Q: Can you tell me your experience when you first opened your practice how long it took to see a patient? We are doing spinal screenings every weekend at various stores, and have about three appointments so far since we first opened three weeks ago. We have an ad running every week in the paper, and chiro postcards about 100 have been sent out thus far. We also ordered a SAMS unit which will really add to the screenings. At this early stage, should I be worried? Sometimes it's hard to remain aggressive and confident. Next, a 365lb. woman approached our spinal screening, and made an appointment to come in next week for our free consultation and exam. I'm a little hesitant about doing the physical on her, and adjusting when the time comes. Is drop good for someone her size or not? What would you do? Also, for a pregnant woman should the whole physical be performed, and what things should be eliminated that maybe a pregnant patient should not do? Thank you. A: Thanks for the e-mail. To answer your first question .. a lot depends on location and more importantly how you promote. Just being at a screening is half the battle the other half is getting them to come to the office. Therefore .. the mechanics of the programs and what you say and do will make or break your efforts. I dedicate a number of pages within my Smart Start Book (you should consider getting this book if you are new in practice) on screenings and the mechanics of this and many other PR programs. Advertising in newspapers may be too broad .. it goes to many people but few come from it. It may be more successful depending again where you are located and how much exposure you have. Sending cards is a great idea .. also dependent on who you send it to and how far these folks are from your clinic. If you were able to call these folks .. even a few a day .. to see if they received your card and if they would like to attend your office workshops etc. will make it more effective. Being new in practice means there is limited funds. Consolidate your efforts and marketing money and get more for your punch. Getting a SAM unit is a great idea .. but again ..only if you use it correctly and practice „closing the sale¾ Spend a few moments per day to either read or listen on tape some books concerning sales. There are many books dedicated to the salesman that borders on what we do during promotional meetings ..such as screenings and workshops. As far as how long it takes to get your practice going .. again this is an open question. I can tell you one thing .. you are way ahead of many of your friends. Doing something .. and you are doing a number of things already .. is half the battle. Now it is patience and persistence. Consider each endeavor and see if you can tighten your scripts and how you do it. I have always provided seminar class time for the DC with limited cash and how best to promote their practice. There are many things you can do besides what you are doing. There are professional networking .. corporate and social workshops .. community wellness programs etc. Consider this as well. I recommend you consider attending the next Fernandez Seminar in Atlanta .. Oct 27 and 28. This weekend is dedicated in promoting the practice .. I will be speaking for 5 hours many of the topics mentioned above .. including screenings and workshops. If interested in attending as my guest for free .. call them at 1-800-882-4476 and be sure they know you are coming as my guest. Also .. he has a successful Practice Starters Program .. usually a coach is worth the money and efforts. So .. keep on keeping on .. see if you can tighten up a bit and hang in there. Also .. always promote from within once those get through your door. As far as the heavy patient. Remember this for your entire professional career. Never do anything you are not comfortable doing. In my 24 years of practice I have let a number of patients go or leave disappointed because I didn¼t adjust them they liked or they felt I was too conservative. Once you leave your comfort level .. you get in trouble. Therefore .. an x-ray will be difficult to obtain. If you use drop .. it will work .. be very conservative and at their level of comfort as well. I use an Activator a lot and this is a perfect time to have one around. Discuss the conservative nature of this type of adjustment and that it will take time to stabilize their spine. No matter .. they will respond with whatever you do. Just do what you are comfortable doing including the exam. I have always done a short and superficial examination so this has never been a problem for me .. so arrange your exam accordingly. As far as the pregnant patient. I don¼t x-ray and I am always conservative in using the drop in the beginning and little use towards the end of their pregnancy. Side posture helps a lot as well as having the handy Activator. As far as the exam .. do whatever you feel comfortable doing. The typical complete exam taught in school is more medically necessary than biomechanical. So adjust your exam to fit the patient and gather data during the adjustment phase. I hope this helps Have a Great Day Dr. M