I have billed myself as an industrial consultant for many years. While I personally like the sound of the phrase, I am also aware of the many definitions available for the term consultant such as: 1) someone who borrows your watch to tell you what time it is; and 2) anyone out of work who owns a briefcase.
In a previous column I stated that I see the role of a consultant to be that of a "problem solver." In my opinion, any clinician who seeks to restore injured workers to their former status, i.e., pre-injury, is attempting to solve a problem. This process often involves not only treating the injured worker, but also communicating with the employer, assisting with the development and implementation of modified work duties and facilitating an effective and safe return to work. In some instances, it may involve visits to the work site and education and training of the worker and his/her co-workers. Therefore, it has long been my contention that any chiropractor who treats work-injured patients is functioning as a "consultant to industry."
During the question and answer session that followed a presentation I had given, I was asked, "What gives you the qualifications to serve as a consultant to industry? You're a chiropractor!"
After a moment, I replied: "I am a chiropractor. That's what qualifies me. After all, I see the worker after the injury. Who better to be able to help with preventing injuries than someone who sees the result if appropriate steps are not taken." My answer appeared to satisfy the audience and we moved on to other questions.
But the question still remains. What gives me the qualifications to bill myself as a consultant to industry? Since I have spent a considerable amount of time and energy attempting to assist other DCs to position themselves in the industrial community, what qualifications do they have, or should they have? Is a DC degree enough?
Let's take a look at the role of the consultant from the perspective of the employer. What exactly does the employer want?
What does the employer view as the primary function of the consultant? Are the needs of the employer compatible with the goals of the clinician, or are they, as I will attempt to explain, in direct opposition?
A few months ago, during a break at one of the postgraduate programs that I teach, a fellow DC came up to me and told of an experience that he had with a company in his community. He had attempted to introduce himself to the human resource director of the company but was rebuffed due to a previous experience the company had with another DC. Unfortunately, this isn't the only time I've heard of a similar problem. As it happened, another chiropractor had previously approached the company in question with the idea of serving as a consultant. He had suggested a series of classes for the employees and, in addition, offered to examine the workers to identify individuals who might be at risk for developing cumulative trauma disorders such as carpal tunnel syndrome. To the dismay of the employer, the DC found lots of problems in the workers and, during his visit to the work site, convinced eight of them to become his patients -- workers' compensation patients, that is.
Needless to say, the employer was furious with the "consultant." Rather than assisting the employer to identify areas of concern, and to develop a proactive program aimed at preventing problems, the employer felt that the chiropractor had "lined his pockets" at the expense of the company. It only takes a few such incidents to create a negative image of all chiropractors in the workplace.
As I see it, the role of the chiropractic industrial consultant should be to avoid harvesting new patients at the expense of the employer. The employer is looking for ways to reduce the injury rate; to protect employees by providing safer work environments; and to reduce their workers' compensation costs. This is not typically accomplished by the actions of an individual who is primarily focused on building a larger workers' compensation practice. Such short-sighted interactions may appear to have an immediate payoff (e.g., eight new patients in a single day), but they tarnish the image of the chiropractic profession and may permanently undermine the credibility and the value of chiropractors to the industrial community. Instead of building a rapport with the company, one that might develop into a long-term relationship that would be satisfying to both the company and the chiropractor, the perceived greediness of the DC harmed not only his own reputation, but the reputation of other DCs in his area.
It is important that any chiropractor who is seeking to be a consultant to industry must be very clear on the goals and objectives. Are the goals and objectives in the best interest of the company, or are they self-serving? It is quite likely that when a workplace is visited by a competent clinician, a number of problem areas will surface. It has been my experience that many companies do not want problems to be made too obvious to their employees. They fear that once they are, their employees will rush to the doctor and their injury rates will rise rather than decline.
It is imperative when consulting with employers that they be made aware of this possibility. Ideally, any problem that is identified early enough should be amenable to minimal intervention, such as simple ergonomic changes in the workplace, rearranging work duties, and stretching or strengthening programs for workers. Only after such changes are implemented should workers seek care. The chiropractic industrial consultant must remain cognizant that most employers don't want their workers going to the doctor. That's often why they hire consultants in the first place: to avoid expensive care.
On the positive side, there are tremendous opportunities for chiropractors to function in the industrial community. There is an increasing demand for competent individuals to work with industry to develop proactive prevention programs designed not to feed a chiropractic practice, but to reduce the health problems of the workers and, consequently, to reduce health care expenditures. With a long history of prevention minded care, the chiropractic profession is well suited to participate in this process. But we must be mindful that the thought of workers seeing a chiropractor on a regular basis and billing workers' compensation for their efforts is not what the employer has in mind.
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
Spearheaded by burgeoning scientific and clinical research literature, psychedelics have reached a level of media coverage and popular interest that has not been seen for over half a century. By “psychedelics,” we are referring to the unique class of substances that includes psilocybin (the active compound found in so-called “magic mushrooms”), LSD, dimethyltryptamine (DMT), ayahuasca, 5-MeO-DMT, and mescaline – each of which occurs in the natural world (except for LSD, which is a semi-synthetic compound).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
