Everything is Awsome.

Everything is is Awsome when you are part of a team.

Thirty plus years on from graduating I am still doing the same adjustments but with so much more understanding. Those early days were so hit and miss. Pop and pray as they say. It took awhile to realise the value of doctor patient co-operation, aftercare instructions, communication styles, raport building and what my limitations are.

Below is a talk I had the oportunity to give to the final year graduating class of RMIT last year. I hope you get a reaction from it — good or bad I dont really care, just as long as it makes your neurons fire I’ll be content.

Chiropractic Success

To quote an American author, Malcome Gladwell, ‘success is not exceptional or mysterious. It is grounded in a web of attributes , skills, opportunities and timing’. Firstly, what does success look like for a Chiropractor. It will be a bit different for each of us. Most patients walk in the door with pain and most of those walk out without pain. Multiply that by 30 years of full time practice and I can safely say I have relieved enormous amounts of pain and discomfort.

Patient gratitude might be an indicator of success.

When I moved on from a practice I was touched by the display of emotion of a surprising number of patients. Having patients weeping because I was leaving was a touching experience.

Each Christmas patients delivered presents not just to me but often to the whole staff of the clinic. It felt great to be appreciated.

Often I have listened to patients tell a scenario that goes something like “I used to be in so much pain for so long that I didn’t care if I lived or died, but now thanks to chiropractic, I am a different person”.

On two occasions, at restaurants, once with my family and another while with friends, I have tried to pay the bill and been told that ‘its already been taken care of’.

The community I worked in essentially, fed me, clothed me, educated my family and provided a place is its society. More specifically, the community came to my aid when I needed them most. One of my children had a severe disability and to even partially rehabilitate him we needed 40 volunteers each week for 4 years. I was overwhelmed by the huge response of generosity and assistance.

Inter-professional appreciation might be a measure of success. I was invited to present ‘Chiropractic Management of Mechanical Low Back Pain’ to a British Sports Medicine Association conference in Belfast. I have been an Expert Witness and a consultant for the establishment of a Chiropractic Undergraduate Program. Three of my young patients have gone on to graduate as Doctors of Chiropractic.

I count as one of my professional life’s greatest triumphs the occasion of being invited to the Town Hall to receive ‘commemoration of thanks’ for ‘service to the community’ by the Mayor. It was a proud day for me.

Chiropractic propelled me into a world where I had to think, problem solve, practice and perform at a level I have always found challenging. It has been a great privilege to be able to work with the public and to be trusted.

Community acknowledgement has meant such a lot to me. I sincerely hope you all have that acknowledgement some time in your professional lives.

After graduating in 1982 I did a few Locums and was the Assistant Clinician at one of the RMIT student clinics. In 1984 I started my first practice. It reached the 6 month goal in its second week. I was getting around two dozen new patients every week for the first few years.

Twenty years later, my next practice in the UK was already established and I doubled it within 12 months.

I have performed over 150,000 consultations and delivered over one million Adjustments.

During that time I’ve made the initial diagnoses of ALS, MS, Parkinson’s, RSD, Syringomyelia, RA, AS, Diabetes, a couple of space occupying lesions of the skull, 2 fractured odontoids and discovered over 20 malignancies in bone. I hope that sounds fantastic. Because it has been. And it’s also about average for most chiropractors with grey hair and wrinkles. When I say this stuff to practitioners of my age or older they know what I’m talking about because they all have had these same experiences and more. My achievements are nothing special. That is what 30 years of full time practice looks like if you graduated in the early 80's.

Let’s look at the antecedents of my generation of practitioners.

In 1983 Australia had a population of 15 million and about 1,000 chiropractors.

2013 has 23 million people with 4,600 chiropractors performing around 300,000 consultations per week. We are still thin on the ground. The cost of a typical consultation was $10 and the median income was $324 per week.

Today a consultation is about five times that and the median income is four times what it was. Our services are still affordable. Most established clinics had their own x-ray machines. Now not so much, around 20%.

My recollection of those times were that there were not many multi-practitioner clinics and even fewer practices with other types of practitioners. The then recent New Zealand Royal Commission findings were favourable.

American chiropractic had been booming for a decade. We were hearing ‘Chiropractor’ on popular TV. Australian State registration had just been achieved.

Health funds started recognising chiropractic services.

The undergraduate program here at RMIT was firmly established with government funding, achieving a world first. All of these occurrences and much more, led credibility to the profession and public acceptance kicked off like never before.

My own situation, which is similar to many others, was that I was the only chiropractor in my town. The guy in the next town and who had basically introduced chiropractic to the region happened to be an excellent human being and competent physician. So I got off to a good start. I quickly became involved with the community by joining various committees. My children were born at the local hospital and attended the local schools. Chiropractic was riding a wave of popularity. Life was good. So 30 years ago, Chiropractic was less well known. It was not uncommon to meet someone who had never heard of Chiropractic. That is, they had never heard the word ‘Chiropractic’ before. Sometimes we were confused with Chiropodists, who by very good fortune now call themselves Podiatrists. Many was a time when an older New Patient would make an appointment and ask to have their toenails cut please! In my town the local Bank managers didn’t know what a chiropractor was and would not give me a loan. So initially I had to use a bank affiliated with RMIT. At community meetings etc. I have been affronted by being introduced as a Physio or Masseur.

As new professionals we were struggling to be recognised within the established health scene. We had to be prepared to walk upstream against the current of mediocrity. Clearly, greater men and women had paved the way before my generation, but I wasn’t part of that and know little of their struggles, which I’m sure we’re formidable. I have had to stand up for what I thought was right and been proven wrong. (bed rest for acute LBP) and I’ve stood firm against derision, misinformation and negativity and been proven right time and time again. Which reminds me of the recent Bad Press in the media. Bad Press usually occurs about three times a year. It is not impossible to say what drives our adversaries to try to dislodge us from the ledge of credibility. This has never affected the attendance of my regular patients. It has often been the source of a good laugh and a chance to further educate some patients. It does drastically affect the flow of new patients in the short term. A negative television program definitely decreases the expected enquiries for 2-3 weeks.

However, this observation shows us that our current patients are our greatest allies. Our results determine their support and for the last 118 years the results of Chiropractic have ensured the profession has grown and established itself as a significant participant in the health care delivery system. Bad Press, of course, should always be responded to but it is not as damming as our detractors would like. It does make me cringe though. Bear in mind there are plenty of excellent practitioners out there making loyal patients every day.

Bad press is unfortunate but the most detrimental thing you can do to your practice and your profession is to practice without integrity. We, as individuals, are each more transparent than we commonly realise. Early in my working life, a regular patient, who I knew to be an astute businessman, came in and announced that he had met my competition. Now I must apologise, I am going to use a profanity which never ever has a place in a professional setting like this but the exact quote is essential.

That businessman said, of one of our colleagues, “he won’t last long here or anywhere else because he doesn’t know ‘you never bullshit a bullshitter’”.
Integrity is a practice builder, lack of it will lead to disappointment on every level.

Several years ago at a seminar, a speaker from the NSW Dept of Health addressed the audience stating that so far that year there had been 18 complaints against chiropractors. The crowd visibly cringed. The speaker noticed. She then said, “don’t misunderstand me, we are studying you because chiropractors have the lowest rate of complaints. We need to know what you are doing right”. Success for you will be different to me. The Antecedents that allowed the success of my generation of new graduates are very different to yours.

About 25 years ago my clinic and others were chosen at random for a ten year study of a number of demographics and profitability was one. During that ten year period the profitability of Australian practices decreased by 50%.

Private practice is in a constant state of flux.

Let’s look at what is likely for you.

The same basic principles apply. Malcolm Gladwell in his book ‘Outliers’ describes the five attributes needed by all people achieving high levels of success. 1. You must have the necessary physical characteristics for the endeavour, a piano player must have fingers. A painter must have eyesight. 2. You must be in the right place at the right time. If you are born into a nomadic tribe in the Sahara you are unlikely to become a rocket scientist. 3. You must be prepared to work 10,000 hours in your chosen field to achieve expert competence. 4. You must be able to recognise opportunities. During that 10,000 hours of work you will mix with people who will offer you chances to be further involved and advance in your field. 5. You must take those opportunities. How does here and now relate to you being highly successful Chiropractors? 1. If you did not have what it takes to do the job you would not be sitting here today. Clearly you have the intelligence and the ability to get you the specialised skill set required for launching into the profession.

You have been regularly evaluated by experts over the last four years and only the most capable have survived the process of education. Look around you at the size of this class and recall the class size on your first week 4 years ago. Natural selection is in play. 2. RMIT is the right place. You could have done chiropractic in any of the 42 schools worldwide but you ended up here. Imagine how the Sydney students are feeling. This is a great place that has significantly contributed to the rise of the profession throughout Australia.

Now is the best time for becoming part of the next phase of the evolving chiropractic paradigm. We have achieved acceptance and professionalism including a unique knowledge base . Chiropractic is closer to being ‘Mainstream’ than ever before in its 118 year history. Now is the right time for the new leaders to emerge. 3. Develop your skill with 10,000 hours of practice. The sooner the better. Get out there. Get involved. Be all you can be. Work, wherever and whenever you can, hone, develop and perfect your skills, practice, practice and practice some more.

Then you will ‘own’ chiropractic, your confidence level will rise, your abilities will increase and you will believe and live the ‘world is your oyster’ and no challenge is too big. Provided you put in the effort. 4. While doing that, your world will be defined by what you do and who you are. Naturally, opportunities will come your way. To be successful you must recognise these.

I think I can see a few current opportunities for the modern chiropractor to maximise their effectiveness. Firstly the upskilling of Functional Neurology might be a very useful adjunct. It seems to have great potential to expand the practitioners’ treatment methods, understanding and range of conditions treated. I might be wrong — I have been before. Possibly it could turn out to be a fad like the others before it, but it appears to have merit at the moment. I hear people talk about Ted Carrick like they used to talk about Clarry Gonstead.

Secondly, the addition of Psychotheraputic concepts and skills, I think, would very effectively make for a greater patient doctor relationship and a loyal patient base. I could easily see the physician of the near future helping their patients with their neuromusculoskeletal conditions and considering the psychological reasons for why their patients make choices that are detrimental to their health.

Finally, the world of the disabled is waiting to be included in everyday chiropractic practice. Attitudes have drastically changed towards this cohort.

The people with disabilities want what everybody else wants, less pain and discomfort, greater consideration and maximum health potential.

We as a profession are very well placed to provide care more often to more people with disabilities. I can assure you this demographic of our population is ready and willing to accept our type of health promotion. And how cool would it be to know sign language? (Hands up) 5. When you recognise an opportunity you must ‘go for it’.

When you choose to extend your Professional Chiropractic attitude out beyond your practice — a new world opens up to you. You will be judged by who you are rather than by what you do.

If you aspire to Elegance and Excellence then you will be respected.

This of course folds back into your practice and you will notice that patients are referred to you by people who you had never seen as patients and know little of Chiropractic. They refer their friends and relatives because of your character. You will be respected and trusted, the referral patient will have have heard ‘ don’t worry, if he can’t help you he will say so, you can trust him’.

Success is available to all that are prepared to work for it. I doubt it will come to those that spend their free time on Facebook or game consoles. But I could be wrong.

I am an average chiropractor and I have met people from probably every country in the world, dozens of different cultures and every imaginable profession and job. I have worked with royalty, politicians, celebrities, junkies, alcoholics, the homeless, indigenous Berbers, Bedouins, Gypsies, Bush people and Aborigines. I enjoyed the latter more then the former. I have represented Chiropractic at Commonwealth Games and other International Sporting events by saying ‘Yes’ when approached. I attended court as an Expert Witness because I saw it as an opportunity. It was not a pleasant experience but it was enlightening. Straying outside one’s comfort zone is well worthwhile. You will help thousands of patients by using the simple approach of every primary contact physician, that is, taking a history, performing an examination and delivering treatment. The better you are at those three elements the more satisfying will be your career and your life.

The History is all important. Your ability to communicate sets you apart from the herd. Your listening skills, your enunciation and your ability to illicit an accurate description make you a physician.

So when a fit, healthy appearing 18 year old presents with intermittent headaches of three weeks duration. It is only after gleaning the severity, duration and time of onset that you suspect a space occupying lesion which turned out to be a fatal Astrocytoma. The two previous doctors had prescribed antibiotics. They didn’t do a decent history.

The Examination is all important. That thorough History determined the starting point for the examination which demonstrates your intellect. Most often the commonest conditions require little more than knowledge of anatomy. But you can never know enough.

Periodically an unusual sign or symptom will show up, and you, who are better educated than I, will know which tests to elucidate an accurate diagnosis. As I mentioned earlier, I like many others, have made some remarkable initial diagnoses.

Sometimes I did not nail the diagnosis on the first visit. I had to take away the information gained in my exam and history and then ‘hit the textbooks’ or google the thing until it all made sense. I expect you will do better than that.

Delivering treatment is all important. Chiropractic is unique. The Art of Adjusting is a life long endeavour and coupled with your individual style of relating to your patients, that combination makes you special. Studies have shown chiropractic patients to be the most satisfied of all the health care consumers. Some of the reasons for that are;

The personal doctor patient relationship, care enough to know the names of your patients.

We are hands on, which conveys a dedication and understanding.

We usually have a ‘down to earth’ explanation of what’s going on with our patients. They ‘get it’ that we know the leg bone is connected to the back bone. This sits well with them and they are comfortable with us. Take the time to listen and take the time to explain.

There are formulas out there touted as the answer to successful practice and I have watched them come and go. They are as much a trap to mediocrity as they are useful. Also, I think a lot of adjunctive therapies are propagated by myth and marketing. Be objective. What has endured for over a century is the humble Adjustment. It takes a long time to perfect and it has it’s limitations, but it is the mainstay of the profession. An elegant Adjustment has precision and control and is a joy to deliver and receive. It is so effective that it’s intra-professional and inter-professional rivals cannot match its effectiveness.

Finally. You, the new generation of graduates, are better trained, better prepared, more knowledgeable and at the cutting edge of the profession. On the other hand, you don’t know what you don’t know.

So look forward to an exciting and wondrous time in the coming years. You will learn about humanity and you will learn about yourself.

That’s it for my first Blog.