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Two responses to a recent preferred provider group questionnaire will help explain my practice philosophy: What is your Statement of Purpose? To offer ready access to high quality evaluation and care (or referral, where appropriate) of neuromusculoskeletal complaints and to provide information and advice about exercise, nutrition, stress management, and life styles in order to minimize recurrences. What are your treatment goals? To help patients return to optimal status in as fast, safe, comfortable, and economical a way as possible and to treat them clinically, personally, and financially as I would want my own family or myself treated if the roles were reversed.
Surveys have shown that the most common reservation expressed by patients who have avoided seeking chiropractor care is that "once you see one you have to keep going back forever." This does not have to be true. It is my desire to help patients get better as quickly as possible and to leave them equipped to minimize recurrences. I will be available to help with recurrences if and when they happen, but I hope that patients will have become well enough schooled as "back owners" to use good first aid measures at home and then seek appropriate care if pain or stiffness persists or increases. Patients who must be seen on a regular basis for prolonged periods of time are the exception, not the rule. The notion of preventative or "maintenance" care is perhaps attractive, but it has not been demonstrated to my satisfaction that chiropractic care can be used predictably in that fashion for all patients. It does help people to be less tense and more limber, and it is arguable that such persons may be less prone to strains and sprains. However, the connection is not compelling enough to justify my scheduling ongoing care for all patients on that basis. There is a subset of patients who apparently are "doomed" to chronic, intermittent back or neck pain, and authorities - medical and chiropractic alike - are coming to the conclusion that these complaints represent a chronic phenomenon with acute episodes. As such, ongoing management of the condition is a more sensible than attempting a "cure," in the same way that asthma or hypertension is managed but rarely cured. Recent, reputable studies have demonstrated that spinal manipulative care continued after the resolution of acute complaints can be effective both in enhancing chronic back pain sufferers' functional capacities and in reducing their levels of chronic pain. It is easy to justify continued care in these circumstances and I will recommend it when indicated. It is problematic, though, in that this sort of maintenance care is not covered by many insurance programs, Medicare foremost among them. As a profession we have enjoyed some good press in recent years which has called attention to the success that chiropractors can achieve in the early treatment of low back pain. They cite a report from the federal Agency for Health Care Policy and Research which recommends the use of spinal manipulation (as a first, not a last, resort) as safe, economical, and effective in the care of low back pain. Further studies were planned to make recommendations regarding manipulative care of muscle tension headaches, as well as neck and other back complaints. Unfortunately, plans for those studies were cancelled for political and economic reasons, but I have every reason to feel confident that manipulation would have been seen in a positive light in these situations as well. Gerard E. Sullivan, DC |
