Episode Transcript

Dr. Jeff Langmaid: Hey Docs, I’m Dr. Jeff Langmaid here with my co-host, Dr. Jason Deitch. Thanks for tuning in for today’s The SMART Chiropractor show, today’s featured guest. We have a gentleman that I’ve known for quite a few years who’s up in the Great Northeast, I guess you could say Dr. David Graber. Dave, thanks for taking some time and coming out with us today.

Dr. David Graber: My pleasure, Jeff. Jason.

Dr. Jeff Langmaid: All right. So you are a man that’s involved in quite a few different things. You’ve been involved in your state organization. I know you. I’ve seen you teaching your own seminars. You have a practice. I’d love to trace it back a little bit because I know there’s so many docs out there that you go somewhere, you see somebody on stage and it’s exciting. And maybe there’s docs out there that love to get involved with it as you began getting out there teaching technique seminars. How did you have the how did you have the guts to get in front of everybody number one and number two? What was what were some of the first steps you maybe took that that led you to where you are today?

Dr. David Graber: Well, I’m an accidental instructor in a sense. I mean, I taught for a year at what was formerly known as New York Chiropractic College in the 80s. Yeah, I’ve been around that long and worked a little bit with the sports diplomat. And oh, what is it? About 18 years ago, I broke my arm. Don’t ask me the details. It’s pretty embarrassing was. And I had to take some time off the office, so I I’ve started hiring associates or I’m looking for associates, and I did a lot of extremity work and a lot of a lot of motion palpation type work. So I was interviewing them. I came across a number of different doctors and none of them. They lasted a day. I said, Thank you. Don’t go away. And I found one woman who came in and she came in. She was excellent and we worked. And then after I started getting my mobility back after a couple of weeks, I started showing a few things and she was very appreciative. After a couple of weeks, she said, You should teach this. I’m going now. I just came off the diplomat, the first Chiropractic sports diplomatic program. Three hundred doctors all over the country’s top notch. I’m like, I hung out with everybody knows this. And she goes, No, they don’t. I took extremity adjusting. I never learned any of this. So I put together a three hour course eye contact in New York Chiropractic College and the three hour course I found it was actually more like a 10 hour course because we had to go back to the basics and very basic basics. And from there, I just got requests and requests, and I started doing more and more work on different state societies and different organizations. And next thing I know it’s, you know, there it is, 2020 to do, and I’m still doing it.

Dr. Jason Deitch: That is awesome. David, what what what do you think is missing for most chiropractors out there and what they’re learning versus what you’re teaching? What are you teaching that sort of helps chiropractors go next level or gain their confidence or expand their service offerings? What what what is it that you think is sort of lacking out there that you’re really able to sort of fill in for them?

Dr. David Graber: You know, Jason, I hate to say it, but basically I’m talking basics, and I’ve always said that chiropractic practice is centered around the adjustment, not subluxation. That’s a whole nother discussion. But one thing I’ve noticed it doesn’t matter what philosophy you have, what practice style you have when we come together in Chiropractic to get better at learning how to adjust, they all a lot of that stuff disappears. And I really I learned that by doing it, sort of watching, you know, one camp and this camp, and they all came together when they all started getting better at getting adjusted. And, you know, we’re basically a trade where you learn on the job you graduate school, maybe get an associate, you put you’re in practice and you’re learning how to develop your skill while you’re making a living. And so you know, you get like a funnel effect. You learn all these different skills that over the years, you get less and less and less and less and you have a handful of things that you do. And where do you go at that point to get better? And that’s one of the things we started with the seminars and said, OK, let’s see what happens on every joint in the body.

Dr. David Graber: We’re going to go over how to evaluate it, how to treat it, a care plan and a lot of doctors. What they’re using in their practice is they’re not using something based on what they’re finding on the exam. They’re using almost like a road like, OK, everybody’s going to get a 12 visit plan or a twenty four visit plan. They’re not specifying it to the patient and the condition, but they can’t a lot of times because they don’t really know how to evaluate that, how to judge prognosis. But once you start to doing that, a lot of that comes from the hands on the Daly hands on grinding skills that we do every day and improving that doctors get better at actually what they’re doing. And it’s really it’s I love seeing it. I get a lot of joy watching doctors get better, get more confident, feel empowered, understand how to communicate better their patients, also other professionals and also with themselves about what they’re doing.

Dr. Jeff Langmaid: I love that, Dave, and one thing that comes to mind for me is, as you describe that is there’s two aspects of any time you’re adjusting a patient, it’s what’s delivered, right? You know, you know, the force, the vector, all of those factors that are involved in what you know what you are, you know, delivering, you know, to the patient as a manner of speaking. The second is your own body. And I had this discussion the other day with a couple of docs and I said there are a lot of broken down chiropractors when they get older, probably due to poor adjusting skills. Now the docs I was talking to, they disagreed with me, but they said if you’re adjusting in a proper ergonomic fashion, you could adjust high volume for decades and never had an issue. Obviously, you know, everybody’s bringing in their own injuries, their own, you know, how they’re built, et cetera. But what have you seen with that now? Not necessarily what’s being delivered to the patient. We can talk about that in a few moments, but the doctor, the Chiropractor him or herself, do you find, you know, how do you, you know, injury or ergonomics doing it correctly, doing it incorrectly? What are you seeing out there?

Dr. David Graber: Well, that you bring up a really great point, but you also can find doctors who are they’re just they’re just bull. They go in, they adjust even a volume day in, day out, year in, year out. That’s the minority. That is the absolute minority. There’s a reason why, you know, W seminars are like, Hey, get yourself to see 100 patients a day, see 80 patients a day, a hundred and 200 patients a day. These stocks in general, unless they’re doing something like an activator or something very, very light. And on their body, they’re not doing it for long. That’s what I found out for a fact. They either burn out or they break down. And that is what happens in the majority of cases with that. A lot of doctors I see, yeah, they we have the walking wounded of Chiropractic. You know this, this profession takes a toll. I’m one of a few years ago, I had a herniated disc in my lumbar spine. I didn’t know if I’d be able to continue practicing. Fortunately, everything turns into an opportunity. I actually learned a whole lot of things I can taking care of this by taking care of myself and getting treated myself to a Mackenzie work. So the work by McGill, the stabilization which I kind of got away from and wasn’t doing, learned how to do that got treated by other chiropractors doing different things that I did.

Dr. David Graber: And that was a little bit of a game changer for me because I look back and say, Oh, what else can we do this do? But as you back to your original point, yeah, bad ergonomics is endemic. Quickly, I did not practice for six months after school graduating because I actually had a wrist injury from basically some very bad instruction, particularly constant. And again, I still have it. It lingers on. Injuries abound in this profession, and a lot of it is from bad technique and we all get into bad habits, myself included. So you need somebody to give a feedback mechanism. And that’s one of the reasons going to seminars can do that. And that’s what they never understand. Will come to a technique seminar and I’m like, Good, let me work with you. They sit back and they watch. They watch, they watch me adjust going, Look, I know this. That’s why I’m here. I want you to do this. And so they got other people to come in there and they’ll they’ll do it. And then they’ll spend the rest of the time like a coffee klatch. And I’m like, Wait a minute, come here. Let me watch you show me what you do. Forget about what I do. Show it what you let me show you how what you do better if you don’t want to take anything from here and I don’t even care what I’m teaching, I’ll show you slide.

Dr. David Graber: We’re doing upper extremity. Your problem inside posture. Let’s go over it. How’s your cervical adjust? And doctors who do that, they never, never walk away, not being a little bit better. And the first thing I work on is ergonomics. And the second thing I talk about is core and conditioning, because that’s another thing. I guess I get kind of like brushed aside. We’re in a physical. We’re athletes, we are in a physically demanding. We are the blue collar of health care. And you have to keep your body if you’re not putting in a good 15 to 30 minutes every day of cord structural strengthening in your body. It’s going to break down eventually, no matter how good a technician, because there’s a demand that’s being put on us, but it doesn’t take a whole lot to actually do that. Get your technique a little bit better. One simple thing any doctor can do is put a mirror in there adjusting room so they can look at themselves not to see how good their haircut is or how good the makeup looks or how bitchy the outfit. But look at yourself when you’re over a patient, are your shoulders up? You know, is your head a line? You look at your own positioning with that. It’s a very stupid, simple thing. Or feel the patient.

Dr. David Graber: Listen, I’m going to a technique seminar. They want to watch me. My technique and action. Would you mind if I film this, this this visit, you have to sign a release and they do that and then you can watch it. Now, first off, most I tell patients, I tell doctors all the time, you do that until patient safety. Videotape yourself. Video Look, I’m dating myself. Record yourself at your workstation. You never record yourself doing your golf swing and let me take a look at it. Few of them do, but doctors don’t. And one reason they probably look at it and just get nauseated feel like, Oh God, I’m not sending you this, and I don’t really care because I have seen so many things which I feel like I’m saving a career, but I start getting involved with doctors to do this. And that’s you’re absolutely right. There’s always going to be outliers in this profession. You’re going to get me out of a soapbox stuff. But this profession, a lot of times, if it’s working for me, I just think that I’m doing it the right way and everybody can do it. That is so much. Chiropractors have it and we just live in our kind of our own narrow view box, not realize that a lot of chiropractors are successful in certain areas and certain domains of practice. But they’re outliers. They are the exception, not the rule.

Dr. David Graber: You know, you guys see it all the time like you do marketing and I’m a client of yours and I love your service and I’m thinking, Why do I love it? Because I could never do this. I could never do what you do. I patient walk it. Hey, I got the email that you sent out and they sort of talking about it, and I’m embarrassed because I didn’t look at the email that I don’t know what they’re talking about a lot of times, but they’re it’s very conversation. So I’m like, OK, am I going to continue doing my marketing? No, I said, I’m going to get smart. I’m going to hire Unmarket Chiropractic. You know that, by the way, that is an unsolicited plug for you guys because I love your service, by the way. Thank you. But the same thing. Any domain marketing communications, you know, a new doctors. When I find new doctors right now, if they if the patient leaves as I did everything right, they hit all the checkbox. They evaluated it right. They covered. Are Basis Health, they had the right care plan. Patient doesn’t stay, and I’m saying, you know what, doc? You did everything right, but you weren’t right. You didn’t say something right. It didn’t come across correctly. You didn’t read the patient, right? Well, I said this, this and this. Ok, what kind of a patient were you dealing with? Did you have an emotional fit? Did you really feel comfortable with them? Did they feel comfortable with you? What was your staff? If you have no idea, what does your office look like? They’re going to make all these judgments are going to be contributing to the decision to stay with you or not.

Dr. David Graber: And you thought your technique was great. I do a lot of great technicians, but their technique hurts. And my first Chiropractor, not my first Chiropractic Chiropractor inspired me to go to school. He was a flying seven fifty second adjustment. As I said to him, one time I was at school, I came back and was like, I’m learning this, this this. He goes, Let me tell you something, you do that your patience will be so, so much in pain. They will come back. That’s a very, very uncomfortable to toggle people. You want to do this? No, I do this because it’s not the best thing for the patient, maybe. But I know that I can get results and they’re going to come back for it. And I thought that was absolutely crazy. Now, years of practice, I realize what he’s talking about. Some patients, you know, doing good is good enough and try to be the best. Sometimes they’re uncomfortable. Some patients will just leave. I answer your question because we were off on a tangent. You did.

Dr. Jason Deitch: You did. David, I want to go back to, you nailed basically confidence is the name of the game. And basically, you said there’s two parts to that. One is you’re adjusting. And obviously every Chiropractor should be as great of an adjuster as they possibly can be. But you also mentioned communication, and we’re starting to touch on that. So knowing your years in the profession and years of experience in leadership positions and coaching, training, et cetera. What are some of the common, I guess I’m sure you have opinions on how most are doing it one way, and there’s probably a better way to be communicating. So what are some of the faults you find that most chiropractors are falling into? And what are the solutions? What are the better ways to communicate that most chiropractors would benefit from learning?

Dr. David Graber: One Chiropractor said to me, he goes you want to be successful for the patient. Shut up and listen. And I’m like Chiropractors talked. But we’re trying to try to put our philosophy into them our protocol our theories. And sometimes you try to press them how much we know because we’re insecure and its like, I see I’m really a real doctor. I use big terms. I actually know how to read an MRI. I’m going to and they don’t care about that. Number one listen to the patient. Number two watch the patient, watch their body language, watch their facial expression. When you say something, you’re going to get a reaction back. It might be a flat reaction. You don’t know what you’ve got to do that patient. It’s that their eyelid went up. That means they actually are excited. Some people are very emotive and some people are not. Some people get it. Some people don’t. Some people say something. And you know what? They give the signal like, Hmm, this is probably going to be my last visit. You got to pick up on that and know that. And these are all communication skills and they’re not easily learned and they’re not learned. And some people are natural or natural born salespeople that are natural born caretakers. Most of us, myself especially, have to learn this day to day patient to patient encounter by encounter. So communication, I would say, starts with, yeah, listen and watch and then wait, because you’re going to get a reaction to what they’re saying. If they think, maybe they said something and you all said, you’re like, you want to jump down or you want to give them a whole speech and a whole education, you got to wait.

Dr. David Graber: What can they take in right now, you know? And then listen, when you realize they’ve had enough and some people that you could give them a whole dissertation on, you could show their MRI and they’re asking question and question. You’re like, Hey, man, this is almost like I’m teaching a class and others just want to know, Hey, I’ve got I’ve got a bad bone and you can fix it. Great. Let’s go. And that’s all they need. That’s all they have to get. And it’s a fine art, and it’s a never ending art. And and what I’ve noticed, I’ve been practice God. I’m going to admit it, but it’s like there are over thirty five years I’ve been out of school. And while this year is going to be my 35th year actual actual private practice, the the audience changes, people change the way they communicate, they understand things differently. Some things that might have worked five years ago or ten years doesn’t work right now. It doesn’t get through. They don’t understand it. Terminology is different. I have a seventeen year old daughter. Believe me, I’m like, What do you mean, did she? I say things. She looks at me like what? I’m like going, what? And she says, Well, how could you think like that? It’s a whole new generation. And you know, she said to you that you be you should be a tick tock. And I’m like, I have never seen it. And she that’s she’s watching the needs to take like, honestly, I don’t get it.

Dr. David Graber: I don’t get it. I really don’t, but I don’t have to get it, they get it, I got to get that, they get it. And same thing with patient patient education. You know, you come up with all kinds of forget all this. There are some bases that don’t change what is before with the patient. And that is, you know, listen, watch, get a sense, feel and then wait process and then respond and respond the way they can understand and respond to the way that you kind of you can have a next step. Yeah. So and it’s by size. A lot of times it’s it’s been like, I think we’re just talking about that before you say, well, your segments here are like 15 minutes, so that’s good. It’s like that’s about the amount of like attention said. I think most people have actually here like this. We’re like shifting scenes back and forth, and it’s not something kind of a, you know, kaleidoscopic explosion of background to keep attention. It’s harder today to grab attention and keep it, you know, for any length of time. So you got to know how to do things at bite size and slow down. When I was, you sat down, you have a 20 minute report of findings. You know, you’re not doing that today. Very few people are going to stamp it. You don’t need to do that today. With the technology we have, we can actually start giving people little bits and pieces, email, text videos, computer give himself to look at it at home. They’re Googling stuff anyway. They Google all of us before they see us.

Dr. Jeff Langmaid: Yeah, you are right about that meeting. The patients where they’re at is really the big takeaway. I think with what you’re describing is really, you know, meeting them where they are at, not we’re not where you are at as a provider is so critically important. But I have a question. I have a gnawing question as a technique guy. What’s your favorite adjustment? What’s the what’s the adjustment, you know, technique, what, however you want to define that what’s the most satisfying to you when you deliver it every time you’re just like, This is my wheelhouse?

Dr. David Graber: Oh, that’s funny. Yeah, what’s your what’s your million dollar? What’s your billion dollar go to? That’s it. You know what? I’m going to be honest with you, this I guess this. I love side posture. I have five different kinds of side postures that I teach, and I honestly, after a while, I’m thinking, Wow, I haven’t done this one in a while. Let me start to implement that. I think it would be just as good as doing the other one. So I like to keep it new and fresh because you know what? It’s not talked about a lot, but this could be a very mundane profession. What we do, a lot of what we do is is pretty rote, and one of the things about knowing a plethora of techniques is, well, if I can have five different ways to accomplish this, then that actually keeps it keeps my interest up as a doctor as well. But getting really good at everyone is the key and not doing something unless you’re exceptionally well at it. Yeah, problem is, like I said, we’re a learn on the job profession. I mean, I love because the effects of that are fabulous and it’s endemic in most of our patients that I’ve found.

Dr. David Graber: So that’s to shoulder the scalpel, thoracic releases, the feet. I mean, I love it. I love it. Just like because patients love it. And you know, the gravity affects your spine and it affects your feet, primarily the two biggest beaten up areas of the human body. So I think that it’s great, ut once you start working on that, forget it. People like going, Wow, you’re different. You start working extremities, especially feet and especially shoulder. Patients know, you don’t got to say, they know you’re different. They know like he’s different. He takes care of everything. And that’s how subtle it can be, because a lot of, let’s face it, we’re known as being Chiropractor back doctors if we’re lucky, neck doctors, but full body, anything hurts. If I have something wrong, you’ll fix it. That’s the message that I want to get across to people. So they don’t. They come to me at my finger. I jam my finger. Can you do something? Yeah, I can, actually. And well, that’s for today’s visit. I’ll take it. I’ll take that.

Dr. Jason Deitch: David is as Chiropractor as are listening to this now, and they’re thinking of themselves, you know, one of the things I love about what you just said was, you know what I got out of it was one of the ways you stay fresh after 30 plus years in practice is to always be learning and growing yourself. Whether it’s your adjustment side communication side, there’s you’re challenging yourself to be better, which keeps you interested as opposed to, you know, getting into the mundane routine, you know, over and over and over again. How would you prioritize to somebody listening, you know? Well, that makes sense to me. What should be my next step? Should I get better at, you know, I guess, communication, which I think it’s a perfect answer. The best way to communicate is to listen better. Is it communication? Is it adjusting skills and learning, you know, five different types of side posture? Or what would you recommend? Somebody kind of go, OK, you know what? I want to challenge myself. I’m going to I want to sharpen my blade. I want to get better at something to keep myself interested in, obviously for people’s benefit. How would you prioritize what those things are? What would be a good next step for somebody?

Dr. David Graber: Well, I think probably well, I don’t know what what’s the best the next step, but I’ll tell you what I do. I have I have like 12 areas that I have marked down, and I have skill sets to develop in each, you know, technique, diagnostics, personal communication, office communication, staff communication. We have in there equipment that I want to either have or upgrade. I’ve got the rest of off hand, but so I have I have I literally have my planner and I have, OK, what am I going to do? And every four to six weeks I try to do something to upgrade or research. That was the other thing. I run a Facebook group called Chiropractic Practice Research. It was something I put together because I was doing all this data collection years ago. I think I started 12, 12 years of 10 or 12 years ago. For my lectures. I said, Wait a minute, I think somebody else might be interested in this. Let me just throw it up there and I just throw it up there and people joined up and you know, it was pre evidence based Chiropractor like Japan. But I’m like, and I just love to see what’s the latest, what’s out there because the research is exploding. That’s a great step that you find out that, hey, what we’re doing, there’s a lot of backing behind a lot of what we’re doing. There’s a lot of challenges, a lot of what we’re doing.

Dr. David Graber: We’ve got to know both. And so I would start off by not taking one thing, but take a number, maybe three areas of your practice. Now, I personally think one would be technique. Another would be patient communication back and forth. And third one, I would say, would probably be kind of like goal setting, priority prioritizing executive function because most people who have run a practice, we are mostly solo entrepreneurs or solopreneur practices, and we have to lead and manage ourselves and our patients and our staff and everything else. So develop those kind of skills first. And I would probably the three core areas I think most chiropractors would get a lot of benefit for. And then just do one thing each every week. Just take one thing. Don’t overwhelm yourself. Take one thing. Like I tell docs, I say, when I get done this summer, I say, Look, make it. Let’s say it’s a lower extremity seminar. I was like, Great, guess what we’re going to do? We’re going to do Monday. You go back to the office on Monday. It’s going to be long axis hip Monday, Talis Tuesday. You know, you’re going to have amortized joint Wednesday fibula Friday, you know, and just check it, just check every patient for that. You know, you’re going to find there’s going to be some dysfunction there, then address it and just work that in that way. Communication? Yeah, ask a question that’s best to you. Ask a question of practice not responding, which is very hard for both chiropractors.

Dr. David Graber: We have to be successful this profession. You have to be somewhat extrovert. If you’re introverted, you get like a very introverted, but you have to learn how to express yourself to be extroverted. Put yourself out there. But you also need to know what to not let the patient express listen and then act on what they said. Try work into something of what they said into your care plan and communication. Or they may tell you something about their lifestyle that you can go beyond being just a technical Chiropractor. It actually help them, and that will bond them to you like nothing else. So I would say those kind of areas. I I don’t like the one thing, Jason, because there’s so many multiple domains in practice, especially these days, and it’s a moving target. So start having every week, take one thing and just work on it and work on it. And it’s great. You guys say, go to the like the Facebook site. They put up the Hey, what is everybody working on for patient communication this week? What are great questions? You ask patients, you know, who’s working on whatever sprained ankles this week or who has thoracic outlet syndrome patient who was a great move for that? We have communities right now, especially. With social media that we don’t have to stay here and be by ourselves, we could reach out and get other minds involved.

Dr. Jeff Langmaid: Yeah, that is a great take home message, Dave. I could not agree more as Chiropractor as we tend to become siloed. And you know, whether you’re hopping on social media or whether you’re driving down the street or going upstairs, communicating with other docs, I think is fantastically important. My big question, I guess, to the docs listening and watching to take on what you said, Dave is doc. What is going to be your one thing? You know, you might start out with a handful of items that you want to work on throughout this year. Chip off one each day and before you know it, you’ll be a lot better off as you look back. As the days become, weeks become, months become years. So Dave, on behalf of Jason, myself and our entire The SMART Chiropractor team, really appreciate you coming on and doc. Keep an eye out when you see Dave Graber teaching a technique at a seminar. Be sure to hop into that class as a man with an exceptional amount of experience and you’ll learn something new that might. It might prolong your career. It’ll definitely make you better with the care you’re given with your patients. Dave, thanks for coming on.

Dr. David Graber: Oh, thank you.