Blog, Live Events, Pediatrics May 15, 2020

Pediatric Elevation & First Visit – Connecting to Parents

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Now here’s today’s host, Dr. Erik Kowalke.

Welcome to the show. We’re going to have fun today. You can see there’s another person on the screen, whether that direction or that direction. Dr. Josh Byers is here. This is Look To the Children sponsored by ChiroSecure and Dr. Stu Hoffman. As always, we just want to thank Dr. Stu for his commitment to chiropractic. If your part of ChiroSecure, you’ve seen all this stuff that Dr. Stu has been working hard to put out and I’ve talked to him several times through this COVID-19 stuff and he’s just been an awesome resource and his entire staff and crew I’ve worked with a lot and we’re just, couldn’t do it without them. So thank you for all that you do Stu for this profession and even shows like this that we can get more information out to pediatric chiropractors.

The point of this show is specific to kids. So we want to give you nuts and bolts that you can take back to your practice today, this afternoon or tomorrow, and actually implement and use to connect with families and kids, and just help get pediatric chiropractic out there and ultimately remove more nerve interference from more kids and see them live happy, healthy lives. So Dr. Josh is on with me today. He’s a good friend of mine and has gone through all of the ICPA seminars and sees lots of kids and so I think his insight will be helpful and fun for you guys to hear and hopefully you’ll get some nuts and bolts to take back and implement in your office.

So I have a practice in Grand Rapids, Michigan, Higher Health Chiropractic. We’ve been open since 2011. We see just over a thousand a week in our office with several doctors and you can see in my picture, this is our six foot apart waiting room. So usually we have 50 chairs in here and I think we have like six or something. Dr. Josh, you want to share where you’re from, who you are, where your practice is?

Yeah, I’m Dr. Josh Byers. I own Ignite Life Chiropractic in Elko, Nevada. It’s in the Northeastern corner. We see about 350 a week, and we also have six feet chairs. I just don’t have a sweet picture of it, but we also are doing virtual waiting room and stuff like that too.

How many kids do you guys have?

We typically see about 100, and about 120 or 150. So throughout we see on a regular basis. Yeah, that’s about what we see regularly too as well so.

Awesome. Cool. He mentioned the virtual waiting room, so if you’re watching this live in the middle of this, we have technology that we’ve helped create and implement to have a virtual waiting room where your patients can actually sign in from the car within 200 meters of your office and it connects to your EHR, tells you that they’re there, you can message them directly to tell them to come into the office. It’s awesome. So if you want more information on that, you can contact, or call me, or eMessage me on Facebook and I can connect you with that. It’s helped us immensely to comply with all of the CDC stuff.

Anyways, let’s get right into it. So we have three solutions that we want to go over today. Three main bullet points on kind of the first visit for kids. So mom’s bringing the kid in, this is the scenario. Maybe she was referred, maybe she just found you off of Google. Maybe she knew somebody in your practice or vice versa. Those are the scenarios. She’s coming in for her first visit, and the first thing we want to talk about is building trust.

So there’s two different levels of this as I was discussing this with Josh when were going through this. One is, does she trust you as who you are as a doctor and a person? And one is, does she trust what it is that we’re going to do, which is chiropractic. And so if she trusts you, she probably has a little bit of trust in you just for coming into the office and making the appointment and showing up, right? So maybe she was referred, she knows somebody in your practice. She read all your reviews off Google, she saw you on Facebook, she watched a video of you somewhere. There’s something that gives her a connection to you as a provider and she trusts you enough to come in and listen to your opinion.

The other part of that is chiropractic. So does she trust chiropractic? Probably not. What is her viewpoint on chiropractic? Who knows? So Josh, you want to go into that a little bit more on like, how do you take up a mom coming in with their kid, maybe trust you a little bit, but has no idea what chiropractic is. Worst case scenario, she had a family member that said that they had a stroke from chiropractic and their kid like went to the hospital and that’s what they heard. Or a pediatrician said, never see a chiropractor. I mean, those are the worst case scenarios, but in that first visit, how do you build trust and how do you connect with them and overcome what they might be thinking?

Yeah, absolutely. So in our office, so it usually starts prior to that even. I would back it up even to the phone. How is our team answering the phone? How are they taking care of that specific patient, especially the babies and the kiddos, they definitely want to talk and they usually talk into that phone call a little more, just because they know that, that’s kind of a sensitive topic or that it’s not well known. “Oh, you can take kids to chiros?” “Of course you can.”

So they kind of speak to that a little bit more, but you build trust as soon as they walk in the door with the practice member coming, or the team member coming out and talking about what we are, how we do and everything is to build trust all the way through when we do the exams to when we talk to them about what’s going on and so just about those. Visually, you look on the walls and you can see we’ve got plenty of kids stuff on the walls as well as family stuff. You want to make the link that it’s everybody needs to be coming in. So you’ve got all of that stuff going on there. You’re making eye contact, those types of things.

So it’s just one of those things where you have to start, like you said, from the basis and work your way up and reassure mom. I have kids so that makes it, I got a little edge there too as well. “Hey, my kids have been adjusted since they were such and such years old. They come in weekly, we get them checked.” Most of our staff, if they have kids, they bring their kiddos in. So making a connection with whoever referred them to as well. So it’s just all about building trust and worthwhile trust too.

You don’t want to have a false sense of like, “Oh, we’re so great.” Beat our chest, but you definitely want to have, “Hey listen, we’ve done this. You’re in a good place.” You also want to make sure that your office isn’t super clinical, because that will really put people on edge. It’ll put mom and dad, they’ll be like, “Oh, this is a doctor’s office.” But at the same time, those kiddos, when they see super clinical, they can get super tight and they don’t want to talk and they don’t want to move and you touch them and everything’s an ow at that point. Now you’re working your way backwards, all that stuff you did, you’re working your way backwards. So you definitely have to make sure that it’s an inviting environment and that your parents feel welcome and that those kiddos feel welcome too.

Yeah, and I think the … It’s okay to just come out and ask parents those kinds of questions. I think we oftentimes stray away from objections, like well, we think the mom is thinking this, but we’re not going to ask her, and then … We were talking about the scenario of the mom comes in with the kid and you think the visit went fantastic.


You got in a first adjustment that day and then they leave and you set up an appointment and you never see them again and you’re like, “Well I thought it went amazing.” So she was thinking something or experienced something and just never said it, and those are the ones that just drive you crazy at night because you’re like, man, I know that kid’s life would have been changed-

For sure.

… and they won’t really tell you what happened or why. That just comes back to them trusting you and I think pictures on the walls of kids, kids in the office at the same time. So when you send the manager a scheduling, so we’ll put families coming in when other families are there, especially new families. We can manage it with codes even so they can book themselves and we only allow them to come in times when we know other families are going to be there.

Initially, that’s kind of what we have to do now that there’s just families all the time, but that’s a smart way if kids see other kids they’re naturally less apprehensive to the whole thing. So really figuring out, okay, do I need to focus on trust as me myself? Do I need to focus on trust a chiropractic? Do I need … What do I need to do as a provider to get this mom and this child depending on the age, you might have to get both to a point where they feel comfortable and secure in this environment and they’re confident to move forward with actually getting adjusted and care?

So the second one, building value through sensory. So this is what is the mom and the child hearing when they’re in the office? What are they seeing when they’re in the office and what are they feeling when they’re in the office? I’m excited to do the tactical one for you because I’ll show you like how we show our mom what an adjustment is on a kid. But just talking about what they’re hearing. Josh, walk through this for me. So what if they hear a drop table? What if they hear … In my office kids are crying more so because they see their mom being adjusted than them getting adjusted.

So the kid already got adjusted and he was great, and now he’s sitting there with dad and mom is getting adjusted, he’s freaking out. If you’re walking through the hallway and you can’t see that, a kid for the first time in their hears another kid screaming. So how do you overcome audibly what they’re hearing for their first visit on kids crying or you’re adjusting room, tables and stuff like that happening?

I mean, everything’s explanation. I mean, that’s really what it is and it’s showing them what’s going on. So our staff will actually show them a table if it’s open. They’ll show them or they’ll try and make a connection too if we’ve got another family here that’s like, I mean, that is a great idea. That’s something we try and implement as best we can and so that they can see. Sometimes maybe if mom’s coming in, she’ll bring the family in prior too, and that makes it easier too, because then if she’s like, “Oh, well we’re going to get you guys assessed and then we’re going to get you going.” And they’re like, they do give you that big look and you’re like, what?

And then you go, “Hey, listen … ” And so you show them. I’ll show them like, so I use an integrator sometimes and so I’ll show them what an integrator feels like, like on their hand or something like that, and we’ll work that way. So any of the apprehension that they have, you’re trying to address it specifically with that child. When we do the scans, when the staff is doing scans, they’ll show them on their arm, this is what the scanner looks like. This is what we’re going to do. We’re going to put it here, and then mom’s right there, or the brother or sister. We usually go with whoever’s the bravest first, so that they can kind of see what’s going on, and if someone’s not, the girls know that to take their time and explain very slowly. You slow down for them. You can get onto their level.

Sometimes I’ll get on … I’m 6’2, so sometimes I’ll go down and I’ll get on my knees and I’ll get down and I’ll be like, “Hey, what’s …” Try and talk to them one-on-one to see what’s going on and those types of things too. I don’t want to take away the rest of the adjustment stuff, but at the same time, I guess what you do, you just talk, you show value because you care. You care about how they’re feeling and where they’re at rather than, “All right, get up here, jump on the table. Boom, boom, boom. All right, will see you later. I hope you feel better. You might show up next time.”

Yeah. So those are great points. So number one, show them everything that they’re hearing in the opposite. If they’re hearing a drop table, try to get them into a room at least show them, push down on the table, show them all that’s the sound, that’s normal. Try to show them what they’re hearing so you don’t leave it up to their own imagination on what’s happening because the kids’ imagination will be something crazy. I guess, watched a movie on or something.

Then getting down on their level. If you’re taking notes, that’s another huge one. Try to get eye level with children is so important and you’ll see them open right up, especially kids that don’t really want to communicate with you or are shy or hesitant. That’s just a huge, huge one. Seeing pictures of other kids on the wall. We have a testimonial wall in our office, and so we share different testimonials when we’re giving them a tour, specifically showing them testimonials of kids and allowing them to see another kid that was in the office and a picture of them and their story is just another way to connect with them. So those are the big ones.

Tactile, Dr. Josh mentioned this too. If you use an instrument like an activator, or an integrator, actually letting them push on it or feel it on their hand is super valuable and important. You’ll learn a lot about a kid quickly. Like one of them will just jump forward and want to do it. Another one will be like no way I’m touching that thing. So then you know kind of where to go from there like, “Okay, how [inaudible 00:13:39] is this child?” But even more so with the mom, I’m like if you are a guy and you have huge hands and you’re manually adjusting that kid or maybe even you’re doing sustained contact, you know the amount of pressure you’re using on an infant is just so small, like the amount to indent a ripe tomato repair.

But to a mom, she has no clue what you’re doing there or how hard you’re pressing. So the likelihood of that child crying when you put your hands on them is pretty high, just because maybe your hands are cold and they’re feeling that, just the sensation. So the mom’s instantly going to think, “Oh, I’m sure she’s just crying because the doctor’s hands are cold.” No, she’s going to be thinking your hurting her baby, right?

Yeah, exactly.

And you can’t recover from that. Like if the mom thinks that you’re … You say, “Well, I’m not hurting her,” she’ll go like, “Well she was crying.” Now you’re on the defense. So you always want to be on the offense in these scenarios, and if you could show the mom what you’re doing prior to doing it, then the mom knows prior to that event even happening. So I’ll just show them on, let me see if I can get this on the screen, like on a forearm and if you push on your forearm, you can feel, okay here’s the radius and it’s hard. Here’s like a muscle belly and if I’m feeling an [atlas 00:14:58] and I’ll show the mom with like my fingers, this is what it should feel like, and if I find a subluxation potentially, maybe this is what it feels like.

And you can give them a rating like, okay, if I feel it’s stuck in this one scenario, maybe that’s an eight of a 10 misalignment versus something like this might be a two out of a 10 but all it takes is this much force for about this long on most infants to remove that subluxation. If you’re actually showing them that, now they’re like, “Oh my gosh yeah, that’s not nearly as bad as I thought.” And if the baby starts crying, they already know how much pressure you’re using, so that gets back into the tactile. So no matter what technique you’re doing, I would suggest you do that on the mom. However, you do your technique, however you can emulate it, the closest to what it’s like when you actually adjust that child is so beneficial for that parent to feel it and sense it and know that’s what’s happening.

Yep. No, absolutely.

Solutions. So this one is really important too Josh. You and I talked about this. I think chiropractors get stuck in the mindset that they need to be the one that fixes everybody’s problems. So if a child comes in with bedwetting, you’re thinking, man, I need to fix this kid’s bedwetting. How many visits do I think it’s going to take before I can fix this kid’s bedwetting? If you’re communicating that to the parent, you’re setting yourself up for failure because you really have no control over how fast that kid’s body heals and responds.

I mean, we have a pretty good idea potentially based on your experience, how long it might take, but you never want to over promise and under deliver, and if you’re promising anything like that, you’re really setting yourself up to over promise and under deliver because we’ve always had the … every one of us has had the kid that took longer than we thought and we’ve all had the kid that responded way faster than we thought. But you don’t know which one’s going to show up potentially and which one’s going to happen. You don’t know everything going on in their personal life outside of the office.

You don’t know the stresses that they go through or what’s happening maybe that you didn’t even know and that would totally affect how fast their body’s going to heal, what their home life is and their school life is, and if they’re on medications, all the stuff that we don’t know about. So it’s really important to understand what is it that you can guarantee and what is it that you can measure and show objective improvement. And I can guarantee we’re going to find sub-luxations, and I can guarantee we’re going to remove nerve interference and I can guarantee the function of that child’s spine and nervous system is going to improve.

That’s what my job is and what I know I can do, and it puts you in a place of confidence because I know I can do it 100% of the time, every single time. How that child responds to that is the variable that we’re working through and communicating. So what does that look like, Josh, for you in an office and in an environment discussing recommendations with parents or just giving them hope on that first visit that they’re in the right place without over promising and under delivering?

No, absolutely. I think people will get stuck because it is imposed. A lot of times the parents will be like, “Well, how long do you think this is going to take?” And then you feel like, “Oh, I’ve got to give you, it’s going to take 3.5 days.” It’s like, “Hey, I’m probably not going to give you that.” So you just got to talk what you can, and that’s how we talk, we talk about increase function and how we can help the baby or the kiddo in that sense. Usually I talk with mom about, you’re in the right spot. You would just want to like reassure, “You’re in a great space.” If I didn’t think this is a great one, I usually tell them, if I didn’t think I could help your child, then we wouldn’t even start this process, right?

If I didn’t think that we were going to be a good fit, then we wouldn’t even be at the table here and we wouldn’t be even doing adjustments. I know that we’re going to get your child better and they’re going to function better, and so it’s just going to take some time and repetition and with those types of things, you try and you’re going to assure them that they’re there and in a good place. I’ve had moms where they’re like, “Great,” and they are on for like a 12 visit care plan and they never ask another question other than what did you adjust today? I’ve met other moms that come in and they’re like, “So what did you do last time? What’s going on with this one? How is this? What’s the Meric chart look like? What’s this chart look like?”

I was talking with his mom … So you have your full spectrum of folks that you want to take care of. So you just really, eye contact and phrases that this is what I expect to happen after this and just being on the offense of things. If you think, if after an adjustment you’re like, “That was a pretty tough adjustment, kiddo might have a rough night.” Talk to mom about that rough night, and so that way you can reassure them, because by anticipating what’s going to happen, you’re going to again make that trust with mom so that mom and dad, and it’s usually mom that’s in, right? But mom and dad, but with the parent and then they start to trust you more because you did. “Oh, it’s going to be a rough night. It might spike that fever.”

Try and take care of that best you know how, but we’ll see you tomorrow and we should be in a better space, but the body increase is functioning better at that point. So just like talking and being on the offense is going to be great and not pigeonholing yourself into, “Well, we’re going to get rid of that. They’re going to have a fever tonight, but it’s going to be gone tomorrow and then colic is going to be gone two days later.” Like, that’s just not going to … It’s not, you’re setting yourself for failure for sure.

Yeah. And I see the exact same thing. Parents always ask, how long do you think this … And usually if we’ve educated them properly up to that point, the way they ask the question is, “I know you probably don’t know but when do you think this is going to get better?” Even for adults. And I’m like, “Honestly, I have no idea. I hope it’s in … In my experience, lets …” Depending on whatever my recommendations were like, “Let’s see a few visits and I’ll be able to tell you if we’re moving in the right direction.”

You see … And you touched on something else there without even really knowing it is always giving them a plan of action. What’s the next step? It’s like okay, this is what I did today. This is what you should expect and this is what I want you to do next, because a mom or a dad with a kid that’s sick or has an issue wants to be doing … they want to help their child, they want to do something proactive. They don’t want to just sit and wait. So if you give them something like, “Okay, I’ll see you tomorrow and this is when I want to see you next and we’re making progress, we’re doing something,” they’ll sleep better knowing that, okay, I’m intentionally taking the action to help my child get better, and he told me this is what I need to do next, and I’m going to go do that and I’m going to find out what I need to do next after that. That’s just so, so important. So I got a question for you, Dr. Josh that was asked on Facebook. How do kids deal with the beard?

They love it. They love it. Honestly, I’ve never had a kid like, “Oh, you’re so scary, you have a beard.” I’m a dad, right? So I’m going to totally admit to, I tell dad jokes all the time. I was going to say that initially with trust too, is that dad jokes are like … it’s like this secret thing you can handle. You just say some dad joke and kids like start laughing.

What’s your best dad joke, if you have one.

Honestly, I go on the moment, whatever’s going on, and I try and read mom and dad. Maybe mom and dad came in and they’re sitting down and they had a tough talk about school, and I’ll be like, “Well, why aren’t you doing your schoolwork?” And they would be like, “How did you know I wasn’t doing schoolwork?” And then like, “Well, you should do your schoolwork before you come to get adjusted.” They’re like, “How does this guy even know anything about my life, right?” Then all of a sudden I’m like, “I’m just kidding. I don’t know what’s going on.” You know? Then it kind of creates a connection. I wish I had one that I kept in my back pocket, and be like a planned dad joke, but they’re usually on the fly and it’s usually something that I would say to my kids.

Like, “Hey, maybe your shirts a little short there, huh?” Then they’d be like, which is controversial, right? But at the same time, mom’s over there like, “Yeah, I already told them. I already told them, right?” I would be, “I’m just kidding. I don’t make those decisions. Your parents make those decisions, but let’s get you adjusted,” and they’re like, “Okay.” It breaks the ice basically, so dad jokes. The beard, it’s never come up. Honestly, most people come in and in the area we live the majority of folks have beard. Majority of dads have beards. It’s a mining town and so they’re like oh, this guy’s like my dad. Wait yeah, he’s like, it’s not that bad.

Awesome piece of advice, just try and make yourself look like most of the dads in your community.

There you go. Yeah, for sure. I mean, you want to blend into your community. You kind of dress up I must admit, and most of them aren’t wearing button up. But I get T-shirt days too, so.

Dr. John in our office, I’ll give him the credit for this one. He always says see you around like a doughnut. That’s what he says in our office like 100 times a day. I’m like, kids love that. But yeah, just connecting with them, being normal, being fun. We have six kids ourselves, so I’m coming up with all kinds of new stuff every day that I learned from my kids.

I like to do cliché things, so if it’s cliché that like a parent shouldn’t do it. So I’ll give like … I’ll go shake hands … Well, it’s not frowned upon now. Well you can do a fist bumps. I’ll literally do fist bumps very awkwardly. There’ll be sitting there and I’ll be, and just wait for it, and then they do it, and then I’ll blow it up and I’ll build big old eyes and they’re like, “What are you doing?” I’m like, “I’m just kidding; I don’t really do that.” Then I’m like, “Come on, let’s go on the table.” I don’t know, just cliché, awkward.

TikTok’s big, so I’ll try and do a half TikTok dance or something like that, and they, “Oh my goodness.” Especially when my kids are in the office and they’re teenagers and they hate it, but they love it. I just got to break the ice. There’s this time for seriousness, there’s a time for fun and we should try and have as much fun as we can.

Cool. So hopefully you guys got something out of this. I like to keep this at 20 minutes for you so you can watch it on a lunch break or something quick. But those are some just quick go to stuff that we do on a first visit to build trust and just engage with people. If you would need to connect with me, Dr. Erik Kowalke, we do a lot of pediatric training in the AMPED program. We run SKED Incorporated, which is the automated appointment reminder system and you get a white label app for your office. We run that and we use that tightly in our office.

You can reach out to me on my Facebook page, Dr. Erik Kowalke. If you want, my email address is Dr. Erik, Good luck trying to remember that one, or you could comment below in this thread whichever page you’re watching and I’ll try to catch back up to you on there. If you have any questions after this too. Dr. Josh, if they have questions for you or they want to come see your office even, I’m sure you’d be open to that. Where can they find you again?

Oh yeah, we’re always open. Always open for that. So Facebook, Instagram, you search me, Josh Byers, the guy with the beard, so mostly other Josh Byers don’t have beards.

And you’re welcome to come to our office too. If you live in Michigan or come by Grand Rapids, we’d love to have you. It’s a super fun place to hang out and visit. Next time I hope to bring you, what is this? May. So in June, a guest to specifically talk about pediatric radiology and what you’re looking for in pediatric films and some anomalies to look for. I don’t know who I’m going to bring on yet. So if you are a pediatric radiologist or you know someone that you trust in pediatric radiology that you think would be a good guest for this, shoot their message my way, and connect me with them. But yeah, that’s what we’re going to talk about in June.

So hope you guys have an awesome May. The sun is starting to shine everywhere you are. Again, thank you Dr. Stu and ChiroSecure for hosting this, Look To the Children. Again, my name is Dr. Erik and Dr. Josh. Thanks for tuning in.

Today’s pediatric show, Look To the Children was brought to you by ChiroSecure.

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