Patients Are More Than Musculoskeletal Beings

As we move forward in discussing the principles of risk management, we should remind ourselves of several factors regarding our responsibility to our patients. Those responsibilities involve the whole person, not just spines, muscles, ligaments, nerves, arteries, veins, lymph and joints. We all know that no cell, organ or tissue can live successfully without proper nerve and blood supply, and that the brain and spine have demonstrable effects on the entire human being. We also know that we are not just a body and soul, but rather a spirit that lives in a body that has a soul.

Through the hundred-plus years that chiropractic has existed in its present form, it has grown and has continued to reach greater dimensions of its destiny. That growth is in part related to the miraculous results it achieves for patients and the women and men who have pursued their particular concepts for natural health care. We all should be grateful for the diversity of personalities and various abilities of those who have continued to discover, rediscover, and fight the good fight of faith it takes to develop new diagnostic methods and modes of treatment.

There Is More to Our Patients than Meets the Eye

In reviewing files and examining countless numbers of patients in our private (as well as consulting) practice, we have had the wonderful opportunity to meet many fine and interesting people. We have also been able to learn and observe what other practitioners are doing in the care of their patients. We can't recall any patient that wasn't well-served or did not find value in the chiropractic care they were receiving, but very often we've seen that the treating doctor missed opportunities to serve them more, in terms of the whole person. Certainly we can't be all things to all people, but we all have the education and ability to serve our patients in this whole-person context.

The Metabolic Aspects of Your Patients

As good as many of our profession's diagnostic and treatment methods are as they relate to the musculoskeletal nature of our patients, we must also consider their metabolic nature. This is not saying that we should indiscriminately prescribe vitamins, minerals or herbs just because they have potential value, any more than we should manipulate a joint or articulation without proper patient history, examinations, x-rays, etc. The same holds true for food supplements; everyone has an individual physical, mental and biochemical nature. As beneficial and necessary as vitamins, herbs and minerals are, each of us has similar but still specific nutrient needs. Certainly some of our manual muscle-testing techniques assist in telling us about weaknesses and possible internal structural, dietary and emotional states and needs, but as potentially valuable as they are, we still need to utilize traditional postural, orthopedic and neurological tests and the evaluation of samples of urine, blood, stool, hair, nails, saliva, breath, etc., to interpret internal functions and needs.

The Absence of Symptoms Does Not Necessarily Indicate the Presence of Wellness

We all have heard and used this statement. As true as it is, at times we do not avail ourselves of other proven tests that give clear pictures of internal function. We predispose our patients to less than the best care and the failure to get well while we predispose ourselves to mistakes and malpractice. The principles of risk management always tell us to do what's potentially best for others, and remind us that what we see on the outside is not necessarily the same as what is going on inside. At the top of the list in most malpractice claims is the missed diagnosis. The reason so many chiropractors have been accused of malpractice is that they simply didn't take the time to take a adequate history and perform or refer the patient for usual and customary diagnostic testing.

People Are Looking at and Evaluating Our Work

We are constantly being examined by third parties who are gaining more authority to hold us responsible for the whole patient, not just our patients' spines or other articulations. It doesn't matter what philosophy a practitioner may be aligned with; what matters in society's eyes and the eyes of most boards of examiners, attorneys and malpractice insurance companies is, "Did we take the time and effort to fully and wholly evaluate the symptoms the patient presented to us, as well as other aspects of the patient's health that may not be demonstrating illness but are considered usual and customary to diagnosis and treatment?"

Reasons Why People Don't Hold Their Adjustments

More than ever, the care we dispense is being assessed by third parties. That's a reality that will become increasingly prevalent regardless of whether we like it or not. Results are not the only things that validate the basis of what we do. People and organizations evaluate what we do, how we do it and what diagnostic basis or foundation we use to care for people. Even though many people we see have chronic health problems related to heredity, injuries, accidents and stress, countless numbers of them have biochemical irregularities that for the most part are within the scope of natural health care. Traditional science knows that, and so should we. If by state law we can't perform certain tests (i.e., drawing blood and performing laboratory tests), every practitioner is still held responsible (in the eyes of the health and legal community) to refer patients for tests that by our undergraduate (and postgraduate) exposures we know should be conducted.

If you want to have more fun, enjoy long life and good heath, and reduce the risk of malpractice, maintain present and future patients, and keep yourself and your practice out of trouble, look at your patients externally and at the test results of their internal biochemical nature. It does not matter what any short-sighted, profit-motivated, cost-reduction company or selfªserving individual considers to be usual and customary. What matters is doing what's best for your patients. Those practitioners who base the services they offer solely on costs, what profits they can generate, or what some insurance company or governmental agency will reimburse are not only violating universal laws but are shutting off the flow of success in their lives.

Change Is Inevitable

One can't help but see that there is a revolution going on in the health industry. Managed care, PPOs, HMOs, etc., are a reality, but so are the adverse effects of trying to regulate health care. Medicine itself is never going to be a good way to earn a living. Many of the changes by managed health care organizations will never be turned back. Society will never again hold medicine or hold medical doctors in high esteem. Soon -- very soon -- you'll see thousands of malpractice suits filed against medical doctors and chiropractors who refuse to authorize care based on the profit-motivated, cost-control treatment protocols of managed health care organizations. Fewer and fewer drugs help people; more and more drugs and surgery harm and kill people. In general, people are becoming more and more fed up with medical doctors and chiropractors who work for managed health care organizations.

People Have Access to All the Health Information They Desire

More and more people are going to libraries and browsing the Internet before they go to a doctor. They can investigate their health options without going to a doctor, including the chiropractor. Most people will choose a natural method for recovery over drugs or surgery. People no longer are satisfied with taking the same drug year after year or going to the chiropractor year after year without getting well. They are going to look for alternatives through professionally trained natural health care providers who are truly wholistic in the products and services they offer. People will also want scientific evidence and competent professionals who support their treatment regimes with batteries of diagnostic tests that fully evaluate their physical and biochemical status.

The Future Is in Your Hands

The future is in the hands of women and men within the chiropractic profession who look to the future and make the changes that the future dictates. Those practitioners who continue to strive for medical acceptance will endure the same loss of income and criticism their new-found medical buddies are experiencing. One of the realities for those chiropractors who continue to limit their their services to manipulation care of the musculoskeletal person will find their practices decreasing or end up treating people without due compensation. This will be related to the fact that there will be thousands of new practitioners cutting into the small pie of potential patients who choose to seek help from chiropractors. Certainly, everyone could benefit from manipulation-oriented chiropractic care, but as it stands, no more than 10 percent of all of society will ever avail themselves of manipulation-oriented chiropractic care.

The potential health pie that chiropractors attempt to draw from is small to begin with. When you add the massive numbers of new practitioners who will enter the chiropractic profession by the year 2000, you are going to have more chiropractors competing for fewer potential patients.

What Will Happen?

A certain percentage of people (about 10%) who want chiropractic care and who belong to a managed health care program will first go to the DC who is an employee of their managed health care program and/or an authorized participating provider of some health care group or organization. These people will not be happy with what those DCs provide, as that care will be very limited in the number of visits they can receive and the services that can be provided to them. Those patients will compare the services offered by chiropractors who are not participating members of a managed health plan, and they won't like what they see. Many managed health care DCs will be viewed by society just as medical doctors are now viewed - as money-grubbing, self-serving, disease care organizations. These chiropractors will be (as most medical doctors have become) nothing more than DISEASE MANAGERS.

Disease Care Companies and Disease Care Doctors

The DISEASE CARE companies will hire and affiliate themselves with young, inexperienced and insecure practitioners who will do what they're told to do by the company they work for. Part of the lack of self-worth and inexperience of those chiropractors is related to some of our chiropractic colleges tuning out very well-educated women and men in the basic sciences, but failing to instill faith, confidence and/or belief in chiropractic. Hand in hand with that liability, many of the chiropractic colleges are promoting nothing but the musculoskeletal approach to practice. This is complicated by many who continue to promote the limited philosophy of B.J. and other fanatics like him. Those people are like birds with their heads in the sand. They think that chiropractic will be saved and kept pure if we limit all chiropractors to treating the spine only, and that chiropractic is the cure all for all things, including freckles, bunions, moles, etc.

Attempting to Deny Reality Will Destroy Your Life

The truth is, they're wrong. No one has or ever will keep chiropractic above competition from physical therapists, physiatrists, massage therapists and all the others running around society promoting their latest cure. No matter how much you try to retrench, put up a defense and circle the wagons, no matter how many laws you try to pass, no matter how stubborn, negative and religious you try to be about chiropractic, you'll lose. Unless we train and encourage our students and established practitioners in the care of the whole body, both physically and biochemically, the chiropractic profession will serve fewer and fewer people, then die.

What Goes Around Comes Around

There is nothing new under the sun. What goes around comes around, and what our predecessors left off of the original basis of chiropractic is again presenting itself. Those who see that they are much more than bone-poppers will see that they have the right and the responsibility to examine and care for the whole person. They will also see that they do not have to join an HMO, wonder where their next patient is going to come from, or be limited to competing for fewer and fewer patients. No chiropractor has to take orders from a MD or self-serving employee of an insurance company or managed disease organization, if they recognize who they really are and begin offering all the expertise they have at their command in diagnostic tests and treatment techniques.

Jerry Lalla, DC
Diane Lalla, CA
Roseville, Minnesota
glalla-greatphysician.com
www.greatphysician.com