September 2019 - chiropracticforward September 2019 - chiropracticforward

Month: September 2019

10,000 Steps Myth, Is An Adjustment Neuro Too, Soft Drinks, & It’s OK To Not Adjust

CF 091: 10,000 Steps Myth, Is An Adjustment Neuro Too, Soft Drinks, & It’s OK To Not Adjust

Today we’re going to talk about the 10,000 Steps Myth, Is An Adjustment Neuro Too, Soft Drinks, & It’s OK To Not Adjust 

But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products
Integrating Chiropractors
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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun and accessible while we make you and your patients better all the way around. Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have collapsed into Episode #91

Now if you missed last week’s episode on Healthcare, the Days Of Old,  make sure you don’t miss that info. It was a bit of a brain dump. The week before that was on Decoding Fibromyalgia and we had a great episode before that one called Closing Patients…..we’ve had a lot of beneficial discussion on Facebook come out of that episode and it’s definitely worth checking out. 

We can’t get started without mentioning the sponsor of the first half of our show, 

Let’s talk about GoChiroTV. GoChiroTV is a patient education system for your office that actually saves you money. Instead of spending money on cable TV or looping a DVD over and over in your lobby, the bite-sized videos are specifically made to inform your patients about the importance of chiropractic, healthy living, and to encourage referrals while, at the same time, presenting the benefits of all of the different products and services that you offer. Specific to your office.

That’s right. It works by using a tailor-fit video playlist that only promotes the products and services offered in your specific practice. Not only that but the videos are updated automatically on a weekly basis so there’s no need to manually update your playlist AND you don’t have to learn any complicated software. You get to just set it and forget it. And don’t we busy doctors need just that?

Listeners of the Chiropractic Forward Podcast can use the promo code CFP19 at checkout to get 15% off all subscriptions. That’s CFP19, which also comes with a 45-day free trial to see if it’s right for your practice. Your discounted rate will be locked in for as long as you have a subscription.

Go visit GoChiroMedia.com to check out the demo reels and get started on your free trial.

In personal practice, I have to say I’m testing. What I mean is that you never have everything as cookie cutter as you’d like do you? I used to have patient time and paper time and life was good. i got plenty done but never seemed to break through as far as patient load. 

I had a new front desk scheduler come on board and she basically ignored my paper time patient time dynamic and, after some time, my practice blew up and went crazy as hell. 

Now, the key is, did the roof blow off because she put the patient preference in regard to the schedule…..did she put their wants first? So they loved it because it was so convenient? Or, was it a natural progression of practice and it happened to simply coincide?

Who the hell knows? I think we do a lot of things right so I don’t know. Here’s what I’m certain of though. If we continued putting patients wherever they wanted to be on the schedule rather than forcing them into a formatted schedule that still takes advantage of peak and most requested times…..if we continue to allow patients to run our practice rather than us running the practice….I’m quitting!! Lol

Here’s the thing, I don’t want to brag about numbers and things of that sort. I’m just telling you that it’s been at a point where, when the patients run the schedule, I have zero time to produce a great podcast, zero time to collect thoughts on anything at all, hell I don’t have time to go to the bathroom. 

So, a couple of weeks ago, I decided it was time to put a foot down. A foot down outfitted with a  steel-toed boot! We will have paper time and we will have new patient time. Period. 

Here we are with week #2 of the schedule playing out and you know what? We are a little slower today than normal. I’ve been in practice long enough to know that is not a big deal. Sometimes, it’s just that way. But there still is that part of me that wonders what in the hell? Is it the new schedule? Is it this is it that? 

Blah…. So, even 21 years later, it can be a rollercoaster. It can be a day to day, week to week, month to month thing and that drives me crazy. Mostly because I believe I have an anxiety disorder. 

Again, I share these more personal problems or issues with you all because I know some are going through the exact same thing and some younger docs WILL. 

I’ve been making plans on being at the Forward Thinking Chiropractic Alliance’s conference called Forward ’19 in St. Louis, MO….actually Chesterfield, MO but had I said that first, you’d have no damn clue where I was talking about and you’d have to get out your Google machine and waste time looking for the damn place and I don’t want to do that to you. OK?

It’s the little things I do for you all right? Anyway St. Louis on the weekend of September 20-22….it’s that weekend. They have Gray Cook as the headlineer. They also have , Greg Kawchuck, Annie O’Connor, Christine Goertz, a guy I got to know a bit through the DACO program and a great speaker and doctor, Dr. Brandon Steele, and several more. It’s a time to not miss. Plus, hell, I’ll be there. 

I’ll be staying at the Drury Inn there in Chesterfield and it’s right next door to a Cheesecake Factory so, honestly, what’s not to love about this weekend that’s coming up on us rather quickly?

They aren’t paying me to tell you about it. In fact, nobody associated with the FTCA has even asked me to mention it. But, I think it’s important and I think attendees will walk away as better doctors. That’s why I’m going. 10% better every day, week, month, and year. 10% better. 

go to https://www.forwardthinkingchiro.com/convention if you’re interested.

Item #1

We have a short one to kick this off with. It’s called ‘For Mortality, Busting The Myth of 10,000 Steps Per Day” by Jennifer Abbasi and published in the Journal of the American Medical Association in July of 2019 (Abbasi J 2019), hot cakes, hot stuff. 

Jennifer says the goal of reaching 10,000 steps every day has been a thing for a while now but, in truth, that may not actually be necessary. She said that older women who walked more than their peers and lower death rates in a recent study in JAMA Internal Medicine but….here’s the gotcha part….but the mortality benefit was seen with as few as 4400 steps. 

She says the recommendation of 10,000 steps may be disinclusive – is that a word?I think you know what I mean. She says 10,000 steps can be daunting to many. Especially older people and can actually keep them from walking any more. Whereas 4,400 is much more realistic and the that’s where the benefit is actually seen. 

Interesting stuff right there and definitely worth mention. I’m taking that to my practice. You should too. 10,000 steps may not be the gold standard.

Item #2

This is one called “Spinal manipulation therapy: is it all about the brain? A current review of the neurophysiological effects of manipulation” by Giles Gyer, Jimmy Michael (don’t trust someone with two first names), and James Inklebarger, et. al(Gyer G 2019). It was published in the Journal of Integrative Medicine in September of 2019. Hell, it’s September of 2019 right here right now. Hot potato, hot potato…..

They start out by saying that the the mechanisms underlying the pain modulatory effects of spinal manipulative therapy remain elusive. And although biomechanics and neurophysiological phenomena have been thought to play a role in the effects we see, more and more studies are showing improved outcomes suggesting peripheral, spinal, AND supra spinal mechanisms are playing a part. 

If you listen to our episode with the esteemed Dr. Christine Goertz, she was very clear in saying that we are currently a long way away from being able to say exactly how adjustments get the amazing results they get. That’s frustrating in a way isn’t it? It is for me. I want to know exactly how. 

In describing the article, she says, “The body of literature reviewed herein suggested some clear neurophysiological changes following spinal manipulation, which include neural plastic changes, alteration in motor neuron excitability, increase in cortical drive and many more.”

I have cited this article in case you want to go and find it. It’s in the show notes at chiropracticforward.com so go check it out. But I couldn’t find the whole article. At least not yet. Not until one of you awesome listeners sends it to me at dr.williams@chiropracticforward.com I would be grateful. 

But it is good for discussion. I actually did an episode dedicated to this topic. It was Episode #56 and I’m linking right here at this spot in the show notes so you can hear it. I actually had several people emailing me with some thanks on that one. 

The first reason this one was a big episode is because there were some knucklehead wannabe chiropractic gurus out in California claiming to have reversed spinal arthritis after two weeks of draining a patient’s bank account….errr. cough…I mean….of treating the patient 4x/day for 3 weeks. Which quickly adds up to a whole pile of steaming fresh hot brown….BS.

That episode came with pictures and illustrations in the show notes even. I was really fired up there. Lol. 

Anyway, the main reason I’m talking about that episode right now is that I provided a pretty solid description of the latest research and ideas on what an adjustment just may actually be doing for our patients. 

Basically, 

A recent paper by Anderstt et al. (2018) confirmed that cervical manipulation results in facet gaping.  This force also improves regional motion across multiple spinal levels during and post-manipulation.

“This study is the first to measure facet gapping during cervical manipulation on live humans. The results demonstrate that target and adjacent motion segments undergo facet joint gapping during manipulation and that intervertebral range of motion is increased in all three planes of motion after manipulation. The results suggest that clinical and functional improvement after manipulation may occur as a result of small increases in intervertebral ROM across multiple motion segments.” 

And according to the DACO learning

It appears that manipulation relies upon signaling properties of the muscle spindles that lie embedded in the paraspinal tissues. As the spindle registers rapid lengthening of the muscle it transduces this into a large proprioceptive barrage. 

The unique nature of a manipulation seems to alter the responsiveness of second-order neurons in the dorsal horn and make them less sensitive to incoming nociceptive signals from injured tissues.”

Adjustments are gapping the facets, improving proprioception and sensorimotor function, helping the body and brain know better where everything is and know better how it’s supposed to move thus, improving that movement and function. 

So, until new research comes out that makes us throw all of our best information out the window, that’s what I’m going with and, for evidence-informed practitioners, would suggest you adopt as well. 

Short break here….

It’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices. 

If you’re a regular listener of our podcast, you know I used it since about June of 2018. Let me tell you about it. 

ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean: 

In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises. 

You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips. 

You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you. 

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! **Short testimony**

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months

That’s ChiroUp.com and super double secret code Williams99.

Now, Item #3

This one is an obvious one and is called “Association Between Soft Drink Consumption and Mortality in 10 European Countries(Mullee A 2019)” by Amy Mullee, PhD, Dora Romaguera PhD, and Jonathan Pearson-Stuttard, BMBCh whatever the hell that is. 

Brand new info here. They took 451,743 individuals from 10 countries in Europe consuming more sugar-sweetened and artificially sweetened soft drinks. 

What they found was that those drinking more of either of those had a higher risk of all-cause mortality. Consumption of artificially sweetened soft drinks was positively associated with deaths from a circulatory disease while those consuming sugar-sweetened soft drinks suffered more deaths from digestive disease. 

So, why not cut them all out? I think water rules the day and NOT tap water by the way. I drink a lot of coffee and tea but I’m doing my best to drink more water. I know I’m supposed to. I get it but dammit it has no umph to it so water just sort of pisses me off and leaves me wanting. Lacking. And basically bitchy. 

Anyway, Item #4

This one is called “Association Between Maternal Fluoride Exposure During Pregnancy and IQ Scores in Offspring in Canada” by Rivka Green, Bruce Lanphear, and Richard Hornung, et al and published in JAMA Pediatrics in August of 2019(Green R 2019). Look out hot stuff everywhere, steamin’ plate…

The question they wanted to answer was, is maternal fluoride exposure during pregnancy associated with childhood IQ in a Canadian cohort receiving optimally fluoridated water?

Their conclusion was as follows “In this study, maternal exposure to higher levels of fluoride during pregnancy was associated with lower IQ scores in children aged 3 to 4 years. These findings indicate the possible need to reduce fluoride intake during pregnancy.”

Interesting stuff. Especially for those of you that make pediatrics and prenatal care such a big part of your practice. Knowledge nuggets all over the place today. You can’t listen today and avoid getting hit in the head with at least one of them. It may slap some sense into the recipient. At least that’s the goal. 

OK, last thing I have on tap today is Item #5

It’s called “Chiropractic conservatism and the ability to determine contra-indications, non-indications, and indications to chiropractic care: a cross-sectional survey of chiropractic students” by Guillaume Goncalves, Marine Demorier, and others. I say and others because I’m not even about to try to pronounce the next name. There would be a verbal murder of probably a perfectly good name and I don’t want to play any part in that. 

It was published in BMC Chiropractic and Manual Therapies in 2019. Once again, too hot to handle, step back one….no two steps…

In the background section of the abstract, they start by saying “While there is a broad spectrum of practice within chiropractic two sub-types can be identified, those who focus on musculoskeletal problems and those who treat also non-musculoskeletal problems. The latter group may adhere to the old conservative ‘subluxation’ model. The main goal of this study is to determine if chiropractic students with such conservative opinions are likely to have a different approach to determine contra-indications, non-indications and indications to chiropractic treatment versus those without such opinions.”

What They Found

  • They had 359 student respond out of 536.
  • They generally recognized a number of contra-indication as well as indications for treatment
  • What the problem was was in identifying non-indications for treatment. 
  • The subluxation students were much more willing to treat someone even when there was nothing relevant wrong
  • For example, they were much more willing to treat a 5-yr-old kid with no history of back pain or disease to prevent future back pain and to also prevent non-musculoskeletal disease. 

Wrap Up

Their conclusion was “It is concerning that students who adhere to the subluxation model are prepared to ‘operationalize’ their conservative opinions in their future scope of practice; apparently willing to treat asymptomatic people with chiropractic adjustments. The determinants of this phenomenon need to be understood.”

I can help them understand it. It’s BS passed on by wannabe gurus and colleges like Sherman and Life and was once shoveled in large amounts by Palmer and my alma mater, Parker. Although, to my understanding, those discussions are fewer and further between at Palmer and Parker these days. 

Look, I’ve made no secret, I’m not a Subby, a TOR, or a TIC. I’m an evidence-informed chiropractor. Just like Subbys and other evidence-informed chiropractors…..I too get great results for my patients. 

Unlike SOME of my Subby counterparts….not all of them….but certainly SOME of them…….I communicate with the medical field in effective ways that make sense to them, I do not take advantage of my patients, I do not use techniques and recommendations not back in part by evidence and research, I run a patient-centered practice, and don’t treat when I shouldn’t and treat when I should, and I do not try to see how many times I can run a patient through my doors based on the idea that I’m going to prevent some sort of mythical loss of curve issue 30 years in the future. Folks, we’re highly educated. It doesn’t happen that way and in 2019, we damn well know it doesn’t happen that way.

Your bank account might not like it but your patients will and they’ll know you care and they’ll know you’re different than the rest when you’re worried about them and NOT their wallet or their purse. 

The golden rule isn’t just for kiddos. IT’s for everyone regardless of age. Treat others the way you want to be treated. If you want to be treated a million times through your life because you may lose some degree of curvature in your neck, then 10/4, rock on with your bad self. 

I for one have no interest in that for myself so I’d never recommend it to anyone. Why would I? Other than financial motivation of course.

I wouldn’t.  

Before we sign off here, I made some awesome evidence-informed brochures and posters for your offices. Go check them out at the store link at chiropracticfoward.com 

While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it. 

Chiropractic evidence-based products
Integrating Chiropractors
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The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

Website

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https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through

TuneIn

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About the Author & Host

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Bibliography

  • Abbasi J (2019). “For Mortality, Busting the Myth of 10 000 Steps per Day.” JAMA Open 322(6): 492-493.
  • Green R, L. B., Hornung R, (2019). “Association Between Maternal Fluoride Exposure During Pregnancy and IQ Scores in Offspring in Canada.” JAMA Pediatr.
  • Gyer G, M. J., Indlebarger J, Tedla JS, (2019). “Spinal manipulation therapy: Is it all about the brain? A current review of the neurophysiological effects of manipulation.” J Integrative Med.
  • Mullee A, R. D., Pearson-Stuttard J, (2019). “Association Between Soft Drink Consumption and Mortality in 10 European Countries.” JAMA Open.

Healthcare Of Old – Days Gone By

CF 090: Healthcare Of Old – Days Gone By

Today we’re going to talk about how healthcare has changed – gone are the days of this and gone are the days of that. And there will be plenty of room for me to spread some personality in there too. If you’re a regular listener, you know I’m never lacking an opinion. 

But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products
Integrating Chiropractors
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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun and accessible while we make you and your patients better all the way around. Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have collapsed into Episode #90

We can’t get started without mentioning the sponsor of the first half of our show, 

Let’s talk about GoChiroTV. GoChiroTV is a patient education system for your office that actually saves you money. Instead of spending money on cable TV or looping a DVD over and over in your lobby, the bite-sized videos are specifically made to inform your patients about the importance of chiropractic, healthy living, and to encourage referrals while, at the same time, presenting the benefits of all of the different products and services that you offer. Specific to your office.

That’s right. It works by using a tailor-fit video playlist that only promotes the products and services offered in your specific practice. Not only that but the videos are updated automatically on a weekly basis so there’s no need to manually update your playlist AND you don’t have to learn any complicated software. You get to just set it and forget it. And don’t we busy doctors need just that?

Listeners of the Chiropractic Forward Podcast can use the promo code CFP19 at checkout to get 15% off all subscriptions. That’s CFP19, which also comes with a 45-day free trial to see if it’s right for your practice. Your discounted rate will be locked in for as long as you have a subscription.

Go visit GoChiroMedia.com to check out the demo reels and get started on your free trial.

We have some great stuff this week. It’s a short week due to Labor Day so this episode may run a little short and that’s OK. I try to not get too long winded. I think I went on about 45 minutes when we talked about Closing Patients two episodes ago.

But, a little gripe session never hurt anyone. If you’ve ever wondered whether Closing patients is right or wrong, get my take by going and listening to episode #88. I lay it out pretty clearly there. 

And don’t forget, last week’s podcast about Fibromyalgia. New info on fibro and treatment. Good stuff there in episode #89

Item #1

I want to start with an article that kind of struck me as…..huh….interesting. It’s called ‘The Old Days of Medicine Are Gone” by Michael Weiss(Weiss M 2019) and it was published in MedPage Today on January 17, 2019. Hot potato, heads up now. 

Weiss is a cardiologist and I have cited this article in the show notes over at chiropracticforward.com. This article refers to medical doctors specifically but there are a lot of parallels that we doctors of chiropractic can relate to. 

The article starts by saying that in the last 5-6 years, physicians have become less and less powerful. So have their patients. This disempowerment is due to a lot of things according to this article. Chief among them are:

  • Health management organizations
  • Managed care and 
  • The insurance exchange

Mr. Weiss says that all of these factors have taken power from the doctors and put the power into the hands of the large insurance companies and in the hands of the government. Well, that’s been going on for at least a generation. 

I remember a pencil pusher with an insurance company several years ago, a person who doesn’t have any kind of degree other than following prompts on a computer…..I remember them telling me how to treat a patient. What they needed. How many times….I was stunned. I will just say that I had a strongly worded conversation that I’m certain went in one ear, bounced around in that dude’s empty noggin, and fell out the other without making any impact. 

But I remember thinking, we are allowing insurance companies, the guys with a financial stake and a financial bias, we are allowing these people to tell us how and when to treat patients when they’ve never seen them in their lives. These patients are just numbers on a page to these companies and they’re going to tell us how to treat them. 

Same goes for the government. Whether it’s a popular opinion or not, makes not one damn to me. I’m going to tell you that when you put all of your healthcare decisions in the hands of one big fat, red-taped fat bureuacratic entity that has already screwed up Medicare and Social Security for no reason at all, due to both sides of a messed up aisle, well, you are once again numbers on a page and sometimes you get what you deserve. Of course that doesn’t mean everything’s peachy and we don’t need some changes to the healthcare system. We most certainly do. Universal healthcare medicare for all though…..I don’t see how that is the solution. Again, one fat, slow, dumb entity that has a history of screwing up big programs isn’t what I personally want making all of the healthcare decisions for me and my family but to each their own. 

Getting back to the article, Mr. Weiss says this physician disempowerment was basically a money grab on the parts of these powers and on the part of the pharmaceutical industry. Well…..of course. I think all that goes without saying doesn’t it? But I’m glad someone is indeed actually saying it. We should be shouting it out loud but, will it change anything? Politicians won’t do anything about it when big pharma is in their pockets and they’re scared of the insurance companies. 

Anyway, he says that doctors’ incomes have been progressively on the decline for years. Can i get an ‘amen’ on that my people. Testify!!  He says this cash-strapped generation of physicians have been forced out of private practice into working for hospitals and huge conglomerates and that gone are the days of Wednesday off for golf, gone are the days of being called a doctor rather than a provider, gone are the days of being respected, gone are the days when patient’s would say “But what does the doctor say?” rather than “Will the insurance pay?”, gone are the days when a physician could direct care they deemed necessary. Even the prescription pad is becoming useless since insurance doesn’t cover a lot of the scripts written these days. 

He says gone are the days when a physician could sit down and perform a detailed and thorough examination. Instead, we have be busted down to being typists, chaotic clerks, mindlessly clucking away at meaningless electronic health records benefiting only large entities. Hallelujah!! 

In order to make money these days, it has to be quantity and, unfortunately, quality many times suffers. For better or worse. When your income goes down, you see more to maintain the income you have built your life around. Quality of care suffers. Not intentionally. Nobody is morally corrupt typically. It’s just a natural consequence. You have bills to pay and you’ll figure out a way. 

Take a radiologist. They used to get about $35 for reading a neck series. Now, after Obamacare, they make $7-$10. I happen to know a radiologist very well so you can trust what I’m telling you. At least here in Texas. Could be different in your area. What happens when you income gets reduced by roughly 2/3 but you still have a big house and some extra toys you have purchased? 

Maybe you have a big garage sale and get rid of the extra fat? Ah hell no, that’s not what happens. Instead of 5 films read in 30 minutes you read 10. Think you might have an elevated risk of missing something? Of course you do. 

Back to the article….I keep getting side-tracked, he says gone are the days when a physician had the luxury of utilizing their skills of observation. He says now there are cookbook guides that have become the puppet masters of the physicians. I’d like to go on record right now, as part of a profession that has no standardization whatsoever…..I’m all for researched and evidence-backed guides. I love it. Give us some guides. Hell, don’t just give them to us, FORCE us to abide by them. Please? Lol. Just make sure they weren’t generated by a damn insurance company. That’s all. 

He says gone are the days of decent hospital stays and the days of when a patient could be cured of infections from a decent stay at the hospital. Now, he claims that patients are kicked out of the hospital early and take the buggies back to their community and spread them which leads to resistant buggies. I’d argue that commonly prescribing antibiotics when it’s a virus was problematic and the cause of a lot of resistance back in the day as well? He left that out oddly enough. 

He hit on a HUGE one when he says gone are the days of reasonable costs for a doctor visit or a drug co-pay. Now, since Obamacare, we see double and triple premiums, up to $100 co-pays, and double or triple deductibles. 

This sucker continues but, before I get to the rest of it, I need to talk about one of our amazing sponsors here at the show. It’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices. 

If you’re a regular listener of our podcast, you know I used it since about June of 2018. Let me tell you about it. 

ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean: 

In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises. 

You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips. 

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Back to the article, Mr. Weiss says gone are the days of visiting an ER and getting immediate care as if illness is the priority. Instead, we gotta get that co-pay covered first. 

He claims the days of physicians not having to worry about a patients insurance are gone. But…haven’t those days been gone since the 80’s or so? Honestly? That’s not something new. He says though that the insurance companies have encouraged minute clinics where the nurse pracs, and he says soon the pharmacists, will be giving the medical advice. 

He doesn’t seem to like this idea much but he’s OK with people waiting for hours to see a ‘physician’ because there aren’t enough of them. I’m pretty OK with nurse practitioners for the more mundane stuff. Plus, in my experience, NPs are more likely to refer to chiropractors for whatever reason. 

While Mr. Weiss is right to some extent, a lot of this is just whining in my opinion. The traditional physician doctor had their run with all of the power, the glory, and the golden ticket they cash when they get their medical degree. And, to an extent, they damn well still have a certain amount of power, glory, and golden ticket status. Although to a lesser extent currently. Admittedly. 

It’s one of the last quotes of the article that gets my goat a bit. He says, “Physicians’ voices have been drowned out, their plights buried, leaving their patients helpless,,,,”

Well freaking whaaaa Weiss. Yes, chiropractic has the status it has in healthcare right now because a certain portion of its practitioners refuse to progress. In fact, they work to inhibit any progress and cripple any efforts to expand the profession. Yep, it’s there and it’s undeniable but, when we talk about having voices drowned out, plights buried, and helpless patients, let’s go a little deeper. 

I’ve said it a million times but the medical field is going to look back on spinal fusions in 20 years and wonder what the hell they were thinking. I think I heard where lumbar fusion surgery has gone up 500+% in the last decade or so with little to zero hard stats that show any improvement in outcomes. 

Oh looky there, I see a herniation. Let’s cut that out and you should be good as new. We know so much more now. We know you can’t cut out pain. We know you don’t treat an image. You treat the patient in front of you because most of the time, there is little to no correlation between what you see on an x-ray and what the person’s pain generator is. 

We know now that chronic pain is mostly in the central nervous system. Not out in some peripheral part of the body. You cannot typically get rid of chronic pain by cutting something out. We know more and more now that it just doesn’t work that way. 

Yet, I feel confident promising you that right now, several fusions across the country are taking place. As I type this out. We also know that less than half of those fusion surgeries will be successful, right?

We know this stuff. Yet, they continue. Unabated. So, while I agree that insurance, the government, and the whole managed care concept have screwed up our healthcare system, I would say that physicians have played very key parts in their own downfall. Hello….opioid crisis anyone? Unnecessary surgery? Surgeries for the wrong candidates? Super bugs from overprescribing? Any of this ringing any bells? 

Have you heard the podcast called Dr. Death? Basically, a so called spinal surgeon down in Plano, TX maimed several patients and even killed several and the hospitals protected him and enabled him to keep hurting people over and over and over again. 

It’s not just insurance companies and big pharma that has cause any fall from grace. And let’s be clear, I don’t think there’s been a fall from grace. Go to a hospital and see the interactions. Everyone still defers very clearly to the physician and I don’t see that changing. It’s just now they have to work more, follow rules, and get paid less. I think that’s the big gripe. 

And to that I’d say, welcome to my world friend. Welcome to my world. 

But again, it’s not just the system. Medical doctors have done their part. And, as a chiropractor, I’d argue that part of that is they have largely ignored the American College of Physicians’ recommendations to try spinal manipulative therapy, exercise, massage, acupuncture, yoga, thai chi, and heat first for back pain. 

Those are the first-line recommendations and they are in concert with The Lancet papers on low back pain, the CDC, the FDA, the Joint Commission, The White House, and just about anyone else with any sense at all when it comes to non-complicated musculoskeletal pain. Yet, as I said, fusions are going on all over the country right now. As I speak. That’s when only 5% of back pain sufferers truly need surgery. 

When does someone truly need spinal surgery? When they hurt? Nope. Not usually anyway. Remember, you can’t cut pain out. Outside of an obvious case of a spinal fracture, tumor…..the bad bad stuff….I think it’s commonly accepted that surgery is necessary in a loss of bowel or bladder function, saddle anesthesia – cauda equina- type stuff, or a progressive neural deficits. 

So, if only 5% of back pain sufferers truly need surgery, why are so many still happening every day? After all of the research and after all of the updated recommendations?

Well, I’d say it’s financial. Get this, according to the American Medical Group Association’s Physician Compensation Survey says their research spine surgeons make $688,500 a damn year on average. 

Me personally, I’m doing pretty well in practice. But, it took me 16 years before I really started putting the pedal to the metal. Now part of that was my fault because I was traveling around playing music. Part of it was chiropractic’s fault because we have a system that eats its own. 

Either way, check this out, it took me 16 or so years to really build but, for an orthopedic surgeon, during the first two years of employment, bring in $400k and by their third year, $670k. Allied Physicians reported the maximum orthopedic spine surgeon salary was $1,352,000. 

Crazy. We have some chiropractors that make that kind of money but it’s not many and it’s not very likely. 

Anyway, I agree with some aspects of the article. Other aspects make me chuckle because, although it’s to a much lesser extent, physicians of our day are dealing with some of the things we’ve been dealing with for years and years. 

If we could just communicate with them the fact that we evidence-based chiropractors can play such a big part in helping them treat their patients and getting them back to work and back to life, I probably would have more sympathy. 

Hell, people come to us because we’re experts in what we do, because we are safe, and because we’re effective but, a large part of the medical field looks at us like stumbling idiots playing doctor and hurting our patients. While that may be true for some in our profession as well as for some in THEIR profession (hello Dr. Death), for the most part, we are all highly educated, highly capable doctors getting patients well. 

Maybe when they begin seeing us in that light, we start to see some sort of deeper, more meaningful integration. It’s started here and there in some pockets of awesomeness but not in general. It’s still a goal worth chasing. 

That’s assuming we chiropractors can get our of our own way. Otherwise, if I were a medical doctor, I wouldn’t want any part of something I could only explain as pseudoscience. I WOULD however be interested in a healthcare discipline that had the randomized controlled trials backing the meat of their modality. Count me in on that. 

And that’s the way I see it today. 

Store

Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly. 

If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders. 

Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it. 

Chiropractic evidence-based products
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The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

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About the Author & Host

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Bibliography

Weiss M (2019). “The old days of medicine are gone.” Medpage Today – KevinMD.com.