Mark A. King, DC;
Steve W. King, DC
One of the things we've realized (repeatedly) over the years is that day-to-day clinical practice is very humbling. Here are a few examples that illustrate the humbling nature of chiropractic practice and provide information you can use in your practice to help facilitate better patient care and continue progressing as a doctor.
Treatment
We are not always sure what the patient needs; some patients get better and we are not sure why, while other patients do not get better and we are not sure why. This can be frustrating, particularly to the new practitioner. We sometimes explain to patients that "we will treat the obvious." For example, if a patient has low back pain with joint dysfunction and poor lumbar stabilization, we will start by working on the joint dysfunction and improving their lumbar stability. We do not immediately think of metastatic carcinoma or a spinal infection, etc., unless there are some other clinical signs that go with those types of conditions. If they do not respond to our care, then we can move on to things that were initially less obvious via further testing, e.g., X-rays or MRI, a re-evaluation, or even having another practitioner evaluate the patient.
We cannot immediately test for absolutely everything the patient might possibly have; that is unrealistic, of course. The use of a mental algorithm as a flow chart allows you to follow a logical sequence. A statement we ask ourselves (and our patients) sometimes is: "Does that make sense?" In other words, if the patient has symptoms that do not seem logical or they do not respond to care as you would expect, ask the question: Does that make sense? If it doesn't make sense, it may lead you to dig deeper, evaluate further and ultimately help your patient to a greater extent.
Patient Care
A second example relates to the rebound effect of overtreating, something chiropractors (at least some) historically have been known to do. Some doctors now tend to compensate for our reputation for overtreating by undertreating. Ideally, we would always provide "best care," and avoid overtreating or undertreating our patients.
You need to give time to allow tissue healing and retraining. You need time to make sure you did not miss anything the first time you evaluate a patient. Len Faye, DC taught the S.A.I.D. principle (Specific Adaptation to an Imposed Demand), whereby serial adjusting is needed to make changes to the patient's functional status. Assess the relative chronicity of your patient and keep Faye's principle in mind when initiating a care plan. Begin with a realistic "best care" plan up-front. It is easier to reduce treatment if your patient responds quicker than expected than it is to convince a patient they need further treatment. If you put patients on a care plan that is best care, your practice will grow because patients will improve and they will tell others.
Your Staff
A third example of humbling practice experience involves your staff. Recognize that no matter how wonderful they are, they are still people and they have lives outside your practice. They may be smart and competent, but they are never going to care as much about your practice as you do. That is simple human nature, not an insult. Realizing this will help your interactions with staff and help get the most out of them, day after day.
In our office, we are always looking for situations in which we can implement efficient systems. Our staff realizes that and tries to help as much as possible. Some people would say we are obsessed with establishing systems. We cannot deny that, but the point is that managing your staff can be challenging, frustrating, wonderful, interesting, and humbling, all at the same time.
Insurance
Another example is particularly relevant for doctors who periodically deal with insurance company reviewers. This can be frustrating, awkward and humbling. Sometimes you will feel as though the doctor who is working for the insurance company doesn't know what they doing, and often they seem to make you feel as though you don't know what you are doing.
The reason this can be humbling is that it is always easier to second guess after the fact. When we are in the room with the patient, trying to figure out what's going on with them and providing them with best care, sometimes you forget to do something or forget to document something -and the insurance reviewer often catches that. Just do best care and document what you do, and most of the insurance reviewer problems go away.
Continuing Education
A final example: Taking continuing-education courses or reading research articles or health-related textbooks often makes you realize how much more you need to learn - another humbling experience. We need to keep studying, learning and growing as doctors and healers, and we must be willing to admit that there are things we don't know and that there is more to learn. If you are still interested and passionate about chiropractic, it makes the learning process much more productive and fun.
In the end, we need to be clinically effective and time-efficient. We need to come to grips with the fact that we are not always going to know exactly what is wrong with the patient and that sometimes we think we have a good understanding of what is going on, but they may not respond the way we anticipate. The moral to the story: Stay humble, keep learning, and continually work toward become a better doctor and a better person by serving your patients and your community. Watch your practice grow.
