November 2015
TABLE OF CONTENTS page 1 CHIROPRACTORS PRESENTING CHIROPRACTIC TO OTHER HEALTH PRACTITIONERS Presentation Tips Getting Ready Presentation Day Following Up page 3 COMMON QUESTIONS AND HOW YOU CAN ANSWER THEM Chiropractic Care and Practice Style Differences with Other Providers Paying for Chiropractic
CHIROPRACTORS PRESENTING CHIROPRACTIC TO OTHER HEALTH PRACTITIONERS As a chiropractor, you are deeply familiar with the many ways patients and health care teams can benefit from the care you provide. Your clinical experience and expertise will help you confidently present the case for chiropractic and collaborative care to other health professionals, executives and administrators at health care institutions and other decision makers. These presentations can open the door to long-term collaboration that benefit patients and your practice. While you know chiropractic well, you may want to build your capacity to engage and interact with audience members from other parts of the health care sector and their questions. The OCA is here to help. Let s go over some presentation tips and address some common questions your audience may ask. PRESENTATION TIPS Getting Ready Plan a presentation you feel comfortable with. Some people like using slideshow software like PowerPoint, Keynote or Prezi. Audience members often remember visual information best diagrams, images and videos and slideshows are a great tool for this. If you prefer a low-tech solution, handouts work well too. The most important thing is that you feel confident and comfortable. Choose the strategy that allows you to feel at ease when you re presenting. Practice is crucial to success. Like an athlete preparing for competition, repetition and practice are the keys to a smooth presentation. Don t worry you don t need to memorize! Focus on being very familiar with the content and flow of your presentation. This will allow you to present confidently and naturally and it will prepare you for audience questions. Know your audience, the community and the health system. Come prepared to talk about your audience s main areas of interest and focus. If the community has some particularly interesting health initiatives, especially if they are relevant to chiropractic, be ready to discuss them. And finally, demonstrate your knowledge of the provincial health care system and how chiropractors engage with system priorities, such as increasing the quality of patient care and reducing costs. Anticipate the questions you might receive from your audience. The more you can do this in advance, the easier it will be to give a great answer. Some specific questions are discussed below. Try to think of other questions that might come up too! 1
Presentation Day Arrive early. Setting up at the last minute can be stressful, especially if technology is involved. Be sure to create a great first impression by arriving with enough time to test your equipment and get situated. Make sure people can hear you. Depending on the size of the room, you may need to speak up. As you re getting started, ask people at the back of the room if they can hear you and adjust as appropriate. Remember to speak towards the audience not your slides! Use familiar language. While your audience will understand terms like repetitive strain injury, certain words that are common to chiropractic may be less familiar. Communicate clearly by sticking with terms that you all share. Not sure if your audience uses a particular word in their practice? Ask them! Stay on point. When answering questions, it can be tempting give a lot of information and to go slightly off-topic. Try to keep your answers concise and on topic. This shows respect for your audience s time and helps them to remember your main points. If you re asked a complex question, you can give a brief summary and offer to discuss the topic in more detail with them after the presentation. It s okay if you don t know the answer to a question. If this happens, be honest! You can say you re not sure right now and that you would be happy to look into it and follow up with them. They ll appreciate your candour and the opportunity to connect with you afterwards. It can even create the opportunity for another meeting that moves your collaboration forward. Stay positive. Demonstrate that chiropractors are team players by always speaking well of other practitioners, your patients and the government. Focus on the positive ways chiropractors can contribute to patient care and work effectively with all other providers, patients and stakeholders. Think of your presentation as the first stage of a process. If you feel a bit overwhelmed, remember that each presentation is one of many opportunities to communicate with your audience. You can always follow up with more details, or volunteer to give a second presentation if they seem interested in a particular topic. This first presentation is a chance for you to introduce yourself and begin the conversation. Following Up Leave literature behind. Materials on chiropractic, clinical efficacy and chiropractic contributions to shared care will reinforce your key messages after the presentation. They can also remind your audience of the contribution you can make when they come across them in their offices in the days and weeks following your presentation. Contact the OCA in advance and we will send you professional, targeted materials you can share. Make it easy for people to follow up with you. Remember, this is an early step in building this relationship. At the end of the presentation, encourage them to follow up with you by sharing your business cards and/or providing your contact information on your last slide or a handout. Follow up! Keep the lines of communication open by sending a short email a day or two after your presentation to thank them for their time and ask if they d be interested in any further information. Your goal is to keep the conversation moving forward and address any unresolved questions. 2
COMMON QUESTIONS AND HOW YOU CAN ANSWER THEM Most presentations have a Question and Answer period at the end. This is an opportunity for the audience to request more details or clarification on something in your presentation or ask about something new. It s also an opportunity for you to reinforce your message and build a stronger connection with the audience. It s also a great chance to uncover opportunities for follow-up conversations. Of course, answering questions can be challenging (and a little nerve-wracking). You may face some questions you ve never considered before, or someone might be looking for data which is not available to you at the time. Someone may have a bias against chiropractic and may even try to stump you. If you can handle these questions with expertise and friendliness, you can enhance your credibility and that of the profession. Let s examine some common questions and some key points you might wish to use as you respond to them. CHIROPRACTIC CARE AND PRACTICE STYLE What is the chiropractic scope of practice? And why is there such diversity in practice style? As regulated health professionals, the chiropractic scope of practice is defined in the Chiropractic Act: The practice of chiropractic is the assessment of conditions related to the spine, nervous system and joints and the diagnosis, prevention and treatment, primarily by adjustment of: dysfunctions or disorders arising from the structures or functions of the spine and the effects of those dysfunctions or disorders on the nervous system; and dysfunctions or disorders arising from the structures or functions of the joints. Within this scope of practice, many chiropractors go on to develop a specific focus for their practice such as injury rehabilitation for athletes or wellness and healthy living. This professional diversity allows patients to find a chiropractor who is a good fit for them. All health care practitioners must practice within their scope and their care should be patient-centred and evidence-based above all else. The key to finding a chiropractor that is a good fit for your patient is to get to know them and learn about their practice focus and style. How often do chiropractors re-evaluate their patients to determine if a prescribed course of treatment is working? If it s not working, what do you do? Some form of patient reassessment is a key component of most patient visits to help track a patient s progress. Where a patient is not progressing under my care, I refer them back to their primary care provider, with notes describing the course of treatment we tried, and how the patient responded. If my patient seems to be facing a health challenge that falls outside of my scope of practice, or if they would be better served by seeing another provider, I refer them back to their primary care provider with the appropriate clinical notes. 3
Is there any risk of stroke associated with chiropractic care for neck pain? Research has not found a causal relationship between chiropractic care and stroke. Strong evidence indicates that while there is an association between chiropractic care for neck pain and stroke, the association is no stronger than the association between primary care physician care and stroke. The Bone and Joint Decade 2000 2010 Task Force on Neck Pain and Its Associated Disorders published their research, including this finding in several journals, such as Spine and the European Spine Journal. One possible explanation for the observed association between either chiropractic or physician care and stroke is that patients might be seeking care from a chiropractor or physician precisely because of the stroke-related symptoms they re already experiencing (e.g., neck pain or headache). The Canadian Chiropractic Association recently released its Clinical Practice Guideline for the Chiropractic Treatment of Adults with Neck Pain which provides guidance to chiropractors with respect to treating patients with neck pain. This guideline is based on a systemic review and evaluation of the most recent literature. It makes clear recommendations on conditions like stroke, including identifying risk factors, diagnosing and referring as appropriate. Do chiropractors have experience providing rehabilitative care and are they equipped to prescribe exercise as part of treatment plans? While chiropractic care is often perceived to be focused on spinal manipulation and this is one of our core competencies the role of therapeutic exercise is absolutely essential to the care we provide. Exercise prescription is utilized by chiropractors very frequently. I personally prescribe it to XX% of my patients. Chiropractors extensive training allows them to develop highly tailored exercise programs and guide patients through them with a consistent focus on goal setting and progress. Is there evidence demonstrating the efficacy of chiropractic care? There is a growing body of evidence that chiropractic therapy is an effective mode of conservative care MSK treatment. In particular, journals such as the British Medical Journal, Spine, the Spine Journal, the Archives of Internal Medicine, and the Annals of Internal Medicine have published clinical practice guidelines and high quality studies (including randomized control trials) which have demonstrated the efficacy of chiropractic in improving back and neck pain patient outcomes. 4
DIFFERENCES WITH OTHER PROVIDERS What is the difference between a chiropractor and an osteopath? In Ontario the title Osteopath is restricted under the Medicine Act to physicians with a DO degree, which is not available in Canada. These physicians are regulated by the CPSO. There are a number of short courses to teach osteopathic techniques, but those who take these short courses are not regulated as osteopaths, may not call themselves osteopaths, and may not perform the controlled act of spinal manipulation unless otherwise authorized to do so. What is the difference between a chiropractor and a physiotherapist? Both chiropractors and physiotherapists are trained to perform comprehensive MSK patient assessments and provide conservative care for patients MSK challenges. And both are regulated health professionals in Ontario. The most important thing to consider when making a referral is to choose a provider with whom you can build trust and rapport and who is a good fit for your patient s care needs. Chiropractors rigorous education in spinal manipulative therapy, which is part of many clinical practice guidelines, is one defining feature of chiropractic. This training consists of more than 450 course hours spent learning about the biomechanics relevant to administering spinal manipulation therapy, perfecting their technique and identifying contraindications. While other professions also provide MSK care as a part of their practice, chiropractic s primary focus on MSK care fosters a depth of specialized knowledge that sets us apart. PAYING FOR CHIROPRACTIC Under what circumstances are chiropractors funded in the public system? All interprofessional primary care teams in Ontario Aboriginal Health Access Centres, Community Health Centres, Family Health Teams, and Nurse Practitioner-Led Clinics may now hire chiropractors. Patients rostered to or receiving care through any of these teams with a chiropractor on staff can access chiropractic through public funds. Chiropractors also provide care through Workplace Safety and Insurance Board Programs of Care, which are publicly funded. 5
How do patients who do not have private insurance coverage for chiropractic access your services? Most chiropractic patients rely on extended health benefits, and many patients without these benefits cannot afford to pay for chiropractic services. This is a situation that concerns many chiropractors, particularly given the correlations between low income and poor health. Several chiropractors have set up volunteer chiropractic clinics at Community Health Centres and other health clinics in their community, offering pro bono services to low-income patients. If you are open to alternative fee arrangements for low-income patients, you may also wish to say: Many chiropractors are also open to negotiating reduced fees for patients who cannot afford regular chiropractic fees. If you are considering setting up a referral relationship with a chiropractor and you are concerned about chiropractic access for your patients who do not have extended health benefits, please ask the chiropractor how they would approach the situation. It is possible to set up referral agreements which specify that referred patients without extended coverage may receive care on a pro bono basis or at a reduced fee. How are claim payments made for WSIB patients seeking chiropractic care within the context of an interprofessional primary care team? An interprofessional primary care team (such as a Family Health Team), its employees, or any providers it has contracted are not allowed to bill the Ministry, a patient, or a third party for services that fall within the scope of the service agreement the team signs with the Ministry. For services that fall outside of the scope of the Ministry service agreement, a team may be able to collect revenue from third parties such as WSIB or insurance companies (which they would, of course, be required to report). Beyond that basic rule, these determinations are made based on an interprofessional team s existing policies related to the collecting, disbursing and reporting of such revenue. WE RE HERE FOR YOU! Need help preparing a presentation, responding to a follow-up question or finding resources to share with a potential partner? We are here to help. T 416-860-0070/1-877-327-2273 W www.chiropractic.on.ca E oca@chiropractic.on.ca 6