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Billing One-on-One, Direct Patient Contact
This is often misunderstood and leads to trepidation when documenting and subsequently billing timed services.
News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
How to Reach Your World With the Chiropractic Message
My latest effort to share chiropractic occurred in mid-May while I was sitting at an introductory parent information night for high schoolers. The IT instructor informed us that each student would be receiving a computer for all their studies.
Keeping Malpractice Allegations at Bay
It has been suggested that in the litigious environment in which we live, the practice of chiropractic should be defensive and practitioners should constantly be watching their backs. An element of defensive practice is a good idea.
Streamline Your Front Desk
Your front office can be your greatest source of efficiency or it can be a constant bottleneck. Increasing the productivity of this area, while not sacrificing the quality of patient interaction, can be a little tricky. However, with some focused effort and intention, your front desk can keep your practice running smoothly.
Understanding Levels of Evidence
The concept of levels of evidence is a cornerstone of research literacy and a great starting point for understanding basic principles of how research works.
The Need for Standards
ISO-TC-249: You may look at these letters and numbers and wonder what they are and what they might mean. They turn into: International Standards Organization- Technical Committee – 249. There is a global organization called The International Organization for Standardization.
One of the most common trends to see in clinical medical practice and public health is the cycles of health "buzzwords." These come and go depending upon the current cultural zeitgeist. One year, "parasites" are causing all the issues, and the next year it's "candida."
Living Well: Lessons From Our Oldest Old
Aging is a significant public health problem, important to chiropractors in practice and important to DCs who teach students training to become chiropractors.
Low Fat vs. Low Carb & the Power of Protein
A science-based website recently posted a nice summary of 23 randomized, controlled trials from peer-reviewed journals pitting low-carb diets against low-fat diets.
Finger (Pad) Pointing: Repetitive-Use Injury Waiting to Happen
"My wrist and hand hurt. I spend all day working on computers and then I come home and spend more time on a computer, usually playing video games."
Discovery: Finding Insights and Each Other in Different Disciplines
Recently I've been thinking about all sorts of things which are hidden from our daily direct experience. That general category is what links nearly everything that catches my attention and then demands some kind of investigation.
Transforming Las Vegas
On a warm spring day in Las Vegas, Sonia Kim, clinic front desk staff, is busy preparing for a full day of intern shifts at Wongu Health Center. She greets patients, makes sure documents are properly signed, and lets the interns know that their patients have arrived.
Holistic Skin Care and Modern Technology
Anti-aging is a concept that we hear in reference to skin rejuvenation and growing older on a daily basis. Aging begins as soon as we are born; therefore "pro-aging" is embracing all stages of life gracefully, with vitality, wisdom, joy, and gratitude as the goal.
Prostate Cancer Risk
A large study published in January 2016 in the American Journal of Clinical Nutrition showed that men who are vegans had a 35% lower risk of developing prostate cancer compared to non-vegan men. The study followed more than 26,346 men who are part of the Adventists Health Study-2.
Hip Flexor Contractures & LBP in Above-the-Knee Amputations
Patients with above-the-knee amputations (AK or AKA) are particularly prone to developing hip flexor contractures. Not to be confused with muscle tightness, contractures are a permanent shortening of tissues which cause deformity or distortion.
A Different Way of Looking at It
The way you and your chiropractic colleagues access information has changed over the past decade. According to a recent survey conducted by Dynamic Chiropractic, almost half (48 percent) of DCs read online articles on their personal computer or laptop daily.
In This Current Age of Anxiety
Anxiety, also referred to angst or hysteria, goes by many names. One, popularized by the sagacious Zhang Zhong Jing, who many practitioners of Chinese Medicine may be familiar with, is known as Restless Zang/Fu disorder.
With Low-Back Pain, Sometimes Little Things Matter
Typical treatments for low back pain involve large muscles like the quadratus lumborum, iliopsoas, and piriformis. However, there are situations when a very small muscle, the multifidus, can play a significant role in the diagnosis and treatment of low back muscular or spinal injury.
Distal Style Treatment of Neurogenic Pain
Treat locally or distally? This question has frequented my thoughts for the treatment of pain throughout my acupuncture career. Each style has strengths and weaknesses, thus the versatile practitioner would do well to forgo dogmatic adherence to any one style in deference to the needs of the individual patient.
Sleepless nights, anxiety, mood swings, euphoric energy bursts, obsessive thinking, and a strange feeling in his chest. That is what Matt was experiencing when he first entered my practice. Rather than being concerned, he was loving every minute of it.
Billing Timed Services
Q: I do not always use physical medicine services but in my state I do have a scope of practice that allows me to provide many of these services. I am trying to understand what "direct one-on-one patient contact" means in relation to physical medicine services.
A Whole-Body Approach to Chronic Tension Headaches
Nearly every day in our practices, we see patients with chronic headaches that have not responded to traditional treatment. They present in our offices with a feeble hope that "maybe" a chiropractor can help.
Parker University Embraces New Era
Change is in the air at Parker University, which recently announced the selection of both a new president and a new consultant for its seminar program.
Building Bridges with Discipline
As practitioners of traditional Chinese herbal medicine, our role is to educate patients and medical practitioners about the various safety aspects of our medicine. Medical doctors that embrace Chinese medicine want to collaborate and include Chinese herbal medicine in more aspects of clinical care to support their patients.
December, 2015, Vol. 15, Issue 12
Facilitating a Coaching Conversation
By Ben Benjamin, PhD
In previous articles, I've made the argument that in many instances, it's less useful to give a client advice than to provide coaching that helps them discover their own solutions.Here, I'm going to discuss one particular circumstance in which advice-giving is both very tempting and potentially very risky: responding to a client who's facing a major decision and asks you directly what you think they should do. The decision may be closely related to the work you're doing with them (e.g., deciding whether to give up a sport in which they've sustained multiple injuries), or it may have little or no connection (e.g., deciding to start or end a personal or professional relationship).
It's often hard to know what to say in such situations. For decisions that are very personal or far outside your scope of work (such as whether to file for divorce or make a risky investment), an outside referral (to a psychotherapist, financial consultant, or other professional) is probably in order. But in other cases, simply advising the person to speak to someone else may feel inadequate. Suppose the person is considering quitting their job. They've talked to you repeatedly about how much stress they experience at work, and it seems to be contributing to extreme muscle tension and chronic headaches. When the client says, "Tell me honestly — what do you think I should do?" What's the best response?
On the one hand, you probably care about the client's well-being and want to encourage them to reduce the stress in their life. You also don't want to be evasive or hold back the truth of what you think. So it may be tempting to say, "Absolutely, I think you should do it."
On the other hand, you don't know all the details of the situation and you're not a counselor (although clients with strong transference may treat you as though you were). Furthermore, this decision is so significant that it really needs to be driven by the client's own values, judgments, preferences, and desires. When people base critical life choices on the recommendations of external authorities — whether it's a massage therapist, psychotherapist, religious leader, boss, elder family member, or self-help guru — they don't get the opportunity to learn from their own mistakes and successes. That type of learning is critical for developing a strong internal compass, sense of competence, and capacity for making better decisions in the future.
Answering a direct request for decision-making advice isn't necessarily unethical, and it may even be the right thing to do in certain circumstances (for example, in a case of physical abuse). However, many times, you can do more good by having a coaching conversation instead. I've talked about coaching in general as incorporating several key guidelines: get permission for having the discussion; inquire and reflect more than you advocate; remain curious; and focus on solutions, rather than problems. There's one specific approach that I've found to be particularly helpful when coaching a client attempting to make a decision, especially when that decision involves just two or three clearly defined alternatives (such as taking an action vs. doing nothing). It can help the person to see aspects of a complex issue that they've overlooked, which — in combination with skillful questioning and reflection — often enables them to discover a creative, satisfying resolution. What follows is an example of how you might describe this method to a client and then put it into practice.
Client: "Tell me honestly — what do you think I should do? Should I quit my job or not?"
Therapist: "That's a hard question. This is a big decision, and I don't know enough to say what's going to be best for you. I do know of a decision-making method that's often useful in this kind of situation, and I'd be happy to walk you through it to help you get clearer on what you really want. Would that be helpful, or no?"
Client: "I was hoping you'd just tell me what to do! But okay, sure, we can try that method."
Therapist: "Okay, great. What I'll invite you to do is to first spend some time thinking about all the advantages of leaving your job. Focus just on the positives — on how that makes sense and could improve your life. Then you'll switch and instead consider all the advantages of staying in your job. Do you want to give this a try?"
Therapist: "Okay, so what's good about the idea of leaving your job?"
Client: "At the moment, everything about leaving seems good! I'm so exhausted and burnt out. I think if I got out of this situation, I'd be a lot happier and more relaxed."
Therapist: "Anything else that would be good?"
Client: "I'd have more time with my kids. My oldest will be going off to college next year, and I want to be more present for her while she's still here. Of course, I can't go without an income forever. I can't be unemployed six months from now. So maybe this is a really irresponsible idea, and I should just stay where I am."
Therapist: "So now you're getting into the downsides of leaving your job. Before we go there, is there anything else that's positive about leaving?"
Client: "Oh, right. Yeah, I think if I could pull it off, I'd end up healthier outside of this work environment. I'm not eating well or sleeping well, and I'm tense all the time."
Therapist: "So you're thinking getting out, or getting into a different work environment, would help you get healthier?" (Reflection/clarification.)
Client: "I do. In my last job, I took real lunch breaks so I'd get out and go for a walk. And I had time and energy to cook at home, so I was making healthier food for myself. I really think that away from this job, I'd lose 30 pounds and my overall health and well-being would increase dramatically."
Therapist: "Can you think of any other positives of leaving your job, or are you ready to look at what's good about staying?"
Client: "I'm ready to look at why I should stay. I know it's risky to just quit without having another job. I won't get unemployment, and if I can't find anything else we'll be in real financial trouble. At the same time, I'm so burnt out that the last thing I feel up to is a job search."
Therapist: "So, in terms of the positives of staying, it's the financial security?" (Reflection/clarification.)
Client: "That's right. I make a very competitive salary, and the benefits are good, too."
Therapist: "And beyond that, is there anything else on the plus side?"
Client: "Well, I do like the work I do. I feel like I'm making a real difference in the world. And I've gotten to meet a lot of amazing people."
Therapist: "That's interesting. It's sounding as though you like a lot of things about your job." (Reflection/clarification.)
Client: "I do — or at least I would, if the workload weren't so crazy."
Therapist: "And what would need to change for the workload to not be so crazy?"
Client: "Basically, I'd need to get an assistant. I had one in my last job. But this position doesn't have a budget for that."
Therapist: "So, if you could get an assistant, you might achieve some of those benefits you'd hoped to get from leaving your job?" (Reflection/clarification.)
Client: "Yeah, then it would be more like that last position, a lot more manageable."
Notice how a possible creative solution has begun to emerge — one that's different from either option the client had been considering before. The coach didn't suggest this idea, but just helped the client consider both sides of the issue (focusing just on the positives), reflect and clarify what was heard, and ask a key open-ended question ("What would need to change?"). Figuring out the details of a resolution would take a little more time, and this first idea (hiring an assistant) may end up not working out. But one way or another, this type of coaching conversation is likely to help the client achieve greater clarity. And it does so in a way that is much more empowering and motivating than simply telling them what to do.
Click here for more information about Ben Benjamin, PhD.
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