:dropcap_open:M:dropcap_close:ost doctors I speak with have a difficult time determining how often a patient should be adjusted. It all seems to stem from our understanding, application, and patient explanation of “maintenance care” and “corrective care”—terminology we often use interchangeably.
What do these terms mean exactly? The vast majority of chiropractors across the globe schedule their patients (adults and children) for their monthly maintenance adjustment visit. We tell our patients that their monthly visit will help prevent and alleviate many problems that they will experience if they do not heed our warnings and accept our preventative-measure philosophy. Patients look forward to the end of their corrective care and the start of their maintenance care because it means to them that they have graduated; they have paid their dues. Their subluxations are corrected and are no more. Now life begins!
Patients are then seen on a monthly basis because it is good for them—that is our mantra. Most doctors are adamant about their patients following this protocol. And our CAs urge patients to follow their doctor’s advice on this matter. It makes total sense not only for the benefit of the patient, but also for the benefit of the doctor.
We all like to see our patients return and be happy to see us. There are also other benefits: Doctors can be certain of a steady income stream from “maintenance patients.”
What about the benefit to the patient? A likely response is that your patients are getting great care, and you are preventing any future problems from presenting. But how certain are you that this is the case? Your monthly maintenance program may not be preventing or alleviating your patients’ future health problems.
Rather than solving or preventing the problem, most DCs place their patients on maintenance care that is simply maintaining the problem. Most of us tell our patients that our monthly maintenance program is of great benefit to them and that it will prevent specific issues from happening to them in the future. However, while the patients’ symptoms are gone, the problem is still very much present. Patients think their problem is resolved because they feel so much better, and as far as they are concerned, you have done a wonderful job.
However, research by Tapio Vidman tells us that a subluxation, once formed, will initiate a degenerative pathological progression if it is allowed to remain for any longer than two weeks. This means that a monthly maintenance patient visit to our offices will ensure the patient will get worse over time. Their condition will slowly deteriorate and accelerate.
Picture for a moment explaining the results of a patient’s progress exam to them and the fact that their films now seem to be much worse. The patient may confront you and ask why you have allowed their condition to worsen when they have paid you to keep them healthy. They may even ask for their money back as you have failed to provide them with a level of care that you promised. This can escalate into a huge problem, including State Board complaints and a possible lawsuit, not to mention the erosion of your reputation in the community.
:dropcap_open:Money will not be an issue as long as they trust you and what you are saying makes sense.:quoteleft_close:
In addition, most doctors do not see their patients on an appropriate schedule of care in order to be able to really correct their patients’ subluxations. Once formed, a subluxation becomes a habit; it is a neurological pattern that the body learns, adapts to, and copes with. Most often, subluxations start in children.
The following excerpt is from a research paper I wrote on this subject:
“In the child, neuromuscular and functional adaptive reflex development represents a critical period of time when the young developing nervous system assimilates, differentiates, and adapts to external and internal stimuli. By means of these processes,the nervous system learns proprioceptive patterns and acquires future habits and reactions by responding to repetitive stimuli.
However, such a developing nervous system is not always able to distinguish between proper and improper stimuli; therefore, it responds to both. This is the conundrum – the response is neither “good” nor “bad,” but rather adaptive to the presenting stimulus. These adaptive responses are remembered and patterned, and thus the young nervous system is conditioned for future response.
This process of neurological “learning” or “programming” of the central nervous system with respect to locomotion, posture,proprioception, and body kinetics begins within a few short months after birth.”1
Unfortunately, many doctors see their patients on a schedule that they feel their patients will accept and can afford. This often translates into a patient being placed on monthly maintenance—and nothing more—once their symptoms are relieved.
Rather than putting your patients on some nebulous and poorly understood maintenance program, I recommend you see your patients on “wellness” care: a maximum of every two weeks, especially for children. The correction of your patients’ subluxation patterning and habit is the most important thing. To me, there is no such thing as “maintenance.”
I suggest you tell your patients the truth. Tell them what you are doing and why. Money will not be an issue as long as they trust you and what you are saying makes sense. Now, get out there and be the doctor you were meant to be.
References:
- Ressel, O, Rudy R, Vertebral Subluxation Correlated with Somatic, Visceral and Immune Complaints: An Analysis of 650 Children Under Chiropractic Care, J. Vertebral Subluxation Res. October 18, 2004
Dr. Ogi is a Practice Coach and teaches the Practice Evolution Program. He is an international lecturer, a pediatric and x-ray specialist, researcher and clinician. It was Dr. Ogi and Dr. Larry Webster who started the whole pediatric awareness and movement on the planet – when it comes to kids, he has no equal. He can be reached at [email protected] or www.practiceevolution.com