The story begins with a patient who had been everywhere - that is, everywhere diagnosis and treatment can take a patient. Mrs. "T" was a 67-year-old widow with severe spinal stenosis and intractable right thigh pain, who used a walker much of the time. She had been to the Mayo Clinic; two or three university medical clinics; and spine rehab centers. She's had psych evaluations and disc injections, and seen chronic pain management people, bioengineering consultants and others.
Some of the surgeons she had seen wanted to "pop the top" off at least four lumbar vertebrae and fuse them, but Mrs. T had decided not to take the risk. She actually had come to my office primarily because of neck stiffness and upper back pain, but, in the course of my examination, she timidly asked if I could do anything for her lower back pain. So, since she had never had chiropractic care before, and because my exam indicated that she did have significant facet pain, I did some manual flexion distraction on her lower back. But no good deed goes unpunished: She could barely get off the treatment table.
I was going to call her the next day, since I was concerned (Maybe I should have left her lower back alone?), but it turned out she was one of my first appointments that morning. "I got more pain relief from that one treatment than anything I've tried during the last year," Mrs. T. happily reported. Six visits later, her back and leg pain were 75 percent improved, and she was walking 30 minutes at a stretch.
Some would call this a miracle, but it was obviously the right treatment for the right problem, and it cost the patient pocket change. So, it occurred to me - where the heck is my medal? I mean, with the pitiful reimbursement given out by the managed care networks, couldn't they at least show some appreciation for these results? A nice pin-on medal with a dangling ribbon would be my choice. Just like in the old Soviet Union, as portrayed in some cartoons, I tried to imagine opening a package from the insurance company addressed to "Dr. Comrade Hanks" and lifting out a shiny badge with "Hero" engraved on it.
We chiropractors are often too hard on ourselves. Our notes aren't good enough, our exams aren't thorough enough, and the Naugahyde on our adjusting tables isn't new enough. We'll find anything we can beat ourselves up about. Is it any wonder we feel our self-esteem under attack every time we request two lousy additional visits from some constipated claims reviewer asking for more evidence of "medical necessity"? However, when our documentation is superb, we never hear about it. A medal - or even a certificate of appreciation - would help.
Can you recall a patient with a tough problem who had an excellent response to care? Did this same patient forget to pay all of his or her bill, despite several nice written reminders? In the next letter, simply ask for a letter of recommendation from the patient. Forget the medal.
A DC friend of mine had the misfortune of diagnosing a rare tumor on X-ray that had been missed by two previous doctors. She saved the patient's life, but ended up on the Deep Pocket list, and was named in the malpractice suit. She deserved two medals: one for saving the patient; the other for sustaining irrational abuse.
I understand matriculation into chiropractic colleges is down, as is enrollment in medical and other healing arts schools. Being any kind of doctor in the present era is no longer associated with obtaining above-average prosperity; in other words, students have figured out they probably won't get rich in this business. So, if money and lifestyle don't attract students, how about attracting a different type of student? Try religious or military-oriented folks, who might like medals or medallions. Could a chest full of medals be a life-goal for enrollees, just like in the military? Better yet, how about making chiropractic a secret society? We could base it on a hermit monk concept, and DCs could wear Trappist-monk-style robes with hoods! Let's call it "The Order of Brothers and Sisters of Chiropractic." If society would honor and respect this model of "healers," I think many students seeking altruism and influence would sign on.
I've bartered my services for bicycles, haircuts and small animals, but these days, I can't afford to switch to a tribute economy. However, if you know any kids heading for military institutions or religious colleges - well, the future of doctors and health care could include a roomy, hooded robe, with plenty of chest space for medals.
John Hanks, DC
Denver, Colorado
jwhanksdc@earthlink.net
