RochesterChiros Blog

I recently had a new patient encounter that went something like this…

Stressed and in pain patient (SAIPP): “Dr. Daly, I think spinal decompression would be very helpful for my pain but I cannot afford the $3,000 down payment. “

Me: “The WHAT?!?!”

SAIPP: “Well I went to another Chiropractor and they told me they would be happy to help me, but that I needed to sign a contract for treatment and pay up front”

Me:

The face is slightly exaggerated (my eyes aren’t blue), but It’s hard for me to come up with any other initial response.  And seriously, I’ve had A LOT of opportunities to work on it.

The story seems to repeat regularly.  People will hear about a new and exciting therapy for their pain, often including one of the following; chiropractic manipulation, spinal decompression therapy, low level/cold laser, soft tissue mobilization/treatment, traction, etc. The advertisements sound promising, and after they visit the advertising office they find out the treatment costs $3,000 and requires a three time a week treatment plan for 6 months.  They will assume that the $3,000 one-time payment is needed for the treatment, and will go ahead with the expense in hopes of relief.  Many of them are unfamiliar with chiropractic and assume that all chiropractors require the same investment.  Not knowing their options, the SAIPP (read above) will end up buying into an expensive plan that is not covered by their health insurance.  I’ve heard this frequently and I’ve tried to shrug it off, but it is getting ridiculous.

Patients of the world:  do not be swindled.  Spinal decompression, spinal manipulation, cold laser, soft tissue work, and just about everything else doesn’t require months of mandatory treatment and certainly DOES NOT require prepayment!  Our office, (along with many other ethical offices) offer the above treatments as needed or as part of a treatment plan at the standard office fee which is covered by most insurance plans (40-50$ per visit around here).  Why?  Because we do not need to guarantee your return! If we are careful with our diagnosis and utilize the appropriate treatment you should want to come back.  If you were unhappy and didn’t like chiropractic treatment; I’m sorry I couldn’t help you, and I will be happy to refer you to someone who might be able to. There’s no paying in advance for treatment here.

Unfortunately patients who have been duped by his business strategy often have a jaded view of chiropractors, and with good reason. They also have a significant bill that their insurance didn’t pay for, and if the treatment wasn’t helpful they could still be struggling with chronic pain.  After finding out they can receive the same treatment for much less, patients are usually a frustrated combination of happy and angry: “hangry”.  Most people aren’t too happy to pad someone else’s wallet with their own money.

            Prepayment is a great way to make a buck.  You advertise extensively, make sure patients are desperate and come to you in pain, and corner them into an expensive treatment plan.  It walks the borderline of ethics, but is an ingenious way to make money.  People who are scared and in pain are often willing to spend money for anything that will help!  I’m just not certain who this treatment is benefiting… it doesn’t seem too patient centered to me.

I love what I do. I offer a specialization in healthcare that is sorely needed.  People are often amazed to hear that their back, ankle, elbow, or neck pain can be treated easily without medication or surgery.  But I do not like how some of my colleagues operate. So stop.  Seriously, it makes us all look bad.  If you are in pain and think a chiropractor can help, do some shopping.  You should never be forced to pay absurd amounts of money or get involved with ludicrous treatment plans to find relief.  There are many of us out there who are looking out for our patients, not for our wallets. – Dr. D

I have heard this way too often and it is always alarming.  Patients come in with a diagnosis they do not understand and are following a treatment plan that either doesn’t make sense to them, or that they do not want to follow.

 No Dr. Bear. I need treatment, not balloons.

This drives me nuts!  Is this lapse in appropriate information on the doctor’s side or on the patient’s side?  Where are these doctors failing to explain a patient’s diagnosis? Why are there patients content with understanding as little about their health as is possible?!  So the following rant is designed to be a public service announcement.

1^st, to the Patients: please, please, please, please, ASK questions. While some doctors may excel at mind reading, most of us do not. We spent so much time in school learning complicated terminology that at times we may forget to clarify in an easy to understand manner. The word “doctor” is actually derived from the Latin word for “to teach”.  After your doctor diagnoses your condition, the next step should be a conversation regarding what it is and what it means.  No one will look down on you because you are not well versed in human anatomy, physiology, and pathology.  The human body is absurdly complicated, and comprehension of how it works often takes years of schooling and practical experience (AKA Med School/Chiropractic School, etc).  So while just about everyone knows what “Kidney Stones” are, a lot of people would be confused if their doctor told them they have a Nephrolithiasis.  When in doubt- ASK. Having questions is expected, and most doctors will not be upset about a patient wanting to know more.

Next, as with any human relationship- if you don’t like your doctor or disagree with a recommendation you CAN get a 2^nd opinion or even change doctors! I hear several times a week “I’ve been going to see Dr._______ for 5 years, but I can’t stand the guy!”  Why on Earth would you spend your time and money seeing someone you don’t like and don’t trust!  Here in Rochester, there are numerous specialists in a wide variety of fields (I would assume it is same in any moderate or large sized city).  If you are willing to travel, you can often find a doctor who is a good fit for you and what you need.

Although… in some locations you may consider taking any medical advice you can get….

2^nd to the doctors: Remember, you are treating people. Many of these people are smart and willing to learn, but have zero training on how the human body works.  As a Chiropractor I see back pain ALL day every day, and while the vast majority is a simple fix I always try to remember that it is often scary and confusing for the patient who is in pain. I have to give kudos to the emergency room staff, oncologists, and other health professionals in fields that deal with more terminal conditions because giving bad news is the worst part of the job… But it is part of the job.  INFORMED consent is a vital part of the healthcare, and if the patient doesn’t understand their health it is impossible for them to properly consent.

In my book, comprehension from the patient is just about as important as a proper diagnosis and the proper treatment.  While we see the doctor to get evaluations of our health, the bottom line is that it is still YOUR health.  If you don’t understand something, ask.  Then ask again, because sometimes we forget.

End rant.

Questions? Comments?  Feel free to contact me- Dr. D.

I’ve heard this story a lot, especially lately.  I figure it’s a significant enough situation that something needs to be said about it. Let me know if this story rings a bell…

“Dr. Daly, I have a friend who cracks people’s backs for free. Isn’t that the same thing you do? If that works why should I see a Chiropractor?

Sound familiar? If not a question you’ve said aloud, I’m certain you’ve either thought it or had someone ask it in regards to Chiropractors.  In retrospect my biggest mistake was not getting anything signed to get that nickel for every time I have heard it… I need better legal representation…

Good question though right? It doesn’t matter who gets your bone to crack as long as it cracks! What’s the difference?!

Well, some might claim it doesn’t matter.  I however have to play the devil’s advocate and say it matters very much.  As I often do, I will elaborate.

So let’s wrestle this, what’s the big deal with people “cracking” one another’s backs.  I can vividly remember people in middle school, high school, and later college who would boast this ability. They would offer to crack your back, and would do so without any pre-requisite qualifications other than success after a few drinks.  So let’s start this simply; the spine is complicated.

There are numerous moving parts, hundreds of muscles, and let’s not forget the spinal cord with its 62 separate spinal nerves.  Chiropractors have spent over 100 years studying just the spine and how it operates. Chiropractors- Both through history and today have spent their years developing techniques to manipulate the spine (cracking).   We know how to manipulate joints with the appropriate amount of force and in the right direction to both create change and avoid side effects.

Without training and education, there are many possible side effects to trying to manipulate the spine. A short list includes broken ribs, sprains/strains, and without a proper examination any number of more serious side effects- incontinence, paralysis, perhaps even strokes! Non-specific and often aggressive attempts to manipulate the spine may get the crack, but are hardly without risk.  Again, not to toot our own horns, but Chiropractors are doctors who specialize in the treatment of the spine. We know how to examine it for conditions and disease, we know how and when to treat, and most importantly we know when NOT to adjust.

All side effects and nuance aside, the most important issue I have with the good ol’ back crack, is that it is practicing without a license.  “So what? It’s not hurting anyone?” Wrong, first of all it is a criminal offense and a felony in most jurisdictions. Second, going blindly into anything that you have no understanding/experience with is always a bad move. Having the tools for the job isn’t the same as knowing how to do the job.  Adjusting the spine may seem easy- odds are you have a spine, and most people have a hand or two, so it seems pretty straightforward. But If I received a bullet wound (yikes, what was I doing?!), I would prefer to be treated by a trained trauma surgeon over someone on the street with a knife and a set of needle-nose pliers!

So let’s discuss the real world example of what can happen when we do this. So we’ll pretend you offer to crack your friend’s back. He’s been having a rough week and you don’t think he should have to pay for what you can do right at home. You tell him to lie down and you proceed to walk on his back to get it to crack.  Now, Let’s also pretend you don’t exactly have a thorough understanding of the spine and your foot slips and you break a rib. Your friend gets mad about the broken rib (which are generally pretty uncomfortable) and does a not-so-friendly thing and sues you.  You have no license, so right from the start you have have zero defense for what you were doing. Next you have no malpractice/ liability insurance, so whatever he sues you for you will be paying for out of pocket. Suddenly the harmless crack you did ends up being a $200,000 oopsie with a chance for jail time.

            This whole post might sound like a ruthless exaggeration, but I would caution you to talk to a Chiropractor first. We spend a significant amount of time in school learning the ins and outs of working with the spine. We know the good, the bad, and the ugly. Nothing is worse than the “adjustments” performed from first year Chiropractors (not picking on anyone, I was there once).  Limited skill and limited knowledge in anything is going to be trouble, but with regards to healthcare and Chiropractic specifically is often painful. We pay for malpractice because even the best Chiropractor, on his best day, isn’t without the possibility for risk.

I swear I’m not just writing this from a soap box to try to sound better or more capable than anyone else. The point of writing this is to bring home an important point- it’s dangerous to practice without a license.  If you think someone need’s a back adjustment either take them to someone licensed to treat the spine, or tell them to wait a few years for you to get the appropriate education and license to do so.  Questions? Comments? I’d be happy to talk- Dr. D.

Great video about responsible chiropractic treatment of Low Back Pain from the West Hartford Group. The WHG, Inc. is a scholarly, clinical practice think tank dedicated to the acquisition of the social, cultural and professional authority for the chiropractic profession where the Doctor of Chiropractic serves a vital role within the mainstream health delivery system as a non-surgical primary spine care physician dedicated to clinical excellence, intellectual honesty, professional integrity, ethical practice and the delivery of patient-centered, patient-safe, evidence-influenced care and best practice.

The West Hartford Group, Inc. is neither a political organization nor service organization but a think-tank that has put forth a model of chiropractic care that is consistent with that of the World Federation of Chiropractic and the Chiropractic Strategic Planning Conference. This model is of the chiropractic physician as the spinal health care expert within the health care system, i.e. society’s primary spine care physician.

It’s not news that chiropractors worldwide recognize the need for greater respect from the public, other health care professionals and various policymakers. What many people say is the missing key to solve this perceived inequity is our lack of general public trust which would permit our self-governance. When the public fully trusts a profession, then truth is what that profession says it is. The professional group defines itself and, without any fanfare or undue prodding, the public accepts this truth. That is the trust that marks cultural authority. Chiropractors have understood that this is a barrier for many years and many chiropractors have set out to build our cultural authority. In this episode, we speak with Dr. Michael Farrell, a chiropractor from the Buffalo, NY region on that subject.

LISTEN TO THE PODCAST HERE

Links for this show

Michael E. Farrell, II DC – practice website

Building Bridges to Cultural Authority by Arlan Fuhr, DC

How can chiropractic become a respected mainstream profession? The example of podiatry. Donald R Murphy et al

Book: Surviving in Health Care by Dieter F. Enzmann, MD Clearly written by a clinical doctor, this book first helps physicians understand the causes of changes in health care. Then, it explains how to devise a strategy in order to survive and prosper in today’s environment. It covers the entire spectrum of medicine, and encourages solutions that meet physicians’ individual circumstances. It focuses on useful tactics and specific actions, rather than quick fixes. Shows physicians how to formulate a strategy to survive and prosper. Includes discussion about cultural authority.

Chiropractic Summit

IHCPR

When we are measuring the impact chiropractors have by their presence in the health care system, and not just in spine care, but our presence overall, there may be something missing. Many chiropractors have had a dramatic effect on the public’s health by being properly trained in diagnosis and emergency procedures. By being a portal of contact for a patient who is discovered to have a life threatening condition, the chiropractor may be integral in starting the chain of survival much sooner than the natural history. Or, the chiropractor may actually perform an emergency procedure that leads to an immediate change in a patient’s ability to survive.

When the lawmakers and stakeholders sit down to carve up the medical allocation pie, there are some large pieces that get allocated to hospitals and emergency care, some large pieces that go to prescription drugs, some smaller pieces that go to specialties like obstetrics. By the time they get around to even thinking about chiropractic care, the pie is pretty well carved up. The justification for this frequently is, well, chiropractic is a nice thing to have. But it’s like massage – not a necessity — more of a nicety.

This episode’s stories illustrate that lives have depended on a chiropractor’s quick actions. Some of the doctors who told their stories are listed below:

* Mike Simone, DC Simone Physical Medicine, Dacono, CO
* Cynthia Vaughn, DC Austin Chiropractic Center, Austin, TX
* John Ventura, DC Rochester Chiropractic Group, Rochester, NY
* Keren Day, DC New York, New York
* Brett Kinsler, DC Natural Health Chiropractic, Rochester, NY
* William Grosso, DC Rockland Health Chiropractic Assoc. New City, NY

Listen to this episode in iTunes or click here

I wrote a blog article on the topic of chiropractors and limited prescription rights, especially as it pertains to the state of New Mexico. That post attracted some heated debate and strong opinion. For more depth on this issue, I wanted to speak to two people who went to the hearings in New Mexico concerning this bill. I contacted Dr. James Winterstein, president of National University of Health Sciences and Dr. Gerry Clum, recently retired president of Life College of Chiropractic West to hear what they had to say.

Listen to this episode on iTunes or over at the On The Other Hand podcast website.

J. David Cassidy DC DrMedSc PhD

J David Cassidy, DC DrMedSc, PhD is a senior scientist in the Division of Health Care & Outcomes Research at Toronto Western Research Institute (TWRI).  He is also a professor in the Division of Epidemiology at the Dalla Lana School of Public Health and professor in Clinical Epidemiology in the Department of Health Policy, Management and Evaluation in the Faculty of Medicine at the University of Toronto.  Dr. Cassidy also holds the Research Directorship in Artists’ Health at the University Health Network.

Originally trained as a chiropractor, Dr. Cassidy practiced in both Ontario and Saskatchewan, where he was a member of the Medical-Dental Staff at the Royal University Hospital and a consultant chiropractor to the Division of Orthopedic Surgery. He also holds a Bachelor’s degree in Anatomy, a Master of Science in Surgery and a Doctorate in Anatomical Pathology from the University of Saskatchewan. His second doctoral degree (Dr.Med.Sc.) was earned in Epidemiology and Injury Prevention at the Karolinska Institute in Stockholm, Sweden.

Dr. Cassidy has authored over 225 scientific papers and chapters in books, including publications in the New England Journal of Medicine, Achives of Internal Medicine, Spine and other international journals. His research interests include musculoskeletal and injury epidemiology. His current research focus is on disability prevention from occupational and traffic injuries, neurotrauma (brain and spinal cord injury) and health issues in artists.

Dr. Cassidy is recently known for a paper published in Spine that examined more than 100 million person years and concluded there was no additional risk of stroke following a visit to a chiropractor versus seeing a medical doctor.

In this episode of the chiropractic podcast On The Other Hand, J. David Cassidy speaks with Dr. Brett Kinsler about this paper, its strengths and its criticisms.

Listen here, on iTunes or use the handy player below. Transcript here.

Craig Liebenson, DC literally wrote the book on spinal rehabilitation and is highly regarded among chiropractors, medical physicians and physical therapists alike in the field of spinal rehabilitation around the world. He has studied and taught with Professors Vladimir Janda and Karel Lewit from the Czech Republic – pioneers in functional rehabilitation and manual medicine, as well as many others who have revolutionized the field. Many of them are contributors to his text.

Dr. Liebenson is an Adjunct Professor in the School of Chiropractic, Division of Health Sciences at Murdoch University and a member of the International Association for the Study of Pain and the American Pain Society.  He helped to set up the Los Angeles College of Chiropractic and Scandinavian College of Chiropractic Rehabilitation Diplomate Courses and serves as a consultant and lead faculty for the Murdoch University and Anglo-European Chiropractic College M.Sc. programs in Chiropractic Rehabilitation. Dr. Liebenson treats many world-class elite athletes, was an NBA team chiropractor and currently serves as a consultant for the Arizona Diamondbacks MLB baseball team. He remains in private practice specializing in rehabilitation in Los Angeles

Dr. Liebenson was the first ever chiropractic member of the McKenzie Institute (U.S.) Board of Directors, a frequent lecturer at national and international multidisciplinary meetings, and has published extensively in journals and books on the subjects of rehabilitation and chronic pain the best known being the multidisciplinary text Rehabilitation of the Spine: A Practitioner’s Manual (Lippincott/Williams and Wilkins), popular for over ten years, it is now in it’s second edition.

This podcast episode is a discussion between Dr. Craig Liebenson and Rochester, NY chiropractor and blogger Dr. Brett Kinsler.

• Craig Liebenson’s Blog
• Upcoming Seminars
• LA Sports & Spine
• Some books by Dr. Liebenson

Click here to go to the podcast website or use this handy podcast player: