When I first joined the hospital staff, the chief of chiropractic gave me a tour. There wasn't much to see, as much of the facility was not open to chiropractors. The red "Authorized Personnel Only" sign on the Emergency Department (ED) door might as well have said, "Chiropractors, Keep Out!" I was on the inside of the hospital, but I felt like an outsider.
Four years ago, our hospital began to formulate plans to allow chiropractors to see patients in the ED. At first, we waited for someone to prevent implementation. A member of the medical staff had to develop a plan and present the idea to the medical executive committee. The medical executive committee had to approve the idea. The idea then had to be approved by the board of trustees. Once approved, there was a one-month pretrial period, during which only the chief of chiropractic was allowed to take calls to the ED. We then had a one-year probationary period, with a limit of two "on call" chiropractors.
During the first year, there was considerable variation in referral practices from the different ED physicians. Some referred freely; some referred rarely. It was even rumored that chiropractic inclusion may have influenced the resignation of one ED physician.
Four years later, we have four chiropractors covering the ED 24 hours a day, seven days a week. All of the ED physicians refer on a regular and fairly consistent basis, and all have commented on the benefits of being able to call in a chiropractor. All have said that chiropractors should be on call in every hospital.
In spite of almost four years of great success, it has still seemed too good to be true. I was constantly waiting for the axe to fall on the program - that is, until a few weeks ago. It started with the director of the ED. When the director is working her shift, she is all business. When she calls for a chiropractic consultation, she relates the necessary information and disappears to see her other patients. She expects the chiropractic consultant to do magic for the patient and then vanish from sight. It is difficult to guess exactly what she is thinking about the chiropractic consultations.
My feelings of security increased when the ED director came with me to speak to the CEO and the ED director of another hospital. I expected her to blandly remark on the lack of problems and the high patient satisfaction in our hospital. Instead, she exclaimed that the program was so successful that she couldn't stop it, even if she wanted. She went on to detail the benefits of chiropractic in the ED as if she had spent weeks working on her presentation. Her appreciation of our contributions to patient care was contagious. The CEO and the ED director from the other hospital left the meeting with plans to develop their own chiropractic department.
One of the ED nurses gave me the next surprise. She was the last ED staff member to give up her misconceptions about chiropractic. She was even unable to accept that chiropractic helped after she witnessed a patient's cervical range of motion improve from zero to near-normal following treatment. She said it was just psychological. We were amazed when she announced in front of the whole ED staff that she had to give us some credit. She went on to say that while working in another hospital, she had overheard two patients talking. Apparently, one was telling the other that if the ambulance had taken him to our hospital, he would have been seen by a chiropractor. She was impressed that the patients made such a big deal about being able to be seen by a chiropractor.
The third ray of hope came when one of the ED physicians brought his wife to my office. He had already medicated her for a painful neck condition. She responded with decreased pain and increased mobility, but she was still suffering. After chiropractic treatment, her husband asked her a question in their native language. He wanted to know how she felt, and was polite enough to ask in a way that wouldn't embarrass me if she wasn't feeling better. While I didn't understand their language, I did understand her demonstrating full range of motion, and the pleased look on her face. He then translated her appreciation in words. Even more important than her improvement was the ED physician's decision to trust a chiropractor to provide care beyond that which he had already provided. He had his choice of any specialist in the hospital. He could have taken his wife to one of the very fine orthopedists, neurologists, or pain management specialists. Instead, he chose a chiropractor because of his observation of chiropractic success in the ED.
We have come a long way from the days when women would beg chiropractors to keep their chiropractic visits secret from their physician husbands. Medical physicians can observe our work in the hospital setting. They appear to like what they see. The next goal is to get more chiropractors into hospitals, so more medical physicians can become educated about what we do well.
John Cerf, DC
Jersey City, New Jersey
