The other day I received a phone call in my office from a young man with lower back pain of four month's duration.
My office manager has been a bodybuilder for 15 years and is also a certified personal fitness trainer. She too hurt her lower back doing squats, and had made the rounds of various MDs to no avail. When she met me, I was able to resolve her problem in one visit using SOT blocking. She had been forced to stop workouts for a half-year preceding my meeting her.
The young man on the phone told me how the DC he had seen verified his insurance and then proceeded to tell him that he would need to be treated three time a week for six months, and one time a week for six more months. The salesman, excuse me, doctor, explained how all the ligaments at his 5th lumbar were so badly stretched that it would take this amount of treatment to stabilize the segment, at a cost of $4,000. Insurance would cover $3,200 and the young man could take advantage of a payment plan for the co-payment. The young man was calling me because he couldn't handle the $800, was uncertain about whether this was really necessary, and wanted a second opinion.
I made an appointment to examine him and encouraged him to not just assume that he was only going to resolve his problem for $4,000. The salesman had obviously encountered this before, because when the young man called to cancel his $4,000 schedule until he got a second opinion, that office immediately made him, as he put it, "a deal I couldn't refuse. Here's what it was: The price didn't change; the fee didn't change, nor did the number of treatments change. What that office changed was the monthly co-payment. It was reduced from $159/month, to $75: the '90s version of very little out-of-pocket.
I write this because I have been in practice long enough to remember $7 visits in 1974, no insurance and the gradual transition into third-party pay. I also remember an '80s term: "goose killers." The term referred to people like the one I'm describing who through greed, were killing the goose that laid the golden egg. Now that indemnity insurance is fading fast and managed care has taken its hold, we all ought to stop and acknowledge the goose killers who've brought this about. Apparently some of them still exist and will probably try to milk the thing to the very last drop. These are the whores I refer to in my title, and I'm afraid they still exist. If chiropractic has made significant strides with its research, 3x/week for six month treatment plans for a 20-year-old that is well-muscled and flexible negate that progress in the eyes of rational people. I can't help but wonder what this office would have done if pre-authorization was required: probably a six week plan with hopes of doing that again, and maybe again. Oh, I forgot to mention that this $4,000 plan would require three therapies on every visit for the full year. For me it's a throwback to the old clinic master's routines that sprung up along with insurance coverage.
Finally let me remind all the whores out there who are in it for the money primarily (I say primarily because these kind of people will give you a moving speech about concern for patient welfare) that this 20-year-old becomes a voter next year. Do you think he could be called upon for a grassroots effort of some kind to help chiropractic?
Right now they still have him believing that he needs all those appointments and therapies. He's even beholding to them for the co-payment reduction deal. Thanks Doc for bring the position of "cost containment analyst" into being, and now managed care.
It's been said that managed care will close approximately one-quarter of the practices in this country. I guess you know by now which kind of practitioner I would like to see in that percentage.
David Koffman, DC, FICS
Longmeadow, Massachusetts
Role Reversal
Dear Editor:
I am writing to share with you something that fascinated me last month. One of my patients brought me an article from a magazine supplement to the New York Times about a medical doctor. The reason he is suddenly a celebrity is that he works with a therapist who uses "Touch for Health" to help the healing of his heart surgery cases. He is not just a renegade surgeon. He works out of a teaching hospital and is one of the top authorities in his state. The article even has a picture of the woman doing the healing in the surgery room.
Last week, another one of my patients was telling me about her brother-in-law who just had bypass surgery at Sunnybrook, which is also a teaching hospital. She said that she was scared but that at least she felt relieved that he was getting "Touch for Health" there.
I think this is all so interesting. Chiropractors wishing acceptance by the medical milieu are denying the impact of the energy exchange between themselves and the person adjusted. We do not want to be called quacks after all. We are scientific, logical "physicians" who are performing purely mechanical procedures. According to the mechanistic faction of the profession, we have no other impact that the relief of joint pain, some sciatica, and headaches. While we are busy quarreling amongst ourselves, restricting ourselves to the mechanical dimension, those in medicine are doing research on the impact of healing energy. What a role reversal.
Quantum mechanics tells us about the wave (energy) and the particle. As a chiropractor, I believe that we have direct access to both. It is known that subatomic particles are influenced by the observer. I wonder what happens at the subatomic level of a patient who is adjusted by two chiropractors of different philosophies. One who believes that he is giving a purely mechanical treatment, as opposed to one who believes that he is facilitating the healing of the body. This leads me to the next question. What happens if only researchers who believe in the mechanical approach do the published researchers? Do we get only a partial truth? If the profession looks up to those researchers for guidance and builds its schools around their teachings, are we in danger? Maybe one day medicine and not chiropractic will prove to the world that healing through manipulation is scientific after all. I would rather that we stop acting out of fear of being regarded as quacks and start acting like the leaders of the healing field.
Lise Janelle, DC
Toronto, Ontario
"... not ordering enough MRIs and EMGs?
Dear Editor:
I am writing to tell you about my experiences with the DABCO board part II. First, I should mention that I graduated in the top five percent of my classes, from high school to graduation. I never failed a test in my life until I took the DABCO II the first time: that was in fall of 1994. It took them five months to let me know what my score was and that my next opportunity to take the exam was a good year after the first time. I was so surprised by some of the lack of professionalism in the first exam, as I described in a letter to ABCO, but I never received a response.
This year, I stayed overnight in the Chicago Hyatt to be rested for the exam. In all, the test cost me about $800. I could not help but notice the tremendous amount of subjectivity obviously involved in the evaluation. All through the 1995 exam, I kept wondering if I should tell the examiner what I was suspecting he/she wanted to hear (based upon my 3 and 1/2 year, 400-hour course, one weekend/mo. in Madison with strictly National instructors), or whether I should tell them how I would treat people in my daily, real-life practice. I chose the latter. I had a haunting suspicion that I was not ordering enough MRIs and EMGs. I inquired a couple of times, and I was told that a "specialty level of examination" was expected of me. I have a busy practice and an incredible success rate (an excellent reputation). I was hoping that my expert level of orthopedics knowledge would suffice.
I am not sure why I am writing or how much detail to go into. I only know that I spent five years of my life preparing for and looking forward to a postgraduate degree. I also know that I am an intelligent person. But that degree is not going to be obtained unless I put on a false front, and I refuse to do that. I will go through the rest of my career as a "board-eligible" orthopedist. I am only thankful that the whole ordeal has left me with better skills, more knowledge, and in no other way affects my practice.
David Holtrop, DC
Sheboygan, Wisconsin
"What in damnation are you people doing?"
What in damnation are you people doing? Dr. G. Douglas Andersen is typical of the new breed of mechanistically-oriented chiro-medics that are permeating our profession and diluting the very purpose of our existence as chiropractors
This doctor makes several statements that so infuriated me that I feel ready to cancel my subscription to your magazine since your inclusion of his editorial insinuates that you give credence to his ideas.
He says: "This is a reputation we have earned for continuing care of asymptomatic patients..." Since when do we rely on symptoms to determine the status of a person's health? I sincerely hope that most chiropractors utilize some form of objective analysis to determine the presence of a subluxation complex, be it motion palpation, Derifield, EMG, ROM, etc., without having to rely on the presence of symptoms. Apparently Dr. Andersen has adopted the medical model of "treat the symptoms not the cause."
Also his comment about personal injury: "The last thing our profession needs is courses on how to stretch a low-impact, five visit automobile accident case into a $2,500 medical-legal suit." This is so ludicrous that I am not even going to comment on it, but I'll let Dr. Croft respond. Dr. Andersen evidently is not familiar with the studies confirming the fact that collisions under 10 mph can have significant ramifications in as much as the extent of bodily damage is concerned.
If you do not receive a flood of letters voicing the same or similar message as mine, I will be surprised not to mention afraid.
J. Michael Weir, DC
Monterey, California