92 Are Your Practice Behaviors Within Practice Guidelines?
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Dynamic Chiropractic – June 1, 2019, Vol. 37, Issue 06

Are Your Practice Behaviors Within Practice Guidelines?

By John Hanks, DC

I used to wear a tie while treating patients. I don't wear one anymore. I used to wear clinic jackets. I really don't know what happened to them. Practice styles and behaviors keep evolving, and I suppose I have changed with them.

But I still like to use vibration to work out stubborn trigger points and fascial adhesions. Do other DCs use vibration much? I don't have a clue, but someone may have to take it from my cold, dead grip someday. It's part of my "practice guidelines."

We health care provider types (all disciplines) know about guidelines. We generally don't like them. But this article is not about those doctors who try valiantly to comply with guidelines. It's about the quirky treatment behaviors docs just can't give up, and the practice habits that may fade away slowly.

For instance, a patient told me recently about an older MD she knew who had recently retired at age 85. To the day he quit, he prescribed antibiotics for everything and everyone, without much thought about precautions. For good measure, he recommended B12 injections for most of his patients, just to "pep them up." Thankfully, he did not still perform blood-letting.

Chiropractic Clinical Quirks

In chiropractic practice, clinical habits can also be a bit odd. My friend Rick once described how his DC treated him when he was growing up in New Hampshire. "Old Doc" would adjust Rick's neck, then let him lie on the table for a full minute or so while he (Doc) stood staring out the window. Then, he would go back to the treatment table, adjust another spinal segment, and return to staring out the window. He told Rick the vertebrae needed to "settle" for a little while before he could adjust another spot. Go figure, since there is not much of a treatment guideline for this style.

What about modalities? How many chiropractors use hot packs on every patient before adjusting them? I doubt this is common now. Did it really make it easier to adjust the patient? Would just lying on the table for a couple of minutes  relax the patient just as much as hot packs? Do we really need a double-blind, randomized, controlled trial here?

Inside the Office

Chiropractic office designs also have evolved. For example, the "open clinic" concept, a large treatment area with no walls, was almost unknown a half-century ago. But resting after an adjustment was emphasized by many DCs in those days.

As a youngster, I remember my much older, chiropractor brother showing me his plan for a new office design. The blueprints placed his hi-lo adjusting table in the center of a circle of six small "feeder" dressing rooms. Each patient was led out of the dressing room to the treatment table, then back to the dressing room after the adjustment. This allowed them to lie down for several minutes to "rest."

It was a style that could facilitate a high-volume practice. But my brother never built this design, since after awhile, even he thought all this "resting" was unnecessary.

#PatientProtocols

Putting patients in gowns, primarily female patients, is a practice that should actually be studied academically. Is it the standard of care these days? When I was first in practice, every woman patient got a gown on every visit. The most disrobing I expected was "undergarments" left on, and the least would be just the blouse taken off. Men would just take off their shirts.

As the years went by and the threat of "perceived sexual abuse" became more possible, more clothes could stay on in my office. If I can (with permission of course) lift a shirt tail, remove a sock or examine a bare knee with professional competence, then shifting clothes around is fine with me. If I can palpate through several layers of fascia and muscle, why can't I successfully palpate through a cotton T-shirt?

I became very aware of the changing zeitgeist when a new, young lady patient presented herself for examination. It was summer and she was wearing small shorts, a "belly shirt" and flip-flops. After taking her case history, I asked her to put on a gown, leaving on her undergarments. Well, she was not wearing any. The look on her face was somewhere between surprise and mirth.

With the gown on, she probably had 10 times the amount of cloth coverage that she had on with her regular outfit. Actually, in the gown, she looked more like a cloistered nun.

Practice guidelines are a fact of life in health care, and like it or not, they are necessary. I am one who agrees that the public should have a basic idea of what is going to happen when they seek care in a chiropractic office. And yet ... I can't help but like the stories of quirky individualism. If nothing else, it is often what gives me fodder for writing!


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