Show Notes

Kayla: Welcome back to the Designer Practice Podcast and I’m your host Kayla Das.

In today’s episode, Josh Satterlee, chiropractor and owner of Trust Driven Care will provide tips and strategies for how to navigate client friction within the therapeutic relationship.

Hi, Josh, welcome to the show. It’s so great to have you here today.

Josh: Well, it’s great to be here, Kayla. Thank you so much for having me.

Kayla: Josh, before we dive in, please introduce yourself, where you’re from, and tell us a little bit about your own practice journey.

Josh: Yeah, so I’m a chiropractor, like you said. I live in a little town called Henderson, Nevada, which is just a little suburb of Las Vegas. If you think about Vegas as a clock the strip where everybody goes is the dead center of that clock. I live down at like five o’clock, I always tell people. So, been in practice all my life out here in Henderson and I’ve had everything from a solo guy running his own practice with no administrative help to a partner, to multiple chiropractors, to a team as large as 15 people that included personal trainers and strength coaches and massage therapists.

And that was all done because I really loved working with golfers. And golfers are for me, the perfect practice. If I were to design a practice, it would be old, crusty, scotch infused country club golfers who have tons of issues that they want treated, tons of money to pay me to do it, and a clear goal about, hey, I want to hit the ball farther and feel better. So I love that.

So that’s kind of where I’m at. I also focus a lot on patient communication and that’s my recent journey. I’m happy to tell the story, but I had a friend who passed away from a bad communication situation and I vowed that I was going to change it. I was going to change communication healthcare. So that’s the mission I’m on currently.

Kayla: I’m sorry to hear about your friend who had passed away. And I know that we’ve had you on a few months ago on our other podcast, your clinical supervisor’s couch. And you’ve went into great detail on how this was a big part of your journey and really why we’re talking about a lot of what we’re talking about today.

Josh: Yeah. The base of the story was he went to seven different doctors complaining of low back pain and everybody did the chiropractor did the chiropractic version of the physical therapist, strengthen his core, the urgent care provided him ibuprofen, blah, blah, blah, blah, blah. Everybody did their kind of lane of things. And nobody realized that he had stage four colon cancer that had metastasized to his spine. And, when somebody finally figured that out the seventh person, he only had about eight weeks to live. So got a bad deal in it. And I would say more than angered me, it enraged me.

And that mixture of great sadness and anger. And I was like, why did this happen? Why the hell did this happen? And so not knowing what else to do or make sure it’s never happened to anybody else I was like, well, I’ll at least look at all the research around patient communication. Why did it fail? The research on PubMed, I mean, I’ve got 80 something different articles and they all say Communication sucks, but nobody’s doing anything about it. Like, it’s admitting that there’s this crisis. So imagine we admit it, yeah, everybody’s dying of cardiovascular disease. What are we going to do about it? Nothing. We’ll just keep having them die from cardiovascular disease. It’s like, no. We start screening with blood pressure cuffs and we start doing vital signs. We start educating kids in school about why to stay active and we put nutrition labels on foods. All of that is because of the number of deaths from cardiovascular disease.

But when we’re talking about communication failures, nobody’s addressing it. All the research is pointing to there’s a problem, but what professional training is anybody getting? It drives me nuts. I guess I still have some emotion around that. I’m sorry, Kayla. It’s just like, it still bothers me.

Kayla: Well, I’m really glad that you’re here today to help break down some of these barriers and share some of the research that you’ve come across so that listeners can take that information and apply it into their own practices.

Josh: Great.

Kayla: So, what roles can therapists play into the friction that might occur between them and their clients.

Josh: Yeah, I think it’s really important to look at that and I think a big part of this issue is let’s step back and remember in any therapeutic relationship, whether you’re saying client and therapist or doctor and patient or surgeon and patient, whatever you want to say, you have, at its core, one human dealing with another human. And in doing so, we have to rely on the limits of that relationship and understand what can happen in that.

So, I’ll ask you this. If I come in as your client. And you see me in the second visit of a day when you had a great weekend, you’re well rested, you don’t have anything going on, and I see you at, let’s say, 10 a. m. as your client, right, an initial visit. And I think, wow, she’s warm, she’s welcoming, she listened to me, blah, blah. Not changing anything. Same office, same patient, same everything. But let’s say at lunch, you found out that your kid has the flu and had to go home sick and you had to rearrange your afternoon schedule. And, you also at the same time found out that you owe 45,000 in taxes. And somebody said, oh, well drove by your house and it looks like something’s flooding in your garage. Okay. None of those things are physical things that happen to you. But if I was then your new patient that afternoon, after you found all those things out at lunch. What’s the likelihood that you’re going to be as warm, as welcoming, as empathetic, as attuned at listening. As you were six hours earlier. And if we can admit that, yes, there’s a likelihood that those things will be different. We can say like, okay, this is a human-to-human problem.

So, then I thought, well, that sucks because there’s no way we’re getting out of humans, right? We’re not having robots do this. So, what can we do about it? And I think the best thing we can do is make sure we have frameworks and checklists that make sure, hey, are we at least hitting these signposts to know that we didn’t miss anything? We might not have done it as well as we did in the morning, but we certainly didn’t miss anything. And if you look at checklists are really famous in the world of aviation and flying planes. Why? Because even if the weather’s crappy, you still got to put that plane back on the ground. And I think that that kind of idea affects healthcare a lot.

Kayla: I like that analogy. So how can therapists navigate the client friction within the therapeutic relationship? So, do you have any frameworks or strategies or tips that can help therapists?

Josh: Yeah, I’ll start off with a really easy tip. It’s a couple articles I discovered within the research that I think applies to all the health care. But when we say what causes client friction, when do humans have a lot of friction? When there’s a misalignment of what your perspective is and what my perspective is. If we agree If I’m like, hey chocolate chip cookies are the best and you look over and you go, yes, I agree. There’s no friction right? But if I say chocolate chip cookies, you’re like you’re out of your mind cranberry white chocolate are the best. Now, there’s some friction.

Or look at politics, right? Like we could agree to 80%. We want our kids to be educated. We want to pay less money in taxes. We want our government to use our money safely and effectively. And we don’t want anybody to be without. Okay, we all agree. Then how come these massive disparities within the political spectrum and to the point where people are screaming at each other, holding signs? Well, it comes down to this friction often develops with people feeling unheard. And it’s no different in politics.

And actually, there’s really good research about this, that one of the number one complaints in all of healthcare is, nobody ever listened to me. Nobody ever listened to me. What was the problem with the doctor? They didn’t listen. If you look at all the research around malpractice claims, I don’t know if you guys in Canada have malpractice. The U S is very litigious. Like we’ll sue each other for anything.

But if you look at all the research around malpractice claims. Almost always, 72 percent of the time, it was a communication issue, not the actual medical act. So, a surgeon could cut off the wrong finger, but if they’re nice about it, there’s a chance they won’t have a malpractice suit. On the flip side, if you’re a jerk, and you don’t listen, and you don’t care about that patient, you could do the correct medical procedure and still get a malpractice claim. So medically you did what you should have done, it was accurate, it was standard of care. But you’re still going to get sued.

So why does this happen? If we’re looking at, no one ever listened to me, there’s a very easy way to fight this that everybody listening can do. And it comes down to this research that’s called the spontaneous talking time of patients at their initial exam. Basically, if a doctor just asked. How can I help a really open-ended question and just sits there and doesn’t interrupt the patient just nods and smiles and says, tell me more. Keep going. How long do you think that patient would talk for? Take a guess.

Kayla: I don’t know. As long as they want to.

Josh: Yeah. When I present and do our workshops, I asked patient and doctors they’re all the time say, Oh, 10 minutes at least. Oh, 20 minutes, an hour. I don’t know. These are all the guesses. But when we look at the research, you’ll be shocked. It’s just 92 seconds on average. 92 seconds that they’ll talk if they’re not interrupted. Okay?

Now, if that’s all it takes, if all we have to do is listen to our patient for a minute and a half to hit the top of the bell curve, then why do so many people report that no one ever listened to me, right?

So luckily, another group of researchers said, well, that’s interesting. Let’s look at the average time it takes for doctors to interrupt their patients. So what’s the average time to interrupt a patient in an initial visit, right? That was amazing as well. 92 seconds is not a long time to listen. But doctors interrupt their patients on average. At the 11 second mark. Just 11 seconds in and they’re interrupting. So, no wonder the patient never feels heard or listened to, or that you care, because before they’re even out of the gate, we’re already interrupting them.

Now these interruptions, by the way, they’re not like somebody saying, let me stop right there, Kayla. It’s not that. The interruptions are done with the best of intentions, but they’re typically like, if you come in to see a chiropractor and I say, how can I help you say, Oh, my back hurts. It’s kind of in the center, but sometimes it goes down the left side, and I stop and I say, Kayla, real quick, would you say it’s like achy or sharp, tingling, or numb? As soon as I stop the conversation, ask those clarifying questions, that’s considered an interruption in the form of communication. So, they’re done with the best of intentions, right? We think, oh, we’re going to get better information. The problem is you don’t get all the information.

And I would tell you any experienced clinician, like I’m sure you can relate to this. You have that on the first visit, you interrupt them a few times unknowingly with the best of intentions. And its evidence because six to eight weeks later, they go, Hey, by the way, I didn’t bring this up on our first visit, but I actually do have numbness on my thigh, or I don’t want to tell you the first time, but my real goal is. I really want to lose weight for my daughter’s wedding that’s coming up, right? They get past that six-to-eight-week mark and they now come at you with some more information. What I think that comes back to is they finally trust you enough to admit to what they really want to address.

Kayla: You know, I think that’s really important and it actually makes me think of the framework that I teach therapists with respect to their consultations with clients and even though most therapists will opt in for the 15-minute consult, which I do as well. It’s sometimes we’re so driven to get specific answers. And I think this goes back into the framework you’re talking about. It’s like letting your patients or your clients speak.

And one of the frameworks that I use is when you ask the question is how can I help you or what brings you in today is letting them speak for four to five minutes about all of what’s happening unless they of course end it quickly but encouraging at least a quarter of that 15 minutes to be about them just telling why they’re here. The other 10 minutes can focus on the other aspects that you need to introduce. Of course, with therapy, we do have to introduce the limits of confidentiality and things like that, but that’s even before we even asked this question, but you can ask the other types of questions after. Even like you said, even if you can go those two minutes, just letting them speak, even though it’s a short period of time, that’s going to help them feel more heard. And when they come back to work with you, that’s when you can go into more specific questions that you’re really looking for.

Josh: Interestingly, I think your approach is totally supported by the research I’ve looked at, because one of the points they make is, when we ask that in the first part, the patient will often tell you what is wrong. I’m nauseous or my back hurts. But what patients really want is that you address how they feel, not just what they feel. And in fact, addressing how they feel is more important on the front end of the relationship. What they feel is long term.

So, for example, let’s use a cancer patient. Early on that doctor may address everything about the tumor and the size and its uptake of how we’re going to treat it with chemotherapy. But what that patient really wants to know is, and I still take care of my family? Will I be able to take my daughter to school? Whatever it is.

And you will know if you’re in the right place in that first four to five minutes, like you’re talking about. If you have some emotional markers, I’m scared about this. I’m worried about this. I’m concerned about blank. Patients typically don’t transition to those emotional markers early on until they feel like they can be honest and trust you enough to handle that. But if you’re just dealing with in my world, like if it’s just pain and like where it is, when the onset is. You know how I would describe it. And we’re not talking about, yeah. And I’m worried that that’s going to take me out of running. I’m scared. I can’t go to the gym anymore. Or I’m concerned I won’t be able to pick up my kids. If you’re not getting that emotional piece, you haven’t listened long enough.

Kayla: A hundred percent.

Josh: Do you see that in your own, like, as you go through that four or five minute, you find that starts out very, what would you say? Sterile and parts and pieces. And then it kind of transitions in the middle to the how and the humanistic things.

Kayla: I have noticed that when you give that four to five minutes to just to let them share, whatever it is, wherever their brain goes without interrupting or having this kind of process in your head that I have to get to this or I have to get this answered and I have to get this within this 15 minutes. Clients will usually stop themselves around five minutes because once they share everything that they need to share, they usually wait for you to say something else.

So that’s when you can start incorporating some of this. So, I do feel it builds the trust. And I always say, and this is from kind of the marketing perspective, your consult is the end of the marketing process and it’s the beginning of the therapeutic process. That four to five minutes, is the key for both, because like you mentioned, it is honing in on the trust, it’s letting people feel heard, but on the marketing perspective, it’s also like, yes, this person is actually listening to me, I’m going to book another session with this person, because this person is worth booking with.

Josh: You know, interestingly, if we’re talking about the marketing and kind of business aspects of this, it all works in conjunction. And I’ll tell you, we have a software. And that software allows us to look into other accounts, right? So we can see all of our clients’ accounts. And when you look at the Google reviews for people who invest that, let’s just make the marker at 2 minutes on the front end of listening. You will see language on behalf of the patient that says. Oh, the reason to see doctor Kayla is she actually listens to you or I feel like she heard what I was talking about. Versus when they don’t take that time you’ll hear like oh the office is nice or the lighting is clean and it’s blah blah blah You’re not going to hear those humanistic things.

But I think when we’re marketing, we want to connect emotionally with potential patients. And so saying the office is clean or their facility is nice and they run on time, those are great things. I mean, there’s not a downside to those. But which one will result in more patients coming in? I think that human language of finally somebody listens to me is so powerful. Especially if we’re saying like the designer practice podcast if you’re trying to design your perfect practice with the patients you want to see and the type of care you want to do. You listening to that woman who has pelvic floor dysfunction after childbirth that that’s who you want to see. Listening to that person as they dumped all the details that every other doctor just kind of scuffed off and was like, yeah, yeah. Okay, move on. Let’s, let’s go. Where’s the pain? And, and they’re like, it’s not that it’s not pain driven, right.

Or I want to work with golfers. So, listening to them, tell me about how does your back feel after a round? How does it feel the next day? Oh, well I lay on the couch for a day and I can’t play with my buddies. Or how would they feel about being the shortest hitter in their group. It’s embarrassing. I feel like they’re going to ditch me. They’re going to find another partner. Anyways, my point being when we listen and we listen specifically to those things, it allows us to capture the right people. And then they go onto Google review you and use that quote unquote secret language to the other people who are looking for that exact same thing. Somebody finally listens to you about pelvic health or golf or whatever. And I think that is so powerful for the business aspect, but it just gets ignored.

Kayla: Yeah, I know when we were speaking offline, you mentioned when something goes wrong into a practice, that you have this four part apology framework. Can you tell us a little bit about that? And also, even before you introduced the framework. First of all, why should therapists even apologize for anything?

Josh: Yeah. Yeah. It’s a great question. And I would say if you’re not apologizing you need to take a slice of humble pie and realize we all screw up because again, we’re humans dealing with humans. And it’s okay. And if you apologize, you will actually see much higher patient satisfaction scores. In fact, the highest patient satisfaction score that’s ever been recorded in research, high 90, so 96%. All were from doctor screwing up, making a small screw up, realizing it, fixing it, and addressing it in front of the patient, and that was higher than if everything went right. So actually, there was a requirement of things going wrong, and fixing it for these high patient satisfaction scores.

Anyways, that’s a different study. But what we’re talking about in the four-part apology framework, an apology is a sign of humility. Because when do you apologize? When you know you were not right. And if you’re listening to this and you think, well, I’ve never hit that point in my life, wish you luck. I’ll just say that. That is inconsistent with the research, and I wish you luck.

But when you do screw up, the group of researchers we’re looking at, why do some apologies come off as like, Icky and not truthful, and they don’t reduce malpractice claims, for example, right? And why do some apologies completely diffuse a very tense situation? So, you have somebody that had the wrong procedure, a patient that was misidentified in a hospital or something. And yet the right apology can eliminate all of that.

So, the basic thing is they came out with these four parts and there’s four parts to a High quality apology. And I’ll explain to you easy way to remember it is to air it out, air it out A-E-R-R, A-E-R-R. And when I’m saying this I always think back to the worst apology You’ve ever heard which is usually a politician who gets caught for something and then you’ll see that they’re missing parts of this. I’ll tell you this. So, A E R R. The first one, A, is acknowledge. Just freaking admit that we screwed up. And acknowledge, Kayla, I’m sorry that we didn’t have your prescription ready for you. Or I’m sorry that, Dr. Joe blew your appointment time and wasn’t here. Acknowledge the fact that something happened that bothered you as the patient.

Number two, explain. Explain what happened. So, it’s not just a, we’re sorry, but there wasn’t a reason for it. Explain dr. Joe was caught in traffic and we had to make a last-minute decision because we knew we had to go back to the hospital. See there’s going to come to this office, see you, or he was going to drive back to the hospital. We chose the hospital and therefore you totally got hosed. But just explain what happened or the reason I wasn’t able to pick up that thing, honey, was I couldn’t get milk from the store was I was distracted by a phone call that happened about something at work and blah, blah, blah. But explain it. It can’t make up for the acknowledgement, but people want to know what the reasons were for it.

The third one, the R is remorse. Show some sign that you’re human and that you have remorse. It bothers me to see you in pain Kayla. I’m sorry that I screwed up, right? Just offer remorse. And then finally, the last R is what they say, reparations. How are you going to make this right for the future? Now be very careful on that one. Be very careful. The most common reparation, people will say, Oh, don’t worry, this won’t happen again. Okay, only use that if you know for a fact this won’t happen again. But in the course of like a healthcare practice, be very careful about that reparation, because there’s a likelihood it will happen again. I mean, if we say late to an appointment, we take the patient back 40 minutes late and I say, it’ll never happen again. Come on, like that’s rot with failure. But a reparation doesn’t have to be any sort of like promise of dollars or discount or hey, I’m going to refund you for today. Although those things may be appropriate, depending on like your situation. But just saying, we’re going to talk about this and your case specifically at the next staff meeting to make sure that we know the things that lead to this. So that addressing it that way is one of the ways to make up for it. And that’s a great reparation. So, A-E-R-R acknowledge, explain remorse and reparation.

Kayla: I love that. Josh, do you have any additional tips or insights for listeners who may be navigating client friction within the therapeutic relationship?

Josh: Oh, yeah, I’ve studied this communication thing a lot. So, I’ve only got 284 more tips Kayla. So just, you know, let’s keep the record button going. No. I will say this when it comes back to that listening, we are in a difficult situation as providers. And I know I’ve said this to you before, but I’ll just say it for the listener. Because in the realm of healthcare, we have to ask high trust questions in a low trust environment. Okay. Again, we have to ask high trust questions in a low trust environment.

So, I’ll use my career as a chiropractor, as an example, when do I need to ask you about red flags like is there blood in your stool or your urine? Do you ever have incontinence? Those are really difficult high trust questions and the likelihood of that person being honest is kind of low. When do I ask those questions? In the first five minutes of the very first time, I’ve ever met this person and been face to face. Well, what other social situation would there be where I asked the hardest questions? In the first five minutes of our first meeting?

And I often use this analogy Imagine you go on a date with somebody and before the bread is ever there you’re asking them about before we go any further any bankruptcies or Are you addicted any drugs? Are you an alcoholic? Sure, you would want to know those things before you get in a relationship with that person. But in social situations, you’d be like, oh, I’m not going to ask that until later. Well, in healthcare, we don’t have that choice. We got to ask right now and we got to be very clear about it. But one of the problems is we’re relying on them being honest with us. And when they’re not how can we tell it’s a subjective information.

And so, you take somebody like me and I go, oh, do you have any incontinence blood in your urine or stool? And they say no I decide not to order an MRI, when in fact those things are occurring, they just weren’t honest with me. Well, I just provided bad care based on my subjective information.

So, the solution to this is a couple things number one, do everything you can Between the time the appointment is made, and that person steps in your office or you meet them online. Message them start building a relationship build trust before the First visit so that’s not the first time you’re trying to make up ground building trust with them, right?

A couple tips if anybody’s interested Pictures are worth a thousand words. So sending a picture of the office from the outside, or here’s what it looks like from the street, or I don’t know if you’re in like a big city, Kayla. But if parking sucks, send a message about, hey, there’s a parking situations, bring your ticket with you. We’ll validate or park in the things with the red stripe on them. Totally cool. If there’s an elevator to use, or if it’s easier, if they use a certain entrance, tell them that. Send a picture with a circle around it, like you would If you’re trying to get your grandmother to show up to your office at lunchtime.

Another one is, if you know that your map link is wrong, and I would encourage everybody, look up your own office on Google Maps and see if the link is correct. You’ll be shocked at how many are across the street, or one building over. And give them some help there. If you don’t have any parking issues and it’s really easy to find and stands out, cool. Send a picture of who they’re going to meet when they walk in. Hey, this is our front desk team. This is Stacey, Michael, and, Ashley. One of them will be here to help you. That can remove some anxiety. Or send a picture of you and your dog. Some humanistic picture of you muddy with your dog saying, Hey, this is Cletus. We hike in the afternoons, but. I look forward to meeting you. My whole point being all these things can build up that level of trust.

Now let’s say you do all that well, or you don’t have a system for that or whatever, here’s two other tips. When you are asking people what their goal is. And I would encourage you asking their goals is important, push back a little bit and create some friction. It’s often advantageous if they defend their goals to you. And I will tell you, you will also be able to sniff out when they’re feeding you BS. And so, I like a couple of questions there in that goal process.

Oftentimes we think of the goals of treatment. And think about that like very medically, like, hey, we want to eliminate this tumor or we want to reduce white blood cell count and get rid of this infection. Cool, but that’s not what the patient’s interested in. Be very clear about the patient’s goals. I want to play golf. I want to have a healthy marriage. I want to dance with my daughter at her wedding in a year. All those are much different than, I want to reduce my white blood cell leukocyte numbers. So, make sure we’re clear on the patient’s goals and how they phrase them. I want to dance is different than I want to feel good to walk my daughter down the aisle.

A couple of questions that are really good to ask there. First one being Kayla, if you didn’t have this going on, so I’ll use pain because I deal in pain. If you didn’t have this pain going on, what would you love to be doing? And so that gives you some insight of what they love to do. I would love to be golfing. I would love to be hiking. Very cool. So now we have kind of an idea about their goal, but I don’t think it’s fleshed out. And then I think it’s important to ask, hey, let me ask you why us? Like, why did you choose us to address this? If they reveal anything there. Oh, my friend Stacy said you’re really good or you recommended my doctor. Those things are good but also what you want to pay attention to is if they mention anything like off your website or your marketing messages. You seem to understand blank or you really seem to address x it’s important to feed them back. Feed them back give them the confidence that yeah, you’re right. We do address those things. Or we are specialists in pelvic floor therapy or whatever your thing is.

And then the other thing to ask is Kayla, why now? Like why even address this now? What is it that made this a problem now? Oh, well, it’s finally hurting this much challenge them just in a little bit. I’m not saying deny them the fact like, well, it doesn’t sound like it’s bad enough, so we’re not going to treat you. But like, why now? They go, well, I promised my sister we’d run a marathon in a year, and there’s no way I can do that with how my foot feels right now. Or my husband’s retiring in about a year and a half, and I know he’s going to say he wants to hike Machu Picchu. I know it. So, when I wanted to motivate her, I would say, Hey, this exercise is going to help you the most when you are hiking Machu Picchu. Not hey, this exercise is going to feel really good when you’re in the kitchen getting the kids meals ready, like she’s not motivated by that. So feed her back the very thing she said was her motivator, and it was hiking Machu Picchu with her husband in a year and a half. In doing so, we can align those treatment goals of ours with the patient’s goals. And magic will happen.

Kayla: I absolutely love all of that. And there’s something that’s coming to my mind. And I had an episode back in December about this with respect to how to choose your next passive income stream. And one of the pieces of this is that you need to understand your client’s journey. With respect to why they’re coming to see you and usually you are not their first choice. They didn’t just wake up and say, Oh, I’m in pain. I think I’m going to go see a chiropractor. I think I’m going to go see a therapist. You are their last resort. So, what is their journey before that? Are they looking for blogs? Are they looking for podcasts like that we’re on today? Are they looking for courses? Are they looking for exercises? What are they looking for? Maybe self-help books? All of these types of things is their journey before they come see you.

So, I love that question of, Why now? For them to come see you now, regardless of what type of practitioner you are, there is some factor that has changed in their life that said, okay, now I have to get personalized help from an individual. Because they probably tried everything else.  

Josh: yeah, it’s so powerful. The other thing is, I totally agree with you they’ve tried a bunch of other things, but also these conditions where people get treatment for. Usually aren’t affecting a single thing, right? It’s like, oh, I would have ran and I had pain when I ran, but when it affected me putting my kid down to bed, that’s when I knew it was worth treating. It’s usually multifactorial when they perceive that.

And as you were saying that, they try a bunch of different stuff. I treat a lot of golfers. And I remember this gentleman came in and he had like tiger balm and icy hot, a foam roller, a massage stick, a stretch band, this a tool like golfers are hyper buyers. And I’m not kidding. You can only showed up to my office with 20 different items that he had tried to use at some point to address the low back pain. And it shows you he was motivated to figure it out and also frustrated that nothing else was working. Where’d all that emotion come from? You know what I mean? There’s a lot of power if we can harness that. But if we ignore it or don’t address it, we’re also giving up a ton of motivation of his. So, it’s so powerful.

When you’re saying about like the episode about your passive income stream the other thing, I think of is a lot of us in healthcare kind of turn our nose up a lot of possible money. That’s aligned perfectly with our perfect practice. So, I’ll use two examples. So, when I had my clinic and gym, the reason was whenever a golfer gets out of pain, their next question is, I don’t ever want this to come back, what do I need to do? And so, I’d send them off to like gyms and find personal trainers in the area. Nobody ever really served them that well and wasn’t doing like golf specific workouts. So, I said, well, the heck with this, we’re going to open up a gym and offer, wait for it, golf specific workouts. And it was perfect. Cause they’d work out for a while. And then their back would get cranky and they’d come back in the clinic, kick them back to the gym. They loved it. Absolutely loved it. Well, that was a big stream of income. Our personal trainers and strength coaches are making us a lot of money for the business for themselves. And for me as an owner. And I think that in all of healthcare, that’s usually the case, right?

So if you’re a mental health therapist, could you offer what we would call an upsell or a cross sell or additional services that are well in line with your treatment goals and help that client get to their goal faster that they really want you to offer. So like with mental health, Yoga, meditation lessons. Those are perfectly in line and often will provide that breakthrough. Why aren’t you the place offering them? If it’s a med spa and somebody’s coming in for Botox, selling them like a skincare lotion set that you believe in and you think, oh, I’ve researched and it, this meets the standards I have. And then if you sign up for this membership, we’ll do a laser facial every six months, it’s perfectly in line. It gets people towards that goal. And who’s going to come in for that? The exact person who’s really, really, really interested in what you offer and what you do. Not the dabblers not the people that are kind of just interested. And so when you talk about designing your perfect practice.

For me, it was really aggressive golfers Well, what do they have in common? They want to get better at golf. How do they do that? They got to get treated and they got to get work out. I was the place for that, right? Could I also have sold them new nutrition supplements? Absolutely. Could I also have sold them different golf clubs or fit them for all these things. Absolutely. We decided there was a limit to what we’d offer, but man, I think so many therapists and clinicians and providers are like, Yeah, we don’t do that here. And their patient is like, well, I don’t trust anybody else to do it. So, I’d really like you to do it.

Kayla: I love that. So, Josh, I know you’re a creator of a specialized all in one software that can help listeners. Can you tell us a little bit about what it is?

Josh: Yeah, well, I’m a chiropractor. I’m not a software developer. So, I want to give accolades to the developers. I just knew that I wanted a way to communicate with my patients better and really serve them. And I use some services that send out like text messages one way. And I wanted to make sure that I could respond to those answers or questions. There’s nothing worse as a customer when somebody sends you a message and you respond and it goes, oh, this inbox is not monitored. It’s just a horrible customer relation. So anyways, you want to do some two-way text messaging. And then I didn’t want to make it hard on my front desk to answer our Facebook messages and our Instagram DMs and our text messaging. So, we just put it all in one place in what we call a conversation inbox. And we allow for all these methods that our patients might communicate with us. Potential patients communicate with us, people who aren’t yet patients, send them information. So, we have what’s called Trust Driven Care. trustdrivencare.com is a software that ties in with the EHR and allows you to maximize that patient communication. Maybe for you, that’s reducing no shows. Maybe for another group, it’s running automatic patient reactivations after 90 days. Maybe it’s getting people who want to refer their friend. Whatever it is, we handle the communication side of things.

One of the most powerful parts of it is we automate as much as we can so that we know it happens every time without any staff having to jump in. And reserve your staff’s time for the things that really matter. Like my mentor said, you can’t automate a hug, so let’s not try to. But when you need to spend some extra time with that patient, you got it because everything else is running in the background. Those messages we talked about sending out a picture or map link. Automatically just get sent.

Kayla: I love that. And actually, it was just yesterday. I brought my daughter to a brand-new doctor. And if I had a picture of where to park, that would have been so helpful. I did eventually find parking, but the anxiety going to somewhere new is real. So being able to navigate and provide some of these resources to your clients or your patients can be really helpful and just making the whole process easier.

Josh: Yeah, I think people underestimate that, too. I remember reading a thing on like Google health or something, and they’re saying, like, over the age of 65, which here in the US is when people get Medicare. But it’s also when you engage in most of your medical visits is over the age of 65. It’s something like 18 or 19 percent of patients reported driving by the office in the week leading up to their appointment. Like so they commit the time to like, oh, I want to see where to park and do it days before. That’s crazy What does that tell you about like how well we’re doing as health care communicators, right? It’s horrible if that’s what the Patients are doing on their own because they’re like, yeah, I won’t know where to go the day of. So anyways, I just found that super interesting.

Kayla: I love that. So, to check out Trust Driven Care, go to trustdrivencare.com

Or you can simply scroll down to the show notes and click on the link.

Josh, thank you so much for joining us on the podcast today to discuss how to navigate client friction within the therapeutic relationship, as well as going into some of those business practices that are related to building trust and to navigating client friction.

Josh: Yeah, well, less client friction will equal a better business. You get more visits, more payments, less arguments about dollars. And they’ll probably refer their friends and family. So, I think it, it just feeds everything. But thanks so much for having me. I really appreciate the time.

Thank you everyone for tuning in to today’s episode, and I hope you join me again soon on the Designer Practice Podcast.

Until next time, bye for now.

Credits & Disclaimers

Music by ItsWatR from Pixabay

The Designer Practice Podcast and Evaspare Inc. has an affiliate and/or sponsorship relationship for advertisements in our podcast episodes. We receive commission or monetary compensation, at no extra cost to you, when you use our promotional codes and/or check out advertisement links.