I’ve been ruffling feathers over here while speaking at AIMA in Auckland. While I am pretty familiar and comfortable with that role (& responsibility?) – this topic ruffled my own, arguably the most. In fact, I kicked off the presentation with, ‘What I’m going to say might make some of you uncomfortable but you know what, it makes me uncomfortable and if it makes you think a little less of me, well, to be honest, contemplating these issues has already made me think less of me!”
As an educator in integrative health, I have overwhelmingly been a peddler of knowledge and skills under the headings of: ‘WHY’ and‘WHAT’
Why – as in why does this patient present in this way, at this time. I am passionate about upskilling practitioners re our powerful contribution to the diagnostics & work-up of each individual. What – as in what changes (supps, herbs, diet etc) need to happen to correct for these very unique elements of imbalance in this patient to therefore aid resolution. We might label this, ‘personalised medicine’. But after so long in practice it’s patent that the best results don’t come from being the cleverest clinician nor the biggest biochemical brainiac. Knowing the ‘why’ and even the ‘what’, while enough for a minority of patients, fall short for the rest and can still fail to be truly about, & exclusively with, the most important person, in mind.
We’ve learned this before but it needs to be said again and again and again: much of any medicine is via the therapeutic relationship – and as part of this, our ability to PLACE the patient at the centre of their own SOLUTION. And therein lies the conversation we need to have in detail with them about the ‘HOW’ But how much time in your current consults is afforded to the ‘HOW’?
Being able to effectively negotiate with out patients the ‘HOW’ is an extension of Motivational Interviewing, Behaviour Change Theory & Patient Centred Care. It returns the humanity to our list of recommendations for each patient, pushing back against the autocracy that can tend to slip in with prescription writing. It powerfully reminds us that the prescription is only ever as good as the patient’s engagement & buy-in, and that’s only ever as good as our ability to write a prescription that is accessible & readily transplantable into their existing lives: to co-create with them Patient Centred Prescriptions. Someone in the audience had been my patient in the past – double awks right – because I absolutely know, I didn’t know this well enough back then. Back then when they were unable to do exactly as I had recommended – with their diet, their supps, their sleep, their work-life balance – they had, in turn, apologised for their ‘weakness’, ‘lack of willpower or diligence’ and me, being ever so gracious, accepted those apologies only to repeat the error of my ways and write yet more scripts that set them up to fail. 🤦♀️ I am committed to getting better at this and in this endeavour, giving both more attention & time in my appointments to the ‘HOW’ & yes I think we need to think creatively about how we use our appt time and between session touch points to achieve this – keen to hear about your perspective and experiences.
At the end of an information & insight heavy appointment, formulating a list of products and doses for our patients to take can feel like a bit of a ‘tada moment’, like a magician pulling a rabbit out of the hat. “Here is the solution – now off you go!” Research tells us, however, that treatment-plans that are a co-creation between you and your patient – evolving from a discussion that not only allows them a voice, but a major role in the decision making – are far more likely to succeed. While we are the authority on our medicines, our patients are the authority on what makes them tick & what’s likely to succeed, in terms of taste, texture, temperature & timing! This is called Patient Centred Prescribing and together with some other tips tricks and hacks I share with you in this episode, can really increase patient buy-in, compliance and therefore bring your treatment plan to fruition and fulfilment!
Are we doing ourselves out of a job? I’ve been talking treatment plans with my New Grads recently. Given, only recently these were major assessment items in their clinic units, they have been trained to create ALL-ENCOMPASSING (biopsychosocial) prescriptions and recommendations of utterly EPIC PROPORTIONS – to simply prove they know it all. Problem is this doesn’t work in the real world.
Emailing your client multiple pages of advice that covers: a whole sizeable supplement schedule that only a military-training could nail (2 tablets 1 XTID 1 X BID, a liquid, a powder, some with food, some definitely not with food) plus dietary advice, plus hyperlinks to exercise advice, mindfulness exercises and a request for follow up investigations before the next appointment…is…a L*O*T!!
It is also ineffectual – because it completely disregards the human on the other end. Let me ask you this, how much change are you capable of between a first and second appointment, roughly a period of 2-3 weeks? Personally, I gotta say not that much. It took my dentist years to get me just embrace flossing & I don’t think I am an exception! With all the knowledge we possess its hard not to see people as (a long list of) problems (& problematic behaviours) that we translate into, and solve via, a prescription.
Effectively we are saying to patients with this practice model, ‘Go change & come back when you’re done & then I’ll probably ask you to change some more!’ That’s both a big ask and a huge missed opportunity.
I hear from reliable sources over the ditch, that GPs are increasingly referring their patients to, or teaming up with health coaches, rather than naturopaths. Given what I’m observing, I get it. Doctors on the whole only have time (and barely then) for a finger-pointing prescription – certainly not the time and touch-points required to actually support patients with the very difficult thing that is, behaviour change. Nor the skills to truly facilitate patients making the necessary and desired changes – so they outsource this role. But we shouldn’t.
After all – I want to be on my patients’ support bench & health care team always – not a flash in the pan, that blinded them with science or my ‘smarts’ and proved to them in one over-stretching prescription – that naturopathy is not for them, or at least, they’re not fit for the task.
At the end of an information & insight heavy appointment, formulating a list of products and doses for our patients to take can feel like a bit of a ‘tada moment’, like a magician pulling a rabbit out of the hat. “Here is the solution – now off you go!” Research tells us, however, that treatment-plans that are a co-creation between you and your patient – evolving from a discussion that not only allows them a voice, but a major role in the decision making – are far more likely to succeed. While we are the authority on our medicines, our patients are the authority on what makes them tick & what’s likely to succeed, in terms of taste, texture, temperature & timing! This is called Patient Centred Prescribing and together with some other tips tricks and hacks I share with you in this episode, can really increase patient buy-in, compliance and therefore bring your treatment plan to fruition and fulfilment!
Have you ever noticed that our products don’t work if our patients don’t take them?!🙄
The reasons for non-compliance, dis- or non-engagement, poor patient buy-in & follow through are many:
*My dog ate the instructions * My inbox swallowed the instructions *As soon as I left your clinic, your instructions left my brain
Reasons also include far more credible things such as non-patient centred prescribing. This is what most of us do when we’re full of good intentions but short on time at the end of a consult, so we just throw a bunch of products and a script with them out the door. Arguably many of us make this mistake also because our training perpetuated this relic of conventional medicine and paid insufficient attention to the therapeutic relationship. In contrast, patient centred prescribing recognises the patient as best-placed to find personalised solutions to their very individual challenges, including, decision making around dosing regimes. So while we continue to ensure & oversee that therapeutic doses are used and that best conditions for taking certain things are adhered to – your patient remains the expert in the room about how to actually achieve this – both in terms of when & where in their very real lives – with a little help from us – and what ‘works for them’, in terms of taste, texture & temperature.
That’s right, I said temperature…are you telling patients to take everything at room temperature??
You need to think again – this is something we can safely manipulate with many powdered & liquid remedies (some exceptions of course!) to match patient preferences & radically increase palatability, pleasure and ultimately patient compliance.
Are you like me? I have supplements scattered all over my house – in places that correlate with an action or moment in the day when I am most likely to take them. This is another important element of Patient Centred prescribing, so I work with my patients to identify these easy solutions too. After the gym? In the gym bag. After breakfast as you leave for work? In the key bowl. At work? On the desk beside the computer screen. Keeping taurine in the drinks cupboard in front of the alcohol is another nifty reminder and trick for those looking to ‘pre-load’ and cut down! Tips and tricks like these save our over-loaded memory. They remove or minimise barriers. They make compliance less effortful. And as a result, you know what? They might just get the results we would have expected!
Compliance Changers – Strategies for Success
At the end of an information & insight heavy appointment, formulating a list of products and doses for our patients to take can feel like a bit of a ‘tada moment’, like a magician pulling a rabbit out of the hat. “Here is the solution – now off you go!” Research tells us, however, that treatment-plans that are a co-creation between you and your patient – evolving from a discussion that not only allows them a voice, but a major role in the decision making – are far more likely to succeed. While we are the authority on our medicines, our patients are the authority on what makes them tick & what’s likely to succeed, in terms of taste, texture, temperature & timing! This is called Patient Centred Prescribing and together with some other tips tricks and hacks I share with you in this episode, can really increase patient buy-in, compliance and therefore bring your treatment plan to fruition and fulfilment!
You can purchase Compliance Changers – Strategies for Successhere.
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Shhhhhhhh(eesh)! I am confessing my sins. As part of our mentoring discussions we try to keep one another honest & in-check with, what seems to be, integrative health professionals’ innate flair for over-delivering. Name someone right now from another health modality that spends as much time on researching & working up your patients as you do. Name another kind of health professional who makes themselves as accessible as you do to their patients. See, I know your type. And feeling like a donkey (in many regards) but especially as in the context of this evocative picture, is not something that happens just once in your career, which you learn from, adjust your load, and never repeat. I should know, I’ve had a bit of a donkey year, myself 🙄
Our old mate, Albert (Einstein), said, “Wisdom is not a product of schooling but of the lifelong attempt to acquire it.”
I think, for health professionals (at-times) over-endowed with care mixed with an infinite curiosity (for answers), we can find ourselves with quite the ‘heady mix’, an excessively heavy load and on a slippery slope of over-delivering. This manifests in different forms at different stages of our career. I’ve talked about some ‘so-common-I-wish-I-had-a-dollar-for-every’… ways practitioners over-deliver in the clinic before. But for those of us that are seasoned practitioners, we master the basics…no sharing of personal mobile phones or even email addresses, clear communication with clients about appropriate times and means of contact, we even commit to taking some time out for ourselves and our own wellbeing (Wowee watch us go!! Physician Heal Thyself!) but often we just find new ways to over-deliver. They sneak in and up on us. It takes us a while to realise we’re back in a familiar place of dangling donkey feet in the air, over-burdened by our load.
But perhaps we should think of this as Process (a lifetime one of becoming wise, like the other guy said) rather than a pathological problem.
And as we near the end of another year, a very taxing year for many of us, take this opportunity to pause, process the strengths and limitations of our practice model over the last 12months and adjust the load so we can proceed towards an ever more sustainable practice.
Because people need practitioners like us; full of care and curiosity, not overloaded donkeys who can’t go anywhere or carry their own load, let alone anyone else’s.
Got some tips you can share about healthy boundary setting for health professionals? We’d love to hear them 🙂
As a health practitioner, you are always actively building: your reputation, your practice and your knowledge.There’s theoretical …and then there’s applied. Some of the biggest leaps we take forward as practitioners come with being shown how (rather than told) & then being forced to ‘do the work’ ourselves, rather than being exposed to simply more information, be that about pathology, patient prescriptions or practice structure! The slogan ‘Just Do It!’, might have already been nabbed and TMed by a huge corporate beast, but this doesn’t undo the universal truth of it! Prefer your mantras to come from mystical philosophers rather than monster multinationals? How about this then?
I hear and I forget. I see and I remember. I do and I understand. Confucius
This mentoring community that I am a part of, we are about applied learning. We learn by doing. We learn, not just through each individual’s patient encounters but through the collective clinical experience. We make what can otherwise be an isolating experience of constantly, seemingly, reinventing the wheel, if not many wheels (!), into one of collegiality and ‘using the force’. If you haven’t experienced Group Mentoring with me previously and are thinking about next year being your year (see below to find out more about our 2021 offerings), we put together this fun little video here to get across that mentoring isn’t about a conversation between just two people.
With Group Mentoring you’ll be learning, through the application of core clinical skills, improved patient questioning, methodical information gathering, evidence based answer finding & getting access to resources that you can apply in real-time in your own practice.
“Having the group session each month, as well as having Basecamp to bounce ideas around in, is a reassuring connection to know is there if I need it. Having just started practice this year and working in an environment without other Nats around, I have noticed the occasional feeling of isolation. So having the monthly catch up keeps me feeling connected to other clinicians and gives me exposure to other cases and perspectives that I wouldn’t have otherwise had.” – Georgie
We have a range of groups on offer to suit all levels and most types of integrative health modalities. Go to our Group Mentoring page to discover the groups and bonus extras on offer for 2021.
Going by the landslide registrations for 2020, our ongoing excellent retention rate of practitioners from year to year & our already overflowing waitlist for 2021, the reputation of RAN Group Mentoring is highly regarded and a popular choice.
So, if being part of our community excites you and if the thought of learning and applying collective knowledge from expertise outside of our own, now’s the time to put your hat 🎩 in the ring, put your hand up ✋🏼 & join the conversation 📣 through Group Mentoring.
I am feeling concerned about many of you because chances are, given you’re reading this, you’re running a small business in healthcare right now. Relax, I am not a ‘Doomsdayer’…I don’t think the current situation has to be the death knell for our clinics and businesses, nor even a near-death experience but I do think it requires:
Dedicated and directed thought
Dedicated responsive planning
Follow through actions NOW to pave your way to a sustainable TOMORROW
I do not think it requires a paid business coach. I am a little horrified to see we are already being preyed upon by coaching businesses wanting us to invest more at this financially fickle time to be ‘shown the way to emerge triumphant from this’. That gives me the creeps. Enough said.
But I do know burying our heads isn’t the answer. In fact, that is probably the best way to bury your business for good. From connecting with hundreds of practitioners regularly I can confirm there is a trend emerging that many of us had absolutely predicted: some reduction in return appointments (patients not yet shifting to online or deprioritising long-standing health concerns and prioritising panic instead) and a much more worrying, more financially impacting, bigger drop in new patient bookings. We will only have this unprecedented run on ‘immune herbs and supplements’ for so long. We all need to do the maths…and fast.
Most of us know well enough the bare bones of our business to know this spells income trouble in terms of right now: via a lower hourly fee and moving forward, in terms of loss of expected growth of client base, in a nutshell a process of ever diminishing returns.
Wringing our hands and worrying is not dedicated directed thought. Which is instead about taking business advice from established experts (who have global experience in previous major financial crises) that is already out there for free and just committing the time to reading it and applying it to your own circumstances. The best I’ve found so far featured in Forbes Magazine…and no I have never read this mag before in my life either, only ever bought it for the pictures 🤣😂 BUT this article contains the essentials of what you need to consider right now and you can use it to form the basis of your planning, decision making and actioning. It applies to business generally and some of it is bit hard to translate out of CEO-speak but I’ve put my hand to it here for you. Please look at this, take the time to ask yourself these important questions about what may happen and how you could improve the outcomes of each new challenge. And if you find that still too difficult on your own, grab a couple of practitioner pals online and see if by putting your heads together you are better able to answer the questions this poses. If we learned anything from our horrendous fire season, it was, hopefully, that plans are meant to be made in advance…not when the flames are beating at your door. I recommend you make one, now.
To make it easier for you (and you know how I love creating resources!!), I have extracted and reproduced a table from this article – Forbes’ Business Strategies for 4 Phases of COVID. I’vejust modified it for you to download and use to create positive business strategies and vision for your future. You can download it here.
At the end of last week I spent 3 days engrossed in intensive ANS planning for 2018. As you can probably imagine these planning days are incredibly exciting, creative, stimulating processes. If everyone involved had brain PET scans performed during these discussions, I think the disco lighting effect in our results would be noteworthy (!) and distinctly different from the stimulation that comes from most of our other work pursuits. Does anyone do disco all the time though? Not many of us. This prompted me to reflect back on a little graph I drew for myself this last month – that depicts the various ways all my different forms of work & how they contribute either money or meaning, or better still both!
Diversification of income streams is a key business catch cry, right?
And this is especially pertinent to clinicians.
But work variety may also be important in meeting our multiple values and need for meaningful engagement.(more…)
This year has kicked off with lots of time spent re-calibrating my own and other practitioners’ businesses models via business mentoring and it’s such a privilege. One symptom that seems to creep into almost every practitioner’s business model though, is one of over-delivery. (Curse that empathy and all those good hearts hey!) Over-delivering comes in many forms, it might sound or look like this…
“I always run over”
Rather than responding to this with further self-criticism and , pledging better allegiance to the clock – we could hear this as a reflection that our appointment structure is out-dated or unsuitable. We need to restructure to allow for the time we really do spend and need to spend with our clients and then adjust the appointment fees appropriately. Having said that be aware of the other golden oldie: (more…)
I really enjoy mentoring practitioners in business – it’s a real privilege to be able to hear about each practitioners’ aspirations and challenges. A few weeks back I had the good fortune to speak with a fresh one! A practitioner who has only been in business for a short period of time. As always before our session, I looked over all aspects of her online presence from her website, to her practice newsletters, Facebook presence etc. Goodness how things have changed from when I graduated and you literally just hung out your shingle!! As much as the online world has created incredible opportunities for people working in integrative health and the public who use our services, I think it has also of course brought the ‘competition closer’.
Have you ever wondered what is the best way to grow your business? Not a cardboard cut-out, off-the-shelf kind of business that every business coach talks to, or somebody else’s business, your business? Business advice like naturopathy, according to Rachel, is about taking an individualised approach.
The traditional model of a naturopath was based on a one on one clinical practice model, while potentially still a path to success and satisfaction, this requires a totally fresh and contemporary perspective on what works today. In addition to this, many naturopaths feel a need to diversify their revenue stream in order to work smarter not harder. The naturopathic path is not always conventional and rarely the same for any two practitioners depending on personality, location, skill sets (including non-naturopathic), passion etc.
