Posts Tagged ‘Chiropractic Practice’

HOW TO BYPASS THE ECONOMIC SLOWDOWN

Thursday, January 29th, 2009

Do you need more new patients to feed the growth of your practice? Are you tired of those training programs that claim to provide the missing piece in improving your effectiveness; only to find that it is yet another technique that is only applicable to a small segment of your patient base? Have you been grappling with how to increase your cash flow and profits in spite of rapidly rising overheads? Are you investing too much of your time and energy in your practice, and not enough time living the lifestyle that you spend all day telling everyone else to live? Are you sick and tired of the public perception or misconception of what you do? “Oh you’re a chiropractor? I’ll come and see you one day if my sore back doesn’t get better by itself!” Have you ever struggled with your confidence and certainty in practice?

My name’s Nick Hodgson and I face all the same struggles that you do in private practice. I’ve started two practices from scratch, bought and managed a successful practice for eighteen years, employed and mentored associates. And at the same time I have organised countless training programs featuring some of the world’s top chiropractic presenters, culminating in my being awarded the Victorian Chiropractor of the Year in 2005, for contributions to the profession. More recently I have been honoured to be the Australasian Training Provider for Torque Release Technique and would like to invite you to join me at one of our programs this year.

TRT is the first chiropractic technique developed through a scientific research project, published in major medical journals, and then featured on the Discovery Health Channel. But the real benefit occurred when TRT escaped the peer reviewed journals and entered the average chiropractic practice. The overwhelming conclusion has been that TRT is the 21st century upgrade that improves a chiropractor’s life without compromising clinical results or ethics.

You see it has answered the two biggest chiropractic questions: “How do you offer your patients the best possible improvements in their health and quality of life, AND AT THE SAME TIME minimise the amount of work that you have to do to achieve these great results?”

Solving these two dilemmas resolves all stressors in the life of a Chiropractor: If your patients get great results, they get excited and they refer and spread the word, and they comply with your recommendations, because they are impressed. And if you get great results with the minimum of effort then you can either make more money by seeing more people, and/or you can spend less time in your rooms and more time on your lifestyle.

But don’t just listen to me: Here’s a sample of some Chiropractors’ personal experiences…

“I have been amazed at the results I’ve been getting out of this process. I would never have believed this to be possible with such a simple technique.” AC, South Africa

“Certainly this technique changed my life… has really helped me finally understand what Chiropractic is and man was I wrong.” CS, USA

“With your help I am able to make a very smooth transition from a pain practice to a wellness practice. ” TG, USA

“It was the best conference and technique seminar I have ever been to. It provided me with some very timely answers to a lot of questions that had been coming up for me, especially about knowing that Chiropractic and being a Chiropractor is truly what I am here for, but being endlessly frustrated by it (me) just not working the best I knew it (I) could. That was until I learnt about primary subluxations and non-linear adjusting.” JR, Australia

“I have found TRT to be the first technique to be superior to what I have done in the last twenty seven years… I have seen intriguing and wonderful results with TRT.” PR, Australia.

It’s so rewarding to get lots of this feedback after every training program…

And the huge advantage of TRT training is that what you learn can be implemented in any style of chiropractic practice:

You love to manually adjust? TRT will show you how to get bigger changes by adjusting less segments – the ones that really need it: You’ll become more specific, more precise and more confident with your adjustments.

Looking for a low-force alternative? We’ll introduce you to the Integrator, the adjusting instrument which was purpose designed, built and patented to correct subluxations. Not like those instruments which are adapted medical instruments. The Integrator offers pre-loading trigger, incredibly high speed, recoil and torque to produce a three dimensional adjustment which has been measured to produce big shifts in state of wellbeing.

See yourself as more of a craftsman than a technician? You will love the fourteen diagnostic indicators of subluxation, and the precise differential diagnosis system to identify the Primary Subluxation at any moment in time, with built in safe guards and review methods to track the response to each and all of your adjustments.

Prefer High Volume? With the assessment and adjusting system you take back to your office, you will be stunned with how quickly you can deliver a magical adjustment. No matter how many patients you currently see – you will be able to see more in less time.

Believe that Chiropractic is more about the nervous system than the musculoskeletal system? Then you need an assessment and adjusting system that breaks out of the mechanistic orthopaedic mould.

You have a Wellness focus? Then you’ll need an approach which breaks out of the mechanistic back pain model and into a neurological state of wellbeing model – TRT offers a unique selling proposition which has the ability to improve quality of life.

You like to be on the cutting edge? TRT has a pedigree of research and development and the next few years promise some revolutionary upgrades to what is already one of the most exciting breakthroughs in chiropractic’s history.

You’re committed to excellence? You see profits and patient numbers as secondary to the quality of the service that you provide, and you are more interested in the product than the profit: TRT is definitely for you as there are no hard sales techniques attached – it’s less about convincing patients that they have to see you forever; and more about providing such great results that they tell you they’ll be seeing you forever.

What’s involved with TRT Training?

ü  A two-day intensive highly interactive training program

ü  Plenty of hands on demonstration and workshop so that you are ready to use what you have learnt

ü  Training manual included with your registration

ü  Tea breaks and lunches catered for inclusive

ü  Free email support following the program to answer any questions

ü  Regular email newsletters and practice tips

ü  Follow-up advanced hands on training opportunities to further your technical mastery

ü  Access to online and phone referrals from the numerous enquiries we get for TRT practitioners

How can you register?

1.      Use our online registration gateway which connects into the international safe and secure PayPal shopping cart. You can pay with your PayPal funds or use your credit card in the safest possible payment gateway

Click Here To Register Online…

2.      Download a registration form and pay us by cheque or electronic transfer

Click Here To Download A Registration Form…

3.      Call us and register over the phone

Call 0419 104 076 (ISD 61 419 104 076)

What happens after you register?

1.      Upon completion of your registration we will mail your invoice with some free preliminary resources

2.      Your training manual will be given to you at the training program

3.      Equipment and resources will be available for purchase at discounted rates at the program

4.      Notify us of any special dietary needs at least one week prior to the event so we can cater

5.   If you are unable to attend due to unforeseen circumstances make sure you give us at least 72 hours notice prior to commencement of program

GUIDELINES FOR CLINICAL GUIDELINES?

Sunday, November 2nd, 2008

There seems to be a progressively increasing number of practice guidelines appearing on the horizon for Chiropractors. If enough of these are generated could it get to the point that depending on whom a Chiropractor is dealing with, they will need to behave and practice in a chameleon-like fashion – what’s good for one patient, may be very different to what is good for another – depending on which guideline oversees that person’s situation?

Some of these guidelines appear to be less like best practice guidelines and more like agenda-based guidelines.

Most recently the Chiropractors Registration Board of Victoria has crossed over a boundary not previously entered into, and that is into the arena of clinical practice guidelines (http://www.chiroreg.vic.gov.au/comment.php). This is being justified on the basis that they act to protect the public against unethical chiropractice – but once reviewed against the standard of everyday chiropractic one might ask who will protect the chiropractor from the public and other third parties?

And if many established and widespread chiropractic practices such as X-raying for biomechanical assessment, use of physiological assessments such as surface EMG, adjusting children and newborns, caring for people with non-musculoskeletal conditions, maintenance and even wellness adjustments are guidelined as fringe, questionable and even unacceptable behaviours, then will future chiropractic practice resemble the service that so many chiropractors have offered to their communities for over 100 years?

Most of these guidelines are presented under the umbrella of “evidence-based practice”: Evidence-based clinical practice is defined as “The conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of individual patients… (it) is not restricted to randomized trials and meta-analyses. It involves tracking down the best external evidence with which to answer our clinical questions.” (Sackett DL. Editorial. Evidence Based Medicine. Spine 1998.)

However it appears that some guideline developers twist the definition of “best” – disqualifying research and publication, or evidence, which isn’t the “best” – that is, if it isn’t a randomised, placebo-controlled, longitudinal, multi-centred, independently peer reviewed, published in a journal which the expert panel subscribes to, then it ain’t “best” and therefore it doesn’t exist…

In fact “best evidence” means the best level of evidence that we can find and what it tells us… If we don’t have the gold standard evidence, then do we have silver, bronze and even minor placing evidence to review and interpret? It is no secret that not only is chiropractic not very amenable to controlled study for a plethora of reasons, but the bulk of our evidence exists in the realm of longitudinal outcome studies, case series, and case studies. If this is the “best evidence” what does it tell us – there can be no denying that they tell us that a massive diversity of health complaints present in chiropractors’ offices, and that positive changes seem to happen?

We can’t say that if 100 “Syndrome A” sufferers present to chiropractic offices tomorrow, what percentage of these people will receive some degree of improvement let alone a complete resolution. But based on the evidence wouldn’t it be fair to say that if a “Syndrome A” sufferer presents to your office tomorrow, that it would be rational to initiate a course of treatment with clear goals and terms for review? How does that seem inferior or unacceptable to any other health care profession’s plan of action? Even after the gold standard research measures that 45% of patients receive an average of 35% improvement, what can we guarantee Mrs Jones on Monday morning? A course of care with clear goals and terms for review…

“Well it might mean that they aren’t receiving necessary medical intervention and maybe they have some terminal condition and detection will be delayed by this unproven approach!” Welcome to the life of a health care consumer trying to deal with a “primary care practitioner” – maybe the medications that the MD would prescribe as an “alternative” to our care would be ineffective or even damaging; may mask or delay the identification of other pathology; and maybe it could take months and even years to get a correct diagnosis in the medical system anyway? Sound familiar?

The chiropractic profession is not alone in the struggle to produce relevant and applicable guidelines which guide best practice, as opposed to restricting practice. “The National Health and Medical Research Council (NHMRC – an Australian Government body) has statutory responsibilities to raise the standard of individual and public health throughout Australia and to foster the development of consistent health standards. As part of this role, the NHMRC encourages the development of evidence-based guidelines by expert bodies.” (NHMRC standards and procedures for externally developed guidelines, updated September 2007)

Is a health care profession’s registration board an example of such an “expert body”? A quick read of the profiles of members of the board suggests that there is not much representation of the chiropractic profession’s academic and scientific community. So has the board received significant funding to employ the services of such experts? Who would know – no names or qualifications of any contributors or peer review panel members are listed in any of the guidelines. The guideline which covers the issue of paediatric care is an exception: It gives thanks to a Medical Paediatrician and an American Chiropractor who also holds Medical Degree, who is a self proclaimed “Quackbuster” who deals with healthcare consumer protection, and is therefore about quackery, health fraud, chiropractic, and other forms of so-Called “Alternative” Medicine (“sCAM”): Is this our desired expert body?

“It is now widely recognised that guidelines should be based, where possible, on the systematic identification and synthesis of the best available scientific evidence. The NHMRC requirements for developing clinical practice guidelines are rigorous so as to ensure that this standard is upheld. As such, guidelines with NHMRC approval are recognised in Australia and internationally as representing best practice in health and medical knowledge and practice.”

I’ll leave it to the educated reader to review the current proposed guidelines based on the following information:

Key principles for developing guidelines:

The nine key principles are:

1. The guideline development and evaluation process should focus on outcomes: This statement shouldn’t be glossed over as it seems that some of the worst examples of guidelines are more interested in practice than outcomes.

2. The guidelines should be based on the best available evidence and include a statement concerning the strength of recommendations. Evidence can be graded according to its level, quality, relevance and strength; (Ideally, recommendations would be based on the highest level of evidence. However, it has been acknowledged that the levels of evidence used by the NHMRC for intervention studies are restrictive for guideline developers, especially where the areas of study do not lend themselves to randomised controlled trials. It is proposed that this issue will be addressed when the toolkit publications are reviewed.)

It is tradition when presenting scientific evidence, to cite the source of your evidence. The proposed guidelines of the Registration Board list no references, and request for such evidence is refused on the grounds of “intellectual property”. Does this mean that there is no evidence? Is it only some “expert’s” opinion? Or are there too many pages of citations to fit in the publication? Who would know?

3. The method used to synthesise the available evidence should be the strongest applicable;

4. The process of guideline development should be multidisciplinary and include consumers early in the development process. Involving a range of generalist and specialist clinicians, allied health professionals and experts in methodology and consumers has the potential to improve quality and continuity of care and assists in ensuring that the guidelines will be adopted;

The board’s approach is to implement this step as late as possible, input only being sort after the guidelines have been drafted; and if past guidelines are representative, additional input will only lead to minor amendments at best.

That’s also why it is best to employ a medical paediatrician and an overseas chiropractor to produce a guideline on chiropractic care for children in Victoria. Perhaps the Australian chiropractic paediatric specialists that abound and the university academia that are responsible for the undergraduate paediatric curriculum were out to lunch when the document was written?

5. Guidelines should be flexible and adaptable to varying local conditions;

6. Guidelines should consider resources and should incorporate an economic appraisal, which may assist in choosing between alternative treatments;

7. Guidelines are developed for dissemination and implementation with regard to their target audiences. Their dissemination should ensure that practitioners and consumers become aware of them and use them;

In the case of the guidelines being discussed here you can download them from the web-site – otherwise you can get someone else to download them from the web-site for you.

8. The implementation and impact of the guidelines should be evaluated; and

9. Guidelines should be updated regularly.

I look forward to the dissemination of the steps and process for implementation of steps 3 and 5 to 9 with our newest guidelines – don’t hold your breath.

So, if the Registration Board’s attempt to offer guidelines is severely flawed where can we turn?

Guidelines have been produced which would more likely live up to the standards of the NHRMC. The Council on Chiropractic Practice Clinical Practice Guideline (“CCP”) is currently undergoing its’ second revision. Following publication of the CCP Guidelines the document was submitted to the National Guideline Clearinghouse for consideration for inclusion. The NGC is sponsored by the U.S. Agency for Health Care Research and Quality and is in partnership with the American Medical Association and the American Association of Health Plans.

Its mission is as follows: “The NGC mission is to provide physicians, nurses, and other health professionals, health care providers, health plans, integrated delivery systems, purchasers and others an accessible mechanism for obtaining objective, detailed information on clinical practice guidelines and to further their dissemination, implementation and use.” In other words the US equivalency of the NHRMC.

The AHRQ contracts with ECRI, a nonprofit health services research agency, to perform the technical work for the NGC. ECRI is an international nonprofit health services research agency and a Collaborating Center of the World Health Organization.

In November of 1998, following review by ECRI, the CCP Guidelines were accepted for inclusion within the National Guideline Clearinghouse.

The CCP has developed practice guidelines for vertebral subluxation with the active participation of field doctors, consultants, seminar leaders, and technique experts. In addition, the Council has utilized the services of interdisciplinary experts in the Agency for Health Care Policy and Research (AHCPR), guidelines development, research design, literature review, law, clinical assessment, chiropractic education, and clinical chiropractic.

The Council additionally included consumer representatives at every stage of the process and had individuals participating from several major chiropractic political and research organizations, chiropractic colleges and several other major peer groups. The participants in the guidelines development process undertaken by the CCP and their areas of expertise are clearly disclosed.

The Guidelines offer ratings of practices based on the following system:

Established: Accepted as appropriate for use in chiropractic practice for the indications and applications stated.

Investigational: Further study is warranted. Evidence is equivocal, or insufficient to justify a rating of “established.”

Inappropriate: Insufficient favorable evidence exists to support the use of this procedure in chiropractic practice.

Categories of Evidence underpinning each rating are presented as:

E: Expert opinion based on clinical experience, basic science rationale, and/or individual case studies. Where appropriate, this category includes legal opinions.

L: Literature support in the form of reliability and validity studies, observational studies, “pre-post” studies, and/or multiple case studies. Where appropriate, this category includes case law.

C: Controlled studies including randomized and non-randomized clinical trials of acceptable quality.

To download the full version and updates of the CCP guidelines go to http://www.worldchiropracticalliance.org/

CAN YOU SEE WHAT YOU ARE DOING?

Saturday, November 10th, 2007

Many aspects of chiropractic practice have evolved - there have been so many modern developments from within our profession, and from complementary professions - many of which make daily practice simpler, more efficient, more effective, more objective, and even more profitable… Whether we talk about the computerisation and even automation of our front desks, technological advancements in our investigative tools, online education and marketing tools, new and diverse technique systems, in-house entertainment and educational multimedia, online and electronic banking options, and I could go on…

But at the same time could it be that as we utilise more and more technologies, and become more dependent on machines to make decisions and record memories for us - That our own innate and intuitive recording, analysing and comparative skills may be withering and vanishing?

How seriously and consciously do you control what you are seeing and absorbing in your mind’s eye, as you are working on each and every practice member, on each and every visit? This was named INTENT by our pioneers.

While you are leaning over and assessing your patients: Are you thinking about what you are going to have for lunch, reviewing your golf swing, planning your next holiday, worrying about your debts, or even rewinding the last patient who was complaining that you hadn’t fixed them yet?

Make a commitment to include the following steps as you examine and treat each person…

1) Become One: When you enter into someone’s field of intelligence (their personal space), you are being allowed into a very privileged place - AND you also enter into a dimension where you can gather enormous perceptions about the state of mind and body of that person - IF you are willing to perceive and observe them! The way to take this to its full potential is to comprehend that when you enter into this “zone” you and your patient become one. Have you ever started to feel angry, sad, frustrated, or agitated while adjusting someone - guess what - it might not be you feeling it - it may be them. See if you can develop this skill of knowing more about your clients than they know about themselves…

2) Visualise: As a Chiropractor, you are extremely blessed, because you have done some of the most comprehensive anatomical, physiological, biomechanical, neurological and even pathological studies possible. As you examine and adjust each person, develop “XRay Vision”: Visualise the structures and functions that you are examining and adjusting as you perform each procedure. Makes the job much more interesting and fascinating. Your diagnostic and technical skills will improve in a quantum leap if you integrate this one skill…

3) See Whole: This transports your visualisation skills to the next dimension: Making the jump from observation, to influence! See the fixated joints start to move again; visualise a person’s alignment being restored; feel the surge of nerve flow and energy transmission; envision cells, tissues, organs and beings becoming whole and vital once again…

When we teach Torque Release Technique we equip you with a comprehensive range of indicators which you use in your ongoing evaluations of your patients’ state of wellbeing, and degree and location of Subluxation. These build and strengthen your intuitive and innate abilities to perceive and differentiate what condition someone is in, AND where and how they need to be adjusted.

When you put this all together you achieve what is probably best described as TOTAL CERTAINTY.

Click Here To Find Out More About TRT Training…