observations from our travels in the world of chiropractic

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Tent Poster – A Merry Heart

“A merry heart doeth good like a medicine…”

~Proverb 17:22, Bible


For a printable copy of this tent poster visit: A merry heart.. proverbs

February 8, 2018   No Comments

Tent Poster-Search for Meaning – Frankl

“Man’s search for meaning is the primary motivation in his life…”

~Viktor E Frankl, MD, PhD

For a printable copy of this tent poster visit Victor Frankl -Search for Meaning

February 6, 2018   No Comments

Start Preparing NOW – New Medicare Beneficiary Identifiers to be Assigned Your Patients

Beginning in April 2018, through April 2019, The Centers for Medicare and Medicaid Services will re assign all Medicare Beneficiary Identification (MBI) Numbers, and re-issue cards to your Medicare patients and Medicare Railroad retired patients. Social security numbers will no longer be used. Instead, a grouping of numeric-alpha characters, such as 1EG4 TE5-MK72, will be assigned.

Things to Keep in Mind:

  • The new cards will not change your patient coverage or benefits.
  • New patients who start on Medicare in April and beyond will be assigned only the new number.
  • Correct patient addresses are critical for getting claims processed and getting you paid. The patients’ mailing addresses you have on file MUST match the addresses the Social Security office has on file.

We have put together a simple, quick ready checklist to keep you ahead of the game.
Email us at services@pmaworks.com
for your FREE copy today!

If you have any further questions, we’re here to help make sure you get reimbursed in a timely manner. These changes are coming. Give us a call!

Happy New Year!

Lisa Barnett
Services Consultant/Coach


February 6, 2018   No Comments

Oklahaven “Have A Heart” – February 7-14th

Oklahaven, a non-profit children’s chiropractic center has been dedicated to making sick children well using natural, drug-free chiropractic care since 1962. To help fund their efforts the Annual Have A Heart Campaign is held in conjunction with Valentine’s Day each year.

It’s not too early to start planing your own “Have A Heart” Campaign for your office bringing a global awareness of the power of chiropractic for the children in your own community while helping out a greater cause!

If you’d like to participate, a complete marketing kit is available directly through Oklahaven simplifying the event preparation for your marketing coordinator.

Click here for a pamphlet with more details or visit the Oklahaven “Have A Heart” web-page.


If you have any questions feel free to call the executive director, Frank San Antonio,  at 405-948-8807.

4500 N. Meridian•Oklahoma City, OK 73112•405/948-8807
Sign up for “Have-A-Heart” 2018 at http://www.chiropractic4kids.com/


February 5, 2018   No Comments

Tent Poster – Happiness is not ready made.

“Happiness is not ready made.  It comes from your own actions.”

~Dalai Lama

For a printable copy of this tent poster visit dalai lama happiness.

January 30, 2018   No Comments

Tent Poster – Remember ABC NBC

“Remember: ‘ABC NBC’  -Always be Curious, Never be Complacent.”

~Bill Rasmussen, co-founder of ESPN.

To download a printable copy  pf this tent poster, click the link. ABC NBC Curious – Complacent

January 23, 2018   No Comments

Facebook versus Email and “Conversational Commerce”

It’s a New Year!

And if you are just reading this in March or September, it’s a new month or a new week!

Whatever time of year it is, it is always time to get the “Word” out.

It’s time to tell everyone in and around your office and community — about your chiropractic and professional services and how they should get them now!

But what is the best way to do this?

Well, obviously, with each person you see when you are seeing them. You – and your health team – have a captive audience. Sometimes referred to as “Table Talk,” this is your way of educating your people at the time of service.

You can augment this with new patient workshops that motivate, educate, and entertain your people. It is a free class but is part of their treatment program because you have found that people “get better faster and stay healthier longer if they get a better understanding of the health process we are doing together.” Also…“It assists with your treatment program and you get a better return on the work you put in. It is just a good investment!”

Then…don’t forget your team. They need to hear about the successes and case stories of how their office really helps people.

But your patients aren’t always in your office. What then? Shouldn’t your conversation with them continue? Other vendors are certainly getting their “word” out. Pharmaceutical ads are pervasive.

What about people who have not discovered you yet – how do best tell them about how you can help them and why they should see you?

Many of you make posts on Facebook in hopes that this will help market your services.

Does it?

What about email? Some of you subscribe to template emails that go out to your patients. How is this working?

I have some strong feelings about this subject — but first I wanted to see what others have said and what the studies show. Here is the question:

Which is the better medium for marketing:
Facebook or Email?

Which works better?

According to most of the surveys that I have seen, email is the winner.

But comparing both mediums is like comparing apples to oranges — both work depending on how much time and expertise you put into it.

But it stands to reason that if you have someone’s email, they are a subscriber and have given you permission to address them personally.

From a sampling of various studies and surveys (references at the end of this article):

“Where is the first place you go online in a typical day?”

  • Email 58%
  • Search portal 20%
  • Facebook 11%
  • News site 5%
  • My company’s website intranet 3%
  • other 3%

“Where do you look when you want a deal from a company that you know?”

  • Email: 44%
  • Company website:43%
  • Search engine (e.g. for coupon codes): 6%
  • Facebook: 4%

Email reaches 79% of the people you send it to (this is the global average inbox placement rate). On the other hand, Facebook’s organic reach has declined to about 1 to 6%, depending on your total number of fans.

So the stats and studies seem to show that you are going to get a better ROI from email.

Over the years, I have observed that patient referrals, patient visit average, and reactivations improve with regular emails.

Facebook and social media can help create familiarity and trust. From this you can direct people to your website for upcoming events or information. You can also buy ads that target specific types of potential patients and set up workshops or make special offers. I have seen this work on occasion very well

But the algorithms, or computational rules, for Facebook and other mediums are always changing and what worked last month may not work this month. Currently, Facebook is becoming more of a “pay to play” medium – peppered with inspirational forwards and political rantings!

With email, you own your list and make your own rules. Plus, it is nearly free.

Email is a direct and personal letter from you to another person.

It is authentic and genuine. It is the reader – and you, personally. It is not manufactured “health news” which is just a mash-up of articles from 1998.

In this busy and more automated world, genuine communication is becoming scarcer… and more valuable.

The biggest challenge is simply getting the email out.

Actually, this is the big problem with all of your marketing – who is going to do it — and when?

We have found some simple procedures that work for getting this done which I offer below. But first, let’s look at the future.

The Future: Trending…

The future medium will continue to be more direct communication for selling. The trendy term is “conversational commerce.”

“Consumers are increasingly relying on messaging apps for all forms of communication, whether personal, business, or commerce. … Messaging apps are becoming the preferred means of communication.” (emarketer)

Messaging is personal, it is one to one.

According to a research commissioned by FacebookIQ and Nielson:

“53% of people are more likely to do business with a business they can message.”


This means, when people visit your Facebook page, if they can chat with you personally, half of them will be inclined to come in for a visit.

You can take a look at a couple of applications – Chatfuel and Manychat – for inexpensive chat programs that you can add on to your Facebook.

You can also ask your webmaster to install a chat system on your web site. An example is websitealive.com.

But the force of all this is personalized communication, something that emails and sales letters and video letters have always done and continue to do better than Facebook.

A few weeks ago I received an email newsletter from a yoga instructor I have followed off and on for a few years. I had question so I sent her an email thinking she might answer it. She did. What’s more, she included a short personal video – directly to me! I am now considering buying her DVD’s when I hadn’t even considered it before.

So how are you going to “Get the Word Out?”

I recommend personally. One-to-one. In a conversation in the office and out of the office through email and maybe… chat.

A Simple Procedure to Get Your Emails Out

  1. Someone in Charge. Assign someone to coordinate your email messages and newsletters. (They can also coordinate Facebook and Chat.)
  2. Time to do the Work. Give them at least 4 hours per month to get it done.
  3. Monthly/Weekly Reports. Have them give you a monthly written report and review it with them. (Advanced: Include email stats and Facebook stats this month and if they are up or down from the prior month. Analytics!)
  4. Email Content. The email should have a 3-4 paragraph (or more) candid letter from the doctor written as if she is talking to “Mildred” or “Jeff,” or just to one patient in particular. You can call it “Health Notes from Doctor Ed.”Or, publish it as a short newsletter, and include a recipe (My Grandma’s Buffalo Chili. I don’t like it but everyone I have ever met loves it. In fact, my uncle claimed it got him his wife, Mildred. Here is a picture of Milly (lucky guy!)” [show picture]
  5. Dictate it on your way to or from work and have someone edit.
  6. Email Service. Use Constant Contact, Mailchimp, or another service and send out your mail.
  7. Frequency. Do this 1-3 times per month. Keep it simple.
  8. Promotions. Attach a monthly promotion to it every now and then.
  9. Funky Office Fluff. Add recipes, success story, local news, or other interesting notes every now and then. (Think of over the back yard fence, neighbor to neighbor, chatting about local news.)
  10. Continue the Conversation. But most important is continuing your conversation with patients. The email is just you continuing your “Table Talk.”
  11. Messaging! Add a messaging application to Facebook and to your website.
  12. Don’t Get Addicted to Social Media. Don’t get sucked into Facebook drama!*

Remember that a practice is a network of relationships built and sustained in part by communication. Now and then attach a promotion to your email and this is one of the least expensive forms of marketing you will ever do.

Keep the conversation going…and going and going.

Till next time,

(*Facebook Drama. Social networking definitely has positive uses. But, according to one of its founding executives, it has negative effects. In an interview at Standard School of Business, Chamath Palihapitiya, (known as “C.P.”) who joined Facebook in 2007 and became its vice president for user growth, says that he feels tremendous guilt for the company that he helped make. Facebook, and others he says, have succeeded by “exploiting a vulnerability in human psychology.” “I think we have created tools that are ripping apart the social fabric of how society works,” he told an audience at Stanford Graduate School of Business. He hasn’t used it for years and won’t let his kids use it either!

“The short-term, dopamine-driven feedback loops we’ve created are destroying how society works,” he said, referring to online interactions driven by “hearts, likes, thumbs-up.”

It is a great interview that you can watch or listen – link at the end of the article.)


Email Marketing vs Social Media Performance (2016-2019 Statistics)

Email Marketing vs Social Media Performance in 2018

Talk on social consequences of Facebook. https://www.youtube.com/watch?v=PMotykw0SIk

January 15, 2018   No Comments

The Merry-Go-Round: Planning for a Prosperous Practice in 2018


Progress in practice is made by steady persistence and passion.

In Angela Duckworth’s new book, she calls this “Grit.”

Think of evolution, think of growing crops… think of growing children!  Whether it is child development or practice development, growth is achieved through steady and unrelenting nurturing and adjusting according to circumstances.

I recommend you take some time to do some planning before the New Year gets in high gear. January and February are good months to do this.  Do it by yourself – and do it with your team. But…

Don’t reinvent the wheel… Just make it go faster with less effort.

 The Vital Few

A few of our actions are always more productive than most of the other actions that we do. Unfortunately, we can get distracted and spend far too much time on activities that, in retrospect, just don’t give us that much of a return.

The “vital few” actions that have helped you the most will be camouflaged, even countered, by the “trivial (but useful) many.” This is a term used by Nathan Juran, famous for his approach to business and quality improvement and the Pareto Principle.

And, I would like you to consider this: In many respects, your business has succeeded in ways that – perhaps – you have not yet recognized.  Therefore, I don’t recommend abandoning all you did last year and start chasing the newest “shiniest” procedures that seem appealing.

The key is to dust off all your actions from 2017 – review everything you did — and see the great things that worked and the victories you and your team achieved.

Then, just find better approaches to do more of this!

Diamonds in Your Office

The idea of having diamonds in our backyard, a story made famous by Russell Conwell (1843 – 1925) of the 1800s, applies. There are many variations, but it goes something like this: there once was a man who wanted more wealth, so he sold his house and left in search of diamonds. Years later, penniless, he happened back to his village where he roomed at a shelter for the poor. The shelter was supported by a grant from a local resident. In inquiring who the resident was, the diamond searcher discovered that it was the person to whom he had sold his house.

One day he paid a visit to his old house, now renovated into a beautiful estate. He talked to the new owner who told him that he had become rich. He said that when he bought the house, he needed to do some digging in the backyard where he discovered thousands of diamonds.

The moral of the story is obvious: you already are rich – you already have the diamonds. You just need to polish them.

Many of the components of your future success are already in your office. But we overlook them, or use them once and then forget about them, like teenagers looking for the next new article of clothing to make a fashion statement.

As entrepreneurs, creatively – we are all looking for that next dopamine high… and seek the next new “shiny” thing.

You have a show on the road. Just make it better. Make it fresh. Set a new standard, and make a new game to “level up!” Add a few new things here and there, but keep doing what is working.

Looking for Your Diamonds

Review what has been working for you. Reaffirm it and keep at it. Look at what hasn’t worked that well and fix it so that it does, or drop it like barbell that you have been holding over your head for too long.

By yourself, and later, with your team, here are some areas to look into:

____1. Review Your Mission Statement. Does it apply? How? Does it need to be customized? Beyond your mission, what is your WHY? Does the mission satisfy this?
____2. What Are Your Outcomes? For example: “People relieved of pain, healthier, educated so that they can and will continue to improve their health… and refer others?” You can also define Minimal Viable (Valuable) Outcomes, e.g., “A patient who accepts care.” Etc.
____3. How Is the Office Vibe? This is determined by your values and how everyone is living up to them. Are these values posted for all to see and check how they are “measuring up?” Are they defined? Do we need to add more, change some, delete some? Should we better define each value? Should we add:

• Trust. Are we worthy of trust with our patients and ourselves?
• Mission Oriented. Do we help each other cheerfully achieve our mission – each day?
• How well are we living up to these?
• How can we live up to these better?

____4. How Were the Numbers? Up, or down?

• When the numbers went up, what did, or didn’t we do? How can we improve upon this?
• When the numbers went down, what did, or didn’t we do? Should we improve or discontinue those actions?

____5. Individual. What can each one of us do professionally this next year to improve our ability to contribute to our team and its mission?

Some of this should be on simple, brief checklists and memo’s. Add it to your Practice Playbook. Document it so that it can be referred to for training and coaching in the future.


Imagine that your practice is a merry-go-round, the kind you find at children’s playgrounds.

It takes a lot of energy to push it and get it going. But… once it is moving, it takes less effort to gradually get it going faster. And faster! And faster…

Take some time to review how you are pushing your merry-go-round. What procedures worked better for pushing it faster? Focus on these… Makes these better.

Go faster… and push less.

And as you do, watch those, including yourself, hold on tighter and smile bigger.

Enjoy the ride!

With admiration,


December 15, 2017   No Comments

November and December Marketing — and Your Higher Purpose

Petty Michel Associates Practice Promotions

November and December are special times for patient marketing, whether you are promoting to prospective patients, active, or inactive patients.

Usually, we have found that internal marketing is better during this time of year as you don’t need to compete with commercial businesses as they slug it out in an advertising frenzy. You can prepare now and schedule your external promotions and community services for January and February. Of course, if you see an excellent opportunity for external marketing now, take it. But the primary focus should be internal for these two months.

November and December are “cozy” months. In North America — we have Thanksgiving. This is a time we give thanks for all our blessings and gifts and family and friends. It is a time when people feel grateful. Christmas is also a time of good cheer and giving, as is Hanukkah and other holidays.

And, for some of you, it is also the season of the yearly hunt — when you bring home the ring tail pheasants, the turkeys, and “da ‘tirty point buck.” (Wisconsin-ese for “the 30-point buck.”)

Your promotions should align with the spirit of the season to be most effective. Donation drives are often held. There are many churches and associations in your town that need help as they prepare to assist the less fortunate.

“Toys for Tots”, “Food for Families”, or “Coats for Kids”, are many popular promotions by local media stations. I don’t doubt that they are helpful, but I do sometimes question their sincerity.

Of course, you want more customers, that is the nature of business. But you must lead with your mission statement first.

Any promotions should stem from your higher purposes.

The Higher Purpose Company
In The High Purpose Company, (Arena, 2007) Christina Arena reports on her team’s study of 75 companies’ efforts at Corporate Social Responsibility (CSR).

She shows how corporations, by doing good, by providing better conditions for employees, more sustainable sourcing of raw materials, and contributing to beneficial causes in their communities, generate more income.

“The central findings of my research can be distilled in the following way: superficiality fails whereas authenticity prevails. Companies that falsely approach corporate responsibility as a form of marketing, public relations, or even philanthropy don’t produce the most meaningful results. In fact, they often waste their money and create additional liabilities. Conversely, companies that truly approach the practice of corporate responsibility as a fully integrated business strategy, wisely investing in profitable solutions to meet unmet social and environmental needs and problems find their performance greatly enhanced.”

According to the Harvard Business Review, business spent more than $15 billion in 2016 on Corporate Social Responsibility (CSR) programs. (Davidson, July 7, 2016) And according to, Linda Novick O’Keefe, founder of Common Threads, “that number is rising as businesses see signs that investments in CSR improve company performance, talent recruitment and retention. (O’Keefe, 2016) “Giving in Numbers”, a study published by the CECP that analyzes giving and corporate societal engagement trends, revealed companies that increased giving by at least 10 percent between 2013 and 2015 actually experienced upticks in revenue and pre-tax profit, while all other companies saw a decrease in both.”

Your “WHY?”
Marketing must be honest, and it has to tell why you are doing the marketing. As Simon Sinek reminds us:

“Very few people or companies can clearly articulate WHY they do WHAT they do. By WHY I mean your purpose, cause or belief – WHY does your company exist? WHY do you get out of bed every morning? And WHY should anyone care?

People don’t buy WHAT you do, they buy WHY you do it.

All organizations start with WHY, but only the great ones keep their WHY clear year after year.” (Sinek, 2009)

I recommend finding charities or causes in your community that your patients care about. That you care about. Then, go talk to the head of the charity yourself – get involved – personally. Emotionally.

One office paid their staff for one hour for every two hours they went out of the office and worked on a community project.

And it doesn’t have to be charities. A Kid’s Day with “Saturday with Santa” can be a ball. One office holds a patient appreciation party with their patients each December with a Christmas Elvis impersonator singing Christmas carols. The one I attended was packed, and a little wild. But everyone talks about it for the rest of the year.

Your patients, and your neighbors, want what you want – a better and healthier community. Communicate that in all your promotions and you’ll get better results, and have more fun.

And, many thanks for you do from all of us at PM&A!


A list of sample promotions on our web site – see reference below.


Arena, C. (2007). The High Purpose Company. Harper Collins.

Davidson, R. H. (July 7, 2016). CEO Materialism and Corporate Social Responsibility.        Harvard Law School Forum on Corporate Governance and Financial Regulation. Retrieved from https://corpgov.law.harvard.edu/2016/07/07/ceo-materialism-and-corporate-social-responsibility/

O’Keefe, L. N. (2016, Decembr 15). CSR Grows in 2016 as Companies Embrace                Employees’ Values. Huffington Post – The Blog. Retrieved from https://www.huffingtonpost.com/linda-novick-okeefe/csr-grows-in-2016-as-comp_b_13657368.html

Sample Promotions. Chiropractic Practice Marketing Ideas For 2016. Retrieved from   www.pmaworks.com: http://pmaworks.com/observations/2016/09/20/chiropractic-practice-marketing-ideas-for-fall-2016/

Sinek, S. (2009, September). Simon Sinek How Great Leaders Inspire Action. Retrieved    from TED Ideas Worth Spreading:  https://www.ted.com/talks/simon_sinek_how_great_leaders_inspire_action

November 1, 2017   No Comments

Tent Poster – Calm Mind – Patanjali

Undisturbed calmness of mind is attained by cultivating friendliness toward the happy, compassion for the unhappy, delight in the virtuous, and indifference toward the wicked.”

― Patañjali, The Yoga Sutras of Patanjali




For a printable copy of this tent poster visit: Patanjali -Calm Mind

September 15, 2017   No Comments