November 2005

Enhancing an existing practice

by Dr. Howard Loomis

Most chiropractors spend their careers in "quiet desperation," to paraphrase Henry David Thoreau. We seem to be endlessly searching for something new to enhance our practice. Often a new diagnostic device catches our eye, or perhaps it's the latest technique, or a new advertising ploy; anything to invigorate our practice. Occasionally we get lucky, but eventually we realize we have accumulated a lot of "stuff" we don't use anymore.

That begs the question, "What do doctors want?" What would satisfy and bring contentment? The inquiries I have made over the years invariably yield the same results (listed in order of preference):

‑‑ More patients

‑‑ Better results

‑‑ More referrals

‑‑ More respect/recognition within the community

‑‑ Higher income

I believe that to achieve these goals you need three key ingredients.

Obviously, one is a form of therapy that successfully treats the type of patients you attract. You are the product of a good education and have already chosen a form of therapy and office procedure that works well for you. But I have noticed during 25 years of teaching seminars that all health care professions seek therapeutic corrections for alleviation of symptoms, a "this‑for‑that approach." None seem to focus on finding the cause of the symptoms. So I would suggest that to enhance your practice you now need the following:

1. An examination that identifies the exact cause of your patient's symptoms.

2. Absolute confidence that your examination will withstand the light of scientific scrutiny and will yield information quickly and accurately.

3. A ceremony to put around your examination that both educates and inspires your patient. Ceremonies are important and you already have one. It is your office procedure. Perhaps you could enhance your ceremony by placing it in a special room, at a special time, with a special assistant, at a special price.

Do you know that for non‑life threatening problems, most forms of therapy are successful about 80% of the time, even if the patient does not seek professional care? To be successful and stand out from the crowd you must be able to solve the other 20% ‑‑ the cases no one else has successfully solved!

Unfortunately, most clinicians treat symptoms which, more often than not, are related to compensations, so miss the underlying cause and never attain complete remission of the problem. This leads to dissatisfaction on the patient's part and eventual loss of a patient. So, what kind of practice do you want? Do you want to treat symptoms or would you prefer to solve problem cases by seeking the cause of the problem and then educate and guide your patients to change their lives?

When confronted with a problem case you need more tests to determine the cause. Any hospital administrator will attest to that and remind you that the money is in the diagnosis, not in the treatment. Every clinician knows that once the cause is known (be it structural or functional) the treatment becomes obvious.

To find the cause of a problem, you must understand how the patient progressed from normal function to the appearance of symptoms. Let's begin with normal body functions, all systems working in harmony. Next, introduce a stimulus or stress to the body. It may be structural (an injury for example), or a chemical/nutritional or digestive challenge, or an event that elicits a strong emotional response. The nature of the problem doesn't matter since the body responds physiologically to any stress in an identical manner.

The body has many possible responses to resist the stress and most occur without the patient even being aware of the changes.

However, if the stress is too strong or continues too long the body must seek additional help for the involved organs. Other organs compensate to maintain normalcy and muscle contractions begin to appear. This phenomenon was first proven by physiologists during World War I and has never been refuted. My grandmother referred to this process as "robbing Peter to pay Paul."

These compensations can continue only so long before exhaustion begins to set in and exhaustion always heralds the appearance of symptoms. The associated muscle contractions now produce recognizable postural distortions with subsequent loss of range of motion in some articulations. In our profession we now have something to treat, seldom realizing these are effects and not the cause.

This sequence of muscle contractions, postural distortions, and loss of range of motion is also accompanied by the appearance of painful and palpable stress points. We can use these points to differentiate somatic (structural) causes from visceral (functional) causes. This knowledge is of incredible importance in diagnosis, but albeit is seldom used to determine cause. Using this information to determine cause in the 20% of unsuccessful cases is the secret to obtaining more patients, better results, more referrals, more respect, and, ultimately, higher income. Remember, once the cause is known, the treatment becomes obvious.

So let me ask you, what do you have to see before you know what to do? How confident are you in your examination and does it educate and inspire your patients? Perhaps the key to professional satisfaction lies within a better examination and a new ceremony!

(Dr. Loomis welcomes input on the subjects covered in this column. To make a comment or ask a question, write to him at 6421 Enterprise Lane, Madison, WI 53719. Visit www.loomisinstitute.com online or call 800‑662‑2630 for information on upcoming Loomis Institute seminars.)