good indefinitely using along with talks about having that free time and trying to The i think one book that. If i could get probably it's probably my favorite book and i think everybody could read this book would change. The world is the right. Just mind by jonathan height.

00:45:01 – 00:50:08

H t He's a professor of psychology. And you right this place all about the thing is Why people disagree about politics and religion. And he's done lows of research on Week al sense of morality from the differences for different people and he wrote a very left wing academic wondering how all these i have come through these right wing people and that just then no good people. Why why is that. And then he studied at and he's realized. Oh no. I didn't understand. And now he looks at it and he's he's got a much more nuanced view event and he can talk to people in the right on the left. And you can empathize with and that's really how many conversations with people who i fundamentally disagree with those pretty big things. But it's allowed me to see. They have a different sent. Some relative means something different to them. They have different values. And i can appreciate that understand why they made the decision. They do want to hold the belief they do without thinking. Well handled it get tested. Because i didn't feel that way but it's how patience explains why patients do things that i think are just completely insane. Like why would you do that. That's such a dumb thing to do. Is values are different. So they're not gonna make the same decisions yeah. I walked lyrical about it. Because it's it's it's the most important book like recommend that i know somebody And the white things sorry fractured and polarized right. Now if we all understood that and we all understood how to talk to people we disagree with a would be a very different place so that would be my number one thing. It always feels like they. They read a book how to win. Or how to polarize people and then it turned into if you don't agree with me in one hundred percent uranium moral person. We all need to respect you at all. Because you don't agree with everything in this topic list like i'm three and five. I think this is probably the problem with the internet is now we will have access to all this information like we have the opportunity to full price done. Increasing are a hundred times a day like we can all become armchair right. Yeah you see it now with the covid thing every like every colleague ever the fundable in his suddenly. Become an epidemiologist rivera logistic overnight. And it's because they read a little bit. They massively overestimate what may actually think they know about. It felt having other people and then other people disagree with them. They'll be if you haven't watched the video then you're an idiot. 'cause you don the sun that i think that's maybe the problem is before we had access to all this information. We sort of respected the people who spent studying the stuff we listen to that. They know more papers happen. Maybe yeah yeah i mean. It doesn't mean there's problems with experts as well. But i'm going to go up in a whole run about a lot of the political leaders like us peon say staffing like. Yeah we don't have a clue what actual information these people have and will never know like. Why don't we just shut up crazy. It's a difficult thing to balance them. Yeah i think that's not something. I would love if more people. I'm doing it now read. If you read that book you'll become more. Laura like me i think about seventy one. I love as well. That's completely separate for like relationships Five love languages so good. Yeah that that's that's the big game changers like i'm all about words and appreciation. I want to tell me she loves me. And then i tell them all the time and then i get annoyed when she doesn't seem to think again because for higher quality time i okay. Are those spending quality time with her. I can be telling her. I love her all the time. But if my heads in my work then she feels she's feeling that love so that's been kinda the same thing i think that it's It's what i like about the communications office that it's improved my marriage and i as every seminar in every training like they said don't go and take this to the clinic and make this work then. 'cause you'll missing mice the benefit. These humans can use these to prevent any interaction. And if you're already doing with patients even if that's what you care about and you'll patients are getting your fast attend. You'll find a full time with that. So yeah anything improve your relationships with people you love is going to improve your paris patience on it. Is it common for a british people to marry non non-british people all. I mean there's less office than you guys say. I guess we have to i You say because. I have a great i think. Yeah exactly i i. i mean. We probably more europeans in the u. k. And there's more. There's a local people in europe. You guys will big ex exactly. I don't know. I don't know it just happened. Just yeah we. We met while we were in college in a little village in south wales awfully. Yeah it just jerry. That's an interesting point. And i know i'm going to go and look up on this tomorrow about some kind of guy dig into some chinese lady in so the cultural differences is kind of fun and keeps things interesting.

00:50:08 – 00:55:00

I'm sure you still have the same type of stuff with. oh okay. yeah if you've ever seen the film my big fat. Greek wedding that was that was an average to look that great rome called to me until i met. I met her family i now. It's like a nature documentary like it's so true that field goal. Funnier and funnier. The greek and they will hold talks about the no. I met her parents. I came around to have this lovely dinner. Mean we gotta sit down to the living room and they put that films. And i'm sitting there with my wife on one side of me and my mother or the other and every five minutes something funny happens you nuts. You were going. We do a no consent without. She's an often. She's on her wedding album. 'cause they kinda skip over the wedding ceremony in that film about baked a two three hour things a huge deal so she talked me through the ins and outs of withing ceremony. Meanwhile like my wife had died or the kitchen just laughing and let's see how long this will not even ready to propose just enough to beat. Yeah okay yeah well took the head over story in my wedding speech as well awesome How can people reach you. Contact you and find out more about your seminars. And all that Best place to me. It's facebook facebook dot com slash patients sends it We do a weird thing in the uk where we spell with differently you guys. So censored is c. e. n. t. r. e. date. We skip out in. Always gonna be patient center dot cardo utai. I actually like both by the main site for the website. You can make it easier for facebook at facebook dot com slash patient c. e. n. t. r. d. Or you can find me. chris at patient-centered looking back. I should probably pick the different name because i didn't realize how difficult that might be at least should have both domains. That's great yeah device. I did work when we face back for the. I'm pretty good replying to people wanting to find out more about people and dead. Yeah all right well have a show notes. Page with the transcript the book resources. And you know it's funny. You said that. Because a doctor's perspective dot com was some dumb holder site for somebody this year a couple months ago. How let me just see what's going on with that site. It was gone. So i bought it. That's why i'm dot net because dot com was taken and now i got both cerro. Come see people now. They're not even doing dot com or dot that they do like a doctor's perspective or patients. Don't send calmer anything end of it. So confusing dot l. y. Come on guys leaving out letters we do. You tell you in which competes with the hack. I've ever like domico. Well that's chris. This is great information today. And i know that people are going to get some tips out of that so i really appreciate your time this week. Back from coming on another great interview has ended. While you're on your phone. Click that review but right a nice review for me five stars if you could as everyone says an industry. It'll help other people to find us when we have enough rankings not to mention i'll mention you and your review on an upcoming episode if you follow me on instagram you only get one link. So i use a link tree and so it's a doctor's perspective dot net slash links with an s. And that's gonna give you everything you need to know the top episodes of two thousand seventeen and two thousand eighteen podiatrist series dentist acupuncture series holiday. Twenty seventeen financial series. How to write a review how to support the show like buying a cup of coffee getting swag like t shirts. The today's choices tomorrow's health book. That's the blueprints for better health. Exercise picking food correctly and financial. And then of course bundle packs which can get you know. Needle acupuncture book forty common conditions including the electric acupuncture pin at a great deal. The resources page has some of the products. That i like. It's a -ffiliated style. So if you buy something from them. I get a piece of that. Just like on the show notes pages if you buy a book from clicking the link i get a small piece of that as well so i really appreciate that things like screen. Castell matic pure. Vpn missing letter j labs speakers pr- alone edge or hawk grips again. If you do need any coaching on how to improve your bloodwork drop weight and the pro loan diet fast mimicking diet.

00:55:00 – 00:56:04

Five day plan. Let me know as well as if you just need some coaching whether it's health whether it's marketing whether you need some practice growth etc reach out facebook. Justin entrust claire. Mcc of course at a doctor's perspective dot net on the top right you got all the social media icons that you can imagine. Click your favorite and reach out. Thank you so much for tuning in. Please tell a friend pass it along. You can go to dot net slash. Listen it's just that easy it will open up right in your app and don't forget appreciate you listen critically. Think and integrate see on the minnesota on thursdays and saturdays. Hope you're enjoying those. I'm definitely having fun. Summarizing the podcasts and less than ten minutes for you you get the nuggets without having to waste your time shots.