Competency Leads to Patient Compliance

Competency is the ability to meet all the requirements that are needed to handle something perfectly. That’s competency.

Where does it come from? It comes from Latin, and it’s to strive for the attainment of something. When somebody is highly competent at what they do, it means that they are excellent at what they do. They can meet the demands of the situation.

Let us bring that into patient care and personal injury.

In the personal injury market today, one of the biggest competencies that must improve is the competency of the doctor understanding exactly how badly injured his patient is.

Competency comes from knowledge. It comes from knowing. It doesn’t come from being blind to something. It comes from knowing it and understanding it.

Spinal ligament injuries are the number one cause of pain and disability in the world today because in general, the market is highly incompetent in understanding how to diagnose this condition. We cannot get a good result with patients unless we understand how to diagnose the condition.

The idea out there today that MRI is the best way to diagnose a ligament injury is absolutely ludicrous. I mean, ligament injuries have two imaging biomarkers. There are 220 specialized ligaments. 23 of those are discs.

Yes, you are going to pick up a disk herniation on MRI, but that’s 10% of the disc structure for the most part.

The other imaging biomarker that’s so important is excessive motion. When ligaments are damaged in the spine, it causes excessive motion.

We can see this on CRMA imaging. Therefore, we can determine how badly damaged these ligaments are by how much excessive motion there is. Of course, we can also have a combination.

We could have both excessive motion and disc herniation at the same segment if a disc is involved if it is in a segment where there is a disc involved.

Remember, in the cranial cervical junction, we have no discs. The only thing we are going to see there is excessive motion.

How does competency in this lead to patient prediction?

It is really simple. The more that you understand your patient’s injuries, the more that you understand the path that the patient is going to take.

Let me give you an example. With spinal ligament injuries, patients will start to receive conservative care. The doctor that understands what that patient is going to go through has the ability to predict what they will go through because they understand it.

In other words, if I’ve been down this path a lot of times before, I have the ability to predict what will happen.

If I’m a Sherpa and I look at someone and I say, “Wow, they’re out of shape,” I’m going to predict that they’re going to get altitude sickness, so I’m going to take precautions. I’m going to have more oxygen for them.  That’s what a good guide does.

Doctors in rehabilitative care today are guides. They are guiding the patient through their recovery.

This knowledge makes one more confident. The more that you know, the more you can understand and predict what your patient will run into along the way.

Every patient is different. A patient that is 45 years old, out of shape, obese, has high blood pressure, is on two or three different medications for health conditions, is not going to rehab the same as a 25-year-old who has 6% body fat, is in the gym four times a week and is a vegan and completely hydrates their body. These people will rehab differently.

But when you have spinal ligament injuries and you know spinal ligament injuries, then you can predict.

One of the biggest predictors, when you get backtest results that show how badly damaged a person is and you’re explaining it to the actual patient at that point, it’s very easy to say, “Look, most people will find that they will start to gain improvement in recovery quite nicely. However, ligament injuries cause instability. Anything that’s unstable is prone to erratic or unpredictable behavior”.

Inform the patient about what can happen. For example, “You can feel that you’re doing great, you’re moving along just great, and all of a sudden you have a setback. You slept on the couch wrong, you slept in a funny position wrong, you slept with somebody’s pillow that was different than your own pillow, you fell asleep at work in the chair and your neck was in a funny position, and it feels like you’re right back at day one with care. You’re not. You need treatment or two”.Especially if a chiropractor is a treating doctor, they need an adjustment or two, and usually, they’re right back to normal.

Now, if you don’t tell them, “Hey, one month, two months, three months into care, you can experience this,” and they experience it, then they think that your care did not work. They think that your care is not good. They think that it’s failing simply because you weren’t competent in the route, you weren’t competent in guiding the patient.

Because if worked with ligament injuries enough to predict what may happen, you can explain that to the patient. And when you explain that to the patient, if a patient now hits that, if they now hit, “Oh my gosh, I woke up… I was watching the Green Bay Packers get beat by the San Francisco 49ers and I fell asleep, and, oh my god, it feels like, my neck, right like it was after the car accident three months ago. And I’ve been in treatment for three months. Oh my god, this isn’t working.”  If you communicated beforehand, they will know you are competent

Now, here’s another example. When a patient has a serious ligament injury to the spine, because it causes instability, they may need lifetime care. As a Doctor of Chiropractic,  a licensed Doctor of Chiropractic for 30 or 31 years, I have been adjusted ever since I was born. My uncle was a chiropractor. I have very little spinal issues. Matter of fact, I’ve never had a problem with my back. I’ve never had a problem with my neck. Have I been in car accidents? Yes, I have. Have I been in rugby accidents, have I had rugby injuries? Yes, I have. Have I had sports-related injuries? Yes, I have. I broke my arm in two places. I broke my leg once. I broke my collar bone twice. I broke my scapula, my shoulder, in five places. So yes, I have had injuries. But do I suffer from any kind of ongoing chronic pain in my spine as a result of any of these injuries? No, I do not.

Why? Because I routinely take care of my spine. I routinely practice maintenance of my own spine. Now, a lot of patients don’t understand that concept. When you have a ligament injury it can cause the patient to need more care. As the doctor in charge of the patient’s care,  you predict where this comes in.

Week one tell them about the severity and location of a ligament injury and also explain that this can mean that they need some ongoing care, two visits, three visits, four visits a year just to help maintain their spine, much like you would go to the dentist twice a year just to help maintain your teeth. They may need that.  Begin talking about supportive care in week one, not when it comes up three months, four months, five months later. I’m talking about it right away because it’s a fact of life.

If at the end of care, the patient is feeling perfect. They don’t have any problems, they don’t have any pain, and now they’re having a hard time understanding why should they come back and see me four times a year for the next year or two just to make sure that this all stays stable. They don’t understand that, so they don’t opt for it.  I’m explaining because I have the ability to predict. I’m competent in this field.

Just for example sake, a patient’s name is Mark. “Mark, do you remember what I told you about these ligament injuries? I said that they cause instability. And anything that’s unstable is prone to erratic or unpredictable behavior. Well, the reason why I’m saying that is because you can start to have a symptom come back because of that instability. It does not mean that our care failed. 

I noticed you’re not opting to see me on a regular basis for the next two visits a year or four visits a year. You don’t want to schedule that. That’s fine. I understand that. But here’s what I want you to also understand. Two things. One, if the pain starts to come back, I do not want you to think for one second that our care didn’t work. It worked perfectly. It just means that the instability has now gone active and you need to come back in for an adjustment or two, a treatment or two, and you’ll be right back to where you were.”

If you tell them that and you basically tell him, “Hey, look, you can hit this,” and they hit it, your credibility goes up, not down. If you don’t tell them about it, so if you don’t give them their future prediction of what they can hit, and you don’t tell them about it and they hit it, they think your care failed.

This inability to communicate will cost you a lot in referrals. It’ll cost you a lot in goodwill. It’ll cost you a lot of patients who think, “Oh my gosh, I just went through three months, six months’ worth of care, and now this thing is starting to go chronic. This didn’t work.”

This occurs simply because most doctors don’t understand ligament injuries enough to understand what to communicate to the patient. If they do communicate with prediction, their patient understands more about their condition.  They are more compliant.  They get better results.  And you get better referrals.

It is very, very simple.

You have the ability to predict. I have the ability to predict. If I have a patient who’s somewhat unhealthy coming into these injuries, then it’s going to take longer. I have the ability to predict that it’s going to be slower.

I have the ability to predict, if they’re not compliant with their treatment program, that it’s going to be more problematic.

I have the ability to predict, if they’re super dehydrated, that their risk for long-term chronic pain is higher.

I have the ability to predict, if they’re obese, that same thing, their long-term risks for chronic pain is much higher.

I have the ability to predict a lot of things.

The providers that we train to do as well.

When you have a spinal ligament injury, you have to find somebody who understands this injury. It is the most common cause of chronic pain and disability in the world today and it’s the most expensive injury in the market today.

There are too few doctors whose primary focus is this condition, whose primary focus is leading their competency in this area to be extremely high.

I have a program called the Smart Injury Doctors Program. We’re creating some of the most competent doctors in the market today for spinal ligament injuries.

That is what these programs are about.

They are short, sweet, and to the point.

What I’d ask you to do is, if you have difficulties in the personal-injury market right now, you have difficulties in the work comp market, you have difficulties in the injury market, tell me what they are.

These are some of the easiest injuries in the market to work with once you’re competent with the condition. Really.

These are not hard injuries to work with. It’s just that there are so few doctors that even understand how to at first just confidently diagnose it and really be competent with it. I mean really certain with it.

For more information on Spinal Ligament Injuries please check us out at http://www.smartinjurydoctor.comor check out our SmartInjuryDoctors® Podcasts on Apple Podcasts, Spotify, Google Play or Stitcher.

For information on spinal ligament testing by board-certified medical radiologists go to www.thespinalkinetics.com