I enjoyed Dr. Tim Mills' article on MUA in the November 20, 1992 edition of Dynamic Chiropractic. After reading the article, I feel there are some issues that were not covered that I would like to address.
- In addition to Dr. Mills' well-written selection criteria for MUA patient candidates, at Doctors Hospital, after eight weeks of less-than-successful chiropractic care, we also require that a patient has had a adequate trial of physical therapy. This therapy is generally supervised, active rehabilitation, as opposed to modality therapy, which has usually already been performed in the chiropractic setting. However, if a patient has had eight weeks of only manipulation with no modalities, such as muscle stimulation, ultrasound, hot packs, massage, flexion-distraction, etc., we recommend that these modalities have an adequate trial.
- We eliminate any candidate who has not had prescription medication, which generally consists of anti-inflammatory and anti-spasmodic medicine. Anyone who has read my column knows that these medicines generally are not conducive to optimal healing at the cellular level. The fact remains: There are many Americans who go to traditional allopaths when injured, get medicine, and have relief of their pain.
- Patients with kinetic disturbances are eliminated. When their kinetic problem is corrected, and they still have spinal pain, then we would consider them a possible candidate for MUA.
- Manipulation under anesthesia is not inexpensive. Whether inpatient or outpatient, it costs the insurance company thousands of dollars. To sell this product to the insurance industry, we must prove (a) that all reasonable conservative means have been attempted; (b) that surgical intervention is contraindicated or has already failed; and (c) that without the MUA procedure, the carrier's long-term cost will be greater, because the patient would be required to continue receiving conservative therapy, whether it be chiropractic, physical therapy, or medicine, in order to perform activities of normal daily living without pain and discomfort.
- Reckless use of MUA will result in a quick loss of this hard-fought privilege. A decision to perform MUA should be made by more than just the chiropractor and medical doctor who will be performing it. At Buena Park Doctors Hospital, cases are only accepted when we have multiple opinions, both chiropractically and medically, that the patient is a good candidate. MUA is an invasive procedure; thus, our goal should be to maximize the amount of very successful cases and most importantly, in those cases where MUA fails, be in a position to defend the procedure as an honest attempt to reduce the carrier's cost and relieve legitimate pain and suffering of the patient.
- One of the least talked about yet most important aspects of MUA, is bringing together two health care communities that for many years have been antagonistic. Since I began the MUA program, I have had the opportunity to work with excellent physical therapists and medical doctors, and have referred them patients. In turn, I have received patients from RPTs and MDs for chiropractic manipulation. When reviewing MUA cases, we find that many patients had extensive allopathic therapy prior to chiropractic. How many times have you wondered how much less chiropractic care a patient would need if you got them on day four, or even week four, instead of month four. The converse is also true. None of us like to hear stories of patients who receive months of chiropractic with no change in their condition and no referral.
Manipulation under anesthesia can lead to greater interdisciplinary cooperation and cross referrals, which in turn will (a) reduce the amount of MUAs needed; (b) lower overall health care costs; and (c) provide better total patient care.
G. Douglas Andersen, D.C.
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