Last week I spoke with a new patient who had been to another chiropractor before visiting me. She was reluctant to talk with me about her visit to the other DC, but finally informed me that after the doctor had reviewed her x-rays, she had been advised to pay a $1,500 lump sum for 60 visits to fix her "shoulder problem." I find it disturbing that some chiropractors attempt to coax patients into paying excessive amounts of money for an extremely large and unjustified number of chiropractic visits.
The typical situation seems to involve a patient who visits a DC that is not a member of the patient's managed care network. The DC doesn't want to lose the patient to a doctor who is "in-network." A cash plan is then offered to the patient for an exorbitant amount of money and "x" number of visits. Obviously, there is no valid reason to suggest a patient needs 60 visits. How does any DC predict a patient will need 60 visits?
When practicing as a conservative care provider, isn't it important to monitor how a patient responds to the initial visit? Isn't it our job to determine if active care and home rehabilitation can help a patient to become less dependent on passive care? Is our goal to help each person to return to full function as quickly as possible and have patients visit our office less rather than more, or to create dependence and boost our "patient visit average?"
It appears that some practice management companies are advising DCs to charge a large flat fee, which the patient must pay for in advance. Management companies tout these plans because they supposedly "promote wellness," provide the patient with a low per-visit fee (provided a patient uses all 60 visits, or whatever number of visits the payment plan is set up for) and generate cash flow for the chiropractor. However, it is obvious these types of financial plans promote dependence on passive care, increase utilization, and dramatically increase the out-of-pocket expense for most patients.
Coming from any health care professional, this type of activity is questionable at best and illegal at worst. I urge all DCs to report colleagues involved in this type of activity to their state boards.
"I am also confident that many of your past athlete guests...cringed when hearing your ridiculous opinions about the profession."
(Editor's note: The following letter was sent to radio sports show host Jim Rome, and carbon-copied to DC with permission to print from the American Chiropractic Association.)
Dear Mr. Rome,
As president of the American Chiropractic Association, I would like to take you up on your challenge to name another health care profession besides chiropractic that offers free exams in malls, and to educate you about one of the safest and most effective forms of treatment available today: chiropractic care.
You may be interested to learn that many health care services are available for free in such venues as malls or grocery stores. Blood pressure tests; blood sugar tests; cholesterol screenings; colon cancer screenings; osteoporosis screenings; flu shots; and a host of other services can often be taken advantage of at the local mall or neighborhood grocery store. In fact, many doctors of optometry actually maintain practices inside shopping malls and "discount" department stores.
Would you suggest that those with vision problems should not consult an optometrist? In addition, medical doctors and doctors of osteopathy often jointly host health fairs or health screenings in malls.
I would also point out that doctors of chiropractic must reach out to the public in ways that might seem untraditional to you, in part, because of the bias and discrimination they face each day from people such as you. By reaching out directly to the consumer, doctors of chiropractic can often counteract the misinformation that the public unfortunately may hear.
I am astonished that you, a sports "personality," would be so out of touch with the importance of chiropractic care in the world of sports. I am also confident that many of your past athlete guests, because of their appreciation for and support of chiropractic care, cringed when hearing your ridiculous opinions about the profession.
While I do not have enough paper to list all the athletes and sports stars who thank chiropractic care for much of their success, I would like to share some of the more well-known names with you: golf icon Tiger Woods, football legend Joe Montana; and baseball stars Barry Bonds and Mark McGwire all benefit from chiropractic care. Interestingly, Mr. McGwire is listed as the current "player of the week" on your very own website!
Bonds, who is preparing to break McGwire's record for homeruns in a single season, has said, "I think that it should be mandatory for athletes to see a chiropractor." Bonds even thanked his chiropractors during his press conference after hitting his 500th career homerun earlier this year. Obviously Mr. Bonds does not share your views.
Olympic speedskater Derek Parra, a two-time U.S. National All-Around Champion, holder of three American records, and the reigning North American champion, credits chiropractic with helping him recover from injury and perform at his best. He is now the most dominant all-around speedskater in the U.S., and has set his sights on completing his medal collection in February 2002 at the Salt Lake City Winter Olympics. Parra, who feels so strongly about chiropractic that he is a spokesperson for the American Chiropractic Association, has said, "I've used a lot of other treatments for injuries and pain, but the problem doesn't get fixed until I go to a chiropractor."
You must truly find it amazing that these athletes are able to "overcome" being treated by "people who ruin spines for a living," as you put it, to perform at such record-setting levels. You may also be surprised to learn that chiropractic is the single most sought-out form of care by our nation's top athletes at each Olympics.
The research supporting chiropractic is voluminous. For your information, I am enclosing two informative brochures: "What Research Shows about Chiropractic Care," and "Doctors of Chiropractic: Part of Your Health Care Team," which features Barry Bonds. Please take a moment to review them. I am also including an important book by David Chapman-Smith, The Chiropractic Profession.
I have met your challenge, Mr. Rome, to name another health care profession that offers services in a mall. In fact, I've named several. Having met your challenge, I urge you to put a stop to the "smack-talking" and name-calling you have aimed at the chiropractic profession.
In closing, I invite you to interview Dr. Alan Sokoloff, official chiropractor for the world-champion Baltimore Ravens, or Dr. Ralph Filson, McGwire's personal chiropractor, and the official chiropractor for the St. Louis Cardinals and St. Louis Rams, on either your radio or television program. Both of these doctors have extensive background in speaking on radio and television. In fact, Dr. Sokoloff hosts a radio show of his own, called "Talking Back," in Maryland. You owe it to your audience, and to your athlete guests who utilize chiropractic care, to provide a fair and balanced portrayal of the chiropractic profession.
I await your response to my invitation. Please contact either Felicity Feather Clancy or Patrick Bernat at the American Chiropractic Association headquarters to schedule one of these guests.
James Mertz DC,DACBR
American Chiropractic Association
Watch Your Back
You produced a good article, "Chiropractic vs. Federal Agencies." (DC, September 1, 2001, page 3). Your point that government agencies "can do anything they want without incurring personal liability for their actions" is most true.
There would be much less antagonism against chiropractors if the majority of them were to discover chiropractic. There are many side-effects of poor care, of therapeutic care, and physical therapy all done under the banner of chiropractic. Where are the good results from that?
Most troubles we have are of our own making. Those in government agencies can see the inconsistencies of what chiropractors do. The game-playing to get the money is easily recognized, and the same goes for those in insurance companies. The question of what happens to patients, result-wise, is ever-present in the minds of claims adjusters and those in government who may believe they are there to protect the public trust.
Most patient management consultants are not friends to chiropractic or to quality care. Most are teachers of greed who have led thousands of chiropractors astray. Manipulations of the mind, spine and pocketbook have little or nothing to do with the one chiropractic objective being achieved, i.e. "removal of nerve interference and the effects thereof."
Outsiders can see, as we have seen, that most chiropractors are caught up in patient management games and maximizing the money flow. With most, "the principles of chiropractic are out the window. Next to go is what is best for patients," as said by Jay Kaufman,DC. I agree.
Fifteen years or so ago, the ACA's legal counsel advised getting rid of both chiropractic and spinal subluxation. President William Dallas of Western States did his duty in the Northwest; James Winterstein did his in the Midwest; Dr. Guy Riekeman at Palmer and his associates are switching the "spinal subluxation complex" for the real spinal subluxation; Dr. Koch is now at Palmer rewriting chiropractic philosophy; Joe Strauss, spinologist, has rewritten many of the "green books"; and innate has produced many devils who actively betray the chiropractic of DD and BJ!
There you have it from one "all-the-way" chiropractor.
Rensselaer, New York
"If you're not a member, you're part of the problem..."
Okay, everyone, let's all go to our offices now and look at the big calendar on the wall. Does it say 2001, or does it say 1895? I'm afraid a lot of "modern" chiropractic offices have the 1895 version.
What did we have in 1895? Horse-drawn carriages on the cobblestone streets; potbellied coal stoves in the houses; outhouses in the yard; and there were no airplanes, as the Wright brothers wouldn't fly at Kitty Hawk until a few years later. Another thing 1895 had was D.D. Palmer and a small, but growing group of students searching for and "eliminating" the true cause of disease, the elusive subluxation. It apparently caused, according to D.D. everything that ailed the human body, from warts to insanity, and everything in-between. Of course, nothing was known about genes, and a myriad of other things, and their role in many conditions.
Many groups followed from this initial set of circumstances, but I want to focus on two. First, there is the group of zealots who remain largely stuck in time at 1895, who consider D.D. Palmer a martyr, and treat everything he said as absolute truth. As a matter of fact, if you dare to disagree with them, you are treated as a heretic. He is looked at as a religious icon.
The other group, larger but much less vociferous, is the one that has tried to keep abreast of current technologies and discoveries and to incorporate this into its evolving concept of the nature of disease and it causation. Its members personify the scientific method. Most of the time, there is no such thing as "absolute truth"; only relative truth couched in the knowledge of the times. This means that man's concept of truth is constantly changing. Except, of course, for religious fanatics, 1895 chiropractors, and other "heads in the sand," who cry, "don't bother me with the facts I know what I believe!"
Discoverers like discovery. Many followers of discoverers like to make martyrs of the discoverer. They don't like a new discovery. It tends to rattle the order in their lives. It's hard for them to swim in new waters. They feel much more comfortable in their dogma-filled wading pools that are "oh-so-soothing" and non-threatening to their belief systems. Besides, they've already found the absolute truth - so why should they look further? The world has done this time and time again. Just look at the Aristotelian world view. Aristotle was so venerated he was not questioned. So with the help of Ptolemy, the earth remained at the center of not only the solar system, but the universe for at least 1,600 years, before Copernicus came along and started to clear things up. Now don't get me wrong. Aristotle was a brilliant man, one of the brightest in all of recorded history, but even he was wrong.
Chiropractic zealots (you know who you are), I'm sure that you are rational in other areas of your lives, for instance, when buying a car, taking blood pressure medication, etc. So what is wrong with your blind allegiance to D.D. and B.J? The problem is that it is not evolving with new discoveries! It's too much like a religious system with its martyr, followers, and claims of "absolute truth." Even many churches that deny the existence of evolution are evolving just the same. The alternative, my friends, is extinction. Evolve and adapt to new surroundings - or cease to exist over time and be relegated to the bins of historical curiosities, and eventually be forgotten altogether.
Now is the time, my more scientific-minded collegues, to become a vociferous group. To allow the lunatic fringe to continue its rantings and ravings is no less than to allow the suicide of the chiropractic profession at large.
Join the ACA. They are not perfect but it is our best shot for the meaningful survival of a rewarding chiropractic profession. If you're not a member, you're part of the problem - not a part of the solution. The ICA and ACA should merge and pool their resources toward common goals and stop bickering like children. Let the majority prevail and have influence over policy, as any democratic system would do.
As has been asked before, if not us, who? If not now, when? If the silent majority does not speak now, then we will all be silenced forever, right along with those stuck in 1895.
Mount Carmel, Illinois