Your Chiropractor As Your Primary Care Doctor?

The concept of having a primary care physician is to control the cost of patients seeing a specialist directly. Under the primary care model, patients see their family doctor who treats or refers to a specialist. This frees up more expensive specialists from seeing patients directly who may or may not be a candidate for the specialist. All said, even though it does cut costs for insurance and patients, the concept can also help direct a patient to proper and appropriate care. In this way, managed care has it right in theory if maybe not exactly for the right reasons. 
Proper care is predicated upon a primary care doctor being a competent differential diagnostician who can manage the overall case especially if multiple specialists are involved. Unfortunately, the way it stands, most primary care physicians are either not very good at differential diagnosis or they just don’t have the time to do it right. Part of the problem, whether they like it or not, is that they are inundated with too many patients. Too many patients creates an environment of hasty visits and poor communication. In addition, there is pressure from the insurance companies to be more efficient and to save costs often at the expense of proper diagnostic protocols. 
Here is where chiropractors can come in. Chiropractors have learned the art of differential diagnosis, pathology, etc. just as much as our medical colleagues. In addition, chiropractors have more training in musculoskeletal diagnosis, radiology, and nutrition. In my practice, I spend a good amount of time during the initial visit discovering any and all health concerns and what is functioning well with a holistic outlook. In short, most chiropractors if they were interested would make excellent primary care doctors. 
There are some major advantages to using some chiropractors as primary care doctors (not all chiros are interested and some see diagnosing as a dirty word). First, we have a shortage of primary care doctors which really limits access to care (I wonder how much worse it will get if go to socialized medicine). Opening it up to chiropractors could significantly ease the burden. 
Second, chiropractors tend to build stronger relationships with their patients. Chiropractors tend to see patients much more than just when their patients are sick enough to go in. In addition, we put an emphasis on building relationships because we have to in order to grow our practices
Third, chiropractors are actually concerned about patients’ health and not just their sickness. Sure most people come in because of a problem but what is the underlying cause and what else can be prevented? You don’t know unless you ask and in my office, at least, we make it a point to comb through your entire history and do a full exam. 
Fourth, although we cannot prescribe medication, our ability to conservatively treat patients in a cost effective manner is second to no other health profession.  
Just like in anything cooperation is the key. There are still specialized MD’s who will not accept a referral from a chiropractor and, there are chiropractors who act like diagnosing is an evil art form invented by the medical community. Both are part of the reason that chiropractic still struggles with a legitimate identity (another post, altogether). 
I think my patients who know me well use me as their primary care doctor. Usually, the switch happens when they have something come up and they go to their MD. They then casually bring it up to me. I take the time to diagnose and educate and then point them in the right direction for proper care. Sounds like a win win to me. What do you think? 

What do You Think of Socialized Health Care?


The debate is in full swing over socialized health care. It seems to me that it is only a matter of time before the politicians decide to take control of the rising costs. I can understand both sides. I am not going to even argue between both sides because it seems like the two sides are comparing apples and oranges. I think most agree that whatever we have right now is not a great solution for the masses. My point in witing this article is will it work in the US? 

Now, I know what you are thinking, “It works in Canada and Europe and people are not as antagonistic or supportive as the two camps portray.” I agree. All of the debate is focused on whether it will be right for the people. But, just as in everything there are other parties involved. I have yet to see much discussion about whether the providers are going to go for this. 
You see, the doctors in Canada and Europe have never really known anything different. They went to school with a certain expectation and are working under those circumstances. This will not be true for doctors in the US if we switch to socialized health care. Think about it this way. Most US docs went into healthcare because it is career where one can help and serve others while also enjoying a certain status and income level. Keep in mind there are two sides to this: the ability to practice as one chooses and the money. 
Lets talk money for a bit because that seems to be the major focus (though I will argue that for the majority of docs it is the lesser issue). Going to professional school is expensive. A lot of time and money is invested in the education of a doctor. As of now, the compensation in most cases is satisfactory but not as good as it used to be. I wonder what compensation will be under government regulation?  
The real issue, however, is not money; it is control. Doctors have taken a beating since the onset of HMO’s. Take a poll of any profession and job satisfaction has more to do with the ability to affect outcomes. If HMO’s are bad wait until the government decides to take over. Medicare is the classic example. Medicare dictates very specifically what a doctor can and cannot do. In additon, if you feel a procedure is warranted but the government does not, guess who wins? Accountability is good, but when a doctor spends more time justifying his course of treatment than actually treating people satisfaction starts to wane. 
The question then becomes how many doctors are going to stick around with changes that will limit their ability to treat patients the way they want to and with a cap on how much money they can make? The other question is whether the government will allow doctors to opt out of universal health care and take private pay only? If they don’t, will enrollment at professional schools decrease and will you see more doctors leaving the field for less stressful and more profitable professions? If they can do private pay how many docs will opt out? Either way, what will our access to health care look like? I don’t know the answers for sure but I can tell you as a health care professional I would opt out so as to avoid the pitfalls and the headaches of governmnt controlled “sick care” and if the government doesn’t give us choice… well I guess I will have to cross that bridge when we get there. 

Subluxation

You many not know this, but there is a word which is either the bane or the glory of almost every chiroprator out there. That word is “subluxation” pronounced sub lux a (long a) shun). Don’t ask why there is so much controversy. Suffice it to say that people squabble over semantics. What is important is to understand the concept.

The literal translation of the word subluxation is minor dislocation. “Sub” means minor or small and “to lux” means to dislocate. When the modern founders of chiropractic started using the term, the thought process was that vertebrae would sublux from its natural position. This minor dislocation would then pinch on the nerve root which exits in between the vertebrae. Pinching the nerve root wouild then lead to poor communication along that nerve channel to the intended organs. Poor communication would then lead to disease.

Makes sense, right? Well, through the years we have learned more. First off, it doesn’t take a dislocation to cause problems with the nerve root. All it takes is a little bit of irritation. This can happen from direct contact from the vertebra, muscle, ligament, whatever, or from inflammation in the area. The point being, the vertebra doesn’t have to shift and pinch the nerve to create what we think of as a subluxation. If the joints of the vertebrae are funcitoning properly in any form that is enought to create irritation of the nereve root and therefore disease.

The goal then for chiropractic patients is to strive to reduce one’s subluxations in order to improve one’s health. So, when we get down to it, chiropractors find these areas of dysfunction and help train the joints to funciton properly.