Josh Satterlee 00:00:00  He was just oozing red flag after red flag after red flag. And I’m like, why didn’t anybody pick up on this? He was just an amazing friend of mine. And so when he died, I felt a calling like, this has to be solved. You have to find out why this happened. So I started investigating patient doctor communication. This is an opportunity for you to stand out through doing the human things humanly and those basics or those fundamentals. If you just do them enough, you’ll win.

Maureen Werrbach 00:00:27 Welcome to The Group Practice Exchange Podcast, where we talk about all things related to group practice ownership. I’m your host, Maureen Werrbach. This episode is sponsored by Therapy Notes. Therapy Notes is my favorite EHR, and it’s one that I’ve been using in my own group practice since 2014. They’ve got everything you need to be successful in your group practice, and they’re constantly making updates and have live support. If you want two free months of therapy notes, go to Therapynotes.com/r/thegrouppracticeexchange.com. 

Struggling with your practices finances? Let me tell you about Green Oak accounting. Green Oak is the industry leader in mental health accounting, and they know exactly what it takes to help your practice thrive, especially when you’re scaling up.

Maureen Werrbach 00:01:11  Green Oak is set apart from the rest by their deep industry knowledge and top notch advisory and CFO services. Plus they offer traditional accounting services like bookkeeping, tax prep, valuations and so much more. Here’s what’s in it for you: peace of mind, financial clarity, and the potential to significantly grow your practice and profits. In fact, Green Oak has the most impact with practices looking for financial guidance when leveling up thanks to their CFO services. And they’re not just about crunching numbers. They also offer a mix of resources like the therapy for Your Money podcast, The Profit First for therapists book, and self-guided courses to keep you informed and empowered and growing your practice. Ready to transform your practices financial health visit greenoakaccounting.com/tgpe to explore all that they have to offer. Green Oak Accounting, your partner in financial prosperity. 

 Hey everyone, welcome back to another episode of the Group Practice Exchange podcast.

Maureen Werrbach 00:02:24  I have doctor Josh Satterlee on. He’s a chiropractor and the owner of Trust Driven Care. We’re actually going to be talking about the power of trust in patient retention, and I’m kind of excited because he’s got some cool things that he’s doing on his end of the world here, in terms of how to increase patient attrition and retention and how communication is important and what he’s learned through it. And I think he has some technology, which I’m excited to hear about as well that relates to this. So I work with group practice owners, mental health group practice owners. So I always love when I get to have someone who’s not a mental health practice owner, but a practice owner of a different sort of health care related business. Come on. So thank you, Josh, for coming.

Josh Satterlee 00:03:06  Absolutely. Thanks for having me.

Maureen Werrbach 00:03:08  Yeah. Okay. So because my audience won’t know who you are. Please tell them a little bit about you other than your chiropractor. What are you doing in your corner of the world these days?

Josh Satterlee 00:03:17  Yeah.

Josh Satterlee 00:03:18  So been a chiropractor for, like, coming up on 18 years. Crazy enough. Which makes me feel old, but went to chiropractic college, graduated, moved out to Las Vegas, which is where I live now. Opened up different versions of chiropractic offices where it was just me, whereas me and a partner, whereas me and we added a gym onto our practice at one point for about five years where I had personal trainers. And basically the reason for that is, you know, a lot of times I don’t know what it’s like in mental health, but in chiropractic you get people out of pain and they’re like, awesome. I don’t ever want this to come back. What do I need to do? And really that comes down to like the right exercise at the right time. Just a perfect upsell, if you will, and to their goals. And it was fantastic because the other side of that is those personal trainers, when they’re well trained, could do about 80 to 85% of what a chiropractor did, but they did it at half the cost.

Josh Satterlee 00:04:03  So as a business owner, I was like, heck yeah, yeah. If you look all in other forms of health care, like MDS have Pas and nurse practitioners working for them, and it just is. That’s just the way it’s going. And so we were able to do that. And then just because we’re short on time, a few years ago, I had a friend that lived in Tucson, Arizona, calls me and says, hey, I have back pain. So I said, go see a chiropractor because that’s my solution to everything. But he went to see a chiro, then a PT, then another chiro, then another PT, his GP, an orthopedist, a hip specialist, and finally an urgent care nurse realized he didn’t have low back pain from like muscles and joints. He had stage four colon cancer that had metastasized. Holy shit to his back. And, it’s hard seeing the story every time. I mean, I’ve told the story for years, but I just realized at that moment, like, dude, our system is failing.

Josh Satterlee 00:04:54  Like, he went to multiple forms of health care. Nobody took the time to stop and say, like, what’s really going on here?

Maureen Werrbach 00:05:00  Yeah.

Josh Satterlee 00:05:01  And unfortunately, by the time the urgent care found his cancer, he only had, like, eight weeks left. And so I went down to visit him, and I was, like, talking to him. Like what? What happened? Like, why? Why didn’t you share this with anybody, you know? And, he said during it, oh, you know, they were really busy and I didn’t want to slow him down. And then I know that, you know, I was taking so much Advil. I know that’s why I had blood in my stool. And, you know, that’s why I lost £30 in a month. Was just. I couldn’t eat anything, you know? And just like he was just oozing red flag after red flag after red flag. And I’m like, why didn’t anybody pick up on this? And so he was just an amazing friend of mine, helped me out some really tough parts of my life.

Josh Satterlee 00:05:41  And so when he died, I was like that mix of angry and also like I felt a calling like, this has to be solved. You have to find out why this happened. And so I started investigating patient doctor communication. And what’s weird is I don’t know what it’s like in mental health, in chiropractic, all the CEO courses, all the courses we sell, there, almost always like 90% of them are treatment based. Treat this for the muscle or do this for the joints, or do this for rehab. Like which is awesome. We have to have great treatments. Some of them are about diagnosis, but almost none of them are just communication. You know, I’ll.

Maureen Werrbach 00:06:17  Agree, it’s similar on our end to.

Josh Satterlee 00:06:19  Okay, which is even crazier to me because that’s your treatment modality too, right?

Maureen Werrbach 00:06:24  Like, yeah.

Josh Satterlee 00:06:25  You would think that’d be primary. So we set out to kind of figure out the issue. And I looked at all the research. I mean, I was going over PubMed late at night after Ryan’s death.

Josh Satterlee 00:06:34  And just like I’m going to figure out this problem, and it comes down to some really simple things that like whenever I say them or just everybody goes, yeah, of course. Yeah, yeah.

Maureen Werrbach 00:06:45  But I feel.

Maureen Werrbach 00:06:45  Like it’s like how 90% of things are, there’s not many mind blowing new information that’s out there. It’s just a matter of like, accountability to doing the things that are obvious. Yeah.

Josh Satterlee 00:06:58  And those basics or those fundamentals, whether it’s basketball or health care. If you just do them enough, you’ll win.

Maureen Werrbach 00:07:04  Yeah.

Maureen Werrbach 00:07:04  Okay, so what did you what did you figure out?

Josh Satterlee 00:07:07  Number one, the thing that drives me nuts. And I’ll just say it here, like. And I have a book with this title. There’s this word like, thrown around, like, oh, you should be empathetic. You should be empathetic. You should offer empathy. Horseshit. That is a stupid way to approach this problem, because empathy is great if we were robots. But the problem is, the way that you treat a patient at 8 a.m. is probably different, and the way you communicate.

Josh Satterlee 00:07:30  Then at 445, when they showed up late, they didn’t do their new patient paperwork. They forgot their insurance card. And you have somebody’s birthday party you’re trying to get to at six. Right? Okay. And and if it’s like, oh, rely on your empathy. Well, you’re a human too. You’re delivering the empathy. And at that point, I don’t think you have as much as you did when you were fresh and rested and feeling good. Right? Or as a business owner, you find out from your accountant at lunch, oh, you owe $106,000 in taxes. It’s like, are you telling me that after that you’re going to be as empathetic as everybody else? It’s ridiculous. So my thought is we were looking for things that could we establish a system that if you did these things on your worst day, you’re pretty good. And if you add an empathy to them, you’re great, right. It’s amazing. And so it comes down to just like five principles that we found.

Josh Satterlee 00:08:17  And I think if you kind of audit when things go wrong or you audit the way you’re talking to people or even with employees, if you just think about these things, it helps kind of clarify maybe where the best focus is. Right?

Maureen Werrbach 00:08:27  Okay. Yep.

Josh Satterlee 00:08:28  Just like if a patient comes in with back pain, if I like do a nutritional profile, how flexible are they? How strong are they. I’m going to find like okay we need to focus on this bucket. So the five things we call it the patch framework. There’s five pieces. It’s named after Patch Adams who the best communicator in healthcare. And if you say client I’m going to say patient. But if you say client just think of it as the catch framework okay. So patch is the P is patient goals making sure you’re clear about why they are there. Like we have treatment goals right. But you know if you’re like I have back pain. And I say oh Maureen we’re going to increase your dorsiflexion by 17% on your contralateral side and then you’re like, I don’t care.

Josh Satterlee 00:09:05  I just want to.

Maureen Werrbach 00:09:05  Be on my back better.

Josh Satterlee 00:09:06  Yeah, yeah. So focusing on the patient goals and like literally writing that at the top of your chart and being like they are here because of blank write A is offering autonomy. Like so many times we just bulldoze our patients and forget that they are part of this journey. So offering them choice. So in chiropractic world that is like, hey, would you rather do some exercise at home or do you want to set up more appointments. So you do them here. It’s your choice but it’s up to you right. The T is tailoring communication methods. So we all rely on verbal and verbal through the research is about 8% of all communication is through verbal right. Meaning 92% of it is something else.

Maureen Werrbach 00:09:47  Yeah.

Josh Satterlee 00:09:47  So if there’s a second language barrier use a whiteboard, draw a picture, have a joint model. And in mental health there’s this like what is art therapy. What is sand table. That’s tailoring communication right. And I always say like think about your mom on Mother’s Day.

Josh Satterlee 00:10:01  You would never email her. You would tailor it for the moment, which is flowers on a card, right?

Maureen Werrbach 00:10:06  Well, I.

Maureen Werrbach 00:10:06  Send a text.

Maureen Werrbach 00:10:08  Oh, Maureen, I know.

Maureen Werrbach 00:10:10  But I do see her, like, every other day because she works for me. And. Okay, so sometimes it’s just a text because I know I’ll see her in a day.

Maureen Werrbach 00:10:17  Okay, cool.

Maureen Werrbach 00:10:18  But yes, I get you.

Josh Satterlee 00:10:19  That’s the tea. So, patch. So see, see is communication basics. And again this going back to those principles like did you make eye contact when you met the patient for the first time. Did you offer some physical interaction like shaking their hand fist bumping, touching their arms? Something to say like we are humans on this journey. Right. Your vocal tone, everybody knows this. If you’re working with a child, like, get on their level, slow down, don’t be aggressive. But again, after lunch when you get hit with that tax bill, are you making sure that you’re still doing those things.

Josh Satterlee 00:10:52  And then the H is humility or humanize. You’re literally the smartest person in the room. That’s why they hired you. But don’t ever rub that in their face. right? And doing things to show them that you to go through tough times, you to struggle with this, you to have kids that get sick, or you to have a dog that are super excited about those humanistic factors, just do so much to build trust with patients that you become their guide on this journey, rather than an adversary sometimes.

Maureen Werrbach 00:11:22  Yeah, I love that framework. The few couple of things I was thinking about as you were going through it. One is that there’s so much distrust in just health care as a whole, and a lot of it due to, you know, people feeling like when they come in, they’re not being listened to or that the provider has their own sort of goals in mind that, you know, unfortunately, are sometimes dictated by insurance of like getting you from A to Z as quickly as possible.

Maureen Werrbach 00:11:49  And so sometimes missing out on like key things that the person is saying. I really like that piece, because it’s also comes from like a more equitable standpoint where you’re putting that person kind of at your level as a provider and being like, what you have to say is just as important as what I’m already thinking about, because a lot of us can sometimes be five steps ahead after a sentence that they say, right? And the second piece is, I’m neurodivergent. And so you brought up in a is like that. There’s different ways that people gather information. Right. You said 8% is through a verbal. But there’s so many other ways that we can. And this is from like I own a group practice as well and have a lot of employees as well. So from all perspectives, I’m always thinking about how can I make sure that I’m communicating with you? I don’t see patients anymore, so I don’t I’m thinking of it more from like my employees, but like to ensure that you’re actually understanding me and that I’m understanding you.

Maureen Werrbach 00:12:46  I need things like written down as they’re being said so I could take it home and like, reprocess whatever was talked about. So I’m often like, I have my like notes app up because they’re just like talking and talking and and I’m halfway through it. Like, I don’t even remember what the first four things you said to do were. And so I love this other piece of like, what are other ways that we can share information to a patient or an employee so that they can understand what I’m trying to say and vice versa. So I appreciated.

Maureen Werrbach 00:13:14  That. Yeah.

Josh Satterlee 00:13:15  In our training we have like a live course that we put on. And one of the first slides is this quote by George Bernard Shaw that says the biggest misconception in communication is that it actually took place. I always think you bring up a perfect point about like we think we’re giving them all the information. But if you look at the research, there was a study done with a bunch of people from a diabetes clinic. Right.

Josh Satterlee 00:13:38  So they need they get these foot care instructions like literally read from a script and it’s five things. And then they pulled them eight hours later and already at eight hours, 50% is forgotten. And the 50% that’s remembered is often incorrect. Yeah. And think about, you know, every mental I’ve gone through couples counseling and personal counseling. So I’ll just I’ll bitch a little bit about your profession.

Maureen Werrbach 00:14:00  Go for it.

Josh Satterlee 00:14:01  The number one problem I was running to. I start my session and they go, how the homework go?

Maureen Werrbach 00:14:06  Oh God.

Josh Satterlee 00:14:06  And my next question.

Maureen Werrbach 00:14:07  Is I hate that too.

Maureen Werrbach 00:14:08  What was the homework?

Maureen Werrbach 00:14:09  Yeah, I’m the same way. If someone gives me homework, I’m done with them as like my therapist. I start my first session being like, I am not one that’s going to like homework. If that’s your style, like I’ll have to look for someone else. I won’t be doing like worksheets at home.

Josh Satterlee 00:14:24  Yeah, that’s a perfect example of autonomy. You direct the pathway because every time they assign homework to you feels like you’re not meeting me where I am, but to other people, it’s like, oh my God, she’s I appreciate that.

Josh Satterlee 00:14:38  She gives me a worksheet every time, right? Yeah. My complaint always is like when I get asked how the homework go, I’m always like, what was the homework? And I think in that scenario, I left your office, I ran back, got some work done. Then I had to pick up my kids from school. Then I on the way home, grocery shopped, and then I went back and I tried to get two more hours of work and blah, blah, blah. And you think that I somehow remembered the assignment. So in that case, just tailoring it and sending out a reminder 24 hours later. Hey, don’t forget your homework was go on a date with your wife, right?

Maureen Werrbach 00:15:07  That actually, yes. Perfect would be great.

Maureen Werrbach 00:15:09  That would be awesome to have technology where you can actually, like, send that homework out. I mean, I’m sure there is, but actually.

Maureen Werrbach 00:15:16  I was going to sell.

Josh Satterlee 00:15:16  Some technology.

Maureen Werrbach 00:15:18  And let’s jump into.

Maureen Werrbach 00:15:19  That. So we’re talking about ways to also increase that trust between a patient or a client and the provider.

Maureen Werrbach 00:15:26  You mentioned that you have some software. What is what’s this. I did not ask beforehand cause I wanted to be surprised during the episode.

Maureen Werrbach 00:15:35  Ta da. Yeah.

Josh Satterlee 00:15:36  So we offer patient communication software that is mostly built around two way text messaging. So when we talk about tailoring communication and autonomy, I think there’s nothing worse. Then I’m sure you’ve had this experience where you get a text message and it says you have an appointment at 4:00 and you go, oh, shoot, I double book myself and you ask, can I move it to 430?

Maureen Werrbach 00:15:58  And they’re like, call.

Josh Satterlee 00:15:59  Yeah. They’re like, this inbox is not monitored. Call our office or email our office.

Maureen Werrbach 00:16:04  I just had that literally just now. So I’m an old.

Maureen Werrbach 00:16:09  Year.

Maureen Werrbach 00:16:09  Old and I had a mammogram scheduled for this Friday, but I’m taking my kid to Colorado on Thursday, and I got a notification 15 minutes before our episode being like, confirm your appointment. And it said, do you want to confirm or reschedule or cancel? And I click cancel because I figured I’ll just figure this out another time.

Maureen Werrbach 00:16:27  And then it said to cancel your appointment, please call it. And I was like, why would you why would you even have that information on there? Because now I have to call, which I, I hate doing. If I could do everything through text, that’d be great.

Maureen Werrbach 00:16:38  Yeah.

Josh Satterlee 00:16:38  And two things there. Like number one, you got stripped of your autonomy the way you wanted to respond, the way you want to communicate. They’re like, too bad that’s not how we do it. Yeah. And it feels like crap. And we can’t create these trust relationships with our patients where they believe in our care if we’re going to strip them of autonomy at critical points. Yeah. And the other thing is, from a business perspective, what probably happened, they just lost that visit, right. Like we’re all trying to fill our schedules and I totally want to support that. I want to make money in health care, too, and I’d love to dive into that. Like what we see in our clients that use our technology when they improve their trust and patient experience.

Josh Satterlee 00:17:14  But you just lost that patient because you just couldn’t have two way texting like, this is not 1993. Come on. Like yeah, yeah okay.

Maureen Werrbach 00:17:22  So this technology, how does it integrate. Like I’m assuming you use EHRs or EMR do you Michael. So like a lot of our patient information is in there. Is there a way that your so.

Josh Satterlee 00:17:34  We integrate with a software called Jane I don’t know if you’re familiar with Jane.

Maureen Werrbach 00:17:37  Yeah I know Jane. Yeah yeah yeah.

Josh Satterlee 00:17:39  So that because I was using that in my office and I’m like, come on, I can’t do two way texting. And I had a guy show up and he’s like, I shouldn’t even be here. I responded to your appointment reminder that I had to pick up my kids. So let’s just do this fast because. And I was like, oh my God, this guy’s doing the right thing. He showed up to his visit, but he’s frustrated because we didn’t, quote unquote, respond. So I was like, we need two way texting.

Josh Satterlee 00:17:57  Yeah. But then it expanded from there. Like two way texting is the basis of it. Like you said, that’s the way you want to do everything. But don’t forget that we’re old and youngins like 20 and 25 and 18 year olds. They perceive direct messages on like Instagram and Facebook. And I probably don’t use Facebook but on TikTok as a preferred communication strategy up front, because maybe I don’t trust you enough to share their phone number. Right? Just like in on online dating, you would never share your phone number first. Yeah, so they communicate that way. But then it has to work for your team. So what we came up with is a combined inbox that if somebody emails, texts, calls, DMs, you Facebook messages, you ask a question, you want to say whatever. It’s in one place so that you can just respond and not go searching and logging into 15 different places. Yeah. And then however, the patient asks the question, respond through that channel if they ask a question on Instagram, answer through Instagram and then build that relationship and then go, hey, can we text you some paperwork or whatever?

Maureen Werrbach 00:18:56  Right.

Josh Satterlee 00:18:57  But people are like, oh, that’s not allowed or whatever. Stop. HIPAA and every other law is driven by the patient. If the patient wants to communicate that way, then the patient is consenting to that and the patient has that preference. And it also builds trust. Now we’re not going to diagnose them through Instagram. We’re not going to send your lab results through an Instagram DM. You’re sorry about the, you know, psoriasis blah blah blah. That’s not what we do. But we can communicate. We can reassure, we can check in, we can set up for appointments. We can, you know, say, hey, we got some lab results back. You need to come in for an appointment. Yeah, that kind of stuff is totally reasonable. So yeah. So that’s part of it. And then from a business perspective, there’s certain things you should automate to just get those tasks off the plates of your team. And there are some things you should never automate. So my friend who passed away, he had this great quote.

Josh Satterlee 00:19:44  He said, you can never automate a hug. Right? And it’s there are times where you need to send a manual message to somebody. Maybe Maureen had a really bad day or found out that she’s taking a big trip. Like, can you message that about the trip and still show that trust?

Maureen Werrbach 00:20:02  Yeah, I like that.

Maureen Werrbach 00:20:03  So where can people learn about this if they’re because I know tech right now is obviously in the forefront and like such a big concern and excitement, it depends on who you talk to in the mental health field, because we were seeing a lot of tech coming in and like trying to shift away from human therapy models to AI driven models. So tech as a whole is a whole conversation in the mental health industry. And so there’s a lot of practice owners talking about how can we integrate tech in an ethical way? How can we use tech in its best ways while still having like human centered conversations? And so where can people learn about this? Yeah. And two, will you be going into other EHRs? So Jane is starting to become a little bit more known in mental health, the Jane app, but it’s probably third or fourth on the common mental health practice EHRs.

Maureen Werrbach 00:21:01  There’s like simple practice and therapy notes. And then I would say Jane is probably right up there because they’re just newer, you know. Is that something that you’re looking for?

Josh Satterlee 00:21:10  Yeah, I started with Jane because I use Jane and my chiropractic buddies used Jane, you know.

Maureen Werrbach 00:21:14  But yeah, that.

Maureen Werrbach 00:21:15  Probably is maybe more common for chiropractic. And it’s just starting to get into the mental health world. We’re seeing more, Jane.

Josh Satterlee 00:21:20  So we would totally go into these other ones. The way we do it is like if we get five clients that I’ll use the same EMR. There’s just a cost to me. And yeah, I always remind my clients, I have chiropractic money, I don’t have a VC private equity money, you know. Yep, yep. So if we get five people using it and we when we started, we did a beta program because we want to get your input like what really matters. Yeah. And when you’re talking software like what fields do we need to pull in. But which ones we don’t.

Josh Satterlee 00:21:44  So like we would never pull in diagnosis or CPT codes.

Maureen Werrbach 00:21:47  Right.

Josh Satterlee 00:21:48  What purpose would that ever serve. Yeah. But when we pull an appointment times how many appointments you had. Absolutely. But your provider. So we can direct you properly. Yeah. So you can go to trust driven care. Com trust driven care. Com and check it out. And the other thing to your first question is you said there like there’s this concern and remember this, there’s a huge opportunity right now because everybody who’s taking on software without remembering the principles of why we even do what we do, is going to screw this up. So there’s going to be this huge pool of people that are like, I hate this. And there are a bunch of practitioners that stupidly integrate AI and let it run wild. Yeah, that’s not the way you do it. We are huge advocates of a patient experience, some of which can be automated, but we will tell you we’re not to automate things. And in doing so, anybody listening this is an opportunity for you to stand out through doing the human things.

Josh Satterlee 00:22:41  Humanly. Yeah. But there’s no reason that you would never send out a manual appointment reminder. Right? You do it two hours before automatically. That makes sense. However, here’s what doesn’t make sense after the initial visit. I always encourage people sending manual message that says, hey, I’m checking in. I just want to see how you do, and then add some personal bit of information that was never written down on any sort of intake paperwork so that patient knows. Oh, my God, Maureen was listening to me. She remembered my dog’s name was scrappy and that I was, you know, picking them up from the groomer afterwards. Like, if you said, hey, I just want to check in. And by the way, you know, give scratchy a little pet for me. Yeah. Those small things that are completely manual, you only have to do it on the first visit, but they do so much for that person to refer people to your office to finish their care plan, to not fall off the schedule, to do all those things that we want as business owners that also produce better health outcomes.

Maureen Werrbach 00:23:36  Right? Right. Yeah, that makes sense.

Maureen Werrbach 00:23:38  Okay. So I can talk about.

Josh Satterlee 00:23:39  This for seven hours, marine I’m sorry, but I know.

Maureen Werrbach 00:23:42  No, this is great. I’ll make sure to have all of this information also in the show notes and all of that. So I appreciate you coming on and sharing all of this information. And I look forward to seeing this grow. As you know, automating certain parts of business is becoming a little bit more prevalent. It’s great to see you know, what’s out there. And this is definitely something that can benefit solo and group practices in the mental health field specifically.

Josh Satterlee 00:24:07  I think the other piece of it is like there’s a huge opportunity right now to think about how much staff do I really need and where should they be. Right. You know, so like having staff that welcomes people in your office, gives a hug, gives a handshake, incredibly valuable if we do that. Right. But having somebody sitting behind a desk that never makes eye contact never talks and is doing things that could be automated is pure cost.

Josh Satterlee 00:24:31  And I think zooming out and looking at it, there are aspects that we should never automate and, you know, never let. I do and there are aspects where it makes sense. So making sure we’re clear on that is really important.

Maureen Werrbach 00:24:43  Yeah I appreciate you coming on and sharing this information. And we’ll be sure to share all of that in our show notes I appreciate it. Thanks. Thanks for listening. Give us five stars on whatever podcast streaming service you use and I’ll see you next week.