To help you enhance your practice and increase your bottom line, Dynamic Chiropractic PracticeINSIGHTS asks practicing doctors of chiropractic like you, for ideas and solutions that have been tested in real-world environments. In this issue we asked: "When working with patients who have weight problems, how do you make them aware of their need to lose weight (measurements, tests, etc.) and what do you recommend regarding their nutrition, diet, exercise, etc. and how have these been effective?"
As always, your feedback provided us with valued insight and effective methods to implement in your practice. The following responses are what we found most useful in answering this question.
Patient Education
While we received varied responses of how to approach a patient's weight problems, most readers believed an educational approach was the best way to communicate weight loss to patients. Charles Clement, DC, of Lachine, Quebec, Canada, encourages patients to empower themselves through education. He writes: "I simply recommend a book entitled The Carbohydrate Addict's Healthy Heart Program by Heller, Heller and Vagnini. One must read the book before recommending it. It can then be explained to the patient, and we can show the patient how to use the info before reading the whole book. Then it becomes the patient's responsibility. If they are interested, I order the book by the Internet and have it sent to them, and present the bill to the patient for what it costs me; no profit."
Ken Ross of Altamonte Springs, Fla, also believes education is key, although he takes a slightly more involved approach. He writes: "All my patients fill out a weight loss questionnaire when they come into the office. I personally go over it with them at the time of their next visit. We take measurements of the axilla, chest, waist and thighs, weigh them and do a body fat analysis. In addition we offer a six- or eight-week weight loss class that focuses on body, mind and food aspects of weight loss. Each class is different and we discuss all aspects of weight loss; not only how to lose weight, but how to keep it off."
Richard Therkelsen of Matawan, NJ, begins by assessing the patient's habits, then offers an individual weight loss program. He writes: "Weight loss is one of the easiest things to talk about with patients. During consultation, I ask height and weight. Then I ask if they feel that this is a good weight for them. If they say yes, there's no further discussion. The vast majority will say, 'I could lose a few pounds.' The door is then open. Follow up with questions like, 'What would you like to weigh?' 'What do you think is your ideal weight?' 'Have you tried to lose weight?' 'What have you tried in the past, and how did that work out?' 'If I put together a weight loss program for you, would you be interested in that?' Most people (even nonpatients) are very interested in what you have to offer."
Purely Products
Some of you chose to emphasis specific products in handling a patient's weight problems. Blair Labig of Xenia, Ohio, sticks to one product when advising patients on weight loss. Labig writes: "We use Standard Process' Purification Kit. It helps to detox and show the patient an easy plan to lose weight and to maintain a much better diet afterwards. Works very well to lower cholesterol, too."
Ryan Bemis of Alton, Ill, promotes a protein powder along with weekly monitoring for patients. Bemis writes: "Our office has been utilizing Ideal Protein. Our patients are getting great results in losing weight. We order bloodwork before they start so that we can show them their progress through a physiological standpoint. We coach them every week to make sure they are following through with their program."
Like Politics, Never Discuss Weight
For some, "weight" might be added to the old saying, "never discuss sex, politics or religion in polite company." While most readers believe addressing a patient's weight is within reason, others feel strongly that weight should never be discussed. Bill Martin of Snyder, Texas, who has also taught about bariatrics, rejects the idea of discussing weight with patients. From his experience, he believes that discussing weight with an overweight patient will ultimately turn them away. He explains: "I used to spend a lot of time trying to help patients learn how to burn off fat. I sub-specialize in bariatrics and read about two hours a day on the topic. I was trained by the same doctor who helped Sylvester Stallone.
"Most (like 99 percent) say they want to get thinner and lose weight, but when I tell them I have the knowledge to help them get leaner and teach them fat is not lost, it is burned, they do not care enough to change. They will not read and then follow the science of fat burning. Remember, most patients learn what they know about nutrition and bariatrics from TV, which tells them fat burning is quick, painless and effortless. They forget what happened to Kirstie Alley and 99.9 percent of everyone else who diets. You can lose weight quickly, but not fat. If you attempt to burn it off quickly, it will all come back and more (as all dieters already know).
"Yes, I have had many success stories, but for every one patient I have helped, I have lost 50 (or more). Overweight and obese people simply do not want to hear that they are overweight or obese, and 99.9 percent will not do anything about it, even if you offer to help them for free. I'm not talking about 20 to 30 pounds; I'm talking about patients who are 75+ pounds overweight. Most of them want to go to medical doctors to get drugs and I have to remind them that 87 percent of nurses are overweight or obese. If the drugs do not work for them, they will not work for you. Most of the successful doctors I know never bring up a patient's weight; not because they do not care, but because the patient will get offended and leave the practice for another doctor."
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.
