primary care

A Frank Discussion with Your Medical Doctor

12 January 2012
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Categories: back pain, chiropractic, chiropractor, Disc Injury, disease, dysfunction, frustrating, healing, Health, healthcare, neck, primary care, Roseville Chiropractic, Roseville Chiropractor, Uncategorized

The purpose of this blog post is in no way to belittle or degrade the medical profession. My best friend is a medical doctor and I have several friends whom I admire and respect who are medical doctors. Furthermore, I have many medical doctors who refer patients to me on a consistent basis. No, this article is for those medical doctors who refuse to educate themselves on the benefits of alternative health care. Lately I have had a few medical doctors tell our mutual patients that they should not get adjusted anymore. Every single one of them cited arthritis as the reason why they should discontinue care with me. I hope this article will educate you as a patient of such physicians and maybe even influence some of them to do some research.

First of all, arthritis is a very generic term. Medical doctors routinely use it for any ache or pain in a joint. Most of the time calling it arthritis is technically true but over simplistic. It seems to me like they use it liberally because they do not want to explain what is really going on. Arthritis means is inflammation in a joint. It can be caused by auto-immune conditions like Rheumatoid or Lupus but more often it is caused by wear and tear. This is rarely explained to a patient so I am going to.

When doctors tell you that you have arthritis, most of the time what they are saying is that they can see signs of degeneration on your x-rays. Examples of degeneration are decreased joint space, bone spurs and misalignment. Essentially, instead of seeing nicely aligned joints with smooth edges, they see jagged edges with varying degrees of misalignment. This happens over time. How quickly is determined by how dysfunctional the joint is. The more dysfunctional the quicker it degenerates. Dysfunction of a joint means it is either not moving properly or not moving at all.

In the spine, the vertebrae have discs that can degenerate. Usually, this is associated with a disc herniation or bulge. Degeneration in the spine can lead to stenosis or narrowing of the openings where the nerve roots travel. Spinal degeneration or arthritis can come in varying degrees and complications. I am very aware of the risks involved with adjusting a highly degenerative spine.

Let me repeat that. I am very aware of the risks of adjusting a spine that has arthritis or degeneration! I also know the benefits. For this reason, I am very frustrated with these MD’s who are telling my patients to stop. Do they think I am unaware of my patient’s condition? Do they believe that I have no regard for my patient’s health? To be honest, I don’t believe they consider this, at all. I see fear derived from ignorance.

The truth is that an adjustment of a degenerating joint can be very beneficial. Retraining the joints to move properly can decrease inflammation and increase the nerve flow to that area which will at the very least slow down the degenerating process. Increased function will lead to improvement to the health of the joint. Are there risks? Of course. There are risks to everything. I believe the greatest risk is doing nothing. It is certainly the most predictable risk.

Trusting in your chiropractor to know when to adjust or not is important. Communication is the key! If you have a condition and you are unsure of your chiropractors awareness of it, express your concern. On that same note, avoid taking advice from people who don’t know. They shouldn’t be making recommendations about things of which they are ignorant. That doesn’t seem to be stopping some of them. If you stopped chiropractic care because your MD told you to, but have’t discussed it with your chiropractor, its time to have a frank and open discussion with all the parties involved, OK?

Your Chiropractor As Your Primary Care Doctor?

29 May 2009
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Categories: chiropractic, chiropractor, diagnosis, healthcare, primary care

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?