Tips for starting a sports medicine practice

And if you have the same copy or text or articles as another place does, then you're going to be penalized actually. So all those places that are trying to sell you a template website that is very similar to other people's websites, tell them to go pound sand because that's really not the best thing you're going to want to do. And some of them do very unethical practices or what we call black hat practices for ranking a site. And it's not a big deal unless Google catches you. And after Google catches you, it tears your whole thing down. You're listening to the Restoring Human Movement podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. And now your host, Dr. Sebastian Gonzales.

Hey guys, it's Dr. Sebastian Gonzales, again, your host for the Restoring Human Movement podcast. Thanks for joining the Movement Movement. Now, if this is your first time to this podcast, just know that if you're a clinician, you are going to get great tidbits and pieces, gold nuggets as we say clinically for basically to kind of inspire you to learn what you might not have known existed. And I was there before I started doing these podcasts. I learned a lot through the course of doing these podcasts. So if you're looking for tidbits of maybe ways to improve your clinical experience for your patients and improve your outcome, listen to this podcast.

91 is great. 94 is great. And 122 is great as well. If you're a patient or lay public listening to this, you still will get quite a bit of information from this. And I like to say that this podcast is a little bit more catered towards the advanced patient and clinician kind of middle ground there. And I know we have different languages than you guys and you have different languages and sayings than we do. And we say tibia, you say shin bone, but we're kind of blending them together in this podcast. So I'm going to make sure that I'll explain as many things as I possibly can along the ways, except for this podcast, this specific episode, this one you're not, if you're a patient, I would suggest you just turn this one off and go to a different one, go to a different one that looks like a topic you're interested in. So this one's more practice management style. And if you're a clinician and you're just getting out of school or you're thinking about getting out of school, if you're a clinician or if you're a student, then this is the one that you're going to want to hear first. And it's funny, the students and the young docs that I've met, a lot of them really want to know clinical stuff, which I get, I totally understand. It's, it's amazing that you guys want to learn more and more and, you know, be able to improve your patient outcome, but it's a really hard thing to get out and get out of school and realize that you have to start your own business. And this happens to a lot of people, happens to a lot of clinicians where they, they finally realize that it's hard to find a job. It's hard to find a place that practices in the style that you want, because a lot of the places out there that have a lot of volume, uh, they practice a lot of volume for, for a reason, you know, it's, it's a, it's a different type of management. If you're into a lot of topics I've talked about in the podcast so far, um, a little bit of loading, a little bit of trial and error, um, and it takes a little bit more time, you know, and I accommodate for that in my practice and I, and I charge more than a lot of people do. Um, but also too, I don't see high volume and I don't do it on purpose. So this podcast today and this, this episode is going to walk you through some of the stuff that you guys are probably going to want to know or didn't really think about that you need to know, but you should probably know. So, uh, as always, if this is your first time, uh, I'm going to share a little story about myself first, just so you can get to know me a little bit better. And hopefully kind of like how you enjoy Jay Leno or Conan, you'll hopefully like me because I'm showing part of me in this podcast. So that's why I do this bit. Um, and we'll get right onto the content after that. Okay. So I know a lot of you probably taken Ubers and Lyfts before, and I was thinking before, I, I mean, I like talking to the Uber drivers when possible, but I really don't like the awkwardness of saying, so is this your, what time do you start tonight? And do you have any good stories to tell? And are we your first ride tonight? You know, things like that. It's just must be so boring to them. And so there's been a couple of times where all this ask them instead of all those boring questions, ask them, so what makes you tick? And they're like, huh? It's like, well, what makes you go? What makes you, what makes you passionate in life? Like, give me, give me a whole story, you know, kind of cut through that crap. Cause I'm sure their job is really boring when they have to answer that same damn question again. So yeah, I've been driving since six o'clock, you know, and like, I'm doing this a little bit extra to kind of put my, my grandson through school.

And, you know, I just came in from the area. I used to live in Chicago. I did a little Uber there and now I'm in Huntington beach and like, oh yeah. So I drive about 30 hours a week. And how boring would that be? So next time you have an Uber driver, perhaps ask him a little bit, something a little bit more in depth, you know, get straight to the point. Let's just make their job a little bit easier. All right. Now on to the content. Now, first off, before we start into all these little bits and pieces of information, just know that there is a document that I've written. I wrote it, I think about a year and a half ago. It's not a hundred percent proofread, but it has some of these same thoughts on it. Won't have all the specific things that I go into today, but it's a lot of things that I wish I would have known when I got out of school. So I offered that up to some of you, some of the students before, and everyone seemed to really like it. So I'm going to offer it again.

It's going to be a free download. You might have to input your information to get it, to get it emailed to you. It's a, God, I forget how long it is. I think I want to say it's like a 20 page PDF. So nothing fancy in it, no pictures. It's just kind of just me spouting off and telling you what I wish I would have known. Now, as we get into practice, there's a couple of things that I know that a lot of people from my school ended up doing because we realized, holy shit, we got to have some stuff. So having your forms is something that at least back then we weren't really forced into having electronic medical records. So you could do paper files. And actually I had a ton of patient files. We had this manila folders and you just put soap notes on one side and you put intake forms and MRI reports, x-rays and so on the other side. And now we don't really have that anymore, or at least I don't. And I believe what the thing was, was back in the day you had to conform to Medicare standards. At some point they kept pushing it back and pushing it back and finally everyone had to get it. And that's why all these electronic medical record softwares are out now.

But you still kind of needed some forms. And so I actually have some forms that I used at my school. It was the school forms and I just took copies before I left. And I don't have the original document obviously, but I had a regional cervical or neck exam. We had a regional lower back region exam. We actually didn't have, we had some that were like hips and knees and so on. I didn't necessarily take those. I ended up creating a little bit more of a checklist when I started using those in practice. So forms are important. I'll come right back to that exam form in a second. Also, you're going to need a consent form. And if you don't know where to get these types of things, just ask another clinician or ask someone who you already worked for. And they're probably going to have something which has worked well for them. Obviously, these consent forms are, they're kind of iffy sometimes, I think. And I think if you speak to an attorney, obviously, I'm not an attorney. I don't even know if they work. I don't think any of us really know if they work because I think the real danger in treating someone poorly or getting someone upset at you is really not whether you're right or wrong. It's just the headache of fighting them in court. So sometimes I tend to think it's a little bit better that when you're in a disagreement with somebody or they don't quite feel understood or they don't feel like their voice has been heard. I think it's just better to hear them out. And I think you'll mitigate a lot of risk with it that way. But obviously, we do need to have those consent forms signed. Minor consent is also another thing as well. Obviously, you can't be seeing people under a certain age. And there's a HIPAA form as well.

And I know this is very dry stuff, but compile them all together. They're not going to be that big. They're going to be like five, six pages or so. I tend to have my history form as a lot of people's red flags in there as well. There's obviously all their review of systems and like, do you have sinusitis and runny nose and things like that, which is all great in finding Danny, but it really doesn't ask some of the critical questions. And actually, I as well, I've built in some more probing questions in there. And I give it to people ahead of time. And they actually, they go onto my website, they book an appointment there. And I really, I mean, if they want to talk on the phone, I'll talk on the phone with them. But at the same time, I really wanted to book on the website for multiple reasons. One of them is because the new patient paperwork gets sent to them, and they have a way to do it online, which comes back to me as a PDF. And it's nice. I can just upload in their file, but it's actually nice to, to give them a chance to fill these things out when they're not in a rush. So, um, cause I've had people walk in, they're like, Hey, I didn't fill the paperwork. And like you give them an intake sheet and it's been literally like two minutes on a form that would, if you even read the whole thing, it would take you about like 15 minutes and they just serve a couple of things and that's it. So they tend to not really think that their past history has any relevance on what they're there for. And perhaps that's because they already know what they want, you know, and that's, uh, that's just their treatment bias. But I tend to like to have a lot of information on people. And the probing question that I'm talking about is I'll ask them, are you ready to get better in the form? Scale of one to 10, 10 being very willing to, uh, engage in, in rehab? What are you, what are you right now? One is I'm not interested, you know? And, um, other things are what is the biggest barrier for your success right now? And some people say money, some people say time, you know? And so it's important to know this stuff because when I'm speaking with them and I'm conversing with them in the first appointment, I want to know what their, what their holdups are. Also too, I want to really want to want to know what their biggest fear about their thing is, where they think it'll be if they don't get it treated, if, well, where they think it'll be if it, if it does get treated and it's, and it goes really well.

So I want them to be able to create a little bit of a vision of where they want to be, not just out of pain. And pain is really, I think it's a terrible outcome measure. Although it's useful for us to figure out why the person is in the state that they're at, I think it's kind of useless, you know? Like there's a lot of people who are, um, a lot of people who are not in pain or what they would not consider as pain and they're just afraid of moving. So there's, there's other, there's other things we can do, I think, to improve people's lives. But anyway, so with the forms, I would, I tend to have the intake form, which is a couple of pages with all those probing questions as well as review of systems. Then we have our HIPAA form, then we have our consent form and so on. If you, if you tend to do credit cards and file and things like that, that would be the place to do it. Now, websites, I mentioned this in another podcast, so I won't go into it too deeply, but I do suggest that you guys do a podcast or sorry, a website and the website doesn't have to be elaborate. Okay. It can be one or two pages. It has to have your contact. It has to have your location. It has to have something about you. And, um, you know, it doesn't have to be a lot.

And if you want the website to work for you, which, uh, scroll back a couple, um, I'm thinking about three, four weeks and you'll see something about a website, a podcast, and you could have the website really work well for you. And I have my website, do my online bookings. It collects leads, uh, it emails people reminders, or at least the software attached to the other end does it. It, it tends to, uh, uh, do very well at, at, at getting new patients in. So there's a lot of things you can have it do. You don't have to, you don't have to go nuts with it, but I would suggest strongly that you just first start thinking about maybe what your logo is. You know, I, I, I, I tend to not think that logos are a big deal, but I know a lot of people get hung up on the branding. I think branding is less important than you think, honestly, because someone comes, someone rolls in, they might not even know where they're at. They don't know your degree. They don't know how long you've been out of school. They don't know any of that stuff. They don't like, not that they can't figure it out, but they just don't care. They just have heard good things about you and they want to come to you and they want you to help them. So branding, I think is important later on when you become a little less, not the face of the company. But I think we as healthcare providers, like they, people want that connection, you know, so it's not, uh, it's going to be going to be as useful in the beginning. So don't work, don't hang up too much on it. And honestly, I changed my website domain, uh, three times, you know, I changed my business name three times.

So you might do this as well. So don't get hung up too much on it, but you start, need to start having something on the website. And if you guys want to go to my website, ptsportscare.com, you can see that there's, as you scroll down, we call it above the fold before you actually scroll. There's only a couple of call to actions. There's, are you a patient or are you a professional? And I really did that because I want to divide people up. Um, I'm not going to show the same information to a professional as, as it would a patient. And a lot of the, uh, patients will see the articles, uh, regional articles on like, uh, mid back pain or neck pain or, uh, loss of sensation into a hand. They'll probably read all that stuff. You as clinicians or healthcare providers, you probably already know all this stuff. So it's like, you don't really care much about it. So why would I show it to you? So I would show you different things. So I would, I would think kind of as a consumer, when you build the website, even draw it out on paper, draw it on paper. And then think about the flow of how you want people to experience finding you. And do you want them to see a picture of you with your dog or your wife? Do you want them to see, um, an article or a, uh, a short video on the condition that you specialize in?

So those are all ways to help validate that, you know, what you're doing to these people. Uh, and it's, it's going to be a really important part of your, of your, um, of your, of your practice. It's one of the most valuable parts, honestly. And I think I said in a different podcast, I don't really go out and do a ton of marketing on the side, you know, and I was going to talk about this a little bit later about business cards. I put a question mark whether I really want to talk about this or not. And I know that I have business cards, everyone has business cards, but how many times do you go meet somebody and they're like, you know what, can you just, can you send me a link to your site? You know? And I think that's easier because people lose cards, you know, I should have a minimalist wallet. I don't want any people's card. I don't want anyone's cards in there, including my own. So I think business cards are kind of on their way out. I don't think you really even need it. If you want to think of a website as being your virtual business card, that works as well. And I know some people might be saying, well, you can leave business cards over at a gym or no one picks that stuff up or I've never seen anybody like those things sit there forever, you know?

And it really just comes down to when someone refers someone to you, it's more of that, hey, I got this guy, go to this guy. What's he do? You know, just go to this guy, you know? Well, what's his name? Well, so I'm going to text you his information. That's typically what happens, you know? So people share it that way. So you won't be trading business cards quite as much as you think. Now, as we go into online schedulers, I think this was something that you guys, if you're just starting, you might think, oh, I don't really want to do an online scheduler yet because it might cost some money. And it does, but I think it really helps with creating a system and a flow, again, how you want people to experience coming into your office. And I had this conversation actually a while back with a patient that she was doing, she basically helps out with kind of sales funnels like that and selling of products. And she says, hey, it takes multiple touch points to sell a pair of sunglasses to somebody. And I said, well, you know what? I'm like, what was your experience coming into my office? Well, she's like, well, I found your website. And then I went to this article and then I called and no one picked up so that I didn't come back, you know? So after that, or she didn't come back to the site.

Later on, she saw me on Instagram and then she reached out for something. And then I text her or I sent her a article back about something or other. And then she called again and someone picked up and asked about, she asked about insurance. She said, we didn't take it. And then she hung up and didn't come back again. Finally, she made her way in, but it took three different interactions to actually get her in. So if we can curate that and actually figure out how to get this person to all the favorable experiences that they need to come in, it's kind of how it would mitigate a lot of drop off. And I'm not an expert in sales. I'll start with that. But I know that when people are selling stuff to you, they're constantly retouching you, okay? They're getting in front of your face and you go into Amazon, all of a sudden you back off Amazon, you're looking at a camera, all of a sudden it shows you a bunch of cameras, you know? And at some point, you're going to be in the right place to actually do something about that camera and buy it or not buy it. And they'll probably stop marketing to you at some point. But I know that when people call, they want an easy way to get in.

They want an easy way to know that they're going to be in the right spot for their condition. It's going to be the right price and they're going to be taken care of. And if they feel neglected maybe and the phone doesn't get picked up, then maybe that's a problem. And for that reason, actually, I have an answering service now. So that's a whole different topic there. But for the most part, online schedulers, a couple options of things that I've used in the past. And here's where I'll get into a little bit of options. By the way, I should go back. Websites, okay? I'd strongly suggest doing a WordPress. I know some people have done Squarespace, I think is what it is, and Wix and all these other simple ones. I wouldn't do those. I wouldn't do those. And I don't, I know that I've talked to a few clinicians already about website stuff. They're like, man, you know a lot of website stuff. I'm like, I know, I've been doing website shit for a long time. And I've been managing my own site for a very long time. And now I don't do quite as much anymore. But I feel like I heard the same kind of things from people. It's like, it's like, imagine if you're trying to get healthy and someone's like, you know, you should drink water. You know, you go to the next person two years later, they're like, you know, you know, you should drink water. It's the same thing I hear about websites. They're like, you know what, if you want to get it right, just go to a WordPress site. And it's not WordPress.com. It's WordPress.org. I think it's org. One of them is a blog based one that one is actually a website one. So I would start there. Websites or WordPress is basically free from what I remember. You pay the domain. You can buy it from like a GoDaddy or you can buy it from, I bought one from Ominous and you can buy it from a bunch of different places online. So you buy the, you buy the website domain and that's like $10 a year. I think $20 a year hosting usually runs you about a hundred dollars a year, unless you're up higher in the amount of people who come to your site per month. And that's like, so mine, I see right now we're seeing about 75,000 people a month that come through. And so it costs me, I think about $130 a month or more because there's more people. So at some, at some point you'll have to pay a little bit more, but in the beginning, just, just pay something for a little lower hosting as you're, as you're really starting to ramp up into your site. Site speed will be important later on, which is obviously there's a hosting part there too. So don't, don't take this as I'm saying hosting is unimportant. It's important at some point, but probably not in the very beginning. So just pick something. So, but I wouldn't go with Wix. I didn't want to go with that stuff. And, and from a website perspective, you kind of want to have your website unique. You don't want it the same as other people's. And there's something called a duplicate content. And if you have the same copy or text or articles as another place does, then you're going to be penalized actually. So all those places that are trying to sell you a, a, a template website that is very similar to other people's websites, tell them to go, tell them to go pound sand because that's, that's really not the best thing you're going to want to do. And some of them do very unethical practices or what we call black hat practices for, for ranking a site. And it's not a big deal unless Google catches you. And after Google catches you, it tears your whole thing down. So I wouldn't, I wouldn't partake in any of that gimmicky stuff.

So back in online schedulers, uh, I use Genbook for a very long time. Genbook, it, uh, it was good. You can put multiple providers on it. I think at the time when I started, it was $20 per month. And one feedback I got on it though, was that it was, it was like, they went from a nice site and they clicked the book now button and they went to something which was almost like one of those old cell phone, HTML. Like, you know, that Blackberries are really terrible. It was a Blackberry pearl. I think it was really terrible at websites. You couldn't really see anything. Like your browser was crap. And then all of a sudden the white iPhone came out and you're like, Oh my gosh, there's color in this browser. It's amazing. You know, it looks great. So it was kind of like that. They would go into something which looked kind of like shady looking. So then I heard it from multiple people that are like, what is this page? And I'm like, what's the booking place place? And they said, Oh, well it looks, I wasn't sure if it was really your site anymore. And I have since moved away from them. I did hear from someone recently that they've, uh, improved that a lot. So definitely go check them out. Uh, another one that I currently use, but we're moving away from is set more set more.

We, the reason we set, we went to it first is because it was more aesthetically pleasing. You can capture credit cards on there. You can charge people right when they book, you'll get an email that says that they paid. They'll get an email that says that they paid. They'll get all the information. Uh, they'll get all of the, um, new patient paperwork as well. The only one hanging up was set more was that you really couldn't cater, uh, a custom notification or email to them when they did a different thing. An example would be like, so a new patient came in or they booked and they would get a piece of, or they would get an email back that says, Hey, thanks for booking. And here is all the new patient paperwork. I can't release some policy as this. So when they booked again, they get the same thing and they've already been in before. So I had a couple people say like, well, I don't, why am I getting another email? I just, I'm like, just ignore that for now.

But it was critical to have it for new patients. So I just left it. What I would really like, it was something a little bit more customizable. So if I have a second time person coming in, perhaps I want to expose them to a list of rehab exercises and videos that I've attached into a Google doc, which I did have, which I do have. And that would have been nice because I wouldn't have to send out or my staff wouldn't send out any information and it would just automate and streamline that kind of stuff. Even though we have the personal type of touch when they're in office, all their stuff would be streamlined when sent to them. They get appointment reminders and all that kind of jazz. So that was all great and dandy, but we are considering moving away from that for a reason, which I'll tell you a little bit in a second. Now onto EMRs, there's many different types of electronic medical record systems. Some of them have online booking, some of them don't. The one that I am changing to is Jane. And this is our first month using it. Great customer support. That is probably one of the most impressive things that I've seen with Jane is that the customer support is great.

Now I'm switching from Dr. Crono mainly because they started to, well, we had, so I'll start with this. We had a, we had a free software for many years and I'm very grateful for that. So I don't want to bash them for that. Their, their interface was more than I actually needed. So it was good. You can go through, you have a patient note, you can hit duplicate, change it. If it was a little bit different on that day and it was all good and great. Um, there was a couple of hangups with creating custom forms back in the day. They used to allow you to have 10 custom forms or what we call macros as well. So macros would be like if someone were to come in and you're like, Hey, they got a Syrian leg pain down the right side, worse with bending forward, worse with prolonged sitting and driving in the car here. If you want to say all that, you just hit a button, a little, a little thing you can click, which would pre-generate all that stuff. And you might've designated as leg pain. And so that's something which is very useful. They started cutting those down on us over the years. And again, I don't, I don't, I don't blame them because I'm very grateful that we had free service for a long time.

But as I started, as they started to start charging over this year, it was January, 2019. Um, they started making it. So you had to start, um, paying 50 bucks a month. I think it was to actually even have your files as read only. So we had to start exporting them out. So that was either we were going to pay to be on them. Uh, and the online booking wasn't quite what I wanted, or we had to export them out. So we ended up exporting them out and going towards Jane because Jane has more online booking capabilities. You can collect credit cards. You can have really, really, really great actually intake forms. My intake forms actually improved. I was using Google forms for a while and, uh, it would generate out a PDF that would go into Google drive. And I would have that right in front of me when patients came in, but this one's even better. Like it was funny. I was actually the day I was, uh, a patient had booked already and it was about 20 minutes to their appointment. And I looked online and I was like, there's no, they didn't have any, uh, form yet. And I'm like, damn, they're going to come in here. I don't know what I'm going to do yet. Cause this is a fairly new thing for us, uh, for the, for the patient to be able to fill stuff out when they're there. It's like, I was going to have to go to an old paper sheet again. And I looked in their file and I could see there was a, there was a draft that was not done and it was their intake sheet and they were doing, I could see that they were doing it. And so when they came in about 10 minutes later, they said, Oh, I just finished in the car. So then it was right on my laptop. It was right, ready to go. And again, you can make it very, very simple, uh, to make a really complex form.

So a lot of the McGill based, um, testing as well as some of the stuff I learned to fix your own back, I put in there, um, as well as dynamic testing from, uh, clinical neurodynamics, uh, shack locks work. So, um, I find that very helpful and you can share these things pretty simply. Now, other things or other platforms are, uh, is the office ally, I think is one. I have a couple of friends who use that and they've been using it since I got out of school and they, they like it. Uh, they, they bill through it. Uh, so I think that's fine. We don't really bill that much. Um, but Jane is something that has billing capabilities that we might use. We currently have a, um, and all people have asked me this is how do you bill insurance? I'm like, I have no idea.

Uh, I, I don't have any idea. We just tell our biller what we do and, uh, it's an outsource biller. It's not an office and they just do it for about four bucks a claim. I know some places will do it for percentages. I didn't want to get into that cause then they could up the percentage and do some type of fraud thing on you. I didn't want to get into that water. So we just did four bucks a claim, but we don't really see a lot of patients that do it. So we might start bringing that back in office. I'm not sure yet. The reason why I'm telling you kind of these, these things all in, um, a cluster right here is because when you really see the dollars and cents of what it is to, to practice, you see that your, your EMR might cost, you know, 70, $80 or a hundred dollars and your website costs, um, a hundred bucks a year, uh, 120 bucks a year or so. Your online scheduler might've been 20 to $40. Your biller might be, I think we end up paying 150 to $200 a month. And so there's all those things that build up. So if you have the capability to kind of nickel and dime the things here, I think really think keeping overhead low is the way to go to, to keep your practice going. So I might actually blend a couple of these things here. I might take the EMR, which is Jane and kind of cannibalize the online scheduler, which is currently set more, which saves me 40 bucks. And I am going to start maybe doing our, uh, stuff in house for billing. Cause really, again, there's really not that much. So, um, the things you can look at and compare them is Dr. Crono is one, um, practice fusion is I think another one. I didn't use that one that much. There is a office ally, which I think is a very, to me, I remember it being a very beta one. It was very simple. Uh, and then there's Jane. So, uh, those are the EMR schedulers.

And by the way, if you do, Chen, if you go to Jane, uh, let them know that you heard that this from me because, uh, we set up a little thing there. I said, Hey, look, I get a lot of chiropractors. So why don't we talk about EMRs a little bit? And they said, okay, cool. So if anyone does come for me, if you want to support the show, just say you heard it from Sebastian Gonzales, as well as the restoring human movement podcast. Now onto phones. Um, I actually got my phone and it's not a hard line. And my dad gave me this idea a long time ago. He said that, uh, when he actually switched offices, he was a dentist and he switched offices across the street. And at the time, I don't know if it was, uh, Verizon or what it was. And so he switched offices and it was like a different, it was a different city. It wasn't that far. It was like less than a block basically. And it was a different city. And the other service didn't let him take the phone number. And so he said, you know what, don't get caught in this again. Cause he had to, he had a lot of marketing and people who called that number. So he lost the number. And so he said, you know what you should do? Just add an extension to your cell phone or get a Google number and then forward it onto whatever phone you want. So that's what we do right now. And I have a, a very basic phone that is attached to my, my business phone. And so I have my personal phone and my business phone. I don't care around both. We just leave the business phone at the office. Okay.

Just like a standard landline. Um, more, a lot of time we don't pick it up. And like I said earlier, some people, um, miss that as an opportunity to come in. So I actually got a, uh, answering service for that. The answering service only really picks up after about three or four rings, I think. So it gives us a chance to answer. The answering service isn't told to act like the office staff at all. We just say, Hey, this is the answering service for performance place. They're busy right now. Can we take a message and we'll let them know how urgent does need to come back or how, how urgent do you need to hear back from them? What's your concern? Do you have a question? So we get this as an email format and it helps me actually call the person back and say, Hey Joe, I heard you had a back issue. Well, tell them about that, which helps me out with, um, kind of getting questions, uh, fostered to them so they can answer them. So I can hear really what their problem is.

And we, if we build a connection, then they come in. So I would say just go with a phone, like the basic phone extension off of your regular plan. It's like 10 bucks. It's like nothing. But one hang up that actually they did is funny. Uh, when I first started the cell phone thing, it was like 50 bucks, 60 bucks a month. I was like, what's going on? Why is this thing so much? You said it was 10 bucks. And they're like, well, you have a smartphone. And I said, well, I don't, I don't need a smartphone. Why do you, what's it, what does that matter? I got a smartphone. And they said, well, if you have a smartphone, we have to put a data package on it. I said, I don't, I don't want a data package. You're like, well, if you have a smartphone, then you have to have a data package. That's 40 bucks a month. And I said, well, we only use it for phone calls. And I'm like, give me a flip phone and give me one of those old school ones, you know, the ones that you break as a burner. And so I have one of those. It's just really, really old. And so when people come into the office, they're like, what is that old phone? I'm going to tell them this whole story, but 10 bucks a month. So it's nothing. The answering service is, uh, it's called office sense. It's out of Florida. Uh, that one tends to work pretty well. We've had them for about six months or so. And I think we've definitely gotten some enough business from the callbacks. It's about a hundred dollars a month, but it will increase, uh, if you have more phone calls, obviously. So that's just another consideration too. But if you are, if you're answering your own phones, you might really want to consider what your experience is when you answer these phones, because at least this is my experience anyways, I'll tell you, and you guys can pick and you decide on your own. So I've noticed that when, when I pick up, people say, Hey, so, um, I'm just calling to see if you guys take my insurance. And then like, I mean, I could maybe, maybe there's a way around this and you guys can get creative with each other. You should, by the way, you guys should get to get with your friends and role play this one. I did it with, uh, my, my intern Jeremy one time, and it was the most awkward thing because it's, it's kind of like saying, Hey, do you have like, you have hamburgers here? And then someone starts telling you about something else. It's like, I just asked a yes or no question. Do you have hamburgers here? So the, like, do you take insurance? And it's like, well, no, we don't, but blah, blah, blah, blah, blah, blah, blah. Right. And they're like, okay, thank you. Bye. So we don't even know what their condition was. Um, we don't even know if we could help them. Uh, obviously we know we don't take their insurance maybe cause I know I don't. So the, the reason why I like the answering service at least for now, or at least maybe you can have, um, maybe someone answers your phone, um, at a call center, or maybe you have your mother answer your phone, or maybe you just have someone, uh, make a real nice voicemail and just prompt them to tell a little story about themselves. You know, something that will get the actual pain point out of them is I found that when I actually call them back, all of a sudden the tables turned, uh, their question might be, Hey, did that, do you guys take insurance? Um, but their concern also was their hip. So I'll call up and say, Hey, my answering service said that you called. This is Sebastian Gonzales. Uh, I see you have a hip problem. Uh, can you tell me about that? And so people love talking about themselves, right? So, um, they'll talk for about five minutes or so on this. And I think I mentioned before in a podcast that I have a 10 minute rule. I, I, when I call back, I attempt to be on the phone for 10 minutes.

Obviously I can't give a lot of medical information, but I can hear their concerns and I can build a rapport and then I can get them to come in and then I can all of a sudden, uh, help them, you know? So it's really hard. You lose a lot of people in the, in the yes or no question bit. And I'm pretty sure if you take a sales class or something, they'll tell you that a, you know, don't get caught down that route and change the conversation a little bit. So, um, that's just a consideration. Think about it. You, you probably won't have to have an answering service, but just, just think about it. Now in regards to weights and stuff and loading, I know we've talked about loading in episode one 22, you don't need a lot. Um, and I have platforms cause I think they're pretty. I had space. Uh, I've rubberized flooring, but you don't need it. In the past, I did have a wood floor and it was a pain in the ass because it would get a little dust on it and people would slip. So I am pretty hard fast on that. You can't have a wood floor.

So, uh, but you only really don't need a couple of kettlebells or if you really want to take it extreme gets, just get a heavy shit, you know, get a, uh, couple water, five gallon water bottles, get some, uh, cinder blocks, get bags of rice, get backpacks, old Jansport backpacks that you don't use anymore and just fill them up with random junk. Those are all okay to use. And those are actually, I think they're preferable because people tend to kind of think, well, I don't have a kettlebell home. I can't do this or I don't, don't have a dumbbell home. I can't do this. So just, I would just pick up a, get a couple heavy things. Uh, I tend to not have things like BOSU balls or, I mean, I have an Eric's pad. I have something just kind of save people's knees like yoga mats. And I have some CLX bands to make sure that I can provide like a, uh, horizontal or vertical load when needed when assisting movement. Um, but for the most part, I have something to hang from. I have things to sit on. I have a couple, I have, I think I have, uh, probably about 10 kettlebells, but you can probably get away with one of each and a couple of heavy bands here and there. And I think that's all you really need. If you're working with people who are, uh, barbell athletes, then you might want to have not necessarily a barbell, but get a dowel, get something that simulates it. So I'm pretty sure you can get people to just be challenged beyond belief without actually loading a bar up. And it is nice to have the, the stuff that people play with in office, but you don't always need it. Um, I have a couple of baseball bats just because I like baseball and they ended up in my office and I've had golfers come in who I use. We partially use a baseball bat or a couple of dowels as something to swing. Some people bring their own clubs in. Uh, I've had people who, um, are testing out their shoulder and I bring a glove in and they bring glove in and I have a ball at the office so that you don't really need a ton. And I think when you really are keen about your exercise, corrective exercise selection, you'll realize you don't need a lot of stuff. So don't make it too fancy.

Now onto a couple of things I think are just general, um, thoughts, thoughts and considerations you need to have as you're starting to practice, as you started to practice are, um, systems, analogies, uh, elevator speech, uh, conversation spill, uh, and conversation skills. Obviously I have lost my conversation skill. Um, actually funny, this is, uh, this is later at night right now. I came back in the office. It's, uh, actually a Friday, it's a Friday night. And, uh, I was, I was just hanging out at home doing some drywall. I'm like, you know what? I got a couple hours for bedtime. I'm just going to come back in, but I, I wanted some chicken noodle soup. So I got some chicken noodle soup and got some broth in it and it was salty. And then damn it. If that did not dry my mouth that I feel like I'm just, you know, talking and spitting up, uh, uh, bubbles in my mouth, you know, you know, that goes when you got dry mouth. So I think it's affecting me a little bit now here. So, um, I don't usually do nighttime podcasts. I usually do daytime, morning time, but it's kind of nice, kind of nice and quiet and cool. Um, nice thing. So anyways, back on the topic. So I think you should arm yourself with, again, the systems analogies like elevator speeches and conversation skills. And let's start with first the elevator speech because I'm going to be a bad person at this, but I'll give you a couple examples of things which typically don't work, at least for me.

So when someone says, Hey, what do you do for a living? And I used to say, I just help people, uh, solve their problems, you know, and it, and it kind of leads them into, well, what does that mean? Say, what do you get a problem? You know? And, uh, then we can categorize it as like a, maybe a body problem. So I'll talk about that a little bit, you know? Uh, I don't tend to think it works very well to say a word and you know what I'm talking about. Don't say a profession that leads someone into a stereotype. So if you're a PT, someone's going to be like, Oh, I did PT one time for my knee. And like, they tell you the whole story and then that's the end of it.

So there's really no conversation about it. It's just, they've, you've said something which triggered them into a thought of what they've done in the past and then they're done with it, you know? And as a chiropractor, you say, Oh, I'm a chiropractor. And they're like, well, you know, my neck, you know, like I've had problems for like 20 years and like, yeah, it's cool. I've been to one before. Yeah. Or anyways, you want a hot dog? You know? So they just kind of bypass it. But I think when you really get deep down into it, people probably find your job kind of interesting. And I think when they dig a little bit, uh, you'll have to almost make these, your answers in a way that will foster a new question. So I won't be great at this because, uh, I, I actually, like I've said many times before, I don't attempt to solicit people's, uh, people to come in that much. Uh, and, and a lot, a lot of times actually when I'm out of work, I, I, I mean, I like talking about, you know, theory and stuff like that and patient care, but I really don't, um, attempt to tell people what I do and I don't wear the shirt out. Like I don't have my car wrapped. I just don't want them to know. It's just like, I like to have a separation of, of work and privacy and privacy sometimes. And it's just, I just don't even bother. Um, and actually I did have one sign, this drove me about crazy. This is an example of probably the reason why I don't, um, I know it's a bad experience, but, um, someone, uh, someone had, someone had, uh, brought a friend, uh, out to a bar and we just had a, we just had a drink and, uh, they brought another friend and this person figured out that I was a chiropractor and they just, they're like, Hey, I'll give you, I'll give you 20 bucks to adjust me. And I'm like, I'm not going to do that. You know? And I explained, I'm like, look, you, you know, you deserve more than that. Like there's more to it than just that. And then, so they persisted and then they got really upset at me that I wouldn't adjust them in a bar for 20 bucks. But anyways, so I tend to go to tend to not go down that route just because it's, it's, uh, irritating to me to be fit into a stereotype. And this is probably what minorities, um, think if you're going to stereotype a minority, you know? So, uh, think of what questions or think of what statements will lead people into something more, you know? And if you know me well enough, uh, I don't, I don't try to do these, but some, for some reason it happens a lot. I'll be, someone says, well, what do you want for a, what do you want for dinner? And I'll be like, well, I don't know, like, um, maybe like a, like a corn husk. And they'll say like, corn husk, what's that? And I'll be like, I'm glad you asked. And then I'll talk about it, you know? And they're like, ah, shit, now he's going to talk about something forever. So, um, try to get them to ask more questions. Make it a game almost. Maybe you can get them to ask 10 questions after you say something. So when you say something very matter of fact, and it's more of a stopping point, like a period that's the end of a conversation, then maybe that's not the right one to pick. Or maybe you ask them questions back and say, Hey, look, Oh, what do you do for a living?

Um, you know, what's your favorite part about your job? And like most people to ask you back, like, Hey, what's your name? Joe. Hey, what's your name? Seb. You know, like it, it seems like common courtesy. Well, people kind of ask back. So maybe you'll get that reciprocation. So, um, another thing I think is useful to arm yourself with is analogies in for answering questions that you typically get. I know as chiropractors, we have the stepping on the hose analogy a lot for disc. We have the jelly donut analogy, or if you listen to, uh, Dr. Michael Fanning's one, he says there's a helicopter and a landing pad. So he had a bad reaction out of the jelly donut one. Apparently, um, if you're looking to give an analogy about loading, about the effects of too much load on a structure over time, um, uh, Dr. Stuart McGill gave the example of holding a pound of butter and what your biceps is going to feel like after about 10 minutes, you know? So all these analogies, I think are going to be useful because you can pull them out of your database really quickly and it seems very seamless. So, um, analogies, analogies, analogies, and the better you can get those analogies to what the person likes, the better. Um, if you're working with dancers, maybe you need to, um, explain things, uh, with experiences that they've had. Uh, I know that I, the other day, I gave an example of the exercise I wanted someone to do, which was called, um, they're called curtsy squats. And so I described it, I showed him and he's like, Oh, like bowling. I said, yeah, like bowling. Yeah, let's do bowlers, you know? So the analogies and kind of making the analogies a little bit more catered and unique to where they came from is, is useful because it's familiar to them, you know? So, uh, we have, um, analogies and elevator speech that you talked about here.

Um, conversation skills, you know, conversation skills are important, really important. And I would challenge you to go out and just have random conversations with random people and figure out what it takes to keep a conversation going and what it takes to actually get them to like you and for you to find all of the interesting parts about them, you know? And, uh, this will help you through your history taking, it'll help you through, um, convincing someone to come in for care. It'll help you through breaking bad news to people, you know? So there's a lot of usefulness conversation. And my dad always said that some people have the, he called it the gift of gab and he's like, some people have it, some people don't. Um, I think people can work on it, you know? And, and I think it is something that can be developed. So, um, I have a friend who has a, who has a kid and the kid's like, I mean, he's like 10 and, uh, he came over to a garage party one time that we had and he was a hoot. He was great. And he was, I had him doing pushups for silver dollars. Um, and, you know, we were just having to go around and like, Hey, go ask that guy over there. What, what it's going to take to get two bucks out of him. And one guy said, yeah, massage my shoulders, you know? So, um, but he was just very interactive. He wasn't like the kid that go hangs out in the corner who only wants to talk to their dad. So, and I, and I've met people with spouses this way where it's like the spouses there who doesn't want to participate in a conversation with anybody except for that one person. It's very sheltered, you know, it's very tough. So I know that my friend said that this is a developmental thing. He just raised his kids this way to be, you know, to interact with the people who are around them. So I would force it for a while because it takes a little bit of time to develop school skills like that. Not everyone tends to have them. So, um, just, just start talking to people. And, um, I thought before that those, uh, those Mormon boys in my class, like they were always real good at conversation, you know, and maybe it's that they go out in their mission. They get the door slammed in their face multiple times where rejection's not a problem anymore. I don't know. Um, I heard of one guy doing, um, he would go up and ask for discounts at places and he challenged people to go out to Starbucks and ask him, Hey, can I get 10% off? You know, just ask him at front and say like, I'm just getting a cup of coffee. Can I get 10% off that? And what it stops is the fear of rejection, but you might be surprised how many times people say yes. So the last thing is creating systems. Um, I tend to think that I get a better exam done with people and I give better care when I have a system in play. And I, and I've actually done exams out of my exam room and into the weight room area. And I've done them at the other people's offices and I'm really screwed, you know, and it's just knowing what's familiar and what comes next. So you don't miss things. And this includes not just exam, but also watching the person, you know, come into your office, look at them through the window, like McGill does, watch him sit there, watch him walk down the hallway. There's things and parts that you don't want to miss, um, that are big parts of your exam and big part of the part, big part of the patient experience.

Um, realizing that you're going to be asking the patient if they have any questions, you know, do you have any concerns? Is there any barriers to your success here? Do you have, do you have weights? You know, are you able to go on a walk? If you can't go on a walk, why can't you? Oh, it's, it's you, you live in an unsafe area. Okay. Well, so then maybe we'll have you walk about your house, you know? So there's, there's a lot of things that might be missed if you don't follow your systems. Um, I, a couple systems that I really try to take care and, um, and get people to do now is I want them to pay in advance to their actual appointment. And I tell them that, look, look, the time that you spend here is time that I want to spend with you and be able to get you to your goal. Obviously money's a thing. Money has to change hands, but you can do that online just like you do airfare. Okay. Just do it up front. That way we don't have to have that stinky money dance at the end where it's like, oh, let me have your credit card. And like, oh, what's the zip code on that? And, and it's a little awkward taking the, taking the money. Cause all of us in healthcare tend to be very afraid of taking people's money and it's just awkward, you know? And I, I think sometimes it skews our recommendations as well for good or for bad. So one thing I tend to do again is I had try to get them to pay up front. That way I know that all that's taken care of and I can spend every last minute answering these person's questions and showing them things. So you might find there's many other systems that you'd like to address in your office. That's just a few that I like to have. Um, I like to find people's resets really quickly. So I know that, uh, I can challenge them a little bit with, with the safety of knowing that they have the net below them. So there's a, there's a lot of things that you might want to write down and just consider what are important parts of your first and second day with these people. What's an important part of, of, of concluding care with these people.

So, uh, lastly is just relax. You know, there's, there's a lot of students who come out of school and they're really, uh, frustrated and they're really, um, have a lot of anxiety about starting their own thing. It's, it's not a big deal. Um, I think as long as you know that like, if you have a spouse who's, who's helping you through a little bit, you have a little safety net, you know, and so don't worry so much. Um, if you have a family that you could, if you bankrupted out of it and you couldn't live in your apartment, I'm sure you'd be able to live in their garage, you know, don't worry about it so much. Um, just relax and just know that your clinical skills skills that you build are going to show through and you're going to do a really great job with them. If you need to build those a little bit, go to a, go to a seminar here and there and, uh, surround yourself with people who, uh, can improve you as a clinician. So just, just relax.

It's, it is an exciting time. It's really exciting, but don't lose sleep over it because it's, it's going to get really, really hard. And just know that when you have free time, enjoy your free time. Um, I, I think there's a lot of people out there, including myself, I didn't take a vacation for like four years, you know, not more than having like a weekend schedule some days off for yourself. Um, I only work Mondays, Tuesdays, Thursdays right now. And I come in on occasion for people on Friday, if I like them a lot, you know? So on Wednesdays, I like to spend some time down at the beach. Uh, I like to do podcasting on those days. I like to have Wednesdays and Fridays in my lifting days, Saturdays and Sundays. I don't think much about it. You know, I might do a couple of things like this on the side, but, um, they're voluntary and it's, there's not pressured. And you notice that I'm way ahead on a lot of these podcasts. I'm like a month and a half in advance. There's no pressure, you know? So I think you're going to get a lot more productivity out of that. Um, if you just learn how to relax a little bit. Now, if you guys are looking for, um, the document again, uh, I will put a link in the show notes for this. It's a, about a 20 page read. I think if I remember it right, I haven't read it in a while, but it goes through how to pay back your student loans, how to, uh, consider leasing something, how to meet other clinicians in your area. So it goes through a lot of stuff, um, that I experienced. And I first wrote it because I went to the R2P symposium and, uh, someone was talking about this one kid and I'm like, Hey, did you hear about Joe? Like, yeah, yeah. Joe's a good clinician. He's great. Well, he's like, Joe's in a PI mill because he's got to pay it back to the loans. And they're like, Oh, that's too bad. Cause Joe, Joe had a lot of potential and, you know, and Joe's going to get stuck in this PI mill for years and years and years, you know, especially if Joe can't control his spending. For all we know, Joe likes to, you know, go out and eat sushi every night and, uh, he won't be able to pay off his loans and he won't be able to pay off that sushi bill. So just, um, don't, don't get, don't get stuck into that, you know, enjoy your profession, enjoy the work that you're doing.

Some people get burned out. There's no need for it. You know, um, I tend to come in and I really, I enjoy trouble shooting with people, but I don't like being rushed. If I'm rushed, I will hate this job. So just enjoy the time and whatever it takes for you to enjoy that, make it happen. It's just, you are the master of your domain and you can control your surroundings a little bit. So, um, as we start to close up, do not forget that, um, I have that book out as well. If you haven't checked out the book, you probably should. The book is called, I will beat back pain. And it's a tool that you guys can use as clinicians to help some people. Like imagine your patient, Tom, who has a wife, Mary, um, Tom always talks about how Mary's always in back pain and it's like, well, Tom, what does Mary do for her back? And like, Oh, I don't know. She tried therapy years ago and she just kind of gave up, you know, now we don't go on trips anymore. And like, we try to go right on the boat and it hurts to like the bouncing hurts in the boat. So, you know, we just don't do as much, but I like, I feel bad, you know, like things like that. Those are the situations where I would like you to use a tool like this. Um, if you want to stock some for your office, great, you know, or if you just want to recommend it to a patient, but it's, it's, it's intended to just coach them through this mental mindset of, of being able to fathom a recovery again. You know, there's no corrections in there. Um, and in the audio version, I tell people, I tell them to go to the trusted person. You know, there is a course in there that people need some, uh, if they need some help in there in the middle of, uh, Nantucket with no, uh, healthcare around them, then they could buy something like that. But I do want to go see people in person. Lastly, if, uh, again, if, uh, you're looking for an EMR and you're looking to test out Jane, um, just mention my name, Sebastian Gonzales, as well as his podcast, restoring human movement. Uh, I'm not doing this to, to pitch them and they're not sponsoring the show or anything, but, uh, they did say that, um, if I, um, have anyone who's interested in using it already, if they mentioned my name, then if I get a handful of people and they'll, they'll comp mine. So I'll be fully upfront about that. So, but I'm not forcing people into it.

It's just the one that I picked, but if you're going to go to it already, because I know a lot of people have gone away from, um, Dr. Crono because of, of that sales part or the, uh, they started charging you, which isn't a lot, but if you're looking to change that probably that's the, that's the trigger to change. So if you're looking to check out Jane, again, the customer services is amazing. Just mention my name and you'll help support this podcast because I don't make any money doing this podcast. This is purely for my enjoyment and hopefully your entertainment in your education. Um, my education to actually interview people. So lastly, uh, leave people better in how you found them and date and Eagle Scout. Talk to you guys next week and we'll probably get into stuff a little more clinical at that point.