Yes, it's true, Humana Health Care will only cover chiropractic if a radiologist diagnoses a subluxation on x-ray. It is also true that they will pay for chiropractic if a patient is referred by an HMO physician. I understand or at least have heard about the gatekeeper system, and how we need more chiropractic representatives to fight for our rights to treat those patients belonging to PPOs and HMOs. Would you believe they have hired a chiropractic student to educate the public and at the same time agree to help pay for tuition? They pay him to wear a shiny tin badge and a blue suit. His uniform is neatly pressed and his boots polished. He patrols the floors and locks some doors but mostly, he studies chiropractic.
Once in a while he gets to study in the pharmacy lobby. Here, they give out up to 170 prescriptions a day. They give him no desk, and so he studies from a music stand and a chair. People waiting in line for their medicine tell him he looks as though he will lead them in song. He replies, "Well, I am going to be a 'choirpractor!'" Some people don't get it.
I am a chiropractic student living here in the Midwest. I am now in my fourth year of chiropractic college. I have tried to keep the cost of my student loans down by working part time as a security guard. When the company I worked for offered to move me from the galvanizing plant (a true "toxic cesspool") to Humana, I was thrilled. Humana was like Club Med compared to the dump I worked at (my job at the plant was to secure 360,000 gallons of molten zinc). The best part was knowing the experiences I received, working at a medical facility, would be invaluable.
The experiences I received were invaluable, at times also very humorous. Once, in "Urgent Care," a make-shift emergency room, a boy came in with his parents. He was about 15 and apparently had been in an altercation at school, at least that 's what his parents told the receptionist. When the urgent care attendant came over and carefully inspected the boy's fifth metacarpal on his right hand and said, "It looks like you have a boxer's fracture," I was only too happy to correct her. "I'm sorry," I said, "You have a bar-room fracture. A boxer's fracture is a fracture of the second and third metacarpal." Every one looked in awe at the security guard. "Well, I did have a test over it last week," I said.
Another bonus to working at Humana was the availability of x-ray view boxes. In the Gonstead class I was taking, the instructor assigned us old x-rays to take home and practice finding subluxations. I would bring the film with me to work and practice on the view boxes. To be politically correct; I only did this after all the employees had gone home and the building was secured. Little did I know for the practical portion of the final exam we would be asked to interpret an x-ray we had never seen before. I was one of three people out of 60 to receive a 100 percent: pretty good considering the clinic director graded the film. What impressed me more was that I correctly diagnosed a 13 millimeter leg-length deficiency on the right, an atlas listing of LS-LP, and an occiput listing of PS-RS-RA, not to mention a compensatory scoliosis with numerous other subluxations. Although I interpreted the results correctly I will never know if the John Doe I evaluated had suboccipital tension headaches. Do you really think most HMO radiologists consider the biomechanical aspect of pain? Do they employ the same thought process as chiropractic? If this film had gone to a Humana radiologist, would they refer? If this person had gone to an HMO physician with a headache, occiput in origin, would he have referred?
On a couple of occasions I was lucky enough to sit in while a radiologist dictated her findings on a Sunday evening. She was very good. She knew her pathologies well and was able to quickly cover about 90 films in an hour and a half. That's about a minute a film. She did not break out the Gonstead ruler and run a parallel up and down the spine and pelvis. I guess that would take another minute or so, and time is money.
Fortunately this is what I practice. I saw the film. If John Doe, or his wife, or his child come in to my office with occipital headaches I will know what to look for and how to treat it. Am I going to use only one tool to diagnose my patients like the Humana radiologist? No. I will use everything available to me. As a chiropractic intern I am just now realizing what a wonderful thing it is that we do. We evaluate posture, range of motion, the central nervous system and employ physical examination procedures as well as taking a thorough case history. We do this to best evaluate how chiropractic might influence our patients health and we don't "Treat our patients spine like a step-child," as one instructor, Hugo Gibson, DC, likes to put it. If Harvey Lillard belonged to an HMO, would the Humana radiologist have found that deafening fourth thoracic subluxation? Would his Humana physician have made the somatovisceral connection? I doubt it.
D.D. Palmer made the connection. He did so because he understood the relationship between the spine and the nervous system. I thank God and Old Dad Chiro for the wonderful profession I have found. I would also like to thank those doctors who went before me, those early pioneers who were the men and women suffering many hardships to bring chiropractic where it is today. It is my profession now: mine to carry to higher levels and future generations.
James C. Womelduff Chiropractic Intern
Kansas City, Missouri
