22 Windridge Lane,
Temple Georgia,
Approaching PCs As A
Spine Specialist
VOICE
Executive Summary
Prepared By
Integrative Care Associates, PC
Prepared For
Fresno Pain Care Specialists
Fresno Imaging
Fresno Cardiology Group
Guerrilla Marketing Strategies
For Establishing Multidisciplinary Collaboration
2
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3
licensee, you will be prosecuted the fullest extent of Copyright and
Healthcare laws.
It is the purpose of the authors, MDs DCs DPTs who understand this and share
acceptance and collaborate with each other – what today’s patients demand, patient
centered, evidence based, preventive care.
Certainly the same steps will work for the various medical specialists and they
should be contacted. However, we believe that the first step in creating this network
should be directed toward the general practitioner.
In the past, chiropractic offices have spent up to 10% of their services rendered
in advertising. In today’s market, advertising per se is becoming less effective. We
encourage converting the use of a certain portion of your advertising dollars into
public relations and promotional events, such as those discussed in this project, the
HMO/PPO project, and other public relations projects to be distributed by VA CAM
Center in the future. It may become necessary to dedicate a part-time or full-time
staff person
strictly to the administration of these public relations projects. We believe it is a
positive step in practice growth.
6
CREATING AN
INTERDISCIPLINARY
REFERRAL NETWORK
With the changes that are taking place in health care, VA CAM Center believes
that one of the most important steps for the chiropractor to take toward building the
practice for the future is to create an interdisciplinary referral network. We need to
build, and in some cases rebuild, the bridges between the chiropractic profession and
the medical profession. The reason there is an old saying that you’re not supposed to
burn your bridges behind you is that it takes longer to rebuild the bridge. The
procedures
mapped out in this booklet will not make it possible to have medical referrals with
the first phone call, letter, or activity that you do; they will not be instant practice
builders for the first month; but, they will be consistent practice builders that will be
essential investments in the future of your practice. We are confident that if you
follow the
steps recommended herein, you will find consistent growth in your practice and
community awareness.
7
Primary Care Physicians CD – The CD Contains all PC MDs
You will need to compile a list of all doctors in the medical profession who
have the potential to refer patients to your clinic or vice versa. Here are some
suggested steps toward compiling this list:
1) Make a list of the MDs that your current patient base utilizes as primary
doctors. Be sure that your health history form has a blank asking for the name
of the patient’s general practitioner. You will use this information to send
patient-update letters, as well as to know the MDs in your area having patients
also utilizing chiropractic.
2) Every patient you have sees an MD, OB-Gyn, Pediatrician (RA Neck
Pain) and the Patient’s PC Letter is sent to all the MDs in your area,
quarterly Pain Report – sent three times per year, for quarterly
luncheons hosted by Radiologist or Cardiologist Endothelial
Health Report (Human Body Image)
3) If you are in a city, limit your list of MDs to within a 5- to 10- mile radius
of your office (or other reasonable distance for your locale). There are a lot of
MDs, and your list would become quite long with names of MDs that do not
have the potential of referring patients a far distance from their practice. If you
are practicing in a small town, this list would include all MDs that have
the potential of referring to your clinic. Some of them may be 15 or 20 miles
away.
4) You will need to separate your list into specialties and limit your work to those
having the highest potential to mutually refer. If the list is small, you will be
able to create your referral network for all disciplines on the same list.
5) When you are categorizing your list by specialties begin with your list of
primary providers, which will include general practitioners, family
practitioners, internists, and pediatricians. As you study this list, you may want
to divide it into categories of highest potential and those who would not be
worth the time or effort. Be careful not be too judgmental with
these doctors. If there is any question, do not eliminate them
from the list. Opinions can be changed. With the proper education and the
8
changes taking place in health care, it’s very possible that some doctors who
have been very negative toward chiropractic will change in the years ahead.
We would prefer that you not eliminate any MDs from your list rather than to
eliminate so many that your list now consists of one or two names.
9
6) If you are practicing in a city, the entire list of MDs can be obtained from
a mailing company. They can also break down the list into zip codes,
convert them into labels, and label your correspondence at your request.
In other words, it is possible for them to compile the list for you if you
prefer not to assemble your own list. However, your list will probably be
small enough to manage by yourself.
1
LETTER OF INTRODUCTION
One thing is certain: an MD cannot refer a patient to you if they do not know
you exist. It is important that they not only get to know chiropractic, they must also
get to know you. The first step toward gaining the MD referrals is to gain exposure
through a letter of introduction. The following page will give you a sample letter of
introduction that you can send to the medical professionals in your area. There are
times when it may be appropriate to have a paragraph thanking them for their referral
and then many other times this may be a “cold” letter. Format the different types of
letters you will need and then instruct your staff on how you want them to be
implemented.
1
[Date)
, M.D.
Dear Dr. :
Over the last few months, I have become increasingly involved in helping
several your city/town 1-area physicians in the management and care of their patients
suffering from back pain = PTSD. Although we have never had the
opportunity to work together, I realize that this is largely due to the fact that you have
never had the opportunity to get to know me and perhaps you have never had the
opportunity to get to know chiropractic. I would like to eliminate both of these
obstacles and establish a friendly, professional working relationship with you.
To briefly let you know who I am, I came to [ your city/town ] Fwhen?]
[provide brief - and I mean brief biography highlighting your educational
and residency background degrees awards]
The latter group tended to be the younger family physicians who were also the
most knowledgeable about chiropractors and more likely to have encouraged patients
to see them. Chiropractic is playing an increasing role in the primary care of
musculoskeletal problems and family physicians should reevaluate their relationship
with these health care providers. As recent as ten years ago the basis for chiropractic
was not scientifically understood. There is now extensive research and data gathered
by primarily medically oriented institutions directed at this. The mechanism for
1
13
Dr.
Date
Page Two
manipulation is now clearly validated and understood. Manipulation has been shown
to be three times more effective than up-to-now accepted outpatient procedures for
non-surgical patients suffering with back and neck pain. It is interesting to note that
presently over 80% of family practitioners and internists in several European
countries, Switzerland for example, are now manipulating their patients. It is also
interesting that manipulative therapy has become a regular course and clinical rotation
in many of the more progressive foreign medical schools. This acceptance of the latest
information and knowledge is making inroads into our country.
I have included with this letter a [see list of enclosures on page 10] or)
a recent article by Arthur H. White, M.D. in a recent issue of JMPT.
In the course of conversations with other medical doctors, they have expressed to me
their particular frustration which can accompany management of non-surgical back
pain patients who do not respond to medication. The majority of my practice is
comprised primarily of this category of patient which can be so frustrating to manage.
What I would like to offer you is help and assistance in handling patients who present
in this way. It is my desire to provide you with a solution to this problem. By offering
qualified, ethical, manipulative care that you can be confident in, those patients can
receive a much needed conservative alternative.
I would sincerely welcome the opportunity to discuss this further at your convenience.
I will be calling you in the very near future to see if this can be arranged. If I can be of
any assistance, please do not hesitate to contact me.
Sincerely,
Bundle O. Bones
D.C.
Enc.
1
SAMPLE LETTER
July 9, 1996
Over the last few months, I have become increasingly involved in helping
several Palm Beach physicians in the management and care of their patients suffering
from back pain. Although we have never had the opportunity to work together, I
realize that this is largely due to the fact that you have never had the opportunity to get
to know me and perhaps you have never had the opportunity to get to know
chiropractic. I would like to eliminate both of these obstacles and establish a friendly
and professional working relationship with you.
1
Dr. Bruce Rodan
July 9, 1996
Page Two
outpatient procedures for non-surgical patients suffering with back and neck pain. It is
interesting to note that at the present over 80% of family practitioners and internists in
several European countries, Switzerland for example, are now manipulating their
patients. It is also interesting that manipulative therapy has become a regular course
and clinical rotation in many of the more progressive foreign medical schools. This
acceptance of the latest information and knowledge is making inroads into our
country.
I have included with this letter a short but educational brochure on the scientific
findings of chiropractic that will make it quick and easy for you to stay current on our
treatment of lower back pain. I would also like to invite you to visit our clinic to see
for yourself how patients are treated.
In the course of conversations with other medical doctors, they have expressed
to me their particular frustration which can accompany management of the
non-surgical back pain patient who does not respond to medication. The majority of
my practice is comprised primarily of this category of patient which can be so
frustrating to manage. What I would like to offer you is help and assistance in
handling patients who present in this way. It is my desire to provide you with a
solution to this problem. By offering qualified, ethical, manipulative care that you can
be confident in, those patients can receive a much needed conservative alternative.
I would sincerely welcome the opportunity to discuss this with you further at
your convenience. I will be calling you in the very near future to see if this can be
arranged. If I can be of any assistance, please do not hesitate to contact me.
Sincerely,
En c.
16
POSSIBLE ENCLOSURES WITH
LETTER OF INTRODUCTION
Enclosure No.2 The Journal of Family Practice, Nov. 1992, Vol. 35, No. 5,
pages
551-555. Reprints can be ordered from The Journal of Family
Practice by phoning (203) 838-4400, and are priced in quantities
as follows: 100-8337.50; 200-8405.00; 300-8472.50; 400-8540.00;
500-8607.50.
Enclosure No.3 “Studies on Chiropractic” by the National Board of Chiropractic
Examiners: a summary of published studies and official inquiries
documenting the efficacy and appropriateness of chiropractic
health care. Reprints can be ordered from The Foundation for
Chiropractic Education and Research by phoning (303) 356-9100,
and are priced in quantities as follows: 100/ea. - $12.00 (free
shipping for quantities over 500).
Samples of these three enclosures are found on the following pages and inside
the back cover.
1
Integration of Chiropractic into Managed Care in a Multidisicplinary Setting
ABSTRACT
The first round of managed care flour- ished from 1990-1995. As the
“economic screws” tightened, all subspecialties of health care lost their unbridled freedom to the
primary- care physician. Patients can no longer visit their subspecialists (including chiropractors of
choice. As the public becomes disenchanted with such limited managed care and as new
re- forms of managed care emerge, the chiroprac- tor and other subspecialists are regaining their
rightful position.
Centers of excellence can clearly diag- nose and treat a patient more quickly,
economi- cally and accurately than the bureaucratic “kicked back” primary care gatekeeper.
Enlight- ened managed care business developers are using chiropractors as primary care health
pro- viders and are using centers of excellence that include chiropractors as a major cog in
the wheel. The new managed care system directs patients to
the least expensive professional who can get the job done most efficiently and accurately. With minimal redirection, the
chiropractor is the ideal professional to diagnose and treat the early phases of spinal problems and can easily triage patients
to the most appropriate chronic healthcare providers. (J Manipulative Physical Ther. 1995: 1S:526-7)
Key Indexing Terms: Chiropractic, Managed Care, Health Services Accessibility.
1
I * Medical Director, conditions or when
N r San Francisco Spine patients became
T Institute, and private frustrated and de-
R y manded to be referred.
Managed care practice medicine, San The medical doctors and
O before 1990 was Francisco, CA. Submit
D limited to such or- advi- sors of these
reprint request to: managed care
U ganizations as Kaiser
Permanence and a few Arthur H. White, organizations were rarely
C
other large clinics and M.D., Spine Care chi- ropractors and rarely
T
understood the value of
I medical groups. Medical Group, 1850 chiropratic.
O Chiropractors were Sullivan Ave., Suite
rarely included in such As managed care
N 200, Daly City, CA organizations rapidly
large health care
provided organizations. 94015 grew, from covering 5%
Managed care is of the population to as
rapidly changing in the In most areas of the Pap
country, managed care er much as 50% of the
20th cen- tury. We all population in many areas
tried to prepare for the accounted for less that sub
5% of the public and of the United States,
21st century. There are mitt there was great
some definitive trends therefore had little ed
effect on chiropractors competition for
that can allow the Apri providing less and less
chiroprac- tor to play a or other health care
providers. Patients were l 17, expensive healthcare.
pivotal role in managed The quality of care and
care in the future. allowed, through their 199
referral to the
medical insurance, to 5.
see any practitioner of subspecialist (including
D the chiropractor)
any specialty.
As managed care plummeted. Many
I subspecialists were
burgeoned in the
first half of the driven out of practice
S or moved to areas less
1990s, primary-care
physicians became heavily involved with
C managed care.
“gatekeepers.” In many
U cases, these
“gatekeepers” were C
remunerated for u
S r
conserving on care.
Referrals to any r
S
subspecialist, including e
I chiropractors, was n
viewed negatively by t
O the business overseers
of the managed care S
N organization. Quality of t
care therefore dropped. a
The primary-care phy- t
sician was not qualified u
H to manage all aspects of s
all dis- orders. Rarely
i was the primary-care The older,
physician even established managed
s knowledgeable enough care organizations, such
to know when to refer as Kaiser Permanente,
t to a subspecialist. have taken great losses
Referrals occurred only in membership because
o under emergency of the newly developing
managed care
1
organizations. Patients
have become
disenchanted with both
old and new managed
care organizations be-
cause of their limited
ability to access medical
care of the quality to
which they had
previously been accus-
tomed. Managed care
organization are joining
together to become
huge, unmanageable
conglomerates that are
unable to monitor quality
of care or the cost of
healthcare. As some of
the organizations attempt
to compete in the
marketplace, they reduce
the quality and numbers
of their subspecialists.
The subspecialists who
are contracted have to
accept contracts for
reduced fees as low as
50-
60% of their customary
fee. Many practitioners
who have not had the
ability to monitor
contracts and track pay-
ments have found their
income to be reduced by
as much as 40%. This
has driven many
practitioners out of the
marketplace.
Practitioners are having
to band together to
better negotiate
contracts and track
payments. This turmoil
and confusion is
sweeping the country.
Some areas have not yet
been stuck but the trend
is inevitable.
2
With public dissatisfaction and foresight by some lightened managed care organization. The Chiropractor
businessmen in managed care, the downward spiral will be tracked by the managed care organization just
of quality and efficiency is beginning to turn around. as any other health care provider is tracked. Those who
Man- aged care organizations are arising that have prac- tice most efficiently and successfully will remain
quality or care as their primary concern rather than in the game. Those who insist on using old methods of
the provision of the least expensive care. It turns out treat- ment and clinging to old belief systems will not
that high-quality care is actually less expensive than survive the 21st century. The new managed care
trying to blockade patients from care. organizations will use the guidelines produced by the
For example, a patient with a medical condition Agency for Health Care Policy Reform (AHCPR),
who is blockaded by a primary-care physician may get which acknowledge the value of manipulation in the
worse because of the procrastination, may get worse acute phases of back pain. There are few, if any,
because of frustration, may be unable to work, may acknowledged modalities for the acute phases of back
lose produc- tivity and may even sue the managed care pain. Therefore, the chiropractor is in an ideal position
organization because of catastrophic occurrence to be the primary manager of acute spinalproblems.
attributable to the procrastination. If such a patient The new managed care organizations are already
has been retired to a subspecialist who was well- looking for inexpensive ways to screen and treat acute
schooled in economy and efficiency, the patient spinal problems. They may turn to nurses or physical
would get well more quickly with less consternation therapists. The chiropractor is certainly in a better posi-
and be happier with the providers of care. tion than is the M.D.
These new managed care organizations, therefore, The centers of excellence for spinal problems will
are using triage organizations to get patients to the be multidisciplinary groups. They too will be looking
most appropriate level of care as rapidly as possible. for the least inexpensive problems. The chiropractor
The chi- ropractor is a very appropriate triage again is in an ideal position to be part of these
individual and also a very appropriate subspecialist for multidisciplinary groups. Some of these groups will be
early referral for man conditions developed and run by chiropractors who will not only
be the primary care giver, but will also function as
THE Future diag- nostician, therapist, educater and
communicater. The chiropractor will make the
Chiropractors must learn and live by the same decision for diagnostic test- ing, surgery, work status
algo- rithms, time frames and economic efficiencies as and disability.
all other healthcare providers. Those working by such
guidelines will be quickly recognized in any CONCLUSION
community as the subspecialist of choice.
Chiropractors who want to become primary-care It is time for the chiropractor to expand his tools an
providers will be invited to do so by the new, more take more responsibility for the whole patient and how
en- to function in our society.
2
SPECIAL ARTICLE
2
been so little study of this problem by family
physicians, and whether this was attributable to their
satisfaction with current approaches to care or to
frustration over their inability to modify the course of Chiropractors account for about twice the number
the illness. In this coun- try, low back pain, of visits for back pain as physicians. In an 8-year com-
dysfunction, and work disability are moving toward munity based survey of six sites in different parts of
epidemic proportions, and the contest in which back the country. Skellee and Brook reported that 7.5% of
problems occur most often results in pre- sentation to the population made at least one visit to a chiropractor;
primary care physicians, particularly family 42.1% of the visits were for back problems and 10.3%
physicians. However, another discipline, chiropratic, for neck problems. Manipulation accounted for 66%
is playing an increasing role in the primary care of of repeat visits.
muscu- loskeletal problems. Family physicians should Thus, in terms of musculoskeletal problems, family
therefore reevaluate their relationship with these health physicians and chiropractors provide the majority of
care pro- viders. ambulatory care in the health care system. They tend to
serve similar populations and yet their services do not
Manpower Issues seem to be in competition with each other. Certainly
both groups have grown in numbers over the past 20
Back pain is the second leading reason reported by pa- years. There are at least 20,000 registered chiropractors
tients for visiting physicians. Every year nearly 13 mil- in the United States who treat over 7.5 million people
lion visits are made to physicians for chronic low each year with services covered by Medicaid,
back pain, and it is the second leading cause of work Medicare, and gov-
days lost. From 1971 to 1981, the number of disabled
people and the costs of care for low back pain
increased at a rate 14 times that of the population
growth. In the medi- cal settings, family physicians
care for 38.6% of the pa- tients with acute and chronic
back pain, compared with ernment-employee and private insurance, as well as
36.9% seen by orthopedics, 16.9% by osteopaths, and state worker’s compensation.
7.6% by internists. Back symptoms are the third most
common reason for visiting a family physician. Perspective on Back Care
2
Chiropractors and Back Pain Curtis and Bove
2
increase physician comfort and confidence in managing
Patients perspectives from another well-designed back pain. Although an increased feeling was noted on
study restricted to an HMO population indicated the part of the physicians that their patients were more
signifi- cantly greater satisfaction with chiropractor satisfied and reassured about their problem, a survey
care than with family physician care. Items of back of the patients
care provided by family physicians with which
patients were not very satisfied were: information
about the cause of pain; ad- vice on recovery time and
how to manage the problem; and instruction on
posture, exercise, and lifting skills.
Patients believed that family physicians were less
confident and comfortable in their diagnosis and man-
agement and showed less concern and understanding
of their problem than chiropractors.
The number of days of disability for patients seen
by family physicians were significantly higher
(mean
39.7) than for patients managed by chiropractors
(mean
10.8).
What were the chiropractors doing right and what
were the family physicians doing wrong? Although
not based on randomized controlled
interventions,these data suggest that family physicians
were not able to provide as clear or rational an
explanatory model of the problem to the patient as the
chiropractors. In addition, they did not individualize
management well. These issues, as well as the possible
value of hands-on-manual therapy, could be
addressed by additional training and education in
musculoskeletal disease either during or after
residency training.
There is some evidence from a handful of
controlled trials that spinal manipulation does have a
beneficial ef- fect for low back pain, particularly for
certain sub-groups of patients with more chronic or
recurrent problems. On the other hand, in a recently
meta-analysis of 35 ran- domized trails of spinal
manipulation, only 51% of the studies showed an
improved short-term outcome. Most of these studies
had methodological problems, not the least of which
were patient selection bias and difficul- ties of
stanardized diagnosis. Other forms of treatment,
including physical therapy and facet injections, have
also been shown recently to be of little or no benefit,
prob- ably for the same reasons. Treatment is generally
pallia- tive and not curative. Setting specific
therapies aside, there are other issues raised from these
studies. Cherkin et al suggest that the beliefs of family
physicians that no specific diagnosis for back pain
exists other than “back strain” and “slipped disc,” and
that there is little effec- tive treatment other than
expentant analgesia, lead to frus- tration and
therapeutic nihilism. The same investigtators have
recently reported on a targeted continuing medical
education (CME) program designed to improve back
care and patient satisfaction. The primary goal was to
2
dis- ability, and rehabilitation. Yet the tools commonly
seen by the above physicians showed that the interven- used by family physicians to treat back pain tend to be
tion had no effect on outcomes of care. Cherkin et al those of biomedicine and referral rather than
suggest, after reviewing several options, that negative behavioral and direct manual therapy, and this may
feelings about back pain patients induced early in explain why patients are more satisfied with care from
medi- cal training may override other determinants in chiropractors, who are much more focused on
back care outcome. musculoskeletal problems and the context in which
This may be subconsciously or openly conveyed to they occur.
patients creating a negative placebo effect.
Positive placebo effects derive from agreement be- Referral To Chiropractors
tween patient and provider on the nature and cause of
the problem, strong assurance on outcome, the use of Over the last 50 years, allopathic medicine has had a
instrumentation, and the “laying on of hands.” In their deep suspicion and concern about chiropractic. Until
recent paper, Koeset at comment on the power of the 1980, the American Medical Association stated that it
placebo and the possibility of beneficial effects of was unethical to refer a patient to a chiropractor, and a
refer- ral to another professional. Placebo modulation physician doing so was likely to lose membership in
of pain through segmental reflexes as well as cortical the Association. National chiropractic associations were
and lim- bic activity through the hypothalamus is well only able to achieve full acceptance as a clinical
substanti- ated by the gate-control theory developed discipline through winning a historic lawsuit against
by Melzack and Wall in 1965. Furthermore, Waddell the American Medical Association, which was found to
has shown that, for chronic low back pain physical pain have conspired with other groups to contain and
contributes only eliminate chiropractic through ethical prohibitions.
40% whereas psychologic distress and abnormal illness Many physicians, probably a majority, are still re-
behavior contribute 31% to the degree of disability, al- luctant to make specific referrals to osteopaths or
though the contribution by illness behavior may be sig- chiro- practors. In a survey of a 25% random sample of
nificantly less for patients with acute back pain. Back chiro- practors in 1973, respondents indicated that 90%
pain, therefore, provides a classic example of the of re- ferred patients attending 10 chiropractic clinics
biopsuchosocial model of illness in which social and indicated
psychologic factors play major roles in pain control,
2
Chiropractors and Back Pain Curtis and Bove
Table 1. Guidelines for Identifying A gerous intervention. Over the years, there has been some
competent jus- tification for these views as a result of unsupported
Chiropractor claims for success in treating a range of medical conditions.
• Treats mainly musculoskeletal disorders with The danger-
manual manipulative techniques ous complications of manipulative techniques, mainly
• Does not do routine radiographs on every patient vascu- lar accidents, occur in very small numbers (about 113
• Does not extend duration of treatment docu- mented cases) and have been used as a weapon
unnecessarily (see Table 2) against chiro- practors. The incidence of vascular accidents
• Writes a response to a referral and outlines following cer-
evaluation and therapy
• Does not charge “front end” lump sum for whole
treatment program The Journal of Family Practice, Vol. 35, No. 5, 1992
• Graduated from a school accredited by the Council
on Chiropractic Education
• Is willing to have physician visit the office to
observe treatment
• Good feedback from patients on care given
2
The Journal of Family Practice, Vol. 35, No. 5, 1992 553
3
INITIAL PHONE CONTACT
Each medical doctor that received an introductory letter from you should be
contacted by phone within two weeks of receiving your letter. This phone call will be
for the purpose of meeting together personally to discuss ways you can help each
other to best serve the patient. As mentioned in your introductory letter, invite the
doctor to come to your office and spend a few minutes touring the clinic and seeing
how patients are treated. You may want to invite the doctor to lunch and simply try to
include the office tour as part of the lunch hour. Arrange your meeting at a restaurant
that is close to your office so you can easily invite the doctor over while you are on
lunch break. If a lunch meeting is impossible, you may want to try to work out a
coffee break time at his/her convenience and at his/her location to make the meeting
as quick and easy for them as possible. Please be aware that a letter of introduction
will not be enough to generate referrals and new patients. Phone contact and a
personal meeting will go farther in getting results than any other contacts you will
make.
3
PROGRESS UPDATE LETTERS
Be sure that you have on your Health History form a blank for the patient to fill in
with the name of their general practitioner. Instruct your staff to get this information
with a release and immediately look up the address of that general practitioner so you
can send to him or her progress update letters. If general practitioners learn that many
of their patients are already seeing you as their chiropractor getting good results, it
will lessen their hesitation to refer other patients to you. It also provides a
commonality between you and the medical doctor. The most common ground you
have is the patients and their well being. On the following pages you will find
progress update letters that can be typed into your computer or used manually
followed by an example of what that letter would look like once it has been completed
with the proper information. These initial and final reports should be sent to the doctor
of every patient that comes under your care regardless of whether the patient was a
direct referral.. The only reason for not sending a report is if you feel the MD may be
anti-chiropractic to the extent that he would discourage the patient from receiving
chiropractic care.
Both the initial report (page 19) and the final report (page
20) should be entered into your word processor and
personalized from the forms on pages 21-23.
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INITIAL REPORT
[Date]
[MU [John Doe presented [him]self to our office for examination and treatment on [6/
18/96] At that time he complained of [major symptom] The patient described the
[pain/condition as [a dull ache with general soreness and occasional numbness in the
right arm]. The patient states that the symptoms are [constant/intermittent] [mild/
moderate/severe in nature and have [not changed/increased/decreased in severity over
time. The problem is exacerbated by [lifting/bending/turning/other]
Thank you for [your referral/allowing me to assist in this patient’s health care]
Sincerely,
3
FINAL REPORT
[Date]
[ML] [John Do presented [him]self to our office for examination and treatment on
[6/18/96] At that time he complained of [majors-vmptom] The patient described the
[pain/condition as [a dull ache with general soreness and occasional numbness in the
right arm]. The patient states that the symptoms are [constant/intermittent] [mild/
moderate/severe in nature, and have [not changed/increased/decreased in severity over
time. The problem is exacerbated by [lifting/bending/turning/other]
Thank you for [your referral/allowing me to assist in this patient’s health care]
Sincerely,
3
Bundle 0. Bones, D.C.
3
CREATING AN INTERDISCIPLINARY REFERRAL
NETWORK INITIAL REPORT TO MD
Medical Doctor’s Name and Address:
d)Lying
e)Sitting
f) Standing
g) Walking
2. Patient’s Martial Status: single / married h) Moving from a seated to a
(circle one) standing position
3
3. Patient’s i) Other
Name: first last j) Other
4. Male Female (circle one) k)Other:
3
INITIAL REPORT TO MD
3
d) Other: l) Other
e) Other: m) Other
f) Other 18. Treatment Area:
a) Cervical
b) Thoracic
c) Lumbar
15. X-rays Revealed: d) Other:
a) Degenerative changes in cervical spine e) Other:
b) Degenerative changes in lower cervical f) Other:
spine 19. [Optional] Add a complete
sentence about
c) Degenerative changes in thoracic spine any other type of treatment.
d) Degenerative changes in lumbar spine
e) Other:
f) Other:
g) Other:
h) Other:
16.Initial Assessment of the Patient’s 20. When will you send a final report?
Condition (Circle one)
1 2 3 4 5 6 7 8 9 10 11 12.
Diagnosis: days weeks months
21. Thank The Doctor For: ---------
a) Referring the patient.
b) Allowing me to assist in this
patient’s health care.
17. In Addition to Spinal Manipulation Patient
Treatment Consisted of:
a) Electromuscle stimulation
b) Moist heat
c) Ultrasound
d) Diathermy
e) Manual traction
f) lntersegmental traction
g) Hot packs
h) Cryotherapy
i) Other:
j) Other:
k)Other:
3
FINAL REPORT TO MD
1) Patient’s Name
b) Other:
a) Very well
b) Moderately well
4
4) The Patient Has Received % of Symptomatic Relief
4
[Date)
I am sorry that we were unable to work out a time to meet together in the near
future. We both have very busy schedules and many times meetings are difficult to
arrange.
In respect of your time, I am sending you a gift, a book that I believe you will
find to be very informative and helpful. It covers a lot of the information I had hoped
we would be able to share in our meeting. Please read the book at your convenience
and hopefully at sometime in the future we will be able to arrange a time to meet
together and discuss how we can work out a professional working relationship for the
benefit of your patients.
Sincerely,
Enc.
4
[Date]
I just want you to know how much I appreciate the opportunity of meeting with
you and I look forward to more of the same.
As a way of saying thank you for your time, I am sending you this special
educational study by the U.S. Department of Health and Human Services that I
believe you will find to be very informative and helpful. Thank you again for your
time and I certainly look forward to a friendly working relationship with you for the
benefit of your patients.
Sincerely,
Enc.
4
PUBLIC RELATIONS ACTIVITIES
1. Sporting Events
Many in the medical profession have hobbies that include golf or a health club.
This can give you another opportunity for common-ground communication that would
establish a good working relationship and can include sponsoring a golf tournament or
a racquetball tournament. This should become an annual event and should be
promoted as such. If you are concerned about the attendance, you may want to
co-sponsor the event with your local medical supplier or another medically oriented
company. This can add validity to your program and help to ensure a certain number
in attendance. However, be absolutely certain that you are recognized as the major
sponsor and be visible during the events.
Time for the Tournament The most popular day for this tournament appears to be
Thursday. However, we would recommend that you talk to some of your friends that
are MDs or attorneys and find out from them what their preferred day/time would be.
We want to fit the schedule of those professionals who are most likely to come.
How to Invite Send a brief letter of invitation that could also include a promo flier.
Send this out 40 days in advance of the tournament date. This would be followed up
the next week by a personal phone call. Your phone contact will be the most effective
means of getting them to the tournament. The letter gives you a source of reference.
Encourage them to put together their own foursome. If they are unable to put a
foursome together, then you will put them with other individual professionals that they
would not necessarily know. Many times they will already have MDs who are golfmg
friends, and this will help you to get more MDs with them, promoting and building
your tournament. They will be glad to put together a foursome since they probably
already have one (and may be golfing on this day anyway). This time you are picking
up the tab. It’s a win-win deal.
Expected Response As long as you have a foursome, it will be worth doing. But a
successful golf tournament would probably be three to five foursomes.
Location This tournament will represent your professional image and success;
4
therefore, if you are a member of a prestigious, private club, that would be great. If
not, you may have a friend who would help you arrange the tournament at his/her
club. If that is not possible, then make arrangements at the public course that has the
most prestigious reputation.
Chiropractic Presentation: Arrange for the MD’s to meet at your office either 40
minutes prior to the time that you would need to leave for the golf tournament or have
them meet after the tournament at your office for 40 minutes for a tour of your office
and short chiropractic-education presentation. Of course, if you are not comfortable
making a presentation to them, this is not a necessity. However, it is a perfect
opportunity for chiropractic education. You can use facts and information from the
brochures that we have recommended or some of the materials you presently use for
your spinal care class. Another possibility would be a slide presentation by Dr. Arthur
Roft of Spine Research of San Diego,(619) 423-9860.
In December you need to plan on spending from $20 to $40 on each office to
present them with a special holiday gift. The range of money spent is determined by
the response from the MD and your budget. In other words, be generous with those
MDs who have already sent referrals and those who have been open, responsive, and
cooperative.
1) Have the gift presented to the office early in the month so it can serve for
Hanukkah or Christmas will get the most notice before it would possibly get
lost among many other presents later in the month.
2) Consider having the gift delivered by a public relations person who would
represent your office in a very professional way. This will make sure that the
proper people receive your gift and it also allows you to know what their
response is to your holiday presentation. The other alternatives, would be
delivery by mail of by the business where your purchase was made. The most
effective method, however, is delivery by someone from your office.
3) Be creative. By this time you should have had the opportunity to get to know
many of the professionals on your list and you may know their personal likes
and dislikes. One doctor may be a golf nut and you could give him or her a gift
certificate.
4
for a green-fee at their favorite course. Another sports fan might appreciate two tickets
to the professional football, baseball or basketball game. They may be music lovers
and would enjoy tickets to a musical or evening concert. You may know their favorite
restaurant and could give them a gift certificate at that restaurant. One doctor might
really enjoy having a picture of Bill Clinton and another one a subscription to the
Rush Limbaugh newsletter. For most of the MDs on your list, you will probably be
presenting them with a generic type of holiday gift. Here is a list of possibilities: a
holiday flower arrangement for the office; a best-selling business book; motivational
cassettes; food of any kind (fruit baskets, chocolates, decorative cans of popcorn,
catered displays from restaurants such as shrimp cocktail, etc).
Be sure your holiday gift is something that would be enjoyed by anyone, except
in the case of those doctors you know who have particular likes. You probably would
not want to choose a gift such as liquor or a Rush Limbaugh newsletter as a generic
holiday gift.
If you have a public health program on TV or radio, many of these MDs could
be contacted to appear as guests on your program. Even if you do not have a radio or
TV program at this time, it may be a good idea to do a 3-week series to promote your
clinic and have MDs as guests. You can interview the medical doctor and once again
build a relationship of how chiropractic and medicine can work together. It also gives
you another reason to send them a letter and contact them by phone. It will give you a
reason to meet with them for lunch and a good idea would be to see if they could meet
you at your office. It seems to make a real difference when you have the medical
doctor see your office and even observe your work. That truly does build good
credibility. Once again, the reason members of the medical profession do not refer to
chiropractic is due to not knowing chiropractic.
4
phone call inviting them to an open house or a meeting to come to your office. There
could always be phone calls with the common ground being the patients.
V. Sponsor A Seminar
Once a year sponsor a seminar at your office for these health care providers.
Again, if you are concerned about attendance, you may want to co-sponsor the event
with your local medical supplier, software distributor, or other medical vendors.
1) Have the seminar on a weekday evening and let them know that it will only
last for a specific time period. Check with some of the MDs with whom you have the
best relationship to see what day and time they would prefer. Offer other possibilities
such as a noon luncheon seminar from 12 to 2 p.m.
3) Part of the seminar should be used to introduce all those in attendance at the
seminar.
5) Consider using an outside speaker. We don’t want to make this seminar a huge
expenditure of money, but want to make it nice enough to draw the people we want in
attendance and make it successful enough that they will want to come back. There
might be some good chiropractic speakers from outside your city,an expert on
managed care, your state senator or someone who could bring to your seminar the
latest developments in health care. Another possibility would be to create a small
panel
4
made up of you and perhaps an attorney or two and MD’s that you either get referrals
from or would like to get referrals. Most of these speakers would assure you of having
people in attendance and at the same time would not be very costly. Another
possibility may be a well-known seminar that is coming to your city that you know
would be good for them to attend. You could invite them and pay their registration.
An example would be a Dan Murphy seminar in your area (Daniel Murphy, 148 A
Ray, Pleasanton, CA 94566, (510) 837-1789). Don’t be afraid to get some feedback
from those that you have the best relationship with to see what they think they would
enjoy the most.
4
ANNUAL CALENDAR AND TRACKING FORM
Orchestrating this entire plan is more detailed than it may appear. In fact, one of
the major reasons for discontinuance of an interdisciplinary referral network is
confusion in what has been done and what has not been done. You should use two
forms, the Annual Calendar and the Tracking Form to monitor your progress.
The Annual Calendar, found on the following page, allows you to establish a starting
date and completion date for the major events that will take place if you follow this
program in it’s entirety. It should be filled out one year in advance and you should be
careful to add the major deadlines for any events you elect to add to this project as
time passes.
The second form, entitled Tracking Form, allows you to track and monitor the
events of individual doctors. This tracking form should be photocopied so each
medical doctor you have contacted has a tracking form in a separate notebook. Be sure
to use the Comments section of this tracking form to make comments on the
receptivity of the doctors. This information is useful in the event someone is helping
you work on the project and in deciding which doctors you should continue to contact.
The bottom of the tracking form should be used to track those patients that have
started care in your office recently who use one of the doctors you are contacting as
their primary medical doctor. Many times we know that we have several patients from
a specific medical doctor but cannot remember which patients see each particular
doctor. By tracking this information, you will be able to have those patients’ names at
your fingertips for reference when speaking with the medical doctor.
4
CREATING AN INTERDISCIPLINARY REFERRAL NETWORK
5
ANNUAL CALENDAR
Starting Completion
5
Doctor’s name: Phone number:
Address:
Office Manager’s name: Specialty:
Doctor’s personal
interests/hobbies/pastimes
Spouse’s name:
Completion
Date:
Letter of Introduction sent with brochure No .
Comments:
5
Invited to year-end holiday party
Comments: [Attended? Yes / No]
5
CONCLUSION
The letters, newsletters, public relations activities and phone calls that you will
make in working through this packet should provide you with constant contact with
the medical profession that will make a positive impact on building medical referrals.
You do not have to do every single activity in this booklet in order to be successful.
But, you will certainly want to do a vast majority of them. While this plan cannot
guarantee success, there is certainly one thing for sure: You cannot do any worse than
if you do nothing! It is almost certain that if you were to carry out these activities for
a
period of two years, you would see good results. This is the best program available for
building a referral practice based on a professional relationship with other disciplines.
358 Clinics
WELCOA clinics