When in doubt, always be more professional

This will come as no surprise, but our profession tends to be “touchy feely,” and many DCs tend to be very relaxed with their patients (often calling them “practice members” and the like). First off, you’re a doctor, and you treat patients. So stop calling them anything else.

But what I really want to talk about is the minute to minute end of this game. The small things that can impact how you’re being perceived.

And we need to be perceived as experts. Recently, I had a patient tell me that her husband mentioned to her that she wanted me to tell her what the results of her recent MRI really meant since he trusts my opinion “more than any of those other doctors.” I only treated the husband once for some rib joint pain, like three years ago. Why did he say that? My guess is that I was super professional about his situation at the time. And here’s the underlying story–I didn’t help the guy that much. As a matter of fact, he was in such pain when he came in that all I did was hurt him on the first day. But I hurt him with love. And I was professional about it.

The beauty of what we do is that we have the knowledge to help people in a big way with the kinds of problems for which people see us. And for whatever reason, we also (or at least should) tend to tell people how they can help themselves. I have explained McKenzie style self-care movements to hundreds of patients who had already been to another practitioner. So far, I’ve still never had one of those patients tell me that any of their previous providers told them even the most basic facts about how disc pain is affected by movements, both for better and worse. Not one time. For real. But that’s probably not a surprise if you’ve been in practice very long.

You can still have your relaxed style, by the way. You just need to be relaxed and professional simultaneously. Don’t think for a second the dude writing these posts somehow doesn’t have a sense of humor with his patients throughout the day. But when in doubt, I always ratchet up the language (both verbal and body), especially when I’m explaining mechanisms of radiculopathy or any other of the more stress-inducing diagnoses we deal with in daily practice.

Another angle when considering the idea of professionalism in practice is your actual competency when evaluating and treating your patients. We tend to see a lot of the same types of injuries and issues within our patient base. It’s easy to get complacent and go through the motions. Don’t. It will come back to haunt you.

This week, I’ve had two interesting patient encounters. Up first was a 24-year-old male with ulnar nerve numbness, but more concerning, weakness. I assumed disc out of the gate, but after a whole bunch of McKenzie style end range loading along with some traction, we made exactly zero change. Ulnar nerve flossing didn’t make a dent either. My spidey sense was tingling. So, I did what I almost never do on the first visit and sent him for an MRI.

And we found this (click the image for the big version):

From the radiology report:  “Probable 23 x 2.6 x 1.7 mm simple syrinx of the cervical spinal cord beginning inferior to the body of C6 and continuing to the superior portion of T1. Postcontrast exam is needed to assure that there is no abnormal cord signal.”

There is definitely abnormal cord signal.

The neurosurgeon I talked to about this thinks the syrinx isn’t the cause of the ulnar nerve issue, but he hasn’t seen the patient yet. The patient has bilateral symptoms, though, so something is up.

But here’s the point–Is the average chiro going to do everything I listed above, or just go straight to crunch town and miss something potentially major? I hear it all the time–a friend has a patient who is responding well to care, the patient goes out of town and drops in on another chiro who in turn makes things much worse by missing the obvious. And these docs never even ask what the patient’s regular DC is doing at home. Straight to crunch town. Like, every time.

The second encounter just this week came when a patient who only came in once, over two years ago, came back and reminded me that I told her way back when that her back pain was being caused by a kidney infection and insisted she go to the ER. She did and was admitted because of the severity of the infection. And again, had she gone to many other DCs, she would have been side-postured with a 30 visit treatment plan for follow-up.

What I don’t want you to hear, here, is that I’m some sort of super chiro or diagnostic genius. Hardly. The more I learn, the more I realize how far I have to go–and it’s a journey without end because we’re always learning more.

I know a lot of students read this page. Spend your time in school learning the real stuff. Learn McKenzie, flossing, and other treatments besides manipulation that can make you a valuable member of the healthcare community. And learn to adjust, too, of course. You’ll still be doing plenty of that (so get to an MPI seminar).

Business after Harvey–some thoughts on our patients

Houston is still cleaning up and dealing with the worst traffic imaginable after Harvey plowed through last week. Florida is dealing with the same situation as I write this. If you run a clinic in either one of these areas, you are likely experiencing an interesting patient demographic in your waiting room. Here’s what I’m seeing:

The “been stuck at home all week” patient.

This person has “survivor’s remorse” from sitting around in their bathrobe for a week while watching Netflix and eating too much. They feel a little stiff because they are. They have only moved as much as is required to go from the fridge to the couch. This accounts for about 1/3 of the people I’ve been seeing. This is also how I’ve been feeling, although I did work out every day in my sweet garage gym.

Still, it was tough watching all of the destruction to people’s homes happen while I was high and dry. I think the entire area that was affected by the storm has elevated cortisol levels and just feels a little off. Many people used that energy to get out and help their friends, family, and in many cases, complete strangers rip out carpet and drywall. Which leads to patient type number two…

Disc patients who have spent several days in flexion

Unfortunately, the position most people put themselves in to tear the guts out of their house is a perfect recipe for disc injury. Many well-meaning people have hurt themselves trying to help in the aftermath of the hurricane. I’ve gotten a lot of practice explaining bracing, neutral spine, moving through the hips, and McKenzie exercises. I was starting to feel like I was stuck in my own personal Groundhog Day at one point when I had my fourth lumbar disc patient in a row.

Most of these people will be short term projects. Many of them had no choice but to back to the activities that got them here in the first place.

People who were coming in for treatment before the storm

I’m always concerned when I leave for vacation or take any time away from the clinic that people will drop off the face of the earth and forget my little clinic ever existed. The real truth is that they always come back. In the vacation scenario, they usually urge me to take time off because they perceive that I work too much. If 31 hours a week is “too much,” then I guess I am. But what I’m really trying to say here is that your people won’t abandon you if you take some time off.

August this year was a solid five week month, and this storm hit during the “bonus days.” In the end, it just meant that my business ran for the usual amount of working days and I got no bonus other than taking a few forced days off. The disc patients who have been coming in tend to be the type of patient I see a little more often during the acute phase of their injuries, so I suspect it will mostly even out.



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