Shift away from the medical model and care for your patients with a structural evaluation

Chiropractors live in an identity warp. We enter school because chiropractic addresses the cause, not the symptoms. And we graduate believing the word cause will be our daily mantra. Eventually we realize that we need to market this, but unfortunately, something odd happens along the way.

It is almost like a religious transformation. Even though we want to concentrate on the root of the problem, we slowly find it is a lot different in practice than it was in the womb of our college years. But the stark difference between our identity then and now is nothing more than theory versus reality, ideal versus real. Unfortunately, the reality is chiropractic is no longer about the cause.

The first step to healthy growth is admitting the truth to yourself. Our profession is on the verge of greatness. But we have to just admit the reality of the situation: We have hitched on to the medical model of care (we treat pain) because that is what the public wants and what the insurance companies pay for. Until we get out from under that rock and teach the public a new model of care, we will continue to fall short of our potential as a profession.

Role Model
While society does not have time for pain, and everyone wants to get better immediately, the truth is the public knows this approach does not make sense. When I recently asked a patient from Seattle which one of the 15 doctors he has seen for his low back pain made the most sense, his sad response was, “None of them.” And that is the truth.

The medical model of care is based on medical testing; and when no pathology is present, the condition is called idiopathic pain syndrome, and the pain is then treated. According to public knowledge, chiropractic provides an alternative to the traditional allopathic approaches with limited benefits. It is time to create our own model of care, and escape the prison of being the alternative to a failure approach.

No one has a handle on how to control the the escalating costs of musculoskeletal care that is causing severe financial losses to companies, both big and small. Athletes hope they do not become injured because they think seeing a doctor after injury is a waste of time. If you do not believe this, call your local high school and college coaches and ask them how confident they feel taking their athletes to primary doctors for recommendations of injuries. But no one is offering them a better solution.

People may say they are fine with the current standards of care, but when they eventually become one of many who experience neuromusculoskeletal breakdown and can find no one who makes an ounce of sense in either the detection of the problem or the correction recommendations, they too will change their minds.

The public is degenerating on an accelerated schedule, as everyone lives in deferred maintenance of structural management. No one has ever done a structural examination on them; therefore, no one has had any structural correction. If patients are not in pain, doctors do not know what to do with them. And that is the registered trademark of the medical model.

Most are begging for a new model of care, whether they are ready to admit it or not. Once they find there is a new model of care on the horizon, and this model is based on structural defects and imbalances, not just symptoms that are the result of total negligence, they will begin to take notice. Once they realize their life is severely compromised due to the existing set of health care rules, they will stand up and demand changes. They just need to know chiropractic is a better model of care.

Take it a step further. A structural exam earlier rather than later will detect problems before they arise. There is a predictability factor available, and if chiropractors are trained properly, corrections can be made long before breakdowns occur.

If a structural exam does reveal the existence of pedal imbalance—excessive pronation, collapsed arches, etc—trained chiropractors can provide not just specific adjustments, but also the adjunctive support of custom orthotics. Keeping the feet in proper alignment can help to improve the structural positioning and function of weight-bearing joints throughout the entire body.

Do you think companies would be interested in that? Do you think sports teams would love to have all of their players with them for each and every game of the season? And, do you think the general public would rather play golf, take a walk in the park, or simply bend over and tie their shoes without excruciating pain when they are 80 years old?

If you have been in practice long enough, you may think the above is unattainable. But, the truth is, change the model of care you deliver in your office, and you will change the outcome of results in your office. Begin to educate your community of a better way, and you will begin to change their lives. You will never compete again with all of the pain-only doctors and therapists. You will be alone in your marketing and products delivered to your community. Once your community understands what you are doing, do not plan on taking any vacations for awhile.

Structurally Fit
The Structural Fingerprint™ Exam is an architectural analysis of a person to determine structural defects, imbalances, and signs of wear and tear. This exam is done on anyone at any time. Preferably, the individual will be asymptomatic, but if symptoms are chronic and do not reduce the patients’ ability to perform needed tests, then it can be done on them as well. If patients are too acute to go through an exam, then the tests must be done on them after they are out of acute pain.

The exam consists of a consultation, determining primarily if the patient has ever had a structural exam. In just about all cases, the answer is no. All patients start from a different point in life, but they must all enter the same door, which is that of a structural evaluation. The exam then moves on to the basic ranges of motion, muscle integrity, joint range of motion, leg-length measurements, foot exam, q-angle exam, and standing x-rays. The x-rays provide 75% of the information, as they tell a wealth of biomechanical information that, combined with the exam findings, is then communicated back to the patient in the report of findings.

The report of findings has little to do with current symptoms. Sure, everyone wants to be out of pain right now, but the bigger concern is the preservation of the structure over the course of a lifetime. Assuming people will live to be 85–90 years old, then all we have to do is present the simple mathematical equation: You are 47 years old with a moderately degenerated disc in your low back that is already causing problems. If you live to be 85, that means you will be on this planet for another 38 years. Do you have a plan in place to preserve your structure? Do you realize that the next 38 years of your life will include the aging process?

With this question, you change the focus from today to the rest of their lives. That is where the focus belongs. We are taught to preserve everything else in our lives, from our finances to our teeth, but no one in your community is talking about preserving people’s structures.

If and when you begin to address patients’ structures and futures rather than their symptoms, that is when the medical model of care will begin to slowly die away, and it cannot come a minute too soon. CP

Timothy J. Maggs, DC, specializes in sports and industrial injury management and is a graduate of the National College of Chiropractic. He writes and speaks at numerous engagements. Maggs can be reached via email: runningdr@aol.com, or via his Web site: www.drtimmaggs.com.