Regardless of your beliefs, your use of technology or your grammar skills, there are still three ways you can improve your practice: better patient care, more compliant patients and an elevated professional reputation in your community. With a nominal educational refresher of the one tool that can help you accomplish all three of these goals, you leave Dr. Ordinary in the dust.
Better Patient Care and Outcomes
I was visiting with a former patient in a larger city about 90 miles from my clinic when the patient told me, "My new chiropractor didn't take any X-rays. I don't think he knows what's going on with my sciatica."
This is not the first time I have heard this type of comment from a chiropractic patient. Patients want to know that their doctor, whom they assume is their spine care expert, has a complete understanding of their spine to better take care of their health. The adage used by some, "To see is to know," could not be truer in some cases.
Conditions such as spondylolisthesis, sacralization of an L5 transverse process, or degenerative findings1 and arthrodesis may impact the outcome or the recovery speed.2 These findings certainly could affect the selection of what technique or vertebral level is adjusted. Defect and vertebral anomalies may have little effect or a significant effect depending on the cause and presentation of the symptomatology.
Each case is different and one global standard is difficult to apply with the many variables possible. More trust is established when a patient feels confident their doctor knows for sure what the diagnosis is and what they are trying to correct, stabilize or improve. When the patient sees it, they know the doctor sees it, too.
Harvard Professor Michael Porter presented the six major elements necessary in a truly value-based system and evaluated and discussed the outcomes aligned with cost.3 For example, taking plain-film (digital) radiographs is usually less than $100 for a two-view region or less than $200 for five views. Some DCs using digital X-ray charge less than $200 for seven views. Clearly this is far less costly than the $1,000+ for CT and MRI scans with radiologist reads. Patients receiving diagnostic testing for $100-$200 is extremely reasonable for the value of the information visualized and diagnosed; thus creating patient value.
Porter goes on to suggest that outcomes for a condition are always multidimensional and include what matters most to the clinicians and patients. Patient reported outcomes form an essential component. It is not just the published literature that comprised evidence-based practice (EBP). There are three legs to the stool of EBP: published literature, clinical experience,and patient preferences; with all three having equal standing. However, you do not need all three to be as strong all at the same time.
Patient Education = Better Compliance
Seeing any abnormal curvature of the spine or biomechanical consideration gives clinicians a more accurate care plan. While posture can be assessed visually, spinal correlation can be more insightful. As spinal health care experts marking up an image, one surely can value the educational benefit of a patient receiving their plain-film image with annotations showing abnormalities and findings right on their smartphone.
Patient trust, confidence and follow-through with care recommendations are more likely when cases having definitive findings that impact the outcome of the care are evident. Modern imaging helps clinicians make more accurate diagnosis and plan more effective treatment strategies for spinal disorders.4
Patients granting permission to their doctor with subsequent documentation acknowledgment to send those images via text or email can still comply with HIPAA. The patient gets the image of their spine and recalls your explanation more easily so they can repeat the findings to their spouse or friends to support their decision to get better. This situational awareness allows for patient encouragement, and the side effect can be more referrals from the patients' family and friends.
A Stellar Reputation
Doctor reputation among patients and their support group elevates with effectively communicated radiography findings. Consider the diagnostic information being described in the radiology report. Having the images inside the report with annotations or a call-out to clinically relevant findings on the X-ray images makes the technical impressions better understood.
Certain areas of the spine that have a measurement or biomechanical analysis annotated so the reviewer, claim adjuster, attorney, and the patient's support group can all understand the radiology report makes for a better patent experience. It can also help persuade those looking to deny care to now consider one more factor – a strong, evidence-based factor – that results in a position change because of the evidence presented on radiographs.
The key is to better communicate the findings inside the radiology report. A chart showing normal measurement compared to the patient's measurement may be applicable; or comparing the right side to the left side can show abnormalities. Referencing certain studies that provide published literature on a certain finding indicating a risk factor may be applicable.
For example, the lumbar lordosis measurement on the lateral lumbar view has been shown to result in DJD of the lower lumbar facet joints and resultant chronic low back pain if hyperlordosis or hypolordosis is present.5 If the lordosis curve is measured and the study is referenced; the need to change the curve through chiropractic adjustments and exercise provides evidence to form the care plan.
Visualizing a lumbar lordosis is simply not accurate unless radiographs are taken. Presenting this information clearly within the report can educate the patient, result in referrals, and elevate your reputation as a detailed, evidence-based doctor, leaving Dr. Ordinary behind.
References
- Marchiori DM, Henderson C. A cross-sectional study correlating cervical radiographic degenerative findings to pain and disability. Spine, 1 Dec 1996;21(23):2747-275.
- Oakley PA, et al. X-ray imaging is essential for contemporary chiropractic and manual therapy spinal rehabilitation: radiography increases benefits and reduces risks. Dose Response, 2018 Jun 19;16(2):1559325818781437.
- Value-based health care. Institute for Strategy and Competitiveness, Harvard Business School.
- Vrotovec T, et al. A review of methods for quantitative evaluation of spinal curvature. Eur Spine J, 2009;18(5):593-607.
- Murray KL, et al. Characterization of the correlation between standing lordosis and degenerative joint disease in the lower lumbar spine in women and men: a radiographic study. BMC Musculoskeletal Disord, 2017 Aug 1;18(1):330.
Click here for previous articles by Steven Kraus, DC, DIBCN, CCSP, FASA, FICC.