UCM 017: Dr. Todd Osborne on How to Avoid the Most Common Mistakes Doctors Make in Their Consult, Exam and Report




UCM 017: Dr. Todd Osborne on How to Avoid the Most Common Mistakes Doctors Make in Their Consult, Exam and Report


Dr. Todd Osborne on the Upper Cervical Marketing Podcast

Dr. Todd Osborne has been a practicing upper cervical chiropractor for over 25 years. Dr. Oz’s first practice in Farmer City Illinois grew to over 300 visits per week. Dr. Oz is also well known for his work in coaching and consulting thousands of chiropractors through the AMC group. He has also been one of the featured speakers at the Upper Cervical Experience Events. Dr. Oz is a master communicator of upper cervical and has built extremely successful referral based Atlas Orthogonal practices.

Dr. Oz is now back in practice with his daughter Dr. Christi and is building another extremely successful practice in Chattanooga, Tennessee.

Who Is Dr. Oz?

Dr. Davis: Dr. Todd Osborne has been a practicing upper cervical chiropractor for over 25 years. Dr. Oz's first practice in Farmer City, Illinois grew to over 300 visits per week. Dr. Oz is also well known for his work and coaching and consulting thousands of chiropractors through the AMC group. He has also been one of the featured speakers at the Upper Cervical Experience events. Dr. Oz is a master communicator of upper cervical and has built extremely successful referral-based Atlas Orthogonal practices.

Dr. Oz now back in practice with his daughter, Dr. Christy and is building another extremely successful practice in Chattanooga, Tennessee. Welcome Dr. Oz.

Dr. Osborne: Hey, Dr. Davis. Thanks for having me.

Dr. Davis: Awesome. Well, last time we spoke on an interview for the blog. We discussed how you got into chiropractic and specifically how you got in upper cervical through your experience with Dr. Sweat, and I will link to that interview in the show notes of this podcast, but today, I want to focus on a specific topic that I know that you've trained thousands of chiropractors on, and you really believe in the importance of, and that is the consultation, exam and report or the CER, right?

Dr. Osborne: Correct.

Why Is the Consultation, Exam and Report So Important to a Chiropractic Practice?

Dr. Davis: Yeah. So, let's get into that. So, why is the Consultation, Exam and Report so important to a chiropractic practice?

Dr. Osborne: Well, there are so many things of importance rolled into the CER as we call it Consultation, Exam and Report from that being your first conversation with the new patient, kind of that first impression if you will, meeting the doctor and you meeting the patient to the communication that's going to set up their care. It's going to determine whether they elect to continue care with you, and it's going to set up the future whether they're going to actually have make decisions for them and their family for continued care, maintenance care, wellness care, whatever we want to describe that as. So, it's the foundation of everything that you're going to do in your practice from day one right on through a lifetime of care for that patient. So, that's the importance is establishing that correct foundation right from the beginning.

Dr. Davis: Exactly and we all know that if you mess that up, right? If you have a poor consultation with the patient or an exam that doesn't do the right things or that report that just doesn't make sense to them, there's pretty much no way to recover from that, is there?

Dr. Osborne: That's exactly right as we say, you never get a second chance to make a first impression. So, you can’t mess it up right from that first consultation and Dr. Bill we've all experienced this. Chiropractors, they have a patient come in, take a lot of time out of their day, fill out all the paperwork, they come in for the consultation, and you do the consult, you do the exam, maybe you take your x-rays, and then you schedule them to come back for the report of findings, and they never come back. So, why does that happen? It makes absolutely no sense. These people have invested their time, their money, and now they don't even come back. Well, something was not right in that consultation or the exam that that person just decided, ‘Hey! I'm not going back there.’

So, those are the type of mistakes that we make as chiropractors, that when we talk on the business model, does it cost us? Yeah, it costs us on the business model but what did it cost that patient? That might have been their only shot at ever receiving quality chiropractic care for the rest of their life, and so if we don't do the consultation and exam correctly, we really blow it for both us and the patient.

What Are Some of the Most Common Mistakes Doctors Make in that First Interaction?

Dr. Davis: Right. So, let's dive into that deeper. Let's start with that consultation, right? So, that first impression, first opportunity to actually, sit down, talk with the patient, what are some of the most common mistakes that doctors make in that first interaction?

Dr. Osborne: Well, there are things to accomplish when you are doing the consultation, and one is getting the patient to like you. Patients refer to you not because of what we do for them, whether they like you or not. Now, getting great results and doing good things for them, that doesn't hurt in the referral process, but ultimately we've all had patients that we got great results with, that never ever referred us anyone, and on the flip side, we can have people that maybe the results were not fantastic, maybe they were good but they weren't anything miraculous but they still refer tons of people to us.

So, one of the things I think the mistakes you're talking about is, we go into the consultation and we're not establishing that rapport with the patient. We don't get that good bedside manner to use an old term.

Dr. Davis: Right.

Dr. Osborne: …from that beginning part and then the other thing that I see as one of the big mistakes we make is, people want to start doing the report of findings and/or educating the patient on chiropractic or on upper cervical chiropractic during the consultation, and that is an absolute wrong time to be doing that. The patient isn't interested in that at that point in time.

So, that's a big mistake that I see when we're coaching and helping people in particularly from the upper cervical community because we have such a great gift, and we want to tell everybody about it.

Dr. Davis: Right.

Dr. Osborne: …and we want to convince them during the consultation and there's a time to tell them about that but it is not during the consultation. So, that's one of the bigger mistakes that I see and just really, I would say one more thing on mistakes is, people spend way too long in the consultation. You should be able to get a fantastic consultation done somewhere in the seven to ten minute range, and if you're going longer than that, you're really losing your authority and your effectiveness with the patient, and so the people that go in that are spending 30-45 minutes in a consult, that's they're shooting themselves in the foot from the beginning in doing that.

So, those are a few of the mistakes that I see in the consultation area.

Can You Just Lose Control in the Consultation Area?

Dr. Davis: Interesting. I want to talk a little bit more about that. When you said, when you let that consult go long, you start to lose your authority and really you can just lose control of the whole situation, can't you?

Dr. Osborne: Oh, absolutely, because again that patients coming in, they want to know what's wrong with me? Can you help? How much is it going to cost? And we get into wanting to educate the patient, spending a bunch of time in there, getting too talkative about the weather or the sports or religion or politics…

Dr. Davis: Right.

Dr. Osborne: …and particularly right now, we've got a lot of that politics stuff going on, right?

So, those are the type of things that tend to get in there that there's no need for that. It's really about the patient and their health, what's wrong with them. You're interviewing the patient, they're not interviewing you. So, the consult and it needs to be done in a friendly manner. We've got great procedures for that and can show doctors how to conduct a proper consultation, get all the information you need in seven to ten minutes but not go over that and have that starting incorrectly with that patient, and them getting kind of a bad taste in their mouth if you will from the beginning stages.

Dr. Davis: Right, and you mentioned other thing it's so important. I see this all time is context, right? If you don't have the right context, you can't give the right message, right? It's the same reason why you don't do a full consultation and tell every patient everything that they ever wanted to know, answer every question they ever have over the phone, right? Because there's no context…

Dr. Osborne: Exactly.

Dr. Davis: …to help them to understand where you're coming from and why the recommendations are, what they are, right?

Dr. Osborne: That's correct and just like you're talking about, I would never do a consultation at church. I meet somebody in the lobby of church, ‘Oh, you’re a chiropractor, I have headaches. Can you help me?’

Dr. Davis: Right.

Dr. Osborne: No, that's not the place to do the consultation or at the grocery store or wherever you might meet someone. It's in your consultation room and then you've got to have the proper context there. That's not the place to conduct a report. That's not the place to educate the patient. That's the place to do the consultation interview to see if we can help the patient. Do they have a problem? We can help and we start that interview process there.

The Key Focus of the Consultation

Dr. Davis: Right. So, that's really the key focus of that consultation if I'm hearing you're right doc. The key focus of that consultation is to find out if you can help that patient and be able to interview them to ask the right questions, is that right?

Dr. Osborne: That's exactly right and to make it not like an interview, to make it more like a conversation like you and I are having.

Dr. Davis: Right.

Dr. Osborne: So, there's an art to it if you will of being able to conduct that consultation, get the questions answered that you need answer, to do it in an efficient amount of time, and to do it in a friendly manner so that the patient likes you and feels like, well, they really got all the information that they need in order to determine if we can help the patient or not, and I just say another mistake just came to my mind is, people telling the patient they can help them right at that point in time, because that is absolutely not. The truth now, is it 99% of the time? Yes, it probably is, if you're sitting across the table from me, and the consult desk, and I'm taking that I'm probably saying, yeah, I'm pretty sure this guy has an upper cervical subluxation. I can, but I would never say, ‘Hey! We're going to be able to help you. We're going to be able to do great things for you.’ I haven't conducted an exam. I haven't seen their films yet. So, I have no idea really what exactly is going on in there until I do that. So, that's one thing that we say is never ever lie to a patient, and if you tell them for sure, right now I can help you during the consult, you do not know that for sure.

So, what if you tell them you can help them and then something happened during exam or during the x-ray. Let's just say during the x-ray, you find that occiput, atlas and C2 are all fused. Now what?

Dr. Davis: Right.

Dr. Osborne: So, you said you could help me doctor? Well, that's before I really knew what was going on with you. So, that's why we say that, it's a process and you start slowly educating the patient during the consult but you're not purposefully doing that. There's some things that are said and the way you deliver your context if you will. During that, that kind of starts to lead the patient down the road towards you being able to help them but you're not. You're not saying that directly to the patient at that time because you don't know for sure.

What's the Key Focus of the Exam?

Dr. Davis: Right. All right. So, let's move on to the next, the ‘E’ in the CER, right? The exam. So, you've gone through the consult. You've avoided those mistakes, those common mistakes, and so now, let's move in the exam. What's the key focus of the exam?

Dr. Osborne: Well, the key focus of the exam is determined, do they have a subluxation or do they have signs of a subluxation that we would need to get x-rays to determine the extent of the subluxation, the direction of the misalignment, whatever technique you're using in order to determine that, but that is the key focus of the exam.

Now, this particular exam during the CER, this is not a neurological orthopedic exam. So, if you just coming out of school and you're ready to do a 45 minute to an hour exam on people, this is not the time for that. If you're going to do that, there is a proper time to do it, but not right now because all you're really trying to determine is, does this patient have the signs of a subluxation, and if they do, then, to make the recommendation that we get films in order to be able to determine that for sure, and give them a full report of findings on what we find.

What Are Some Common Mistakes Doctors Make

During the Exam?

Dr. Davis: Right. So, what are some common mistakes during the exam that you hear doctors make?

Dr. Osborne: Well, once again just spending way too much time and they're in there running every orthopedic and neurologic test that they were taught during school, and again that's probably the biggest mistake. The other big mistake that I see is that, they're not really even doing an exam to determine, they're just saying, ‘Oh, well yeah you need x-rays,’ and they're not even doing an exam to help the patient walk through those steps of determining that you do have a subluxation and this is why we're going to take the films, and then right back to probably the standard mistake for most all chiropractors is, we want to educate.

So, we get in there and we want to talk to them about chiropractic and upper cervical and what it is, and just getting into a BJ Palmer Lyceum during the examination, and again there's going to be a time to educate the patient and talk, but not now, and as we say at AMC, the CER during the consult, you're the ear and you’re hearing and listening. During the exam, you're the eye if you will, because you are examining, you're seeing what's wrong, and then when we get to the report of findings, that's when we finally get to be the mouth.

Dr. Davis: Right.

Dr. Osborne: So, are you obviously talking during consultation and exam? You are, but what we mean by that is that's when you get to, ‘Okay, here's the spine, here's the atlas, here's the nervous system, here's what's going on,’ and you get to go into that.

Dr. Davis: Right.

Dr. Osborne: Now, there are small steps during the exam that are that small educational steps as you go through that, but if you get too far on that, that's a big mistake, and like we said, ought to be we have a five-point exam that we use at AMC but whatever points you use to determine, does that patient have a subluxation through palpation, range of motion, posture, heat, scope, whatever you're utilizing there. All those things come into play, but that's all you need to determine, do they have a subluxation and if so, then you can recommend the films that they need.

Once You Take Those Films, What Do You Recommend You Do Next?

Dr. Davis: Right. All right, so now, you've gone through the exam, you've recommended films, and now you're going to take your films, and then once you take those films doc, what do you recommend you do next?

Dr. Osborne: Well, we're going to send the patient home, and have them come back for a report of findings, and I don't know if that's what you're reaching for there.

Why Is It So Important that You Need to Send the Patient Home and Do the Report the Next Day?

Dr. Davis: Absolutely. So, why is that because there are some Upper Cervical docs who will do everything on the same day, and so why is it so important do you think that you need to send the patient home and do the report the next day?

Dr. Osborne: Well, there are several things there but the main factor is the importance of the x-ray and your analysis. So, when you have the patient come back, they sense a lot more importance with that, and not that I'm trying to be a medical doctor or emulate them in any way shape or form, but think about that. When you have tests run at the hospital or at the medical doctor, wherever that might be, do you instantly get those results? No. In fact, a lot of times it's going to be, we'll let you know in a couple weeks or a few weeks or that type of thing. So, it builds anticipation for the patient, and it builds importance in there because I really do want to study the films. Does it take me time to analyze those films and really look at them and really know exactly what's going on with the patient? Absolutely.

So, that builds importance for the patient that I'm going to take the time to do this. We will have you come back tomorrow the next day, whenever that might be, and I'll be able to study these films tonight. We can sit down and I'll give you a full report and tell you what we can or cannot do at that point in time, and so, I practice for four years where I did see the patient. I guess immediately, if you would say. I would go as soon as I could get the x-rays analyzed. Then, I would go back into the room with them. Do a report and go ahead and get them adjusted. Then, I started doing the system that AMC taught us, which was to wait and in that particular case, I seen a dramatic improvement in just my overall case acceptance, and people really taken their condition seriously by going to that method of waiting to give the first report, and I will say this now, if you've got someone that is a true emergency type pain patient, which I know an Upper Cervical doc, we don't see near as much as maybe a standard chiropractic doctor would, because we've kind of went away from that pain side of things for the most part in the upper cervical.

So, we don't see a lot of the emergency, but if there is a true emergency, then there are some ways you can handle that, and still see that patient that day if need be, but I'll tell you that you'll never have as much compliance and respect from that patient that you see that same day as you do from those that you have wait and come back.

Dr. Davis: I agree and I noticed too when I was in practice that I really was able to get more clarity about the case when I was able to study those films, analyze those films when the patient wasn't there, right? I found that when I had opportunity to actually sit down, study the films, analyze them, think through their case, think through their consult, think through their exam, and not feel rushed because they're sitting out in the waiting room waiting for me. It allowed me to be just a better doctor all the way around.

Dr. Osborne: Absolutely. I would completely agree with that. It allows you to be thorough and again you're not under pressure. They're not setting out there. You have other patients there, and you're trying to figure out how to fit them and maybe you don't look at the x-rays quite as long as you would if you had that time, and so, you can kind of rush into it, and go ahead and try to get them adjusted, and maybe you don't give the patient your very, very best in that type of situation where like you indicated, I've got plenty of time. I can study those tonight or the next morning, whatever the case might be. I can really look over the films and think about it. In fact, if I want to consult with another chiropractor or mentor or someone like that and my technique failed or something on a case, that gives me time to do that too, and say, ‘Hey! Dr. Bill, can I send you these x-rays and tell me what you think?’ Something of that nature.

So, it's just all-around and I know it's hard for chiropractors that have always adjusted them that same day. That's really tough for them but once you start doing it, you start to get an understanding that you're able to deliver better care, and the patient is more compliant, and more receptive to it, you just never want to go back to adjusting the patient on the same day as they came in as a new patient because it's so much better for both sides.

What Are the Common Mistakes Doctors Make on the Report of Findings?

Dr. Davis: Absolutely. All right, so, let's talk about when they come back. All right, so, they come back for that that next day and they're going to get the report of findings of what exactly you found and how you can help them, and so, talk about that as far as again. Let's start with the common mistakes. What are the common mistakes doctors make on that report?

Dr. Osborne: Well, again there are lots of mistakes to be made and quite frankly at this point, the mistakes have already been made more than likely in the consult and exam. If they're not doing that correctly, by the time you get to the report, you haven't set the table well, if you will.

Dr. Davis: Right.

Dr. Osborne: So, the stage is not set well, but during the report, one of the big factors that I see on the mistake side of things is, we get to into chiropractic with them, and what do I mean by that? What I mean by that is that, if you and I were standing in front of the view box Dr. Bill, you and I could talk a specific language.

Dr. Davis: Right.

Dr. Osborne: …and talk about the atlas, and the apical ligament, and the brain stem, and the cerebellum, and all those type of things that we could get into and discuss, and whether doing Nucca or AO or orthospinology, whatever technique you're using, we could get into, ‘Oh, this is 2 degrees here, and this 4 millimeters here, and this is 6 degrees here,’ and quite frankly, 99% of your patients, that means absolutely nothing to them. Unless maybe you get an engineer or an architect or something like that, that's really into the numbers, then they might grasp that a little bit, but Upper Cervical doctors, I see them making that mistake. We want to describe what we see as an Upper Cervical doctor, and this is here, and this is five millimeters, and all that type of thing.

Dr. Davis: Right.

Dr. Osborne: ...and it just doesn't resonate with the patient. The patient as Dr. Owen has always said, most of these patients, you could hang the x-ray upside down, and do the report, and they wouldn't know the difference, right?

Dr. Davis: Right.

Dr. Osborne: So, Dr. Slade has always said, you need to do your reports, so a second-grader would understand it. So, if you can do your report for a second-grader to understand it, then everyone will understand it, and so, there are some basic things to cover, but keeping it simple, again the mistakes are that we want to do the BJ Palmer Lyceum in front of the view box. We finally get to talk. This is our show, and so we get up there and we do like a 30-minute, the most awesome upper cervical talk ever in front of the view box.

Dr. Davis: Right.

Dr. Osborne: …and I would do that, and I remember when I first started doing upper cervical, boy, I would get in there, and I would just hammer them with this whole upper cervical thing, and what's going on, and I still remember one time, I got all done with this, and I turn around to the patient, the patient goes, ‘So, does that mean you can help me or not?’ And I was like, ‘Gosh! I just spent 30 minutes explaining all this to you, like four years of my chiropractic college, and all the knowledge I have.’ Right? But they don't really want that at that point in time. What they really want to know is, what's wrong with me and can you do anything about it?

Dr. Davis: Right.

Dr. Osborne: …and so obviously we're going to start educating on the upper cervical, and what's going on in the spine, and cover what we need to cover in the report, and there are certain things just like the consult. There's certain things to cover, the exam and that report. There are certain things to cover there.

One more mistake as I'm thinking about it is, I don't think in front of the view box. Most and I say view box, I know we're in a different age now. We have monitors now.

Dr. Davis: Right.

Dr. Osborne: …but when you're in front of the x-ray, you're giving your report. One of the biggest mistakes is, chiropractors do not put enough seriousness on what's going on with the patient, and that's a big deal.

When you, we like to go in there. We don't like, most people don't like to be the bearer of bad news, and so, we try to sugarcoat it if you will.

Dr. Davis: Right.

Dr. Osborne: …and I say, ‘Oh well, Dr. Davis you've got, yeah this is misaligned here, and your neck straight, and you've got some degenerative disc disease and all that, but we can really help. There's just a little bit here and a little bit there, and we can help you with that.

Dr. Davis: Right.

If You Give a Light-Hearted Report, Then Expect a Light-Hearted Commitment to Care.

Dr. Osborne: …and it doesn't put the seriousness onto the case so that the patient can really grasp what their need is, and the value of your care, and that they may need care for an extended period of time. This isn't one adjustment or two adjustments. If you give a light-hearted report, then expect a light-hearted commitment to care.

Dr. Davis: Right. That’s minimizing, right?

Dr. Osborne: Exactly, minimizing.

Dr. Davis: Minimizing the condition and the importance of care, right?

Dr. Osborne: That's exactly right. Minimizing their problem, and then that obviously, then that minimizes the value of what you have to offer to the patient.

Dr. Davis: Absolutely. Alright doc, well, this has been great awesome value that you brought to me and to our audience, and I just wanted to give you last chance here. I want to make sure that let everybody know. We're going to put it in the show notes, will link to our last interview with Dr. Osborne along with a link to AMC.

If you want to check out AMC and what Dr. Oz and the group are doing over there, we'll have that in the show notes as well as www.uppercervicalmarketing.com/podcast, but doc, I wanted to give you a chance to just encourage the doctors and the students out there before we go.

Words of Encouragement - Get a Good Solid Technique to Communicate With the Patient

Dr. Osborne: Well, I would just say this is, if you're listening to this podcast, you're either an Upper Cervical doctor or possibly thinking about becoming an Upper Cervical doctor, and I can't encourage you enough to continue on that.

The Upper Cervical doctors, we've put ourselves in a place of specialty if you will, and we really are the top of the top when it comes to that, and so make sure that you get as good at your technique as you possibly can, but here's one thing that I noticed across the board with Upper Cervical doctors in particular, we are really, really reliant on our technique, and we think the technique is what's going to bring the patients in, and get them to stay, and get them to refer, and that's not what it is.

It's your communication with the patient, and that's why I always describe Dr. Bill, as having two techniques in your office. You've got your adjusting technique, and you have your communication technique, and if you don't have a good communication technique, you don't get to use the adjusting technique near as much as you should, and so my encouragement is for students and doctors out there, that make sure you understand that, whether it's with AMC or someone else, get a good solid technique to communicate with the patient so that you can offer the great gift of upper cervical care to as many people as possible.

Dr. Davis: Awesome. Well, thank you so much doc for being with us today. I really appreciate it.

Dr. Osborne: Thank you Dr. Bill. I appreciate you.

Links Discussed in the Show:





Resources Discussed in the Show:

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UCM 017: Dr. Todd Osborne on How to Avoid the Most Common Mistakes Doctors Make in Their Consult, Exam and Report
UCM 017: Dr. Todd Osborne on How to Avoid the Most Common Mistakes Doctors Make in Their Consult, Exam and Report
UCM 017: Dr. Todd Osborne on How to Avoid the Most Common Mistakes Doctors Make in Their Consult, Exam and Report
About the Author: Dr. Bill Davis
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