As we start up the practice, our main focus is largely on the big things that have to happen.  Getting the build-out done, paying your loans, building your practice, managing your overhead, managing and trainging your staff, etc.  

It is very easy to let a lot of little things pass you by.  I have found that over the years, what has really helped my office, and made my life a lot more enjoyable, is to focus on the little things.  

For example, a friend of mine works for a chiropractor near where we live.  It is a small office in a small town, and it is just the two of them in the office.  She recently had a major surgery to correct a problem she let go for a few years.  The recovery is slow and she can't be in the office for a while.  

I gave her a call about a week after the surgery to see how she was doing.  Man, she was irate!  The doc she works fo, hadn't called, texted, emailed, facebooked, or anything to see how she was!  The lack of contact truly upset my friend and significantly altered her view of her boss.  

A simple phone call would have prevented serious damage to their working relationship.  Five minutes.  A little thing.

Patients will bring in food, or a letter, or some other gesture to show their appreciation for you.  What will you do in return?  What ways are you showing your appreciation for them?  

When a business contact sends you a referral, what is your process to show appreciation?  Is there a process? 

These little things add up to have a dramatic effect on the overall opinion people will have of you.  Here are some suggestions on things to consider.

• Never underestimate the power of flowers or a plant.  When someone has a family member pass, a surgical procedure, an end to a relationship, and so on; a small investment will not only bring a smile to their face but will pay back tenfold in the future.  
• Handwritten thank you notes are also quite effective, and simply cost a stamp!  These can go to your staff, your banker, your accountant, someone who grabbed your lunch, clients that helped you out, and so on.

Yes, the big things are important, but don't forget the little things!  Not only will they help your business grow, they will also help you fall to sleep with a smile on your face.

Whether you are a new graduate or an experienced practitioner, think about this question.

If a loved one called you from across the country to seek a referral for a neurosurgeon what would you do? 

Even if you did not personally know a neurosurgeon you could safely rely on certain criteria. 

Look up their CV, find out the medical school they graduated from, see which accredited hospitals they are affiliated with and chances are you would have a good idea based on credentials that this individual would be a rather safe referral. 

What about referral to a chiropractic colleague?  How do you go about making that referral with any degree of confidence? 

This is not an indictment of all the D.C.s but rather of our lack of “third party credentialing” to provide at least a sense of confidence.

So how do D.C.s get their name and reputation “out there” so when others are looking for a D.C. your name will make the list. 

Participation in your state and national association is a good start.  While participation does not guarantee competence it demonstrates professional responsibility. 

Additional certification, ongoing post graduate training, published articles, website that outlines your mission for your office, community involvement and civic contribution all go to help form the impression that provides confidence in making a referral. 

It is important to start early to help build that reputation so when the need arises for a “referral you can trust” it will be obvious that you are a good choice.

Every day there is another incident where the lines cross between professional and social relationships.  The blurring of boundaries is creating a huge issue in law and medicine.

The innocent violations of HIPAA, confidentiality, Protected Health Information (PHI) and a host of other breaches of confidentiality are almost too numerous to mention. 

While it may seem unlikely that we will go back to a world without Facebook,Twitter or LinkedIn, it is increasingly more difficult to escape from the horrors of early lapses in judgment that occurred during a moment of euphoria which clouds long-term judgment.

• Employers are increasingly going on Google searches with prospective employees or associates.
• Board of examiners and malpractice attorneys are looking up clients on these social networks.
• Patients and prospective patients are turning to social networking to look up their doctor and often uncover unprofessional photos and comments that can never be erased from the web.

Doctors can avoid these problems by discussing patient/doctor, patient/staff and doctor/patient boundary issues ... and by emphasizing the importance of privacy, confidentiality and adherence to HIPAA rules and regulations. 

The waters of the virtual world are turbulent and can create significant problems for the unsuspecting.

It was clear at this point in our conversation that Dr. Z had ideas about getting involved in community organizations and networking with local businesses.  But how does this translate into new patients in the practice?

Dr. Z plans to leverage the contacts he makes within the community.  He is going to focus on groups that have not had interactions with the practice in the past and join organizations with members he doesn't know and are not already patients.

You see, the thing is, Dr. Z needs to be the point of contact for the patient.  It factors into his compensation whether the patient is his or not and if they came to the practice through his efforts.  So keeping track of where the patients heard about the practice is really important.

Clearly, community involvement is an important component of Dr. Z's marketing plan.  But I asked if it was important for him to be involved in organizations in which he had a passion for the organization's mission.

This gave Dr. Z pause.  I'm not sure he had thought of that aspect of it.  "I guess I need to think about that.  I've been thinking about this from my perspective and not from the perspective of the organization and the other volunteers involved."

We talked about this for a bit and I shared my perspective as a volunteer leader with a few non-profit organizations in my community.  I told him that if he is not sincere in his motives he will likely not put in the effort expected by others involved.  Also, if he finds organizations he has a genuine interest in, it will be less like work and more productive.

I think this was a good lesson for Dr. Z.  I know from my experience, if a volunteer is only involved to promote their business, the volunteers like me who are genuine about the mission will be resentful and insulted....and not very likely to be supportive of the business being promoted in the first place.

Dr. Z thought for a moment and replied "I never thought about it like that, but that does give me another way to think about my involvement."

What a nice way to help bring reading into the lives of your patients.  Consider a lending library, I did for about 30 years and we had to do it by hand with a rolodex file with return dates and names of the book and lender. 

How easy today with computer programs to keep track of the books, and what a wonderful way to introduce many new books on Health, Motivation, Leadership, Mind Body, Business and a host of other topics that you may elect. 

One note of caution, read the book first before you put it in your lending library just to be certain that the book is consistent with your views and that you can converse easily with your patient who asks about it. 

Charles Tremendous Jones said:  “You’re the same person today that you were yesterday except for two things—the people you meet and the books you read.”  Open up a new world for some of your patients and they will be eternally grateful for your influence and leadership.

Recently at the ACA House of Delegates Convention in Portland, Oregon, I met a young doctor who impressed me with his attitude on growing his business. In our conversation about his seven-year-old practice, I threw out a question that students at recent Starting into Practice programs asked me.

“Are you discouraged with this economy, and do you have a strategy to weather this storm of slow growth while everyone around you is panicking about finding new customers?”

This young doctor smiled and proceeded to tell me that his office building has no outside signage to indicate that he practices there. He does no advertising, nor does he make the usual speaking rounds of the Rotary Club, Lion’s Club, etc. He said he built his ever-expanding practice on the principle he had decided on from day one.

“I give my patients my undivided attention from the time they walk into my clinic until they leave. My first patient recommended my second patient who introduced me to a friend of his, a radiologist. The radiologist and I became fast friends. I referred to him, and over time, he referred to me.

He introduced me to several hospital staff when we would attend social functions together. I gained their respect and have been included in just about any hospital fundraiser that goes on in town. 

My growing patient base kept the referrals coming in until I realized that I was doing something that even advertising could not match. Taking care and listening to my patients. So now, even in this poor economic climate I am seeing growth.”

I realized the lesson that came from this young man was simple. Patient-centered care builds growth.  So, for you new docs, don’t sweat all the small stuff. You’ve got one task.  Care about your patients and give them your expertise and your ear. I see nothing but smooth waters ahead for you!

Anyone out there have any more tips on building up a practice in lean times?

What a great time to communicate chiropractic to an audience in grades K-6. 

Why not start a program called “Spooky Spines” where you go to the school and teachers K-6 and offer a 15 minute program on the spine. 

Make it fun! Tell the teacher you will be bringing in a plastic spine or (even better)full skeleton as well as an x-ray of a spine. Then talk to the children about The SPOOKY SPINE and make it into a story about health and the importance of posture (throw in some tips about knapsacks).

It can be a fun 15 minutes of learning about the importance of the spine and the doctor who works with the spinal column - the chiropractor. 

Make some arrangement with a local ice cream shop to purchase gift certificates for each of the children.  The store owner will get to know you (not a bad thing), the kids will remember you (not a bad thing) and the teacher may invite you back for another lesson on health.

Also consider providing the kids with a posture coloring book to take home so that mom and dad know the program you provided.

It really does not take much to “stand out” in this world of email, tweets, and other electronic messaging.  

Just for fun, I stopped folks on the street and told them I was doing a survey and asked them when the last time was that they received a hand-written note from anyone. 

Most had to think about it and when they responded I asked the second question:  How did you feel when you got the note?  Most were pleased and from the smile and expression on their face it was a memorable experience. 

We often talk about “genuine communication” and perhaps you have not given those two words much thought.  But think of the impact you can have - and how you stand out in the crowd - by sending handwritten notes to your patients and individuals in your community who have done something outstanding to deserve attention.

You will never know the impact that your personal handwritten words will have on the individual receiving your message.  There is something special about getting a personal card or note in the mail.  You simply stand out among the crowd when you communicate in a manner that almost seems to be a lost art.  Try it for a few months and see what kind of feedback you get. 

It is probably the best 44 cent investment you will make in relationship building.

You grinned upon reading the title because you've probably heard that line before. 

Sometimes, it's an enthusiastic response.  Sometimes, it's a "Hey! can you crack me?" comment, and sometimes it's the beginning of "their story" of chiropractic. 

Sometimes that story is about a positive experience; sometimes not so much.  

What is that all about?  Has anyone else noticed?  Do dentists, mechanics, teachers, surgeons and beauticians also suffer this awkward social moment?  

From late show digs to sit-com stars - chiropractic doesn't always get a good rap.  Yes, the profession has come a long way over the years, but we have room to improve.  What is the key to establishing the cultural authority we so obviously lack?

• Is it the way we advertise or market ourselves? 
• Is it the "parlor tricks" and "quick pops" we've all been asked to perform?  
• Do YOU "perform" on command? 

There is no one correct answer,  but I wonder...what are your thoughts?

Twitter, Facebook, MySpace, Gmail, all of these terms are the mark of a generation.  Those from that generation know exactly what you mean and how to find it.

We are not caregivers to one generation.  There is a significant portion of our patient population that relies on local advertisement rather than digital advertisement.

So how do I get the word out to those who aren't  "plugged-in "? 

I'm thinking about going real old-school and sending a personal note...in ink, by hand to those inactive patients over a certain age. What age should I pick and am I wasting my time? I think it would really stick out to some patients who are tired of form letters and mass mailing reminders.