I gave a big sigh, got out of the car, and tried to greet her with a smile.
"Went out again, did it?"
She looked almost pleased. "Would you believe that within an hour after that last adjustment I felt it slip right out as I was putting on some lipstick?"
She first came to me with injuries from a car accident. She had suffered a moderate, uncomplicated cervical strain, and I started treating her about three times a week. This in-again, out-again thing had been going on for about three months. Then I made the mistake of showing her the x-rays, which revealed some mild rotation of her atlas. After seeing the x-rays she started coming in every day, showing up without an appointment and telling me that her neck was "out" again. She began twisting and trying to "crack" her neck, even while waiting in the reception area. I would reassure her, give her exercises, insist that no one should touch her neck for a few days to let it "settle," but I had little success.
She began demanding that I adjust her harder, with recoil techniques and strong traction. I was getting increasingly nervous about treating her. I referred her to a couple of different physicians, but she never made the appointments. And here she was again this morning!
I adjusted what appeared to be a slight tightness near the occipital area, then made her hold her neck with her two hands while she walked to the car. I gave her the same old speech: "You're going to be fine. Your neck is in great shape, and we can discharge you." I casually mentioned her insurance claims were pending review, and I didn't know if the insurer would pay for further treatment.
"But Dr. Hanks, they have to pay. I'm sick. I have a long recovery ahead. My atlas goes out and I need my adjustments." I knew then that there would be hell to pay to release this patient from care.
Sure enough, the next morning when I arrived at the office, Libby, my CA, had already put her in a room. "She's landed on the moon, for all I can tell," said Libby. "Be careful in there."
When I opened the door, I was struck by how cold it was. She was quietly sitting on the adjustment table. As I came nearer, she slowly raised her head, and I could see her eyes were as big as pizzas.
"Crack me! Crack me!" she growled. "Make my atlas spin 'round!"
I backed out on tiptoes. "I'll be right back," I said, and gently closed the door. She really had my attention now. She had to go, but how? Then it came to me - something that I had never before obtained for any patient an IME (insurance mediated exorcism).
The woman on the telephone from the insurance company said they would send a doctor right over. I explained that I needed someone immediately, and within an hour, my receptionist knocked on the door to my office. "He's here," she whispered through the door. When I opened it, there stood a man with a long coat, a broad-brimmed hat, and a serious look on his face.
He spoke in a monotone, with no emotion. "Where's the patient? Tell me about her." I quickly summarized the events leading up to today's crisis. As he listened, the color slowly faded from his face, and his hands began to shake almost imperceptibly. "You were prudent to call," he said reassuringly. "Nothing short of an IME can resolve this situation."
As we entered the patient's room, he opened the door smoothly and with some authority. She seemed to know why he was there, and stared at him with a lop-sided grin. "You're a chiropractor, aren't you? Take an x-ray of my atlas!" she demanded.
The IME doctor ignored her demand and walked over to where she was sitting. With great care, he held her head in his hands and seemed to gather his strength. Finally he spoke. "I proclaim that you have reached maximum medical improvement, and your insurance will now stop paying."
I never saw her again, nor have I needed an IME since.
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