Former Clinic Director at Logan College of Chiropractic Outpatient Clinic
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- Ursula Andra Cummings
- 5 years ago
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2 Paul Blomerth DC, FIACN 1983 graduate of Logan College of Chiropractic Former Clinic Director at Logan College of Chiropractic Outpatient Clinic 1984 to present Private Practice at Ludlow Chiropractic 1991 Board Certification in Chiropractic Neurology Hospital staff privileges and practice at Wing BayState Hospital; (part of the BayState Hospital System)
3 A different way to think about practice.
4 eg: Low Back Pain
5 One-half of all working Americans admit to having back pain symptoms each year. Experts estimate that as much as 80% of the population will experience a back problem in their lifetime. Most cases of back pain are mechanical or nonorganic- meaning not caused by serious conditions such as inflammatory arthritis, infection, fracture or cancer. Americans spend at least $50 billion each year on back pain and that s just the more easily identified costs.
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7 Gallop poll commissioned by Palmer College.
8 51% of Americans have had experience with a chiropractor at some time in their life. 60% of chiropractic users only want to see a chiropractor if they have pain. 42% of population think that chiropractors are trustworthy. 63% of population think that chiropractors have their patients best interests in mind. Both of these percentages increase with exposure to chiropractic. 43% of patients believe that chiropractic treatment takes too many visits. Only 13% of MDs and 7% of PTs discourage their patients from visiting a chiropractor.
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10 See Chiro only when in pain See Chiro when not in pain
11 trustworthy not trustworthy
12 Have patients best interest at heart Do not have patients best interest at heart
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16 What if we were to increase our utilization by the public by treating and releasing acute patients Vs Attempting to convert all patients to maintenance patients. This concept may not be for everyone.
17 I received a referral from a local PCP.
18 32 y/o male with a 6 month hx of worsening LBP No trauma, No prior history of LBP. No provocative or palliative activities or positions. Constant achy pain without leg sx. Pain keeps him awake at night, no relief with lying down. No changes in bowel or bladder. Examination: No scars bruises or discolorations. No postural abnormalities. ROM: full with out change in pain level. Neurological exam: WNL Orthopedic Exam: WNL DX:??!?
19 PCP found a bladder infection. Tx with antibiotics. Patient still has back pain. PCP returns patient to my office. OK, so I ll try one adjustment. Patient feels a little worse. Patient returned to PCP with instructions to look and keep looking until he finds something. You are definitely not a chiropractic case!
20 Patient is alive today. Unbeknownst to me the PCP is Chief of Medicine at local hospital.
21 Invited to apply for staff privileges. 1 year to negotiate contract Help from Dr. Dave Taylor and the MCS Hospital Relations committee.
22 Independent contractor 50% of billable services rendered Hospital does billing Provider pays own Malpractice insurance. Hospital provides 1 medical assistant Hospital provides adjusting table, hydroculator and ultrasound machine.
23 Maintain a current license as a Chiropractor Maintain malpractice insurance at appropriate level. 1 million/ 1 Million. Board certified in specialty appropriate to field ( Orthopedics, Neurology, Sports Medicine )
24 Drug seeking patients Litigious patients Difficult patients. Read behavior problems. Failed surgery patients
25 Most MDs are good people who just want to help people get better MDs will be amazed by things that we take for granted such as handling of an acute SI problem Not all Docs will refer to you. Some have their favorite ways to handle a case and will stick to it.
26 Communication is key A phone call or hallway consult can be invaluable. Eg: RW s MRI
27 This type of practice is not for everyone Patients referred in the medical setting are generally a sicker group of patients. They are on more medications and have more complicating medical conditions
28 Delivering care to in house patients is rare But isn t that what we say, that we keep patients out of the hospital!!
29 However, the need for chiropractors in outpatient clinics and referrals to private practice setting is a potential growth area.
30 2 Surprise Specialties that refer; Urology-Back pain from kidney stones ENT-TMJ cases that present as ear pain
31 It is assumed that you are someone who is well qualified. It is assumed that you are someone that they can count on and communicate with. You are a cut above and can be trusted.
32 Take a good and accurate history, OPPQRST. Do a good exam ( avoid epinemic test names) Give your diagnosis in language the can be understood across professions Write out a treatment plan with a time table for release from care. Ask patient if you can send a copy of your exam to their PCP.
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34 Act, Dress, Behave like a professional Be kind to All ( You never know who knows who ) Be positive
35 Avoid negativity Don t over inform. Wait to be asked for research. Eg; Does your EHR automatically spit out references backing up your exam findings or treatment procedures. Don t countermand their PCPs orders
36 Functional-This means a different thing to MDs. Subluxation-Remember that Rheumatologists have a different definition.
37 Acute vs Maintenance Lessons learned here can benefit all practices This type of practice may not be for everyone
38
39 59 y/o male with a 2 year history of worsening bilateral LE weakness and stiffness Recent visit to neurologist. DX; myositis due to statins. Worse with rest and trying to sleep Better with being up and moving around Exam Lumbar ROM full and pain free? Weakness with toe and heel walking. Reflexes in lower extremities +4 Bilateral clonus, plantar response downward Upper extremity reflexes +2
40 Case # 2 MRI revealed severe spinal stenosis with cord infarct Patient referred for surgical consult.
41 46 y/o R male with a 6 mo hx of progressively worsening L hand numbness. Describes numbness as involving whole hand. No provocative or palliative positions or activities. Saw neurogist. EMG/NCV showed mild delay of conduction of ulnar nerve at olecranon.
42 Exam: Full cervical ROM w/o pain or numbness. Neuro exam WNL Ortho exam equivocal for TOS Myofascial exam equivocal at L scalenes Motion palpation showed fixation and tenderness at T-1 rib on L. Decided with patient consent to begin a trial of treatment for 2 weeks Manipulation to T-1 rib and myofascial release to L scalenes Patient failed course of tx. Slight progression of sx. MRI ordered.
43 MRI revealed : Midline benign chordoma. Patient underwent successful surgical resection and returned to full normal activities.
44 74 y/o R male with a progressively worsening feeling of numbness in LEs bilaterally I feel like I have sponges in my shoes Worse with being on feet for a long time 20 Minutes Not helped that much with rest.
45 Exam: Lumbar ROM limited but not provocative of sx. Romberg's produces a lot of swaying but patient does not fall. Difficulty with toe and heel walking. LE myotomes WNL DTRs 0 but symmetrical. No clonus. Plantar response downward.
46 Paget s Disease
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