Here is the scene: The staff member finishes a scan at a progress exam. It can be a 2,3 tech scan or a full NSFi. The printout emerges and the doctor or the staff glances at the colors and the patterns and nods in approval.
Now just imagine you are in the patient’s place. The scans have something to do with my spine. The doctor has used the words nerve and stress and I still have some type of back/neck pain. What the heck do all these colors mean? What is he/ she satisfied with? How much longer do I have to come for this problem?
Can you really blame the patient who comes in for spinal related pain, gets told a bigger story about stress, health and wellness and then judges their improvements on their comfort rather than their test results? Well, before we blame the patient or ourselves, let’s look at the dynamics of the relationship and how we can ensure its honesty. If you are seriously setting goals that go beyond pain and structure, then the scans are an ideal method of tracking progress. If you are using the scans to measure NMS integrity alone, then the frustrations will mount within both parties. The starting point for all care plans must be built upon truths and consequences.
Truth#1: the scans identify habits that have been created by the body’s best intentions to maximize it’s efficiencies in light of the subluxated state. They do not necessarily point directly to the subluxation or the pain and inflammation that may be attendant to the symptoms a patient is feeling. These habits are identifiable in a variety of neural processing states and NMS positions and motions.
Truth#2: Pain and symptom management are early stage identifiers that the body is responsive to your interventions, NOT that it has healed the subluxation. Subluxated systems are ridiculously inefficient and protective. Scanning detects the efficiencies that neural processor possesses and relates them in regional color patterns or scores them numerically against normative scales.
Truth#3: A chiropractic care plan must have goals that identify the needs of the patient, the desires of the practitioner and the reality of the situation. There are consequences of a short sighted plan and limited adjustments. If the neural processors are persistently distracted then the system is out of sync and requires a chiropractor’s intervention. Do your adjustments stabilize the spine, reset the neural sequencing, arouse innate or all of the above?
Truth #4: A patient will follow your care plan for as long as they value the outcomes that you are certain of. If you have developed a certainty that your care model unwinds the neural-dural tension and sets the tone for healing and potential, then the scans will reflect your excellent work. If your method is focused on structural integrity with the HOPE that the neural system SHOULD release its old habits, then the scan progression can appear more variable. Certainty and specificity wins the day.
Truth #5: Information is free; advice is valuable and at times priceless. I suggest that you be more certain than speaking in generalities. Trust your greatness and give exacting advice. Tell the patient how long you feel it will take to clear a scan or raise the NSFi. Develop an outcome relationship with the patient. That’s what they are aiming at. The days of endless attendance because of the elusive holy grail called wellness, are over. Be a master of your outcomes and assure your integrity with proper communication and commitment on your part. Celebrate the shifts in the scans as much or more than the improving comfort in the patient.
There are a gazillion more truths to explore in practice but these were the ones that resonated as I wrote this blog. Send me a whole bunch more of your truths and we can discuss them in this blogosphere. As Pat Gentempo reminds us, ”You are not alone.”
Ahh, the return to normal. My life got interrupted by just that; LIFE. Glad to be back and sharing some perspectives on the art of chiropractic communication, scanning and all things relevant to pushing chiropractic into the greatness realm.
I was recently on a call with my friend and colleague, Dr. Yannick Pauli. He and I did a WNL session focused on the destructive nature of ADHD and the importance of being the powerful leader in your community where parents and children can go to be cared for. The transcript for this call has been generously shared by Dr. Pauli and is available in the “free stuff “section of the Docfletch.com website. I twisted his arm and he is now offering an 8 module program to train DC’s on how to position your practice to be masterful at working with these wonderful souls. Go to www.ADHDwellnessexpert.com for more info. In the course of this call, Yannick suggested that the subluxation was better viewed as an invitation by the body to let us in and begin the necessary change. This is contrasted to the notion that it is a lesion that needs to be cut out or removed.
One of the great challenges that we face as chiropractors is to step away from the medicalization of disease and focus on the principle of dis-ease. We need to do this away from the quasi-religious notion that we hold the power to heal people. Chiropractic is a science that understands and utilizes the relational aspect of the subluxation to disease and the impact it has on reorganizational behaviors and strategies in the human experience. A subluxation is a distinct measurable component of a system that has been mired in an adaptive loop, unable to break free to complete the healing experience. Chiropractic sciences measure that adaptive response through the neurological and biomechanical windows primarily. In light of this we have a tendency to organize the care plans along those end stage repair strategies connected to movement, posture, pain and comfort.
After Yannick suggested the invitational nature of the subluxation, I was struck by the image of “Alice through the looking glass”. As we work over the patient, I envision that the subluxation is akin to a window through which we peer. There are many veils that distract and obscure the perfection that lies within. These can be categorized as neuro-mechanical, neuro-emotional, neuro-metabolic and of course, neuro-bio_logic. Each of us has the opportunity and perhaps the responsibility to analyze and detect these distinct characteristics and then choose the most effective adjustive strategy to lift that particular veil. The goal of course is to arouse the innate intelligence to be more evident. We can accomplish this with specific adjustments targeting specific forms of subluxation.
There was a time in my career when the emphasis was on honing your adjusting skills by attending relevant seminars. These days there are few seminars along these lines compared to the business/practice building ones. My observation as a coach is that it’s pretty tough to build a practice when the outcomes are clouded in doubt. A starting point might be to acknowledge that one size of adjusting does not fit all subluxations and that if it does then there is a distinct limit to the scope of your care plan.
We’ll spend some more time exploring the use of certain scans to be more specific as to which subluxation class you are observing. Classically, the scans are best to observe the chronic, neuro-emotional state and then tie that in with the neuro-mechanical outcomes.
So, consider the opportunity you have to peer into their Universe through their subluxations. This perspective may just expand your horizons and keep you from being the Mad Hatter in your town.
Dr. David Fletcher is an accomplished coach and the co-creator of the Greatness Movement. Spend a moment and get your own personal GAP (Greatness Action Plan). Its’ fun and its free. Send a request directly to docfletch@docfletch.com .
Time mark…8:39 EDT… Canada scores the tying goal in second period against USA. More goals to come for sure!
Who says goals don’t count. All of Canada is glued to the television tonight to watch their team play a round robin match against their arch rivals. Imagine when the games really count.
Goals are powerful measuring sticks for everyone wheteher you are Olympians, hockey fans or chiropractic patients. So often we forget to use strings of goals to connect the patient with where they are to where they need and want to be. Unlike a hockey game, there are more than 60 minutes of a game to play in health, wellness and life. We have an oppportunity and a responsibility to inspire and direct our patients with attainable and far reaching goals.
I focus on developing an early understanding of stress and the functioning nervous system. This is where my goals start with the patient. Developing a new awareness for the habits that are taken for granted is a priority. I relate the processing of stress with the reactions that I locate, measure and palpate within the spinal core. My goal is touch and tell. My goal for the patient is an ah-ha. I use all the tools I have to get that ah-ha. On a big goal basis I use the NSFI score to set a goal of neural spinal change and functional improvement . I have xray images to talk about long standing and life altering changes. I use the scans and the images to reinforce my message and to confirm my certainty. My goal is to inform, inspire, and interrupt the subluxation patterns.
I have a multitude of other goals for my patients and my community. A primary goal in this category is referrals. I believe that chiropractic is an authentic grass roots movement that is for the people. It is a simple yet profound message that can easily be relayed from neighbor to neighbor, friend to friend and within the family. Asking my patients to refer their closest people to me for chiropractic care is an automatic in my office. My beliefs are represented by my goals.
Time mark…9:06 PM and the score is 3 goals for the USA and 2 goals for Canada. Goals are everywhere and sometimes there arn’t enough of them when you want them. ( 20 minutes to go. Lets see if there are more Canadian goals in the near future)
“All men’s miseries derive from not being able to sit in a quiet room alone.” So says Blaise Pascal who just happens to be one of the understated geniuses of Western thought. I took his advice and for the past few weeks I have done just that; sit and contemplate the next great adventure. You may have noticed the lack of blogs being posted as a consequence.
Here are some thoughts about being a chiropractor and producing chiropractic that have filtered out from that quiet room.
Its all about the relationship. No matter how we deliver the adjustment, the greatest change comes about from a change in perspective. A shift is neccessary from being the doctor to be viewed as their”trusted advisor”.
We must streamline our thots and procedures to service thousands of new patients. Our systems are too cumbersome at present to take it to the people and get them to respond . In this incredibly fast paced, technology based, communicative world its appropriate to ” call the question” early and service the patient with incredible and reliable service with identifiable outcomes.
We should be willing to work in an abundant mindset and build businesses that reflect our creative expression of greatness RATHER than show up and dutifully put in the houtrs each day.
Chiropractic’s message is incredibly simple to understand, accept and promote. Who doesn’t get that stress contained within the spinal core can disrupt a spine, a body, a life and eventually a community.
Its a good time, if not the best time, to refresh our vision of commitment and our business practices. If we are willing to risk our greatest assets: time and reputation on a daily basis, then its appropriate to seek rewards of equal value. What is it that drives you to be in the office daily? If its the paycheck then its definately time to rejig. If you are focusing on your retirement options then your dream is busted and your demise is imminent. Legacy should be replacing retirement thoughts.
Chiropractors,like all other workers, are inherently lazy at their entrepenurship. The creative side of life is not meant to be numbed by the repetiton of innane work. There is a reason that we chose to eat what we kill. Entrepeneurship keeps us hungry for success and success demands creativity. As Dave Mager always reminds us,” Game face on…everyday”
Well, that’s it from the easy chair. Maybe the room needs to be a little less quiet as I come up with solutions. Stay tuned as I share some useful practice and positioning thots.
A patient who has been with me for about 6 months now shared this observation with me today. He reminded me that he had been to another DC before consulting our office. He has a long, long history of debilitating LBP with the usual radiations etc. He also has sleep difficulties combined with RLS and so was medicated to try and sleep with less pain and spasticity. His original DC was a young grad working in a downtown rehab styled clinic. The doc was thankful that he had access to the MRI’s because they “absolutely contraindicated adjustments” and so the course of extended care was only focused on core strengthening. No manipulations, no passive stretching just core retraining. My patient was faithful to a fault and finally recognized that he had tapped the expertise of this lad with no appreciable improvement and called to see if there was some way to ease the chronic pain.
I’m not going to comment on the selection process in the colleges but the results are evident when the majority of candidates are kinesiology grads with a biomechanical background. The challenge that faces all DC’s is defining what makes them and their offerings of chiropractic unique. There is certainly nothing that warrants chiropractic uniqueness in a better approach to core training. For God’s sake lets all get over the distinction between fixation and subluxation. What makes the chiropractic approach unique is that the “lesion” that emerges as a consequence of altered neural tone and a limitation in the expression of innate is a subluxation. A component of the subluxation process is a vertebral reaction that may or may not exhibit a fixation in the biomechanics of a segment or two. We all endure fixations either episodically or chronically. It’s part of living in a gravity and motion dependent existence. Remember the original definition presented by Palmer via Stevenson in 1927. There were three necessities to claim the existence of a subluxation: loss of position and inevitably motion of 2 contiguous vertebra; an alteration and eventual closure of the IVF and most of all an interruption in the expression of the Innately tuned mental impulse. Well, 1 and perhaps 2 are associated with fixation but there must be a shift in neural-dural tone to qualify as a subluxation.
If you remember my model of subluxation for patient orientation using the three layers concept, then it is so easy to understand that layers one and two associate with fixation while a persistent disturbance interfering with the communication along the 3rd layer of neural-dural tone means that the person is no longer suffering from the limited biomechanics of a fixation but rather, they are developing devastating health issues related to the loss of vital communication. Subluxations are identified and adjusted by chiropractors and so that is what our role is within the community of healers and health care providers. We are also incredibly capable of coaching and advising how to optimize the results while under adjustive care and to share and care for people to limit the potential to become subluxated. There is a lifetime of work to do in our communities let alone within the world.
Back to my patient… I identified that indeed he was subluxated in several regions of his spinal core. We reviewed his neural efficiency patterns and looked at the destructive changes to his spine. He was definitely fixated in many regions including his lumbo-sacral region. Undoubtedly the tissues in this region were generating tremendous pain and restrictions. Joints and soft tissues hurt like hell when they are damaged and stressed out. We identified his limitations in lifestyle management and we laid out a care plan that addressed his immediate issues and offered to care for him through the reorganization time frame encompassing recovery, restoration and finally, wellness care. He was told that this was to be a collaborative effort for him to achieve the best results BUT if he chose to just use adjustments as a therapeutic approach, that was OK as well. This thing called an adjustment works whether the patient is totally compliant with lifestyle modification or not. In my years of parenting and “spine-parenting” I have learned it is wise to be creative in inspiring people to achieve results. Guess what? He is feeling better and healing at the same time. If we were to look at his MRI and biomechanical parameters he would still be in trouble but his neural scans are shifting and easing. He describes many wellness improvements such as clearer thinking, less night pain and spasticity, improved digestion and more mobility in the spine and he is happy! It’s probably all a placebo because his structural metrix are all abnormal still. I agree whole heartedly with the young DC that manipulation of this man’s lower spine is risky and non productive.
If managing the deteriorative fixation was the goal of care, I suppose all that I would be left with is the surface approach to soft tissue and mobilization with movement. As a chiropractor my eyes are on the subluxation and if there is a chance to adjust it, and why wouldn’t there be, then this man will improve and heal. That’s the law of nature that is embedded in the philosophy and the principles, all 33 of them, of the chiropractic doctrine. Of course there is limitation of matter but so long as there is a life spark and enough time, there is an opportunity to heal on many levels.
It’s just right to be and act as a chiropractor if you are going to call yourself one. It’s a glorious and noble profession that has spent too much of its time trying to fit its philosophy and practice into the square hole dictated by medicine and chiropractic licensing boards. Be the artist that you know you are and stop defining the care you do as a modified physio approach. Find the subluxations and adjust them. There will be much more healing going on at that table and it won’t be limited to the person lying on it.
Happy New Year to all of you who read and respond to this blog. 2010 is already becoming a powerhouse of change. We have filled up the two coaching spots that were available and so my amazing assistant, Linda, has bribed me to open up two more. You are welcome to call in and see if my communication training and my methods of practice development are right for you. If not, I get a chance to meet more cool people from around the globe! Be well and Be Great!
