My Practice Diary

Greetings, fellow DCs. I graduated from Palmer College in Davenport in 1980 and have been practicing chiropractic since in a modest town hiding in the hills of southern Indiana. This diary contains notes and reflections from my practice.

"Another satisfied customer"

I got the call right after lunch. It was the voice of a young woman with an accent I grew up hearing.

"Yah, sehy, my friend here hurt her back dis mornin' at de ballpark. Could we come and you take a look't her?"

It was the accent of a Scandinavian American, 'yust like my 'randpa's. There was a national softball tournament in town; it had to be one of the players. "Yah, shure, yu bet," I parroted. "Yust come on over."

They were from North Dakota, a long way from home. I was curious how they happened to call me, wondering if it was my oh-so-Scandinavian name. After all, I only had a one column, two inch ad in the yellow pages. Compared to the full-pagers, I was all but invisible.

It turned out they had called several other chiropractors, but all of them wanted x-rays and bundles of bucks to see the injured woman. Why is this so? Are we so scared of the lawsuit boogie man that we (all right, some of us) would just let a person who needs care suffer? I recall one of my teachers at Palmer who said his dream would be to take a portable toggle table back home to Egypt and just adjust anyone who needed it.

I guess we're too sophisticated for that now. Too scared. Too worried about making money.

It turns out that this young woman, Jan, was a bit stiff after riding in the back of a Honda Civic for, oh, 900 some odd miles straight. No kidding. She woke up stiff that morning. Her teammates decided she needed an adjustment, and they proceeded to do a lumbar roll -- to the best of their ability.

Eeeeah! Wrong!

Well, that little bit on non-specific manipulation only made things worse. Jan was not as acute as I had feared, and with a little bit of traction to loosen her up, some good placement and relative specificity, we loosened her L5 and SI with satisfying pops. She got up straight and smiling; another satisfied customer.
Sure, I'll never see her again. Sure, there will be no x number of visits per condition. But despite her initial discouragement at not getting anyone to take her as a transient patient, she and her friends left with a positive impression of chiropractic. To those who would have let her suffer, try and remember what you got into this business for.

"He was a walking drug store"

My first look at Jeff did not give me a good impression. He had a bug-eyed, wild look to him. Then again, I was not surprised. His grandmother was bringing the 12 year old in for chronic neck and back pain. Turns out he has been diagnosed as having Tourette's syndrome and ADHD.

He was a walking drug store. And I thought schools taught kids to "Just say no."

Jeff needed work, badly. His mother was caught up in an HMO; given poor Jeff's condition, I relented to filling out the damnable referral authorization forms. His grandmother smiled and said that regardless of what the gatekeeper doctor decided, she'd be paying me. Her other daughter had been in to me for treatment of a long-standing condition and responded quite well.

I asked the all-powerful gatekeeper wizard of the HMO for six visits to see what I could do for Jeff. Truthfully, I expected none. I got one visit approved.

I wrote the MD back, expressing my amazement at what he thought could be accomplished in one visit. I vowed to refer any patients I had that needed medical evaluation to him. If, in his estimation, one treatment is all that is necessary for a chronic condition, he was the man my patients needed to see.

I got the six visits.

As expected, an adjustment fixed Jeff's chronic neck and back trouble. On a follow-up visit some weeks later, his grandmother also said he hadn't had a Tourette's episode since seeing me as a new patient. She and Jeff's mother had talked the physician into taking Jeff off the Tourette's drugs. When I had last seen Jeff, he had been drug free for two weeks and had thinned considerably, facial roundness and weight gain being side effects of the medication.

The poor kid still needs a man in his life, and other than a bit of playful wrestling in the office, I can't give him that. You can help people, but you can't fix their lives.

Address Change Snafu

I got a letter in the mail from the insurance company. The letter said that payment had been delayed because they had sent the check to my old address, and I would not get payment until I sent them a change of address.

Hello?

I had sent them a change of address when I moved, which was more than two and a half years ago. I sent them another change of address the first time they tried to send a check to the old address. Some time later, I faxed them a signed change of address on my own stationary when they failed to pay and said they needed a change of address.

This letter was the last straw. So I called them up.

"We need a change of address," the pleasant woman without a clue purred over the phone.

"I've done that four times," I answered.

"Oh, you couldn't have, or we would have it," she emphasized.

I remained quiet for a second.

"Ah ... let's see; you don't have my new address to send me the check, but you do have my new address to send me a letter telling me that you don't have my new address."

Silence. "We'll get back to you."

I'll hold my breath.

"That was a simpler time ..."

It's 48 degrees this morning, in mid-August, no less. There's a blessing of cool Canadian high pressure air. I block the door open at work, trying to get that wonderful air into my sealed box of a modern office. Central air and heat are great, but how about windows that actually open?

Walking outside I took a deep breath, letting the fresh air detoxify me down to my toenails. I don't have a busy schedule today. I've been on vacation almost three weeks in the last eight, during which time I haven't schedule new patients (it makes follow-up too hard). Patients are also on vacation. The office rhythm just gets out of sync.

It is always slow this time of year; and not just for me. The local work-like-hell-and-advertise DCs are doing just that. The newspaper is filled with their smiling faces. Of course all the MDs not connected to the local pick-a-winner HMO are advertising also. Healers advertising is, to me, unseemly. It's as if we want to make well people feel sick, although I realize that's not the intent.

On impulse, I grab my desk chair and move it out the front door onto the south facing, but shaded concrete slab in front of the office. I grab my newspaper, sit down and lean back, each breath filling my lungs with that marvelously fresh air. I laughed at myself. Here I sit looking like Floyd the barber in Mayberry.

That was a simpler time, less hectic. Even if you were the town doctor or chiropractor, you could sit outside and enjoy a fine day. People looked up to you as a doctor, a professional, but you didn't look down at them. You were just one of the local folks.

Times have changed. Now, it is expected that a doctor acts a certain way, drives a certain car, lives in a certain neighborhood, ad nauseam. What's nice about being a chiropractor is I don't have to wear the white jacket with the stethoscope around my neck and always looking and acting serious.

So I sit outside in my reclining desk chair, comforted that my patients are used to my idiosyncrasies. One of my patients, a transplanted Californian, called this San Diego weather. It's no wonder why so many people flock to California.

As I got busier that day, I left the chair out front. It was used by many people, mostly older folks who probably recalled those slower days, and children, who didn't know life was supposed to be serious.

It isn't.

"She's the most famous person I know, and also one of the nicest"

Susan came in this week. I had not seen her for almost a year. Susan is a professional opera singer. In the year of her absence from the office, she had rubbed elbows with Placido Domingo and that round mound of operatic sound himself, Luciano Pavarotti. Susan is very good at what she does: a rising star.

Susan came to me some years ago after an auto accident: a nasty case of whiplash on a rain-soaked San Francisco highway. After the accident, she found that her voice, and by extension her life, did not have the power that it should.

Susan's mentor/instructor teaches here at Indiana University, and somehow Susan was sent to me. She needed care. Subluxation had caused altered dynamics of the cervical spine, and the anterior cervical muscles were working to straighten the neck and keep the head vertical. Those same muscles are also accessory muscles of respiration. When you sing for a living, these muscles are put to use lifting the rib cage and expanding the respiratory volume. Now, they were not. Or at least, that's my story.

After the second visit, she came into the office all smiles. "I can sing again," she announced, then proceeded to show me.

The sonic blast of her voice was unlike anything I had heard come from a human being: what resonance, vibrato and sheer power. It was so loud and so unexpected that my jaw dropped open like a cartoon character. I felt like walking around her, looking for a microphone and amplifier. I understood why people paid money to hear her sing. It was unforgettable. I've been her chiropractor ever since.

Susan comes from Alabama, but you'd never know it to hear her speak. I teased her about it once, and she lapsed into a lilting southern drawl to prove she was the genuine article. Of course, she has to sing in Italian, French and German. O mio babbino caro would not sound right with an Alabaman drawl. Susan comes in when she is in town to get checked or worked on. She needed it this visit. We fixed her up and sent her traveling for another six months, a modern wandering minstrel.

Susan is going to make her solo debut at the Metropolitan Opera in New York this fall or early next year, she said. She's thrilled, and I'm thrilled for her. She's the most famous person I know, and also one of the nicest.

For better or worse, this is my practice. Take care of those patients, and of yourself.

Gary A. Knutson, DC
Bloomington, Indiana
gaknutson-aol.com