119: Casual Care Plans

Casual Care Chiropractic. That's the topic we're gonna talk about on today's edition of the KC KC CHIROpulse podcast, brought to you by Kats Consultants. I'm Dr. Michael Perusich, and I'm joined in the studio with, as always, my good friend, Dr. Troy Fox. Troy, the Casual Care practice. 

 

Yeah, interesting concept.

 

Yeah, I coined that term. You did actually. Yeah. It's a, it's an interesting term because we see in practice, um, a couple, three different models. I mean, you've got your typical insurance based PI care model where the patient is required to be on a treatment schedule to follow through with kind of an insurance protocol, right.

 

Um, Got, and you're waiting on payment and so forth. Mm-hmm. , you've got the, we, we've seen an uptick of what we call walk-in chiropractic care clinics. Mm-hmm. , that sort of thing. Mm-hmm. , yeah. I'd call that the casual care clinic where you come in, you get adjusted. You never get educated as to what chiropractic really is.

 

Right. You are left to base your need for chiropractic care on your pain level that day. So if I'm a five out of ten, I may walk in the door, I may call the chiropractor that day. That's, that's more of what I call a casual care. Wellness based chiropractic requires a little bit of education. It's not that far off from casual care from a standpoint of, yes, you may end up putting a patient on a short treatment schedule, but if they're coming in and they're going, I don't have any.

 

Uh, readily available symptoms or I've just got a little twitch in my neck and I thought I'd come in and have you check it out. Um, now we're looking at an education process that involves explaining the difference between pain and function, right? And that's really what I get into with patients. Patient might come through the door because of pain.

 

My whole goal when I work with a patient to get 'em to understand, it's kinda like dentistry, really great example. If I only went to my dentist when my teeth hurt, I'd probably be getting a lot of teeth pulled, and it really isn't what I want. But if I didn't know any other way to do it, Would I do it that way?

 

Yeah, probably. So. I, I've got a, I, I've got a patient that is a chiropractic patient that only comes for chiropractic care when they're in dire pain, because that's all they know. I've never educated, I've never told 'em a thing, right? And all of a sudden, at 70 years of age, I've been treating 'em for 30 years.

 

I've been treating 'em since they were 40, but they only come in about once. Three to six months. Sometimes it might be a year before I see him again. How you been? Well, I, I haven't, I haven't had a whole lot of pain. Nothing I can't manage. I hear that every once in a while in practice. Right. Nothing I can't manage.

 

So I waited until now to come in and, you know, that patient, they're a train wreck. When they lay down on the table, they've got multiple, multiple areas that are just on fire and it's like a train wreck. Yeah. How did they, and, and so you're, you're just like, okay, so you do what you do. With that patient that's resistant even to the education.

 

But that type of casual patient eventually comes back to you when they're 70 years old and says, doc work on this. And they're willing at this point cuz it hurts so bad that they're actually gonna follow through with some treatment and they're gonna do what you tell 'em to do. And then they say to you, this isn't getting any better.

 

I don't understand why, because I've gotten chiropractic care my whole life and at that. You have some splaining to do as a doctor. What did you do with them for the last 30 years? Did you tell them the truth about the care that they needed? Did you talk to them about wellness and keeping your spine functional and the nervous system at peaked out performance?

 

Or did you just say, Hey, gimme a call when you heard again? I, I have a funny story there. This tell me, this actually happened in practice. I had this, this lady, super nice lady. Mm-hmm. , she started chiropractic care when she was 30. Mm-hmm. , she wasn't my patient at that point, but, um, when I was seeing her, she was, uh, well into her sixties mm-hmm.

 

and she would only come in twice a year. Yeah. And it was the same story every time. I've been going to chiropractic for some odd years, and I don't know if I'm getting any better.  and I would say the same thing every time. Well, at twice a year, probably not. Can you imagine? Mm-hmm.  if you brushed your teeth twice a year, and she would laugh, but mm-hmm.

 

you know, the dental analogy that you brought up is such a great way, so I, and I got a couple of directions to go with that. The dentist tells you to brush your teeth every day, right. Sometimes twice a day. Three times a day. I know. Mine tells me, you know, you really should brush your teeth three times a day.

 

I'm like, well, you must own stock in toothpaste. But yeah. So what do we do? What are we telling our patients they need to do every single day for good spinal health? Mm-hmm. , are we telling them anything or are we just telling them to come back when it hurts? Mm-hmm.  Does the car mechanic tell you to, oh, just, just come back when the oil light comes?

 

Just come back when you see smoke pouring out from underneath the hood. No. You know, we, we have to take command of our patients. Our patients come to us because we have knowledge and tools, our hands, and we, we know an art that they want. Mm-hmm. .  and they want us to tell them how much they want it, but so often times we're leaving it up to the patient, which you, you cannot do.

 

And I'll go back to the dentist for a second. Why are the dentists so busy? Have you called a dentist lately to try to get in? Mm-hmm. , it's six to eight months to get in. Mm-hmm. . Now maybe it's, they're not great at scheduling or maybe they see a lot of 'em, or it could be a lot of reasons. I know every dentist I've ever gone to, it's because they're busy.

 

Mm-hmm. , and they're telling you how often you need to come back. And Dennis, Dennis, for years told everybody, you need to come back for a year. And then, I don't know, probably 20 years ago, they started telling everybody, you need to come back twice a year. Now my dentist says, I wanna see you every quarter.

 

Mm-hmm. . Mm-hmm. . Wow. Yeah, I get it. And then she tells me in between, you gotta brush your teeth, you gotta floss. Do not, and she says this every time, do not wait for pain. Mm-hmm. , if something doesn't feel right, something's not right. Whatever you call us and get in here, we need to treat our patients the same way.

 

They deserve the same level of care. You know, you, you can't, you can't see the spine. Most patients don't know what the spine does. That's what we need to be teaching patients, why that level of care is important. I'm gonna go so far as to saying not recommending care for our patients or not telling them a future direction is almost negligible.

 

I mean, we don't see that in any other area of healthcare. No, there is no other. Now here's, here's the other thing that you put on yourselves, docs, and, and this is a, this is a saddle that you. And sometimes you make me bear it too, which kind of upsets me because your patience will come to.  and they will say, Hey, I just moved to a new town.

 

I've been getting chiropractic care for the last 20 years, and I usually delve a little deeper. I want to know how often you've been seen. Were you on a regimented schedule? Were you being seen periodically? Were you just calling when you hurt? I ask all those questions because guess what? Here's where you saddle yourself with, and it's a saddle with cockle bursts underneath the blanket, right?

 

When you don't recommend to patients what they need to do, and you allow them to become a train wreck before they see you again, what happens is, is the expectation is, is that you're the savior, you're gonna fix them. Mm-hmm.  when they walk through the door, and you're gonna do it in one visit. And if you don't, you're not worth your salt.

 

That's what we say here in the Midwest. You're not worth your salt as a chiropractor if you can't fix me in one or two visits. Some of what I've heard over the years, and unfortunately we put ourselves in a bad position. You know, my response to that, if you went to a physical therapist, you would not expect to be fixed in one or two visits.

 

You would expect that if you went, say, for some shoulder rehab after a surgery, it would take three times a week for a number of weeks, right? For you to get better. Right? Right. So now all of a sudden you come in here with a major spinal problem and, and you've got significant, you, you're, you're dragging a leg right now, walking in here, and you think that somehow I'm magical enough to fix you in one visit.

 

Right. So we have to be honest with our patients, and I think if we delay care for our patients and by delaying care, going wait until it hurts so bad, you can't stand it any longer. That's what we do. When you're 45 years old and you have a bad hip, a surgeon goes, you're too young for. Wait until it's way worse, until you just can't stand it.

 

Cuz we wanna push this out as long as we can. That's the only time in healthcare you ever hear that? Except in some chiropractor's offices where we go, wait until you're a disaster again and come see me. Right. I don't have to educate when I do that because they can just use pain as their only indicator.

 

Then at that point, I think that is poor education. Yep. I think we as chiropractors know better. I think I, I don't know of any of us chiropractors that wait until we hurt so bad, we can't stand it to get adjusted. If you are, I mean, I'm sorry, I, I, I don't agree with you. I think we were taught better than that in school.

 

I don't think this comes down to a philosophy issue. It comes down to a patient care issue, and so I'm very passionate about that. Yeah. I, I think it's something we're both passionate about and. And I think that's where it has to come from. It has to come from the heart, it has to come from your mindset.

 

It's not really a philosophy standpoint. Mm-hmm. , we all probably have great philosophy in chiropractic care, but it's, it's a mindset that you've gotta get into that you are the leader of the patient. They're looking at you saying, what do you want me to do? What do I need to do? And that patient, and I had 'em too.

 

That patient that comes in and says, I'll give you two visits, doc to get me out a nine outta 10 pain. I would laugh and I would say wrong clinic. You want the guy down the street cuz I'm not even getting into that. Yeah. And they would laugh and get on the table and I'd, you know, get the number of visits we needed.

 

And you're gonna get those patients right. You're gonna get those patients. Yeah. But that all that patient is saying is, Hey, doc. Thought process is maybe a couple of treatments, cuz that's typically all I come in. Mm-hmm. I'm looking to you to tell me something different is going on and it needs more care.

 

Don't be afraid to tell people what they need and why and why. Exactly. Yeah. We, we, we have a tendency sometimes, I don't know if it's poverty complex or if it's mindset or shyness, or maybe we just don't want to hear No. Well, yeah. Sometimes we don't want confrontation. Yeah. But you know, it doesn't have to be confrontational to tell a patient what you need, you know?

 

Mm-hmm. , oftentimes I would say, you know what? I think you need this based on my, my professional opinion and my evaluation on you. I think you need this. If you think you need something else, that's up to. Yeah, you do. I want you to know what, I want you to know what my recommendation is. Yeah. You're gonna do what you do because of ultimately I work for you.

 

Yeah. Quite honestly, I work for you, so I'm gonna, you know, I'll note it in my notes if you decide you're not gonna follow my recommendations, but here's my recommendation, here's what I, here's what my past experience tells me. You're probably gonna need to get better. Yeah. And I'm telling you right. Troy, we've seen hundreds of chiropractic practices mm-hmm.

 

and we see the difference in the practices that have the mindset and the passion mm-hmm.  and the ones that don't. Yeah. And then we hear the complaints of, oh, you can't make it in chiropractic. Oh, I can't make enough money. I, I'm not getting by the reimbursement so bad. Where's your mindset? Where's your mindset?

 

Are you in the casual care chiropractic mindset, or are you in the leadership care? I just coined that myself. I like it. Are you in the leadership care chiropractic mindset? Mm-hmm.  Lead your patients, talk to them. Yeah. It's, it's all about, I mean, there are so many different things and directions we could go with this because there's so many different four hours, there's so many different facets, like a diamond.

 

There's so many different facets to this. But be passionate about your patients. Be passionate about the care that you give them. Don't be that casual guy that when the patient walks in, you just go, I don't want a confrontation today. I don't really want to have to tell 'em something different than they already believe.

 

And you just get done and you go, gimme a call when it hurts. Right? I'm just, I'm not a big fan of that, and I think it sells you short and it sells your care short because then at that point, if that patient doesn't make some sort of miraculous recovery in one visit, you didn't do a good job. And we know better.

 

We know better than that. You can give the most fantastic adjustment on the planet. And if you're loaded with spasm, inflammation, you've got, you've got nerve, you know you've got nerve root compression. You got all that going on. How long is that adjustment gonna last? Well, in that one in a million. The patient's gonna walk out of there and never feel pain again.

 

Never feel dysfunction. They're gonna walk straight. They're gonna track straight down the street. But in 99% of cases, by the time they get to their car, their body is already trying to undo what you just did. Yep, yep. 

 

Because it's rehabilitative in nature. So what is it? Something like Don't, and don't quote me exactly on this number.  I'm pulling this off the top of my head, 80%. Of, uh, conditions relapse within 18 months because they weren't properly treated in the, the, the right amount of time. 

 

I mean, if that doesn't tell you to tell the patient to come back, and I don't care if the patient's saying, doc, I absolutely will not schedule.

 

I will not. Tell them when you think they need to be back. You know what? Mm-hmm. Bob, I really would like to see you in three days, doc. I can't do that. I'm not coming back. I'm not gonna schedule. Okay, Bob, just remember I'm putting it in my notes that I recommended three days. So when you come in two weeks and you've got the same thing going on, and it's worse, I'm gonna look at my notes and I'm gonna say, Bob, I told you three days.

 

So, you know, at some point when you wanna listen to me, maybe we can get past this. Mm. Be forthright with your patients. It's okay. You just brought people. Appreciate it. You just brought up a point and you didn't say the word, but the sound of, of your voice, the tone. And the things that you said told me that you're the doctor authority, when you work with patients, the patient doesn't drive the care schedule.

 

You do. Oh, absolutely. Exactly, exactly. Absolutely. So even if they're not gonna schedule, even if they're not gonna schedule the whole whatever, tell them what your recommendations are. I think that's imperative and they, and they do what they do with it. It's no different than a surgeon recommending surgery and then you electing not to do it.

 

What would you think if a surgeon. I don't think this guy's got the finances or he seems a little standoffish. I don't know that he's gonna do this. Have you ever heard of a surgeon go on? I didn't recommend the surgery because I didn't think they would do it. No, no. They recommend it and then you do what you want with it.

 

And I think we have to do the same thing with patients. I agree. So everybody get out of the casual care chiropractic mindset. Get into the leadership care chiropractic mindset, and not only will you retain patients, not only will you improve your outcomes, but you will blow your practice up in a very profitable way.

 

Troy, good to see you today. And hey, everybody out there, make sure that you go to cats consultants.com. Check us out there, there's all kinds of free things on there. Check out our blog. You can, uh, see some of our other podcasts. Be sure to pod, uh, subscribe to the podcast so you mm-hmm. , watch it every week.

 

Yes, we do this every week. From all of us here, We really appreciate you guys tuning in and listening. There's so many of you out there listening now to our podcast, so that's super exciting to us. So thanks for tuning in to the KC CHIROpulse podcast, brought to you by Kats Consultants.

 

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