This Is How Healthcare Is Supposed to Work

At our Open House I spent a few minutes talking about how I approach pain and injuries in the office. Really, none of it should be groundbreaking. It's how healthcare is supposed to work. I wanted to share a summary of this discussion for those who could not attend.

People come in all the time looking for an adjustment or a “back crack.” But that's just one tool. Before we do anything, I want to know: Why does this hurt? What can we change? And am I even the right person to treat it?

Pain doesn't always mean damage. And something showing up on an MRI or X-ray doesn't automatically mean we found the cause of the pain.

Arthritis, disc bulges, bone spurs, degenerative changes, meniscus tears...we find these things all the time in people who function pretty well.

That doesn't mean imaging isn't important. I've ordered plenty of MRIs, including on someone's first visit when the history and exam told me we needed one. I've also found things that resulted in an immediate referral.

When imaging is clinically indicated, get the imaging.

But for most everyday back, neck, shoulder, knee and other musculoskeletal problems, we can learn a lot by actually examining the person first.

Move something. Load it. See what happens. Retest it.

Can we change the pain? Can we change the motion? Does strength improve? Can you do something now that hurt five minutes ago?

That gives us information.

Then treatment gives us even more information.

Try something reasonable. See how you respond. Reassess.

This is also why I've never understood deciding on day one that someone automatically needs 20 or 30 visits. How could I possibly know that before seeing how you respond?

Maybe you improve incredibly quickly. Maybe you don't improve at all. Maybe we need imaging. Maybe you need a different treatment. Maybe you need someone other than me.

Healthcare also has a business side that we don't talk about much. Large healthcare systems often measure productivity using things like RVUs, or Relative Value Units. There are legitimate reasons for that, but the reality is that more visits, imaging and procedures can also mean more revenue.

Chiropractic isn't immune to that either. More adjustments and longer treatment plans mean more revenue for us too.

That's why the question shouldn't be “What service can we provide?”

It should be:

“What does this particular patient actually need?”

Sometimes that's an adjustment.

Sometimes it's exercise, dry needling, shockwave or another treatment.

Sometimes it's an MRI.

Sometimes it's an injection or surgery.

And sometimes it's me telling you that you don't need to come back.

The goal isn't avoiding imaging, injections or surgery. When they're clinically indicated, they're incredibly valuable.

The goal also isn't avoiding treatment.

The goal is using the right amount of the right care at the right time, and getting you back to doing what you want to do without making you dependent on our office.

That's really it.

The adjustment isn't the goal. The MRI isn't the goal. The procedure isn't the goal.

Getting you back to your life is.