It's not something chiropractors like to consider, but performing manual adjusting or positioning patients is not without its hazards to the DC. In fact, one study noted that as many as 40 percent of chiropractors had suffered a serious injury within the first five years of practice from either manipulating (67 percent) or positioning (11 percent) a patient.1 In light of this, perhaps the time has come for you to consider how to do the work you love with less wear and tear on your own body. The obvious answer may seem to be switch to an instrument adjusting system.
Perhaps you have a high proportion of patients who are nervous from a manual adjustment. Let's face it, that distinctive sound from a cavitation can be disconcerting to a patient unused to chiropractic care. And there are always those patients who are simply not comfortable with hands-on contact, no matter what you do.
Nevertheless, adjusting systems may not be for you. And, even in you think an instrument may be the right tool for your practice, do not rush out and purchase one. Take a few moments and consider not only how such devices may benefit you, but more specifically, your personal and practice goals.
In essence, readjust your thinking before you start using an instrument device to adjust patients.
In preparing this story, Dynamic Chiropractic PracticeINSIGHTS asked a panel of industy experts how they would go about investigating an instrument adjusting system if they were in the market to buy one themselves.
(Obviously, an expert allied with a particular company will tend to be biased to that company's products. Therefore, in this series we report the comments that reflect a consensus on the general characteristics that make for a good product in order that you may make an informed decision as you do your research into a particular product or service.)
Many Factors to Consider
As mentioned previously, there can be a multitude of reasons to switch to an instrument adjusting system. As Joe Evans, DC, with Pennsylvania-based Sense Technology, explained, there can be a multitude of considerations and questions to ask before selecting an instrument-adjusting system: "Can instrumentation help me extend my career? Can instrumentation help me treat difficult cases? Can instrumentation help me recruit more patients? Can instrumentation simplify billing?"
John Crunick with Sigma Instruments, also based in Pennsylvania, agrees that there may need to be some serious soul-searching before purchasing an instrument adjusting system: "What is the doctor's goal? Treating more patients? Dealing with the aging population? Practice building? It is important that the doctor explore his/her particular reasons for moving to instrument adjusting. This will help guide the doctor in determining the level of sophistication they need in their practice."
Understand What You Are Getting
All our experts agreed that a significant part of considering how you want an instrument adjusting system to work for you is to know precisely how the system works. If you understand that, you will have a better sense of exactly how it will fit into your practice.
Arlan W. Fuhr, DC, of Activator Methods International, based in Phoenix, Ariz., explains that it is vital to really know what you are getting for your investment. He explains, "When selecting an adjusting instrument, doctors should take the time to truly understand what an instrument has to offer. Most importantly, the doctor should determine if the instrument is supported by research, and whether it has been studied in clinical trials that have resulted in peer-reviewed publications. Such research and the associated clinical trials likely prove the efficacy of the instrument."
Dr. Evans seconds the importance of looking at the research supporting the instrument: "Many chiropractic techniques claim benefits that are completely unsupported by valid research. Instrumentation techniques are no exception. Examine the research that each company has produced, particularly research that documents the clinical results that can be obtained with the instrument."
Ed Miller, with IMPAC Inc., out of Salem, Ore., believes that the most important understanding a chiropractor should have of an instrument adjusting system is its potential technological advantages, depending on the practitioner's needs. This will, in turn, lead to greater versatility. He says, "What technological advantages does an instrument offer? Do the due diligence, ask the vital questions and then distance yourself for a span to obtain a balanced perspective. This allows for the best decision. Not all instruments are created equal. Some instruments offer convenience and versatility while other instruments may restrict a practitioner to just two or three forced settings. Greater versatility allows you to tailor the thrusting forces to match the needs of your individual patients."
In addition to understanding the research behind instrument adjusting systems and the potential advantages (or disadvantages, depending upon your practice), it's also important to look at the different effects produced by different devices to get a full understanding. As Crunick explains, "With the expanding number of choices in the marketplace, it is important to understand the underlying technology. The treatment modalities fall into two very different categories: percussive and vibratory."
[pb]Take Your Time
Don't feel a need to rush into your purchase. This is a big investment for your practice. It will mean a number of changes in how you work with your patients. Our experts all stress the importance of doing due diligence, investigating the company, and think things over thoroughly.
As Dr. Evans notes, "You owe it to yourself and your practice to perform 'due diligence' before purchasing any system. In other words, take a bit of time to sample the wares before rushing into a purchase. Attending seminars will enable you to hear the company's marketing and let you get a hands-on demonstration of their instrumentation. Take information back to the office and review with your attorney. Lease commitments can be complex and costly. Make sure that you really understand what you are purchasing and your obligations under the agreement. Some companies offer a no-risk try-before-you-buy in the form of a trial unit that can be used in your practice for a limited time to let you establish whether their instrumentation is right for you and your practice."
Part of taking your time may also involve asking lots of questions, not only of yourself but of the potential vendor from whom you intend to purchase your instrument adjusting system. Miller stresses the importance of asking questions, not only of your colleagues' experience with a particular vendor, but also of the vendor itself: "Look at the company's history. If your peers enjoyed a long, positive relationship, it's a good bet you will also be very satisfied. Explore how long the company has been in business; what kind of reputation have they built with their products and service. Research their track record in: overall value, performance, quality, reliability, durability and versatility."
Fuhr also weighs in on the matter of researching company history and track record. As he says, "A doctor should consider the history and business practices of the company selling the instrument. The company's years in operation, current product registration with the FDA, patents and intellectual property protection, a comprehensive product warranty, and product liability coverage for doctors who purchase the instrument are all indicators of its legitimacy and the product's quality."
Of course, the next question may be how to go about getting this information. Crunick provides a series of questions to ask any potential vendor: "Do they support the customer? Are they FDA approved? Do they produce their own products? Are their products of high quality? Do you feel comfortable with the company? These issues are important because as you move forward with implementing instrument adjusting it becomes an integral part of your practice and your relationship to the vendor should be supportive and stress free."
You Make the Difference
All our vendors stressed that it is you, not the device that makes the difference. As Dr. Fuhr explains, "Some companies promise a doctor a successful practice as long as he or she makes a substantial investment in an instrument. But an instrument alone cannot make a doctor successful."
Evans sums up by listing the differences you will see once you find the right instrument-adjusting system for your use: "Prepare for some changes in your practice. Instrumentation brings with it not only the ability to relieve your physical stress, attract more and different patients, treat difficult and unresponsive patients more effectively and simplify billing, but also enables many patients to become completely pain-free surprisingly quickly."
Reference
- Holm SM, Rose KA. Work-related injuries of doctors of chiropractic in the United States. J Manipulative Physiol Ther 2006 Sep;29(7):518-23.
Five Ways An Adjusting Device May Improve Your Practice
One of the biggest questions you may have if you are considering switching to using an adjusting device on your patients is how this may help you improve your practice. We asked Dr. Thomas DeVita, who uses adjusting equipment in his practice, to give us five ways in which using any adjusting device can improve a practice:
It will set you apart. Most patients equate chiropractic with back pain. Having a practice in which you use an adjusting device can create a niche market for treating any number of disorders.
Research will back up your work. If you are using a complete adjusting-device method, you can call on the research to validate your work. This can be particularly useful in legal cases, where you can point to the research to show your work is effective and not harmful.
You can put patients at ease. Every chiropractor has experienced the nervous patient. An adjusting device will put these patients at ease because it may appear less intimidating than a manual adjustment.
You can treat a broader spectrum of patients. Some patients, such as children or the elderly, may respond better to an adjusting device than to manual manipulation. Being able to use an adjusting device opens up your practice to a whole range of new patients.
Less wear and tear on you. Because it takes less force to use an adjusting device, there is less stress on the chiropractor's body. This can easily translate into more years of a productive practice
