Integrative Approach, Great Results · Integrative Approach, Great Results: How to Build a Strong & Successful Practice in Any Economy by Robert Doane, L.Ac. ... ÚSame physiology

© Acupuncture & Wellness Center, P.S. & Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715Tel: 626-780-7182 • Fax: 626-609-2929 • Website: www.eLotus.org • Email: [email protected]

Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute1

© 2010 Acupuncture & Wellness Center, P.S. & Lotus Institute of Integrative MedicineShall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute.

Integrative Approach, Great Results:How to Build a Strong & Successful Practice

in Any Economy

by Robert Doane, L.Ac.

Presented by:Lotus Institute of Integrative Medicine

PO Box 92493, City of Industry, CA 91715Tel: 626-780-7182 • Website: www.eLotus.org

.



a The 3 honorable motivations for entering the field of Chinese Medicine

a Your “Purpose”

a Importance of Pre-payment for Long-Term Care (Patient Commitment)

a The Report of Findings

a Effective Marketing

a General Tips on Running a Practice


a The 3 honorable motivations for entering the field of Chinese Medicine

Ú 1. To help as many people as possible

Ú 2. To master the medicine

Ú 3. Making a decent living for yourself and your family


a You must have a mission statement

a You have to work - Why are you working at this medicine?

a Be a HAPPY personÚ Unhappy people are like a virus – they make happy people sick!

The purpose of this clinic is to help as many people as possible in their quest for optimum health, and educate them about the benefits of oriental medicine so they may, in turn, educate others.



a Key: Commitment to healthÚ Need placebo effect (Western Dr.’s have it already)Ú Positive attitudeÚ Money & EthicsÚ Saves clinic time & money Ú Saves patient time & moneyÚ Improves patient flowÚ Estimate treatments (give more if need to)Ú RefundableÚ Pay as you go patients = dabblers


a Day 0 – Consultation/Free visit to the clinica Day 1 – Intake – Establish Chinese diagnosis & get

patient out of denial about their healtha Day 2 – Explanation of TCM & it’s similarities and

differences to Western Medicinea Day 3 – Explain the 3 phases of care &

treatment plan optionsa Day 4 – Determine which type of treatment

plan the patient wantsa Day 5 – 1st visit of their plan + herbal consultation




a Purpose of Day 0:

Ú To let the potential patient check you out (sniff test) to make sure they are comfortable with you before they begin treatment

Ú For you to explain how the process works to gauge their “rate of response”

Ú To help weed out curiosity seekers and patients who you are not equipped to treat


Day 0 – Consultation / Free visit

a Need to make a good impression!

Ú Schedule them to come in when the clinic is busy (Psychological effect of a busy practice)

Ú Look professional

Ú Make sure office looks nice and clean


Day 0 – Consultation / Free visit

a Length of visit: Approx. 15 minutes(no more than 15 minutes or the visit shouldn’t be free – do not de-value your time by giving away an hours worth of your time!)

a Have patients fill out short information formÚ Have them mark down some of their problems Ú Do a Chinese Pulse Diagnosis

a Show them the clinic (tour)Ú Treatment roomsÚ NeedlesÚ Herb room


Day 0 – Consultation / Free visita Commit patients to the next 5 visits

Ú Tell patients that you need 5 visits from them to determine their “rate of response”

Ú 1st visit: No treatment, consultation only@ Exception: If they are really in pain or live far away

Ú Check their insurance for them@ If no insurance, give them a major discount

Ú Have patient schedule and pay for all 5 visits in advance

Ú Give them their new patient paperwork to take home with them to fill out completely


a Purpose of Day 1:Ú Have the patient realize their own state of health

(health crisis)

@ Patients need to “admit” and face their health problems in order for them to realize that they have to do something about it so they can live healthy lives

@ Get them out of denial!

@ Explain that you may not be able to accept their case


Day 1 – Consultation/Health Intakea Length of visit: 1 to 1 - 1/2 hoursa Comprehensive Health Intake

Ú Very thorough paperwork needs to be used in order to document patient’s symptoms & health history

Ú Visit used to establish their Chinese diagnosis

a Establish ALL of the patient’s health issues

Ú Patient may have come to you for knee pain but during the Health Intake you discover they have sinus problems, high cholesterol and migraines

a No treatmentÚ Exception: Patient is in a lot of pain or lives far away




8. Lung Function: FOR LONG TERM-CARE PATIENTS ONLY: On the day of your RE-EXAM, only check the boxes that NO LONGER pertain to you, or if you HAVE NOT experienced the symptoms for two weeks. Add up your boxes and date.

#1 #2 #3 #4 #5 #6 #7 #8 #9 #10 #11 #12Nasal Discharge (color___________)

CoughNose Bleeds

Sinus Congestion

Dry Mouth

Dry Throat

Dry Nose

Dry Skin

Allergies (what?_________________)

Alternating Chills/Fever

Sneezing

Headache (location______________)

Overall achy feeling in body

Stiff Neck

Stiff Shoulders

Sore Throat

Difficulty breathing

Smoke cigarettes (# per day_______)

Sadness

Melancholy

Total Boxes CheckedDate:____________ RE Date:

9. Spleen, Stomach, FOR LONG TERM-CARE PATIENTS ONLY: On the day of your RE-EXAM, only check the boxes that NO LONGER pertain to you, or if you HAVE NOT experienced the symptoms for two weeks. Add up your boxes and date.Small/Large Intestine Function

#1 #2 #3 #4 #5 #6 #7 #8 #9 #10 #11 #12Loose Stools

Constipated

Incomplete Stools

Diarrhea

Blood in Stools

Mucous in Stools

Undigested food in the Stools

Total Boxes CheckedDate:____________ RE Date:


a Crucial question to ask after patient realizes their health issuesÚ “On a scale of 1 to 10, 10 being someone who will do anything,

go anywhere, pay anything to get better, where are you on this scale?”

Ú You want to get a “10” from the patients@ “10’s” are more committed to taking care of their health problems

Ú Patients who say “6 or 7” will be difficult patients

@ Might not follow through with commitment@ More skeptical@ Many times the reason for low rating is money issues (don’t ignore

money issues! Ask them “If I could find a way to make this affordable for you, how committed are you to taking care of your health?)

� You would probably tell this patient that you cannot accept their case.


a Purpose of Day 2:

Ú Educate patients on Chinese Medicine (CM) and how it differs from Western Medicine (WM)@ You must show a strong and distinct difference between

CM & WM

Ú Get them excited about the possibilities of what this medicine can do for their health!


a Length of visit: 1-1/2 to 2 hours

a Schedule a group of patients for this visit

a Explain Chinese medicine from a biomedical perspectiveÚ Donald Kendall’s “Tao of Chinese Medicine”Ú Makes CM more scientific and credible

a Paint a “Vision of Possibilities” for your patient


a Chinese Medicine vs. Western MedicineÚ Same physiologyÚ Same anatomyÚ Different focus

@ CM: Health-based medicine� Improves quality of life/health of patient

@ WM: Trauma-based medicine� Decreases morbidity


a Western medicine

Ú Based on Greek system

Ú Started around 1200’s

@ Average life span during that time – 30 years old

Ú Best doctors worked for the royal family

Ú Generally were called to treat the dying

@ 14th century: 1/3 of people died from the plague (over 30 million people)

Ú Focus: Diagnosis and treatment of serious diseases




a Western medicine

Ú Runs tests to see if patients are sick

@ Often tests come back normal, so Dr. tells the patients that they are fine, even when the patient feels terrible

@ WM tests are skewed to detect serious illnesses, not for detection of patients who do not feel healthy

Ú WM is a medicine to save lives, not to promote health


a Chinese medicineÚ Started approx. 3500+ years ago

@ Average life span of the Chinese during that time – over 60 years old

Ú Best doctors worked for the royal family and warlords

Ú Generally were called to make the warlords and their people virile and strong

Ú Focus: Helps make and keep one healthy

@ To help prevent what has not yet come to pass


a Chinese medicineÚ Four aspects of Chinese medicine that needs to be

functioning well to be healthy:

@ Qi (Oxygen)@ Blood@ Organ@ Function of the nervous system

Ú If there is an obstruction in the blood flow, the areas of the body nourished by that blood and qi are affected and if not fixed, will turn into a malfunction

Ú Mayo Clinic study


a Chinese medicineÚ If the malfunction continues and is not treated, then

there is a disease process, which then produces symptoms

Ú Need to move the qi and blood, (have them circulating again) otherwise the problem will never go away@ WM only suppresses the symptoms with drugs

@ WM also suppresses functions, which is why you get tired and drowsy after taking the prescription drugs


a Chinese medicine

Ú #1 etiology of TCM: Blood Stasis@ Vascular functioning decreases as we age

� Decreases down to only around 30%

� At that point the body loses its ability to heal itself b/c all the healing agents of the body are found in the blood, but the blood is not circulating to the injured area

@ TCM helps increase your vascular functioning to above 30%

� Major symptoms will disappear

Ú Chinese medicine is a health medicine





a Purpose of Day 3:

Ú Explain to the patient the course of treatment and the 3 Phases of care:@ 1. Relief Care@ 2. Stabilization/Corrective Care@ 3. Maintenance Care

a Day 3 is also done as a group session


a Phase 1: Relief CareÚ Symptomatic reliefÚ 90% of the time, problems will come back

when the treatment stopsÚ Treatment: 3 times a week (1-3 months)

� Use gym analogy

Ú End of Relief Care: Patient tells you that they feel 90% better in more than 2 of their consecutive visits@ Relief from major complaints@ Vascular functioning is above the 30% level


a Phase 2: Stabilization/Corrective Care

Ú Increase the blood flow from the 30% level up to potentially 100%

Ú “Stabilize” the Relief Care so that the problems do not return

Ú Treatment: 2 times a week (3-6 months)


a Phase 2: Stabilization/Corrective CareÚ End of Stabilization/Corrective Care

@ Every month, there’s a “Re-exam”: Patients fill out the same intake form they filled out on Day 1

@ Cross out the problems that are now 90% better@ Graph their improvement progress on a monthly basis@ When the graph stops going up, and has flattened out

and is now moving horizontally = Stabilization (End of Corrective Care)


0102030405060708090

100

% of Blood Flow

Months (of Treatment)

End of Relief Care

End of Corrective Care


a Phase 3: Maintenance Care

Ú Maintains the result received in Stabilization/Corrective Care

Ú Treatment: 1 time/month

a The “Wellness Doctor”




a Option 1: Simple Plan (4-6 months)Ú Patient wants us to focus on only 1 or 2

health complaints@ This plan is usually chosen because they do not

have a lot of health complaints or for financial reasons

@ Plan may be just herbs or just acupuncture

@ Plan does not include re-exams


a Option 2: Emperor’s Plan (4 – 6 months)Ú Patient wants us to treat all or most of their health

complaints@ This plan usually includes most of the services offered

in the clinic:-Acupuncture-Herbs & Herbal Consultations-Re-exams-Massage-Liver Cleanse/Weight Loss-Nutritional Consultations-Acupressure Training


a Key: Commitment to healthÚ Need placebo effect (Western Dr.’s have it already)Ú Positive attitudeÚ Money & EthicsÚ Saves clinic time & moneyÚ Saves patient time & moneyÚ Improves patient flowÚ Estimate treatments (give more if need to)Ú RefundableÚ Pay as you go patients = dabblersÚ Payment & Financing options are available


a You must overcome your money issues/fearsÚ Only then can you help them overcome theirs!

a Is your care “expensive”?

Ú Cost of Western Medicine

@ 1. Pharmaceutical costs@ 2. Hospital Costs


30 Day Supply:

Cymbalta (Depression) $163

Nexium (Acid Reflux) $176

Advair (Asthma) $189

Oxycontin (Pain Relief) $511

Humira (Rheumatoid Arthritis) $1748


Hospitalization for Back Pain: 3.3 days at $4683 per day =

No Treatment-

justpainkillers

and tests = $15,454!

$15,454




Hospitalization for

Pneumonia:5.4 days at

$4407 per day =

$23,800!


DO NOT –for one moment–

think that your care is EXPENSIVE!



a Purpose of Day 4:Ú Patient Commits to care

If you feel like you are having to “sell” or “talk them into it” you have not done the other days correctly!

No SELLING!


a Day 4 is an individual sessiona No more educationa Before treatment ask the patient which one

of the 2 care plans they want:

Ú 1. Simple PlanÚ 2. Emperor’s Plan


a Patients who decide on Care PlansÚ Need to have a positive attitude and strong

desire to get better@ Tell them that in order to get positive results they

need a positive attitude

Ú Pay in advance (covers acupuncture, herbs, massage, etc.)@ Commitment to health by the patients@ Give discount for paying in advance

� Patient will pay nearly twice as much for “pay as you go”




Ú Pay in advance (covers acupuncture, herbs, and massage)@ Do NOT use the pre-paid money, put the money in a

bank/escrow account� Withdraw the money only after the service is rendered for

each visit� Check with legal counsel or accountant on how best to do

this for your practice

@ If patient decides to drop out of care, refund them the remaining amount in the account

@ Need to estimate how many visits necessary for the patient

� If miscalculated and estimated the # of visits wrong, provide free treatments


a “I have no money”a “It’s too expensive”a “I don’t believe in debt.”a “I don’t believe this will work for me.”a “I’ve lived with this for years – I’ll be fine.”a “This will take too much time and I’m too busy.”a “My Dr. doesn’t believe in acupuncture/herbs.”a “My spouse doesn’t believe in this.”


Ú This appointment is the first appointment of their “care plan”

Ú Should be scheduled on Day 0Ú Always book an Herbal Consultation &

Treatment for this visit


a .


a Trains you how to successfully educate your patients

a Helps you to retain your patientsa Training on how to organize your clinic

operationsa Trains you on how to promote your

business & generate new patients


a Objections:




a 1. Move to where there are little or no acupuncturistsa 2. Answer the phone!a 3. Group patients together a 4. On the 2nd, 3rd visits, explain to the patients what you

are going to do and why, and what the result will be a 5. Have a receptionist


a 6. Hire out your billinga 7. Create a beautiful space to practicea 8. Be confident – even if you are nota 9. Payment at the time of servicea 10. Collect 1000 names of interested people before

you open your doorsa 11. Make friends with local pain specialists

Ú Send them patients you cannot fix and they will send you patients they cannot fix


a 12. Join the local Chamber of Commerce and sponsor an open house. Also join the Rotary Club in your area.

a 13. Do acupressure workshopsa 14. Hiring of employeesa 15. Speaking engagementsa 16. Think SUCCESSa 17. Attend public events in your area for marketing

purposes


a You must be “everywhere” in your areaÚ You have to CONSTANTLY promote this medicine

a Grass roots marketinga Press Releasesa Newsletters (National Awareness Months)a Health Lecturesa Build a network of local health businesses

Ú Become the “go to” person for health information


a Attend as many local events in your area as possible, anywhere they will let you set up an informational booth!Ú Expos

@ Health, Safety, Wedding, Women’s, Kids, etc.Ú Local FestivalsÚ County FairÚ Local school district benefits fairsÚ Holiday Craft Fairs


a Your goalÚ To expose people to the benefits of TCM

@ Best option: Free Chinese Pulse Diagnosis@ Alternative options: Ear or tongue diagnosis@ Can do acupressure, never give them needles

Ú Ask them “What do you want help with?”@ Explain to them that your medicine may help them

Ú Sign them up at the event for the Free Consultation (Day 0) at your clinic

© 2010 Acupuncture & Wellness Center, P.S.





@ STRESS SURVEYS (form used to collect their info)@ PATIENT SCHEDULE (PRINT THE NEXT 2 WEEKS)@ CLIPBOARDS@ PENS@ BROCHURES (CLINIC)@ INFO CARDS (TREATMENT INFO)@ APPOINTMENT CARDS@ MAPS@ CHAIRS@ TABLE@ TABLECLOTH@ TENT & EQUIPMENT TO SECURE TENT@ CLINIC INFO SCREENS@ EXTENSION CORD(S)@ PULSE DIAGNOSIS SIGN@ FLOWERS FOR TABLE@ CANDY@ CANDY DISH@ TOYS@ TOY BOX@ BALLOONS


a Key considerationsÚ Whatever you do has got to workÚ Whatever you do has to show results (apparent to the

patient)

a Utilize to the fullest extenta TCM - a great medicinea Tools of the trade

Ú Making them work togetherÚ Staying true to the founding tenets of TCM


a HerbsÚ Dr. Jimmy Chang’s Pulse Diagnosis & Herbs

a AcupunctureÚ Scientific Explanation of How Acupuncture Works

(Kendall)Ú Balance Method (Dr. Richard Tan)

© 2010 Acupuncture & Wellness Center, P.S. & Lotus Institute of Integrative MedicineShall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute.© 2010 Acupuncture & Wellness Center, P.S. & Lotus Institute of Integrative MedicineShall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute.


Jimmy Chang’s Pulse Dxa Why this method draws in new patients a How this method is efficient for a busy practicea How this method builds patient confidence and

compliancea Pulse Diagnosis Manual, Pulsynergy by Jimmy

Chang




Why Use Herbal Extracts a How this method is efficient for a busy practicea Why this method can allow you to see more

patients


Acupuncture



Communication to Patients

a Dr. Donald Kendall’s ExplanationÚ How scientific explanation helps patients understand

how acupuncture works

a Biomedical Explanation of How Acupuncture Works


a Dr. Richard Tan’s Balance Method

Ú Why this method is essential for a busy practice

Ú How this method draws in patients


a Pain PathwayÚ To feel pain, 2 nerves are involved

@ 1. Sensory Pain Nerves (Nociceptors)� Tells the brain there is pain: “ouch”� 2 types

� A Delta Fibers: sharp pain� C Fibers: dull, throbbing pain

� Sends signals to L5 Æ Up the spine Æ Track ofLissaurÆMidbrain


a Pain PathwayÚ To feel pain, 2 nerves are involved

@ 2. Proprioceptive Nerve Fibers� Tells the brain the location of the pain: where

the “ouch” is� Fires continuously at the affected area Æ Sends

signals up the front of the spine ÆMidbrain




a Pain PathwayÚ Midbrain releases endorphins / enkephalins that binds

to pain receptors to relieve pain

a Patients with chronic painÚ Proprioceptive neural threshold is too lowÚ Signal to midbrain is weak

@ Patient cannot pinpoint the EXACT location of pain@ Midbrain does not release endorphins / enkephalins


a Acupuncture creates a strong stimulation and “re-boots” the proprioceptive nerves

Ú Needles jump the neural signal threshold and stimulates the brain to release endorphins / enkephalins

Ú After a few hours, the signal gets weak again

Ú Next day, needle the patient and stimulate the signal again@ Keep needling and jumping the threshold until the body

REMEMBERS and RE-ESTABLISHES the normal threshold to signal the brain


a Acupuncture needle punctures mast cells ÆMast cells burst Æ Cells release

1) Leukotrienes and 2) Prostaglandin A and BÚ Leukotrienes

@ Anti-inflammatory agent of the body@ Vasodilates the area of the needle

� WBC enters and clears the inflammation

Ú Prostaglandin A and B@ Triggers the local proprioceptive nerves and sensory

pain nerves to fire© 2010 Acupuncture & Wellness Center, P.S. & Lotus Institute of Integrative MedicineShall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute.

Q & A


a Keep in line with insurance billing

a Discounts for payment in advance

a Herbal consultations and acupuncture treatment costs must be separated


a You must (and can!) get your charting down to less than 1 minute

a Get your paperwork organized





a Basic info on diagnosing and treating this very common issueÚ F – FatigueÚ A – AnxietyÚ D – Depression


a Diet & NutritionÚ The China Study, by T. Colin CampbellÚ The McDougall Program, John A. McDougall, M.D.Ú The Tao of Healthy Eating, Bob FlawsÚ The Anti-Inflammation Diet & Recipe Book, Jessica

Black, N.D.Ú The Diabetes Solution, Richard Bernstein, M.D.

a PhysicalÚ Pain Free, Pete EsgoscueÚ The Stark Reality of Stretching, Dr. Steven Stark


a Apprenticeship Programa Intern Programa Medical Traininga Front Staff Traininga Operations & Marketing Traininga Clinical Paperwork

Documents

Integrative Approach, Great Results · Integrative Approach, Great Results: How to Build a Strong & Successful Practice in Any Economy by Robert Doane, L.Ac. ... ÚSame physiology