​Building and Evidence Based Chiropractic Business with Dr. Brandon Steele | Interview by Noah Volz

You are all about clinical evidence, clinical excellence and evidence-based medicine. What does that mean to you and what does that look like for somebody who’s a student like me?
Dr. Steele: In school you follow the evidence. You do all the orthopedic tests you’re supposed to perform, the questions you’re supposed to ask and so one. When you get into practice you quickly realize that nobody falls in those buckets and there is always more than one thing going on. Or you’re treating someone and they don’t get better. It can be difficult. I always thought of myself as an evidence-based provider. I quickly realized that experience and being more evidence informed tended to guide my practice. I have found a happy medium where I merge an evidence-based with an evidence informed practice. Get all the best information, but then to use your experience and your intuition to actually get to the root problem and find the right solution.

Noah: What research do you use to inform your decision making? Where do you get a lot of that research and how do you determine what’s useful and valuable for your clinical practice?
Dr. Steele: It’s tough. Here's how I did it when I was in school. I used a three ring binder and I printed out all the articles from the library. Articles that I had heard about from Motion Palpation Institute and other seminars. MPI are the smartest when it comes to evidence-based medicine and learning how-to palpate and adjust. 
I would recommend that you write down everything you know about every condition and then you put it into a hard drive and you have all this information in those folders. When the patient walks in with tarsal tunnel syndrome the question is how you retrieve that information. It takes energy and it's tough in practice. This morning I saw someone with tarsal tunnel syndrome, a thoracic spine compression fracture and an inversion ankle sprain. How do you treat all those things effectively and efficiently is really dependent of how much you can retrieve out of your knowledge bank. In school you are creating your knowledge bank and going through the research to see what’s applicable, it all takes a lot of time, but as you use it in your practice it become easier to take that information and use it practically.
Noah: School is creating a knowledge bank. What can we do to create a knowledge bank outside of school?
Dr. Steele: I spent as much on outside certifications as I did on tuition. I had to pay all that back, but learning from the best at those high quality seminars from people who have an interest in patient centered care was a smart decisions. There are a lot of people out there who are very intelligent and have a product to sell. You need to find those people that are doing it right and learn from them. Every practice that you see is going to do things differently. Everyone has a little bit of a different flavor on how they treat something. My number one recommendation is to find those people who practice similar to what you're going to do, who have a similar mindset. That doesn't mean they have to do the same technique as you, it just means that they need to have the same model of evidence based, outcome centers and patients centered model like you want to practice. Learn as much as you can from them. Take their exam forms, take someone else's rehab program, take someone else’s business policies and then merge it all together. A lot of people are unsuccessful when they get out in the real world and I think the reason is they are trying to use a system their not comfortable with. When somebody comes in my office I know exactly what I'm going to do. I'm very comfortable with that because it's my way of doing things. So making sure you know exactly what you're doing comes from experience and to do that you have to work in clinics. 
Noah: Can you briefly describe your practice model and the method that you utilize?
Dr. Steele: We have a unique situation where we work with the medical community. So, our entire practice is based off medical referrals, my responsibility is to get somebody in and out of pain as fast as possible. Then, when they are out of pain I tell them “I like you and I never want to see you again, so take everything that we learned, take everything that we've done as far as rehab and the advice and the movement modifications and run with it.”  In our model it takes six maybe eight visits and they’re out of pain. Hopefully I never see them again for the same problem. It turns out that when have that kind of model people say, “I saw this practitioner, he did a good job.” Then they do a Google search. 
This is what we do and people expect that. I would tell the students to find someone who works like you want to work. Make sure that you find something that matches up well with you and your long-term goals.
Noah: As a referral based clinic with other medical professionals what do you see changing in healthcare and what recommendations do you have. For students in this landscape?
Dr. Steele: I have a unique view on that. My partner is the president of the Illinois Chiropractic association. I'm the president a couple organizations that work with several colleges who are moving in the direction of outcome based care. No matter what letters you have after your name you need to know that health care is going toward outcome based care. It doesn't matter how many times you see them, or how much it costs to see you, and how fast you got them out of pain. The reason is because patients are now footing the bill for our services. In the decades before you submitted a bill and you got paid. Now you submit a bill and there's a third-party administrator who gives you less. It’s moving towards accountable care organizations and affiliate clinics with hospitals where you have to be seen as a valuable resource. That means you have to get outcomes. If you do that, it doesn't matter if insurance is paying the bill or if they are a cash patient, you're a service that people want to buy. That's the reason chiropractic has been around for so long. Manipulation is a very powerful tool. It is event more powerful with other techniques. I see that the future of healthcare is outcome based care independent of the person, the technique, or the letters behind her name.
Noah: Outcome based care is very important. I wan’t to offer high quality care when I get out of school. Can you talk about Chiro Up and how it's relevant for students?
Dr. Steele: Chiro Up is the thing that I dreamt about throughout school. It is a virtual knowledge bank, which is a website. The website can take that information and it can be reproduced the next time you diagnose that condition. We have a board of directors who give us all the information, all the evidence, all the literature form the most recent published journals. Right now we have 91 musculoskeletal conditions and you can pull-up the current literature review. It will show you how do you diagnose it, what are the most sensitive tests, how do you treat it, when should you refer, and what are the radiology considerations. Everything you’d ever want to know about these 91 conditions and it gets continually updated on a monthly basis. You can take that evidence-based information and turn that into a condition report for the patient which states, “here’s what it is, here's how we're going to treat it, here are the exercise that we’re going to do with pictures and videos and descriptions and this is caused by your running technique and here's advice on running shoes. Everything you’d ever want to tell your patient is all in here and it’s all information that you put in there. We have a foundation of content but you can go in and customize it. You put in your own exercises, your own pictures and you can really create your own clinic because that's the information you're going to be giving out to your patients.
That same information can be used as marketing through MD Connect and when you see a patient they give that report to their doctor. Then we measure our results and 30 days later they're going to get an email from you that says what percent better they are, how satisfied they are and how how likely they are to refer this practitioner. Also, we have gathered data on 500 doctors worldwide on what they do and their results. Now I can see worldwide on what different people are doing and the clinical results they are getting in how many visits and what percent better they are. At the end of the year we go back to those providers say “you’re doing a great job at plantar fasciitis, what are you doing differently” and that's where the evidence informed practice comes in. We learn from the best and integrate it into Chiro Up. 
Noah: Trying to create a well rounded care plan is hard. It’s great to see what worked for other people and to build on the foundation of all the people who've come before me. How can students learn more?
Dr. Steele: Students can always visit our busy clinic at Premier Rehab in Swansea, Illinois right outside of St. Louis. Chiro Up is free for students. Students know so much now. The quality of education is