“Office Lunch for 45”

I just finished a lunch presentation at a medical office with 4 MDs, 6 PAs and 35 employees.  This is a great time for me to share what happened and how it is always about the same issues. I did get some different questions as well, so I will outline them with answers for you to learn from.  Let’s start with what I brought.  By the way, you should ALWAYS have a set of 5 binders all set, in your office, ready to go.  There is nothing worse than lying in bed at 11:45 PM and thinking, “CRAP! I didn’t put binders together for lunch!”  This is EXACTLY what I did and with a full patient day ahead of me, I didn’t go back to sleep right away.  Therefore…for the lunch, I took a single binder for the practice.  Many of you ask how many to take and for me, at the initial meeting, I took one for the “practice.”  Remember, this is all about building up another reason to show up there.  In this binder I brought the following: my updated CV, 2 of the most recent bimonthly fliers in color and two research articles, one on chiropractic maintenance care and one the other on the “natural history of lower back pain.” 

I arrived a few minutes early like I always do (I am alone); I don’t want to miss anyone.  Everyone in the medical office is important and it is critical to make friends and build advocates on the inside.  I introduced myself to each person when asked. If they didn’t, I just said hello.  I always put on my “fellow worker in the trenches” hat.  Many of these nurses and medical assistants work a hectic week; make sure you have respect for that.  There are always questions about how to introduce yourself to people in that setting. Do you say, “Dr. Owens,” “Dr. Bill,” or “Bill?”  What is the proper way?  The answer is to use your gut and the style that fits your personality, but don’t be (or appear to be) obnoxious or condescending.  When working in a peer to peer environment, in the hospital setting for example, doctors usually use first names.  I have gotten a lot of respect from staff by doing the same thing with them as well.  This is different in my own office when we are interacting with patients; in this case, I was invited in and consider that a privilege. When asked today, I said, “Bill Owens, I am a chiropractor”.  They get that chiropractors are doctors; they aren’t stupid.   They immediately asked where I am located. 

Now comes the first learning issue.  Whenever someone in the group mentions another provider (not chiropractor) that you work with, make sure you keep dropping that person’s or practice’s name during the lunch.  You will be speaking in shifts, so you have to remember to start over.  If you engage in one LONG story, no one at the lunch will walk away with anything useful.  When asked my location, I always include that I work with the traumatically injured.  The medical assistant said to me that they no longer take workers compensation.  I said, “It has been a difficult system to work with, but what do you say to the patient when they tell you they were hurt at work?”  She said, “We don’t allow them to come in.  We give them [XYZ Medical’s] number.”  I said, “Wow, that is great.  They are a great practice, PT and pain management. I work very closely with them in my city office.  In fact, we co-treat a lot of patients together.”  What I did was create an advocate for myself.  The medical office is already trusted because these patients are sent there.  Due to the fact that I also work with them, we have built more confidence and avoided any feelings of us or them competition.  I repeated the medical clinic’s name during the meeting.

When the first MD came in, he introduced himself, extended his hand and like the other 1000 lunch meetings I have done, I had only the time it took him to each lunch to talk with him.  He asked what my background was, looked at me and waited.  I am not going to go into that; you can look at my CV.  THIS PART IS CRITICAL.  If you don’t know how to say what you do and WHY YOU ARE QUALIFIED TO TAKE CARE OF HIS/HER PATIENTS, write it out and practice it.  I hit the high points about specificity to trauma, advanced imaging post-grad training, evidence-based practice, outcome measurements and being credentialed to render Cat I AMA credits to medical providers.  That was done is less than 2 minutes. Think of it as your personal commercial.  We made some other small talk and reviewed the research.  He then asked me what pain management groups I like in the area.  (I caught this immediately as a test to see who my friends are; birds of a feather…)  My answer made him smile.  My response was, “I don’t like to send patients for medication consults when an injection is appropriate.  I would rather have the medication delivered to the exact site and adjust them rather than use a systemic agent such as a pill.”  We discussed why epidural injections don’t often work and why trigger point injections prior to the chiropractic adjustment offer some of the best outcomes in pain management.  I had his attention.  Now it was my turn to ask a few questions. 

I asked him, “If a patient of yours were to randomly find a chiropractor at their office, how often would you get a report?”  The PA that was sitting next to him jumped in immediately and said, “NEVER.  We don’t get them EVER and that is why we don’t generally refer to chiropractors.”  ONCE AGAIN, SAME THING, REPORTING….I then asked him if he cares how the patient is treated on the conservative end and he said NO!  Finally, I asked how he deals with successful outcomes versus non-successful ones.  He smiled and said the successful ones don’t come back to him!  The bad outcomes show up and he reads the report (if one was sent).  

There was another MD that was also sitting with us, but she mainly listened.  Once the conversation was over, we hung out for a little while and the first MD left just after he asked if I was leaving the binder.  I still had 2 things left to find out.  First, how they schedule their referrals…Some use EHR and some use a script pad.  In this case, she said, “You need to make sure that you see Barb on the way out. Barb is our rescheduler.”  Interesting word and I never been in a practice that works like that.  She has a drawer full of cards and the MD will go up with the patient and ask.  Barb is the key.  OLD SCHOOL…Glad I asked.  I asked one of the medical assistants to take me up to meet her; I didn’t want to be wandering around a medical office.  That is disrespectful.   Once I saw Barb, I said, “Dr. Miller wanted to be sure that you received a stack of my business cards for referrals.”  She gladly took them and thanked me. 

Lastly, I wanted to meet their billing person since they told me they keep that in-house.  As a certified professional coder, I am doing a lunch presentation titled, “Using the Laws of NY to get Paid” next month.   I wanted to me her in person and make sure that I had given her a flyer.  I was taken to the basement office where they do all the billing, introduced myself and gave her the flyer.  All in all this was a similar event to most.  The interesting thing is what WASN’T asked:

– My GPA

– My technique

– Chiropractic and stroke

-The difference between straight and mixer

– What is a subluxation?

The focus was on my CV, how I measure outcomes and we talked a lot about research.  If you want to work with the medical community, these items are key. 

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