Editor's Note: This is part 2 of a three-part series on creating a healthy aging practice to better serve the aging baby boomer population, which likely will comprise an increasing percentage of your patient base in the coming years. Part 1 appeared in the March 1 issue.
Teaching postgraduate seminars has given me the opportunity to travel around the country and see what is happening in our field. It's great seeing what the chiropractic profession is up to nationwide. I am seeing students shift away from making X-ray markings to learning advanced exercises for whole-body movement. Some of the key differences I see in young doctors today is that they use modern technology and keep evolving. Patients want to have a much more active role, a more consistent relationship with good, caring doctors. That's why I believe there's a need for much greater action by chiropractors today in the healthy aging specialty.
We can be a responsible voice. We need to speak up to patients; not speak at them, but with them. I believe our job is to be a better health care solutions provider for our patients – better than the government, the insurance industry and everyone else.
Have you noticed healthy aging is a popular topic? People everywhere are living longer and are concerned about growing older. All of this implies opportunities for chiropractors as leaders in this field of natural health care. Aging and growing older increases the demand for health care. Aging poses challenges – we get weak muscles, poor lung capacity, loss of balance, increased belly fat, etc. – that need to be addressed so people can enjoy their lives.
People seem to have less trust in government, yet at the same time they seem to be asking government to impose more health regulations and provide more health care. This is our opportunity to explain to patients that everything in life is an exchange. You have to ask yourself, "What are you willing to exchange for X? Your bad back for working out? I'll teach you how to work out to improve your bad back!" Your belly for diet and exercise?"
We need to keep up with the increased pace of innovation. The applications of computers, lasers, nutrition, exercise, etc., to the biomedical / chiropractic field are exploding. We can do much more today than we could ever do before. We are on the verge of being able to decipher your genome for less than $1,000. We are moving to an era of so-called personalized and customized medicine, whereby we will be able choose the treatment knowing the specific nature of the disease in an individual. (In cancer treatment, this is most advanced.)
As a DC, have you stayed advanced? Is palpation "it" for you? I like to think I have kept up with the times. I use my hands all day long to give me information and treat, but I also use deep muscle stimulation, laser, taping, nutrition, traction tables and of course, exercise therapy. I test using the SFMA, Functional Movement Screen (FMS), body composition analysis, gait analysis, and vitamin blood tests. I think I have a modern chiropractic office.
Healthy aging concepts include creating workout programs, building muscle and decreasing body fat. I like to test a patient's body composition using bioelectrical impedance in my office (body fat, lean muscle mass) and then teach the patient how to perform some body-weight exercises, band work and kettlebell exercises. Then I retest after a few weeks to see if the patient is following the program. I check balance quality with a gait analysis system every two to three weeks to see if the balance part of patient's fitness is improving.
Train your patients to stand on the stability pads every time they come into your office and retest using some measure. Balance training is a key concept. Chiropractors often forget the importance of proprioception – that stable relationship between the nervous system, the inner ear and the eyes. You can test the balance system with a simple one-leg-stand test, but it helps tremendously to test the balance system using gait analysis.
You can do a lot to help keep patients in sync with gait. Aging patients want physical stamina and good balance; the ability to move around and travel (through different time zones); be able to make good food choices; maintain good vision, good hearing; and all kinds of other demands. They want to avoid "losing it" psychologically. They want to go to sleep and turn "off" and wake up "on."
Technology has changed the way everyone communicates. We're all using some sort of communication tool: a smartphone, an iPad, a laptop. Opening the computer is often the first thing people do every morning. Anyone, anytime can contact me, and in general I do respond. The job is 24/7, 365 days a year. Patients have a legitimate demand for access to their doctor. I now have a system that integrates all of my exams and allows me to directly interact with patients online. I use it to follow patients' daily diet and exercise programs.
I believe patients want healthy aging strategies. You have to be able to express a plan, set goals, steer patients in a healthy direction, and teach them healthy living strategies! Your job is to recognize the right path forward, and then align and persuade people to do the things you know will be relevant for the long-term success of their aging. Patients want you to lead. No pun intended, but chiropractors have the backbone and the integrity to be straight with people about healthy aging.
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.
