Herein lies the problem. I have treated Elma once a week for years. I admit it. And it used to make me feel uneasy. Because by today's standards, at least in this case, I am an "outlier" from the standard deviation, a no-good purveyor of unnecessary treatment, a bandit who fosters dependency on the weak and the ailing. I could be judged a throwback to modern chiropractic practice; a maintenance-care-mongering, subluxation-obsessed, controlling "chiro-maniac," who revels in the vision of people lining up outside the office, like they would at Starbucks, because they can't face the day without their adjustment.
And, to make it more interesting, Elma never gets better. For over 80 years she has been dying, or as one old-time chiropractor once told me, "No one gets off the planet alive." She comes into the office now on a walker, where once she trotted in aided only by a cane. I am pretty sure that when she dies, she will state it in her will that I'm to give her one last adjustment - just to see if it might help.
Because, you see, it always has helped. I mean, she has tried it all, from massage to colonic irrigations. But she tells me every visit that she receives the most value from chiropractic treatment. How do I know that she's right? Well, I have no idea.
Don't misunderstand. I have had a lot of time over the years to try some measurements. I had her fill out questionnaires like Oswestry, Roland-Morris, and pain scales, pain drawings, etc., and the results never showed any lasting improvement. I've referred her to physical therapists, orthopedists, psychologists, massage therapists, yet she tells me that chiropractic helps her more.
It is obvious that I offer Elma palliative care only. She appreciates it, and I'm glad to help. But this type of treatment is far from maintenance care. It is truly "elective" care. She elects to come in, and I elect to treat her. Dust off the old Mercy Guidelines, and you will see on page 118 that elective care is defined as "not medically necessary," much like Swedish massage can be. It is "to promote optimum function." There is no basis for insurance coverage, and Elma is glad to pay cash.
I relate this story because I think it is time for chiropractors to quit apologizing for taking care of chronic pain patients. There are plenty of flaky patients with tendencies for imprinting on passive care, just as there are doctors who secretly are contented with promoting such dependency. I'm not talking about them. I'm taking about the elderly Elma's of the world who come to the office to socialize and experience some kindness and human touch!
The next time you might be feeling like you're not doing enough for some similar patient, well - chin up! If you're really doing the best you can, take pride that you still offer something of perceived value to your patients. And to all those managed care companies, chart reviewers, independent examiners and such, don't worry about Elma and me. We're doing just fine.
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