A year in the life…

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I reckon I could launch into my stereotypical cliche, “oh my, has it really been a year?” but we all know that it has.  Not that it seems like it.  Not by a long shot.

The learning curve has a long, steep grade and I’ve pedaled my way to the top, huffing and puffing all the way, nursing my bruises and even earning a few spurs.  The greatest mentors have echoed over and over again that how you practice a year in will be vastly different than how you started out, and how you practice 5 years in will be different, and how you practiced in 15 years will be worlds away from how you practiced at 5 or 10.  And so on.  I always took their word for it.  Now I’m realizing how right they are.  And I have the feeling that as we celebrate the anniversary of our first year in practice, we’ve only scratched the surface.

Because I’m me and I’m incorrigibly content with the way I am (at least in this arena), I feel the need to record a Year In Review of sorts for the cyberarchive – maybe someone else will see it and benefit and maybe not – if nothing else, it may help me remember our freshman roots someday.  You never know.

I’ve discovered what a joy it is to care for people, to watch them get better before your eyes.  They become calmer, happier, healthier-looking.  The bags under their eyes disappear, their skin regains some color and youth, their step reclaims its bounce and symmetry.  Sometimes missing hair grows back, sometimes a walking cane evaporates.  People are happy and proud to share their new healthier eating habits, stress reduction techniques, blender or other cookware purchases, exercise regimens, Dr. Oz gems, and supportive shoes.  They’re jazzed to report that they’ve lost weight, discovered a recipe, sleep through the night, given up coffee, and gotten their energy back.

I’ve discovered that people will pick up on your underlying vibe and read you like a book, even if they don’t actually realize they’re doing it. Often without meaning to, they’ll expose holes in your process, weaknesses in your presentation, wavering confidence, or uncertainty anywhere.  They notice details – office cleanliness and decor, body language, vocal inflection.  You’ve got to be aware of these and turn them into something you can use advantageously.

Sadly, I learned that the more you selflessly give, the less people appreciate you.  You’d think it’d be the other way around, but it’s not.  You can tell someone you negotiated great rates with a lab to save them hundreds of dollars on blood testing.  You can even tell them you’ll offer these labs at your costs only, going through the trouble of ordering them and processing payment without any markup whatsoever (in stark contrast to every other medical office, which does mark up lab work–and handsomely) and they raise their eyebrows and smile and say, “wow, that’s great!”  But when it comes time to value your work and pay you for it, they suddenly forget that you’re already hundreds of dollars cheaper than the guy across town offering a similar service, and even though you’re always doing them favors, you hardly ever reap the fruits of your labor.

Also sadly, I learned that you’ve got to get tough with some people.  Some rudely gab on their cell phones during their appointment time.  It is indeed their scheduled spot and they can use that time as they wish.  But if one of us is working with them, trying to accomplish a particular goal (for example, relieving a particular muscle spasm) during that visit, these distractions take time away from that.  As a result, the goal can’t be reached and there’s a risk the patient will stop coming in, thinking they’re not making the progress they should and blaming it on unproductive visits that somehow relate back to the doctor’s/therapist’s shortcoming.

You’ve got to get tough with other people, too.  A cleanse means a cleanse.  Gluten-free means gluten-free.  Twice a week means twice a week; monthly visits means monthly visits.  Ten o’clock means ten o’clock.  Talk to your insurance company means exactly that, too.  People try to bend rules, test boundaries, push limits, seek exceptions, and spot holes in your system.  People don’t mean to piss you off, they’re just being them, not quite understanding the situation from our point of view.  I don’t expect them to.  However, many of these House Rules are spelled out from the git-go in the paperwork and during the first few appointments; the rest would appear to be common sense that should hardly warrant any mention.  However, many people don’t read or care, and others forget.  Many weren’t paying attention in the first place.

It’s OK to be a hard-ass.  Don’t be a prick about it, but don’t be wishy-washy either.  People can smell that like a fart in a car, so don’t waver.  You can shake in your boots on the inside, waiting for their reaction to something (“no gluten – ever”, or “that’ll be $1200”) as long as you can do this without batting an eye yourself.  Pretend their total will be $12 and say it like that.  Pretend you’re cutting tire rubber out of their diet when you say gluten.  Practice makes perfect; with enough of it, you’ll be able to tell people things that seem outrageous to you but if you do it right, people will respect you.  It’s like the hard-ass teacher that laid down the ground rules on the first day and nobody screwed off in his/her class.  People moaned and groaned at first but they usually look back on that class as a great class and the teacher as a great teacher.  Use that phenomenon to your advantage.

The first year (and probably more) of practice is spent figuring out 10,000 ways not to do something.  I think that if you’re not always changing something up or improving upon something, you’re missing something or not putting in enough effort.  I’ve realized it’s smart to put off big purchases on equipment you’re not sure about because you could be led down a path you didn’t expect, and this path could take you far, far away from your original vision or plan.  This isn’t a bad thing – life happens.  But money is finite, so spend wisely.

Which brings me to my next battle scar: all things finance and budget.  If you start your own practice from scratch, you’re going to blow through money.  There are definitely ways to save here and there, and those can make a huge difference, cutting your investment in half (or even less) without sacrificing quality.

Research really pays off here.  It’s crucial.  Before stepping into or agreeing to anything, you’ve got to do your homework.  Don’t sign until you’re comfortable.  If you haven’t researched, you’re not comfortable like you think you are.  Go look things up.  Go make sure.  Because money is finite, there isn’t a whole lot of room for do-overs.  And you can’t press the undo button in most cases – what’s done is done.  If you messed up, you’ve got to chalk it up to expensive experience and move on.

But make no mistake – you will probably financially free fall, if you’re investing in a new endeavor without a stream of income.  When writing the budget, don’t forget to add in your living expenses – many people consider just the business expenses and go under because they’ve got to eat and pay rent, too.  Don’t make that mistake.

Trust is key.  If people trust you, you’ve got everything.  They’ll follow your advice.  They’ll keep their appointments.  They won’t bitch about insurance.  They’ll feel good for coming.  They’ll feel like they’re in the right place.  They’ll take their supplements.  They’ll comply with their diet changes, stretching, and exercises.  And, they’ll tell their friends.  You may even get their families.  Trust is fragile and priceless – don’t break it.

It’s OK to see some people go. Some bitch about Medicare.  Others try to run your practice.  Some bring a toxic vibe to the place.  Others are just a plain headache.  Some conveniently “forget” the rules.  Some are really high maintenance.  Try to understand them and have compassion – many of them have been through crap.

Others have always drunk from the silver cup and can’t be bothered to do anything for themselves.  We’ve seen the whole spectrum already.  I love them where they’re at and I respect them and empathize with them, but that doesn’t mean that our clinic is the right place for them.  If they want to be here, we’re more than happy to have them, as long as they respect the clinicians and our other patients and as long as they make the same commitment to themselves that we make to them.  Those are really the only two requirements for being part of our practice – everything else falls under those two broad categories.  It’s not rocket science.  Yet, it’s beyond the capacity of some.

That’s OK.  It’s OK if you’re not able to get everybody better.  It’s OK if you can’t please everyone.  It’s OK if some drop out of care for one reason or another.  Learn from it what you can, chalk it up to experience, and move on.  Don’t beat yourself up over it; it may not be your mistake.

Don’t automatically assume it’s the patient’s fault either; maybe you missed something or got complacent.  Don’t allow dynamics to change and start treating longtime patients like friends.  They’re close, but they’re still patients, not friends.  Blurring those lines may feel more friendly and comfortable for you, like you’re taking the relationship to the next level, but that might be confusing and maybe uncomfortable for the patient, so don’t do it.

I’m surprised at how many people balk at a physical and paperwork packets.  But then, that may be a subconscious shortcoming that my partner has to work through.

Last but not least, get out in the community, meet the average people, and show how YOU can help them.  Get this – it’s not about you.  It’s not about your clinic.  It’s not even about the chiropractic profession.

Sure, you can attend a conference or health fair and when you do, as a Doctor of Chiropractic, you represent the chiropractic profession.  You have an opportunity to make chiropractic look really good.  But you do this by focusing on the prospective patient and making it about them.  After all, they approached you because they have a problem or other need that they think you might be able to fill.  Don’t try to convert them to some fringe subluxation theory or attempt to indoctrinate them before they’ve even started care.  Guess what?  It’s a turnoff and few will stick with you (something to the tune of the 6% of the population we currently see).  Just talk about how you can help them.  Do it in plain English, with simple explanations, using a lot of familiar analogies.

Tell them something about their problem they haven’t heard before.  Help them understand.  Don’t hard sell.  Let them know you exist; they’ll come in when they’re ready.  When they come in, focus only on them.  Not your upcoming fishing trip, not your electric bill, not your virus-infected computer.  You’re their for the patient, everything else is just details you can attend to later.  The patient is the here-and-now, and you want to make sure not to screw up future here-and-now opportunities.  This involves the trust I mentioned earlier.  Trust is earned, and you build it through saying what you mean, offering options and recommendations, letting them choose, and then respecting their choice, whatever it may be.  The last thing people want is another hard-sell, especially from someone they see as a doctor.

One gem I learned is that if you answer your own phone, make sure not to let on that you’re a doc, but to pretend you’re a receptionist.  This works better if you’re female, but males aren’t out of the game.  The reason I started going undercover is this: when people realize they’re talking to the doctor, it’s suddenly two things 1) a quest for every question to get answered right then and there (and after the 20th, 50th phone call, this gets really old), and 2) it’s personal – not only do they want to know everything you do but they almost act like you’re the bad guy if you don’t file their insurance.

Contrast this with the impression that they’re talking to the secretary.  You can be as vague as you like because you’re not the doc and you’re not expected to have all the information.  So this takes the pressure off because it’s OK to misspeak or make other mistakes on the phone, and you’re not having to defend yourself against probing questions or quests for free advice or quick fixes.

It has literally been a dream.  It has gone by about as fast and it has felt about as surreal.  It has been a lot of work – networking meetings, sitting through sales pitches, phone calls, free or pro-bono work, changing up procedures, gaining respect, and enduring growing pains.

Two of my mottoes:
“You won’t get good by being busy, but you’ll get busy by being good”
– and –
“That’s why they call it practice

I wouldn’t trade it for the world.

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