Your practice philosophy can influence how you present chiropractic to your patients, regardless of whether you went to a more philosophical chiropractic school or you went to school that did not emphasize the chiropractic philosophy, as much can influence the way in which you manage your chiropractic practice and the way in which you manage the care you provide your patients. In teaching around the country and the world, I have discovered that there are three main types of practice management philosophies and each one has its pros and cons.
The three types of practice management philosophies that I have discovered are:
1) Pain Approach
2) Philosophical Approach and the
3) Functional Approach.
In the pain approach to practice management the patient will be under care for about 6-8 visits. This practice management approach only takes 6-8 visits because this is generally how long it takes for a patient to get out of pain with chiropractic care. Chiropractors can get a patient out of pain relatively quickly; we are very good at doing that—it’s keeping them out of pain that’s the harder job. Patients do not have pain without a reason. Pain will be the last thing to show up and the first thing to go away. But, if the underlying cause is not cared for, then the pain will come back. This is what I term the medical model of healthcare.
The goal of the medical profession, for the most part, is to get the patient out of pain and, hopefully, address the cause of the problem from a physiological approach. This is not an effective chiropractic approach, and the patient doesn’t receive the true value of chiropractic care under this approach. A chiropractic practice needs lots of new patients each month under this approach, as well, because the retention—6-8 visits, is very low. Clearly, this is not the most practical approach to deliver chiropractic care from a clinical viewpoint.
In the philosophical approach to chiropractic practice management, the patient receives the true value of chiropractic healthcare, but are we expecting too much from our patients? The chiropractic philosophy of healthcare necessitates a huge paradigm shift to most, because they have been inundated with the medical model of healthcare. It is very difficult to teach a patient what a subluxation is, and how that impacts their health. Even further, it is difficult to demonstrate how the chiropractic lifestyle approach will benefit them, and do so within their first few visits. With this in mind, it is possible to teach a patient over time. This includes what it is to have a chiropractic lifestyle and how this lifestyle fits into the current healthcare model. In order to be successful at this sort of re-education,the office must have a large retention statistic.
The functional approach, on the other hand, is an approach that is able to SHOW the patient how they are doing functionally. In this approach, the patient moves from an “I BELIEVE” that chiropractic works mode of thinking to an “I KNOW” that chiropractic works mode of thinking. Chiropractic is not a religion, but many people believe that it works similar to a religion. This is partly due to the fact that the chiropractic profession doesn’t have a plethora of scientific evidence beyond neck pain, back pain, whiplash and headaches to PROVE what chiropractors tell their patients that chiropractic does beyond those neuromusculoskeletal entities. The functional approach relies on objective functional testing to provide evidence on whether or not the patient is getting better, staying the same, or getting worse. The patients are able to SEE for themselves whether or not they are getting better from a functional standpoint. When we look at Figure A, we can see that, if a patient is functioning normally, he/she should have no pain. If the patient is not functioning normally, then there must be a malfunction and the result of abnormal function or malfunction is pain. This paradigm also indicates that acute malfunction brings intermittent pain. As the acute malfunction persists and becomes chronic, the pain will worsen until it is constant and more severe. It is in this way that patients can become pain-free over the course of care and still have a malfunction. Because the patient still has a malfunction, the pain will inevitably return.
Clearly, the functional approach to chiropractic care makes it more likely to be able to demonstrate and administer the true value of chiropractic healthcare to patients. The functional approach to practice management and treating patients is also able to prove whether or not the patient has subluxations. If chiropractors treat subluxations and this is what separates us from other healthcare professionals, then why are chiropractors not evaluating patients to see if they have subluxations? How can a doctor of chiropractic show patients that they have subluxations? We can answer those questions by simply breaking the subluxation down into its components. (See Table 1)
Table 1 shows the subluxation broken down into its five different components and they are:
1) Kinesiopathology
2) Myopathology
3) Neuropathology
4) Pathophysiology
5) Histopathology
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Table 1: Objective Tests to Evaluate for Subluxation |
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Subluxation Component |
Objective Test |
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Kinesiopathology |
Computerized ROM Testing |
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Myopathology |
Computerized Muscle Testing |
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Neuropathology |
NCV, EMG, DSEP |
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Pathophysiology |
Radiographs, Computerized ROM Testing |
|
Histopathology |
Diagnostic Ultrasound |
As chiropractors, if we are evaluating patients for subluxations, then we should be evaluating patients to see if they have some or all of these components. Table 1 also shows the corresponding diagnostic tests to OBJECTIVELY determine whether or not the patient has that component.
Kinesiopathology refers to the abnormal position or abnormal movement of the vertebrae. In order to objectively test to see if the patient has this component, the chiropractor should use computerized ROM testing and radiographs. To objectively evaluate the myopathology component or the abnormal muscle function, the chiropractic physician should utilize computerized muscle testing. Neuropathology refers to abnormal nerve function. To objectively test for abnormal nerve function, the doctor utilizes tests such as nerve conduction velocity (NCV), electromyography (EMG) or dermatomal somatosensory-evoked potentials (DSEP). Pathophysiology is abnormal function of the spine and body and can be evaluated by using radiographs and computerized ROM. Histopathology is the abnormal tissue function and can be evaluated objectively by using diagnostic ultrasound.
By utilizing diagnostic tests to evaluate the patient for subluxations, the doctor of chiropractic is able to gather a baseline of data at the beginning of the care plan, as well as to periodically reevaluate the care plan with all the data collected. This will help assess the progress of the patient and relate that to the care plan. This is the manner in which the patient moves from an “I Believe” that chiropractic works to an “I know” that chiropractic works form of thinking. The patient becomes focused on the functioning normal rather than just getting out of pain. This is the true value of chiropractic care.
Dr. Dwight C. Whynot is in fulltime practice in Johnson City, Tennessee. Dr. Whynot gives license-renewal lectures on Evidence-Based Chiropractic Practices which are promoted by the International Chiropractors Association and sponsored by Myologic and Spinal-logic Diagnostics. For questions regarding evidence-based practice procedures, email questions to [email protected].
For 12-hours CCE license renewal lecture dates and places call the ICA at 1-800-423-4690.
For more information on Myologic or Spinal-logic, go to www.myologic.com or www.spinallogic.com.