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  • Writer's pictureSarah Ecker

How Using Targeted, Inclusive Language Exploded My Business.

A story about me, a Doctor of Physical Therapy, who set out on a journey to find out exactly how to become the go-to provider for a special group of people in the middle of Chicago.

Hi! I'm so glad you're here! My name is Sarah and I am here to help you attract vulnerable, marginalized, or otherwise left-behind people and communities to YOUR business. Whether you're a fitness guru, a nutrition expert, or a practice of medical professionals trying to do better for more people...let's get these folks through your door. Here's a little story about how I did just that...

“Guess what happens when you ask thoughtful questions or offer educational materials that make people feel safe, seen, and even heard…wayyyy before you even have a conversation?”

Once I realized that I was not your typical Doctor of Physical Therapy who wanted to work in an outpatient practice where you see 537 patients/hour while spending the rest of your waking hours on copious amounts of bureaucratic documentation…I opened my own practice from scratch. Following my clinical doctorate degree, I furthered my education in a specialty area of rehab called Pelvic Health (sometimes referred to in an unfortunately limiting way as “pelvic floor therapy”), where I became a certified practitioner helping folks with everything from complicated spine, hip and pelvic orthopedic issues, to urinary and fecal incontinence, persistent pelvic pain, sexual dysfunction, and preparation/recovery from surgical interventions related to these areas. Early on in this rehab niche, I noticed that despite practicing in a very diverse community, my patients were mostly cis women, most had gone through at least one pregnancy and childbirth (aged from late 20’s to 40-ish), mostly from a comfortable socioeconomic status, mostly white, and overwhelmingly straight. Our referrals came mostly from OBGYNs.

So where were all of these other people who had pelvises? You can’t tell me that everyone else’s bladders, bowels and genitals were running like finely tuned machines on permanent tropical holidays with plenty of fiber, fresh water, and fountains of lube?! Where was everyone else? And why weren’t they coming to our practice?

Like all good clinicians who really just want to be philosophical creatives/Bob Dylan…I decided to take these questions on the road. As a traveling/contract provider, I worked in high-needs communities all over the U.S., in every rehabilitative environment possible: outpatient orthopedics, skilled nursing facilities, sports medicine, wound clinics, acute care, home health. I saw everything. In most of these facilities and in patients’ homes, the patient needs were so complex and the peoples’ health so neglected for so long, that sometimes you wore 10 different clinical (and social) hats to try and provide the services your patients deserved. A majority of my patients in these communities had multiple co-morbidities— meaning: they had a hell of a lot more going on than the specific “physical therapy” reason for which I was seeing them. Sure, maybe I was seeing them because they just had a heart surgery or a joint replacement…but more than likely, they were also managing things like diabetes, hypertension, chronic pain, addiction, trauma, and not to mention things like living in food deserts, little access to transportation and public services, unemployment, inconsistent working utilities in their homes…oh yeah, and all while trying to care for both themselves and their families.

Did I lose you?

What does this have to do with bowel and bladder problems and sexual dysfunction and me blowing up my own business? Everything, actually. When you have issues like diabetes, heart disease, poor functional mobility, poor access to food, services, and safety…no one is asking you about anything other than the obvious issues affecting your health. But guess what— each of these comorbidities are RISK factors for pelvic health problems (amidst others). But no one is asking and no one is informing…therefore, there is no conversation and certainly no problem solving.

Well, I started having conversations. I started asking screening questions. I started educating. What did I find? No matter the person’s sex, gender, age, socioeconomic status, race, sexual orientation…people were suffering in silence with things like incontinence, pain or inability to have pleasurable sexual experiences, pain “down there,” chronic constipation…and a resounding retort to my questions was always: “no one has ever asked me about this before.”

Seriously? Do you know WHY Alice broke her hip? Not because that's what old people do— but because she tripped and fell while rushing to the bathroom because she has urinary incontinence and was worried that she’d have an accident.

Do you know WHY Randall has depression and can’t seem to kick his low back pain no matter what the intervention? Because he’s been suffering in silence with painful erections and this has caused immense stress in his life. Huh…interesting… stress contributes to both hypertension and heart disease and chronic pain… which contribute to ED...oh, did we mention depression?

…see where I’m going here? Chasing the tail of wellness...round and round and round…

A person cannot be defined by one problem or diagnosis and as my wound care professor in PT school famously (if not grotesquely) quipped, “You’ve gotta treat the WHOLE person…not just the Hole in the person.” Truth!

“You’re a diabetic.”

“You’re a walking heart attack.”

“You pain is psychological.”

“If you just lost weight you wouldn’t have any problems."

“Men don’t have problems with their bladder. That’s just for women who have babies.”

Guess what happens when you ask thoughtful questions or offer educational materials that make people feel safe, seen, and even heard…wayyyy before you even have a conversation?

When I stopped doing contract work to build my own practice, I KNEW that I wanted to offer a healthy, compassionate, welcoming environment for a special group of people who are often not seen in the medical world, not heard by their providers, many times suffering in silence (and sometimes worse) because they feel as though no one wants to help them.

I wanted to serve the LGBTQ+ community of Chicago who were suffering from pelvic pain, sexual dysfunction, pre- and post-op gender confirmation procedures, and any type of chronic pain issue that had been compounded by years of trauma, and many times physical abuse and violence. These folks had a special place in my heart not just because of the obvious neglect I had seen during my near-decade of practicing, but because well, I was one of them. As a gay woman with my own less-than ideal experiences within the medical world, I could totally relate. I had very upsetting—actually no—straight-up shitty experiences in GYN and PCP practices. I knew what it was like to try and figure out where I fit on the form that asks me if I’m sexually active and if so, what do I do for birth control? Does "HE" wear condoms during "intercourse"? (Uh....?)

I knew what it was like to be interviewed by a fertility doc when my wife and I were first exploring our reproductive options. The doc was quickly going down her intake checklist and without missing a beat, corrected herself on the “do you have pain with intercourse?” question with a split-second look up from her laptop (as if to confirm that she was indeed speaking to 2 women) saying, “nevermind, you two don’t have intercourse.”

Heck, I even know what it's like to be in a room of esteemed medical experts at the top of their game in a continuing education course or webinar where the topic is "dyspareunia" (a.k.a. painful sex) and the description of "sex" by the "professionals" is clearly only defined as cis heterosexual sex. C'mon, people!

I know what it's like to scour the websites or social media of prospective providers, CrossFit gyms or acupuncturists for ANY sign of “do you accept and respect me here? Do you get me? Am I safe with you?”

So, how did I ensure that as a provider I would never EVER cause my patients the trauma and distress that I, and certainly—they—had experienced throughout their lives while doing nothing more than trying to take care of their bodies?

I designed all of my Dream Practice’s content with a giant, fluffy, cozy and targeted welcome mat of compassion and empathy—and of course, some real strategy in attracting my particular groups…and BAM! Business began to boom. I mean, it was not easy. I studied and taught myself business and marketing strategy and copywriting for years prior (already having writing/editing experience in my cache), provided pro-bono services and education to local clinics and institutions, scheduled as many coffee dates with like-minded inclusive providers I could find… I busted my ass. But! I built exactly what I dreamed of building. And yes, the LGBTQ+ folks with pelvic health issues came streaming through my door, relieved to have me on their team and finally having hope for recovery and healing.

But do you know what else happened? Other historically marginalized groups started coming through my door too (inclusivity in action is contagious)!

When I asked people why my practice??, they said:

“because you said [blank] on your website,”

“because your patient intake form included people like me,”

“because your webinar did not exclude me,”

“because your newsletter included problems that people like me have and no one else talks about,”

“because I saw a rainbow flag or a BLM sticker on your door and hoped I could feel safe here.”

"because my friend said they felt safe here, so I figured I could too"

"because you have people in your waiting room who look like me"

Most impactful of all:you say the same things in person that you do on your website.”

My wife makes fun of me for touting this statistic, but she’s in sales, so I have to rub it in from time to time. Plus, I’m a shameless goofball and don’t mind hearing myself sound absurdly and pompously ridiculous.

“Hey honey, did you know that I have a 100% closing rate? I’m ‘THE CLOSER’. If I worked at your company, I would be in the President’s Circle.”

"If I played for Dodgers, I would be Kenley Jansen."

[or when I walk into a room:] “The CLOSER has arrived!”

Gross, right?

It’s true though. In the tenure of my private practice, 100% of prospective patients who got on a call with me (after studiously combing through my website, credentials, educational videos, etc.), scheduled a new patient visit with me 100% of the time (nope, not one cancellation either). It may have taken some of them a month or 2 to mull it over…but I always followed up on them to see how they were doing, and they ALWAYS scheduled a visit. Impressive huh? Not really. I mean, I guess it is?…but it was really as simple as building something that was burning in my heart- something that I knew would help some very special people who needed that help. I used the words that I had always dreamed of seeing on a provider's Branded materials (in print and in person). Then, it was just a matter of me being me. It’s easy to be consistent in your words and actions when your intentions are whole-hearted.

Anyway…now I’m embarrassed. What a tool!

To me, the highest compliment of a business successfully run are current or former client referrals. And I still get them today even though I closed up shop in Chicago at the end of 2020 and since moved out of state. And honestly, I did not have to do a ton of marketing and outreach after creating my initial communications: mission, call to action, content frameworks, etc. Because, well—referrals! Your words open the door…your actions and ability to reflect and adapt keep your door open. You can’t have one without the other.

I used words and strategy to recruit the folks I wanted to serve.

I used my actions to solidify my words.

I revised as needed.

Result: Having a steady stream of my dream clients walking through my door meant that I had never been happier or more fulfilled in my professional life, and it was an honor to wake up every day and do my thing, for my people.

So I leave you with this. Who do you WANT to serve? Seriously, dream big here. There’s a lot of exclusivity and hyper-marginalization happening in our world right now— especially in the health, wellness and medical arenas. Who's missing from your business? I KNOW there are business owners, product developers, fitness gurus, and expert medical professionals out there who have it in their HEARTs to make themselves open to a particularly vulnerable population. Let’s get those folks through your door! Not only do they need you — but you need them too. You’ll see. Let’s make it happen.

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