chiropractic methodology

RE: chiropractic methodology

hi there, have met a chiropractor who has just completed a Diploma in Sports & Remedial Massage with Active Health Group who says that she probably wouldnt need to use her chiropractic techniques now, but opt for the more beneficial ones learnt on the course.

😀

by the way, she did very good gentle manipulations as taught by McTimoney, I dont think I would go for the other sort as taught by the British Chiropractic Association now....

This thread is getting v old without any comment from those that know. Why ?

well, when I arrived on the site, this thread was alreasy 2 1/2 years old, so I took it to be a dead thread.
It's also a contraversial topic, with a lot of bitterness between the "factions".
I'd also suggest that your wording of the question implied it's own answer.
The question is predominantly between the "remedial" and the "wellness" approaches. It's philosophical and opinion driven.
It probably doesn't, but does that answer your question?

Hi Stephen,

I am a chiropractor and have worked in both of the methodologies you talk about in your posting. I think it is probably a little unfair to post such an unqualified comment on here without the knowledge behind both.

What you refer to in terms of payment (cost per session, or prepaid treatment), has nothing to do with the length of time spent with a patient. What does apply to the length of time spent with a patient is usually what technique the chiropractor is using. For example, most of the traditional chiropractic techniques require significant time to analise and treat a patient, and will vary depending on what is found on each visit (case and visit specific treatment). Obviously in these cases different people respond at different speeds, so these chiropractors typically charge per visit. Examples of these techniques may be Sacro-occipital technique, gonstead technique or McTimoney. Another example of this may be a dentist applying a filling to stop a tooth ache. Once the pain is gone, so is the treatment required.

The other type of treatment i think you are broadly refering to as simply quicker visits is probably best used in an example. Most of these techniques require a course of treatment rather than just symptom care, i.e postural correction techniques. Due to the research done on these, certain conditions will require specific treatments and adjunctive procedures, and to achieve that objective the chiropractor will have a guidence schdule for a patient, and would know the approximate number of visits required. Some of these chiropractors may offer prepayment of services, as it is known in advance how long it will take. The most common example of this would be specific postural rehabilitation techniques such as Chiropractic biophysics (CBP). see Another example of this may be a course of orthodontic treatment to correct a specific tooth alignment problem. An orthodontic would rarely (if ever) charge per visit.

Unfortunatley this type of chiropractic is more open to abuse from unethical use (as is orthodontic treatment), however i would believe this is very rare.

Before seperating chiropractors / chiropractic into 2 such broad areas based on time spent with a patient, you should try to understand a little more about the what and whys.

I hope this helps.

Matthew

Thanks bia and especially Matthew for your detailed answere I now have better apreciation of how misunderstandings of the shortness of treatment time equate to different treatment approaches.

However given the vast specific and general knowledge chiropractors have to give to their clients I cant help feeling short treatment times must inhibit this?

As for the wording ect ect of the question at least it has at last been answered. And if you dont ask, you dont get.

Regards steve

To again reply to that, most "corrective" chiropractors do address all the other issues. Usually in the form of longer appointment times. For example, when i worked in this type of clinic, during a corrective course of treatment, patients were booked longer appointments at specific times through their care plan to go over things such as postural correction, exercises, traction, education (i.e ergonomics and such) ect. Also if they ever had questions, or wanted a longer visit (anywhere up to half an hour), they were booked in for that time at no extra charge.

One key point is that a therapist charges for time, whereas a specialist practitioner charges for expertise. For example, if you had to get an immunization from your GP, you would want them to do it as efficiently as possible, not leave the needle in for 15 mins (a ridiculous analogy... but one to think about). Just as if a patient requires a specific spinal adjustment, and you already know what it will be... how long would it take?

Regards,

Matt

the other point that's worth making is that chiropractic treatment comes with risks of side-effects (most commonly, feeling beaten up), so to give more treatment just to make the patient feel thay've had their money's worth is unethical.
The other factor I've come across, is the time spent talking to patients, we they often don't see as relevant to the treatment, so I've had complaints that I've spent 7-8 minutes talking to them, 5-6 minutes examining them, but only 2-3 minutes actually treating them. In which cases I just tell them that correct diagnosis is the key, if I treat the wrong thing, then I've given them side-effects, but no treatment, if I treat the right thing, then an adjustment takes a fraction of a second, the time is spend getting there. Early on in a course of treatment, there usually is not much to do, the history is generally more of the same, the examination is generally finding which adjustments to do today, and the treatment is generally just adjusting them; which can all be done in 5 minutes. Later on, you start introducing STW, dry needling, elecrotherapy, rehab etc and it takes longer, often I'll book them a double session, but I don't charge them double for it. But the way my diary works, I don't know before you arrive if it is going to be a "simple" session or a copmlex one, that depends on what you tell me when you arrive, so I have the same appointment time for all (personally 20 minutes, which is slightly longer than my average time with the patient {including changing}, so I usually run on time). Sometimes I'm ahead of schedule, sometimes I'm running late, but my patients know that if I'm running late, there's a good reason for it.

Essentially, I agree with Matt; I'm charging for my expertise, not my time.

PS, electrotherapy is often an exception, and used more in the earlier stages of treatment.

what are your thoughts on having 2-3 patients "on the go" at once. I found it quite unethical and did not feel like a patient centred approach was being applied. I found it very rushed as had to keep going off to treat another patient and would then come back to do another "adjustment"

heres another one. what is your appraco if you have a patient come to you and has had previous sessions with a chiro but they did not resolve the problem? Do you go through your usual treament approach or do you take a different approach? ie if 6 session of adjustments with another chiro was unsuccesul what approach would you take?

what are your thoughts on having 2-3 patients "on the go" at once. I found it quite unethical and did not feel like a patient centred approach was being applied. I found it very rushed as had to keep going off to treat another patient and would then come back to do another "adjustment"

Do you mean a chiropractor working 2-3 rooms at once, or 2-3 patients in 1 room? if the former, then I'm not a fan, but have no ethical objections, just personal (just seems a bit "join the queue, same for everyone"). If the latter, then I have significant issues ethically, specifically related to patient confidentiality.

heres another one. what is your appraco if you have a patient come to you and has had previous sessions with a chiro but they did not resolve the problem? Do you go through your usual treament approach or do you take a different approach? ie if 6 session of adjustments with another chiro was unsuccesul what approach would you take?

Sometimes a different chiropractor doing the same basic thing can have a different outcome, down to skill / power / specific technique used etc etc. You also can't make a diagnosis/treatment plan based on someone else's findings. I'll listen to what the patient has told me about the previous, and I'll take that into account; but it would be remiss of me to discount something based on 2nd hand information - though I may bring in the other options sooner.
I guess I'd use the information the same way as I would any other information - as an indicator, not a hard, and fast certainty

Hi,

I don't think it would make any difference. Each and every patient that comes in as a new patient to my clinic gets assessed for what they have wrong with them, when i see them. The care plan is to correct that cause (found on the examination). If it had (for example) improved 50% from when they went to the first chiropractor, they would probably require 50% less care.... however when examining them, you are starting from a new point.

All practitioners, whether it be a doctor, dentist, chiropractor or physiotherapist will relate to this every day in their office. Eg. if someone went to one dentist and needed 5 fillings, but they only had 2 done, it's pretty easy to assume that if they went to a new dentist they would need 3 done. If the first dentist didn't fix any, they second would have to do all 5.

It seems pretty simple.

Matt

Regarding the 2-3 patients on the go at once, that is a tough one. It really depends on the techniques being used, and this is imployed by physiotherapists too. For example, when using EPT equipment (i.e tens unit or other similar), it may require to be in place for 20 mins. If this is time to see another patient, that is the best use of time.

For example, in my last clinic i already had a waiting list of over a month for new patients, and approx a week for current patients. If i didn't use time management effectivley i could probably only see 70% of my capacity. Would you rather be in the 30% i could never see, or allow me to use my time effectivley?

I don't think its an ethical issue at all, more so a personal one. In many years of practice, i have never had a patient complain about this issue..... although i have had many complain that i can't fit them in to my 5 12 hour days!

Matt

You've interpretted that 1st question slightly differently to me; and yes, I had (in my last practice) a 2nd room I could leave people in whilst using electrotherapy/dry needling etc, where I just start the treatment, then leave them with a magazine for 20 minutes. No problem with that at all.

I'd got the impression he was talking about chiropractors who work 2-5+ rooms in a single session, with a chiropractic assistant filling in a tick-box form and preparing the patient, even to the point of patient positioning on the bench based on the last treatment given. Chiropractor comes in and repeats last time's adjustments, and heads straight on to the next patient. These chiropractors can often see 3-5+ patients in a 10 minute slot.
I worked somewhere like that for about a week after graduating, and it really didn't take long to realise that it wasn't for me (I already suspected it wouldn't be, but was desperate for a job at the time).
Yo9u also get chiropractors who work in a single room, laid out with 5 benches in it, again with a couple of assistants and the same happens, but without confidentiality - and it's that confidentiality that I have major issues with. Both are just too.... production line for me.

yes this was what i was poitning at. I've come across both of these situations. ie having 3 patients on the go in 15 min sessions and having 2 patients on the go in reception (!!) with a screen divider seperating each treatment area!

yes i got the production line feeling. just did not seem like each patient was recieving 100% attention that they need and are paying for.

Do you mean a chiropractor working 2-3 rooms at once, or 2-3 patients in 1 room? if the former, then I'm not a fan, but have no ethical objections, just personal (just seems a bit "join the queue, same for everyone"). If the latter, then I have significant issues ethically, specifically related to patient confidentiality.

Sometimes a different chiropractor doing the same basic thing can have a different outcome, down to skill / power / specific technique used etc etc. You also can't make a diagnosis/treatment plan based on someone else's findings. I'll listen to what the patient has told me about the previous, and I'll take that into account; but it would be remiss of me to discount something based on 2nd hand information - though I may bring in the other options sooner.
I guess I'd use the information the same way as I would any other information - as an indicator, not a hard, and fast certainty

yep ok with that about the different standard of adjustments between chiro's. However if a patient comes along to you having been to a previous chiro whos treatment has made them no better or even worse should this not be taken into account? ie what could look like an obvious problem with an obvious solution might not be such an obvious case? could having 8 manipulations with one chiro and then another 8 with another chiro (and so) lead to possible over treatment?

Yup, and I would have taken it into account. I'd also say that if they were worse after standard STM, then I wouldn't use that as a first choice modality for that patient; I also wouldn't have given them 8 failing treatments if they had that history (I'd only go as far as 8 without improvements in very chronic, stubborn conditions anyway).
So yes, it would affect my judgement, but I wouldn't discount that the patient could just have had a chiro who didn't suit them before either; so I'd still usually try my first choice treatment (assuming that that would be SMT); but I'd probably be keeping a closer eye on any changes, and, as I think I said, would include other options earlier.