Education

For New DCs: Patient Education and Motivation

By Frank M. Painter|October 14, 2009|Education, Practice Management|

For New DCs: Patient Education and Motivation

We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.

This is Chapter 7 from RC’s best-selling book:

“Developing A Chiropractic Practice”

These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.

Chapter Seven: PATIENT EDUCATION AND MOTIVATION

We described in the last chapter how an individual who is sick, in pain, or worried must be dealt with in a special atmosphere of understanding and consideration to lessen the anxiety involved. When health is lost, the sense of security is lost, and the person is operating on the basic motivational levels of self-preservation and threatened personal safety.

Patient education and motivation are two important solutions to this problem, and these are the primary subjects of this chapter. Professionally, these disciplines begin with and end with the professional services offered. Other major topics addressed include motivational communications, practice development, office systems, and auxiliary techniques.

Introduction

While the doctor’s diagnostic and therapeutic skills help to restore hope and relieve some of the patient’s emotional stress, a strictly technologic approach is not always enough. A patient’s emotions and frame of mind must also be considered as a component of a patient’s holistic state of health. The state of rapport between patient and doctor can be just as important as the technical care provided, and this rapport is established on a foundation of sincerity, understanding, kindness, and personalized care.

A doctor has moral obligations and professional responsibilities for each patient’s health. Thus, the physician should anticipate possible patient stress by questioning the scope of everyday activities. This questioning and the resulting consideration, however, does not mean to conclude with blunt condemnations. The alert doctor will be aware that typical patients are not interested in the technical aspects of their conditions. They are interested in the removal of pain, discomfort, immobility, and how the condition affects their life-style. Therefore, it is important that the patient’s everyday activities, hobbies, work and personal habits be considered along with the clinical aspects of the patient’s condition.

Many years of study does not guarantee a doctor a successful practice, nor does an attractive office with a nice location that incorporates modern equipment and pleasant furnishings. These factors only establish an opportunity for success. Every professional needs new patients to replace dismissed and self-dismissed patients.

Professional Services

Comprehensive health-care involves certain professional services to meet certain situations. Basically, all office policies and procedures are designed to support a chiropractic office’s four major services:

(1) consultation,
(2) examination,
(3) treatment, and
(4) education.The initial consultation and history are required to help determine the type of initial examination procedures necessary to isolate the cause or causes of a patient’s complaint or complaints. The second consultation follows examination and data evaluation and is held to review the findings with the patient and recommend a treatment program or referral. Ongoing consultations are necessary to receive progress reports from the patient, to counsel the patient against harmful acts, and to provide education toward healthy behavior and performance. The initial examination is necessary to profile a patient’s structural and functional status at the time of entry into the practice and to arrive at a diagnosis and prognosis under recommended therapies. Periodic examinations are necessary to monitor the results of recommended therapies, challenge the prognosis, and offer data to objectively confirm a patient’s subjective reports. All therapies should be designed to assist the patient in returning to as near a state of health and resistance to disease or normal stress as is possible.

These continuing services are involved in most all cases to some degree, but emphasis is considerably altered depending upon the type of case presented and the type of health care necessary at a particular point in time. For example, the typical office will offer five forms of health care:

Review the complete Chapter (including sketches and Tables) at the ACAPress website

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For New DCs: Getting Known Within the Community

By Frank M. Painter|October 13, 2009|Education, Practice Management|

For New DCs: Getting Known Within the Community

The Chiro.Org Blog

We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.

This is Chapter 8 from RC’s best-selling book:

“Developing A Chiropractic Practice”

These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.

Chapter 8: GETTING KNOWN WITHIN THE COMMUNITY

This chapter describes individual responsibilities and projects in patient and public relations. It also portrays some of the more important aspects of national public relations developed by organized chiropractic, along with implementation in various degrees at the state, district, community, and office levels. Initial efforts, sustaining efforts, and development efforts are explained.

It has been previously shown that interpersonal relations generally involve the four steps of

(1) attention,
(2) interest,
(3) desire, and
(4) action.As the goals of mass public relations and community relations programs are to gain public attention and interest in public health in general and chiropractic in particular, these subjects will be emphasized in this chapter. The development of patient desire and action is a function of the individual practice. This was shown in the previous chapter, and it will be embellished in this chapter. Regardless of the public relations or advertising methods used, there can be little practice or professional growth without patient interest and desire.

Introduction

Be they good or bad, everybody has public relations. Positive public relations is that attitude and course of action taken by any individual or group that desires to identify its actions and goals with the welfare of the people to gain widespread understanding and good will.

Public relations in chiropractic can be approached from both an individual practice viewpoint and a professional viewpoint, and these are overlapping and indivisible functions. That is, what is good public relations for the doctor is good public relations for the profession at large, and vice versa. Thus, a well-planned, high-quality, national public relations program will profit the profession little if individual practices are not imbued with the attitude of positive public relations and the development of safeguards that make poor public relations impossible.

Ethical Promotion

Ethics, a service-oriented attitude, and high-quality conduct are the basis upon which any public relations program must be built. Public relations begins in the local community and takes shape through the contacts of individual people with one another. In both the business world and the professions, a good reputation is founded on good works that are communicated truthfully and candidly.

Public relations is not the propagation of favorable publicity regardless of merit, nor is it phony promotions and cheap publicity stunts designed to manipulate public opinion. It refers to true identification with the public welfare — education to mutual concerns, operating in the public interest, and communicating this performance. As the business world has learned that it can, and must, take a careful account of the attitudes and wishes of the public before it evolves its programs of action, so must any health profession.

It must be realized that the modern doctor of chiropractic is a combination of scientist and healer, and this integration has led to growth from fixed orthodoxy and sometimes illogical traditions. As healers, we must be aware of basic psychologic and human-relations facts that contribute to the “art” of our profession.

Poor public relations, ill-will, and resentment take place when either doctors or their assistants fail to identify with the patient’s situation. Patients inevitably react negatively to a procedure or transaction when they are expected to understand without knowing the facts as understood by the doctor and assistant. Thus, it is each doctor’s and assistant’s responsibility to give the facts to the patients and to the public.

The Professional Image

Review the complete Chapter (including sketches and Tables) at the ACAPress website

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Lower Back Trauma

By Frank M. Painter|October 11, 2009|Diagnosis, Education, Low Back Pain|

Lower Back Trauma

The Chiro.Org Blog

We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.

This is Chapter 12 from RC’s best-selling book:

“Chiropractic Posttraumatic Rehabilitation”

These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.

CHAPTER 12: LOWER BACK TRAUMA

Although it is easier to teach anatomy by dividing the body into arbitrary parts, a misinterpretation can be created. For instance, we find clinically that the lumbar spine, sacrum, ilia, pubic bones, and hips work as a functional unit. Any disorder of one part immediately affects the function of the others.

BACKGROUND

A wide assortment of muscle, tendon, ligament, bone, nerve, and vascular injuries in this area is witnessed during posttrauma care. As with other areas of the body, the first step in the examination process is knowing the mechanism of injury if possible. Evaluation can be rapid and accurate with this knowledge.

Low-back disability rapidly demotivates productivity and athletic participation. The mechanism of injury is usually intrinsic rather than extrinsic. The cause can often be through overbending, a heavy steady lift, or a sudden release —all which primarily involve the muscles. IVD disorders are more often, but not exclusively, attributed to extrinsic blows and intrinsic wrenches. An accurate and complete history is invariably necessary to offer the best management and counsel.

INITIAL ASSESSMENT

A player injured on the field or a worker injured in the shop should never be moved until emergency assessment is completed. Once severe injury has been eliminated, transfer to a back board can be made and further evaluation conducted at an aid station.

Neurologic Levels

(more…)

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Motion Palpation of the Cervical Spine

By Frank M. Painter|October 7, 2009|Cervical Spine, Diagnosis, Education, Motion Palpation|

Motion Palpation of the Cervical Spine

The Chiro.Org Blog

We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.

This is Chapter 3 from RC’s best-selling book:

“Motion Palpation”

These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.

Chapter 3: The Cervical Spine

This chapter describes the basic biomechanical, diagnostic, and therapeutic considerations related to motion palpation and the cervical spine. Emphasis will be on relating the general concepts previously explained about the chiropractic fixation-subluxation complex to specific entities that can be revealed by motion palpation and frequently corrected by dynamic chiropractic. Some aids to differential diagnosis are also included.

APPLIED ANATOMY CONSIDERATIONS

There are seven sites of possible “articular” fixation in the cervical spine. They are at the bilateral apophyseal joints, the bilateral covertebral joints, the superior and inferior intervertebral disc (IVD) interfaces, and the odontal-atlantal articulation (Table 3.1).

Table 3.1. The 27 Sites of Possible Spinopelvic Articular Fixation

In the cervical spine (7 possible sites of fixation)
Bilateral apophyseal joints	2
Bilateral covertebral joints	2
Superior and inferior IVD interfaces	2
Odontal-atlantal articulation	1
In the thoracic spine (8 possible sites of fixation)
Bilateral apophyseal joints	2
Superior and inferior IVD interfaces	2
Bilateral costovertebral joints	2
Bilateral costotransverse joints	2
In the lumbar spine (4 possible sites of fixation)
Bilateral apophyseal joints	2
Superior and inferior IVD interfaces	2
In the pelvis (8 possible sites of fixation)
Bilateral superior sacroiliac joints	2
Bilateral inferior sacroiliac joints	2
Sacrococcygeal joint	1
Pubic joint	1
Bilateral acetabulofemoral joints	2

The Apophyseal Joints of the Spine

Throughout the spine, paired diarthrodial articular processes (zygapophyses) project from the vertebral arches. The superior processes (prezygapophyses) of the inferior vertebra contain articulating facets that face somewhat posteriorly. They mate with the inferior processes (postzygapophyses) of the vertebra above that face somewhat anteriorly. Each articular facet is covered by a layer of hyaline cartilage that faces the synovial joint. The angulation of vertebral facets normally varies with the level of the spine and can be altered by wear and pathology.

In visualizing the motion of any joint, it is helpful to keep in mind that the hyaline-coated articulating surface is not the shape of the often flat bony surface exhibited on an x-ray film. Most apophyseal joints of the spine have a convex-concave shape.

Fisk states that the posterior joints of the spine are more prone to osteoarthritic changes than any other joint in the body: “Evidence of disc degeneration precedes this arthritis in the lumbar spine, but there is no such relationship in the cervical spine.” However, most authorities agree with Grieve that the presence of arthrotic changes in the facet planes does not, of itself, necessarily have any effect on ranges of movement, neither does the presence of osteophytosis.

Regional Structural Characteristics

Review the complete Chapter (including sketches and Tables) at the ACAPress website

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Posttraumatic Rehabilitation: The Rationale of Rehabilitative Therapy

By Frank M. Painter|October 6, 2009|Diagnosis, Education, Rehabilitation, Technique|

Posttraumatic Rehabilitation: The Rationale of Rehabilitative Therapy

The Chiro.Org Blog

We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.

This is Chapter 1 from RC’s best-selling book:

“Chiropractic Posttraumatic Rehabilitation”

These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.

Chapter 1: The Rationale of Rehabilitative Therapy

Preface

For many centuries, therapeutic rehabilitation was a product of personal experience passed on from clinician to clinician. In the last 20 years, however, it has become an applied science. In its application, of course, much empiricism remains that can be called an intuitive art –and this is true for all forms of professional health care.

The word trauma means more than the injuries so common with falls, accidents, and collision sports. Taber* defines it as “A physical injury or wound often caused by an external force or violence” or “an emotional or psychologic shock that may produce disordered feelings or behavior.” This is an extremely narrow definition for trauma can also be caused by intrinsic forces as seen in common strain. In addition to its cause being extrinsic or intrinsic, with a physical and emotional aspect, it also can be the result of either a strong overt force or repetitive microforces. This latter factor, so important in treating a unique patient’s specific pathophysiology, is too often neglected outside the chiropractic profession. (more…)

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Is Chiropractic Complementary, Alternative, or Mainstream?

By Frank M. Painter|October 5, 2009|Education, News|

Is Chiropractic Complementary, Alternative, or Mainstream?

The Chiro.Org Blog

SOURCE: University of Minnesota

I just ran across this remarkable page about chiropractic, located (of all places) on the University of Minnesota website. I hope you will find this of interest:

Is Chiropractic Complementary, Alternative, or Mainstream?

Chiropractic may seem mainstream because of physician referrals and the frequent role of chiropractic in interdisciplinary teams in settings such as rehabilitation centers. Furthermore, visits to a chiropractor are commonly reimbursed by most health insurance plans.

But chiropractic is still considered a complementary and alternative form of healthcare because it is not regulated by medical practice statutes. Chiropractic is not currently taught in public universities along with medical or nursing schools and does not include pharmaceuticals or surgery in its care of patients.

How is it complementary?

Today chiropractic most often shares a complementary role with conventional medicine. Many people seek chiropractic care based on referral from informed health professionals who understand the unique skills and perspective of the chiropractor in caring for perplexing problems.

Doctors of Chiropractic (DC) may also be members of an interdisciplinary team. Interdisciplinary practices are now becoming more common in a variety of settings, with chiropractors, medical doctors, physical therapists and others working as partners in occupational health, sports medicine teams, and rehabilitation centers.

In this role, chiropractors may provide the primary intervention of manual therapy to normalize joint function in patients recovering from injuries, or they may work cooperatively, for example by providing manual therapy and nutritional guidance for patients undergoing chemotherapy.

How is it alternative?

The roots of chiropractic are distinctly alternative to the conventional allopathic system of medicine. Chiropractic has a unique philosophy that stresses the body’s innate intelligence and focuses on preventive care as a means to sustained health and quality of life.

Recent cooperation with academic medicine has been troubling to some within the chiropractic profession, suspicious of the growing cooperation with medicine in practice and research. Purists embrace the founding principle of hands-only care and reject modified approaches. Most chiropractors in practice today, however, appreciate the important roles of multiple modes of care for patients.

What’s the bottom line?

So chiropractic fits all the labels in some respects! It seems “mainstream” because it is one of the most commonly used “complementary” therapies and is regularly reimbursed by insurance.

On the other hand, it retains its own unique philosophy of care and the central role of the chiropractic adjustment in its regimen of care. Thus, chiropractic remains both a complementary practice and an alternative healthcare system.

References:
Chapman-Smith, D. A. (2000).
The chiropractic profession: Its education, practice, research and future directions.
West Des Moines, IA: NCMIC Group Inc.

Expert Contributor: Larry Kuusisto, PhD, DC

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