Joanna Hudec, DC, shares her experiences in the Integrated Medicine Fellowship at the National Naval Medical Center—a first for the chiropractic profession

On June 18, 2004, I graduated from the National Naval Medical Center (NNMC) in Bethesda, Md. It was the final step of my 1-year fellowship in integrated medicine, which made me the first chiropractor to receive a diploma and graduate from a military institute residency program.

Joanna Hudec, DC, and William E. Morgan, DC, NNMC chiropractic department head, at the Integrated Medicine Fellowship graduation ceremony.

I was an attending clinician in the outpatient clinic at Texas Chiropractic College (TCC) when they offered me the unique fellowship opportunity. The program is a collaborative effort between William E. Morgan, DC, the NNMC chiropractic department head, and TCC. Morgan envisioned and recognized the need for DCs to be educated and trained to work in an integrative hospital setting. His vision allowed me to step into the expanding arena of military hospital chiropractic.

The basic curriculum consisted of medical rotations during the first half of the day and treating patients in the NNMC chiropractic office during the second half. I clocked more than 1,000 hours of hospital rotations working with medical doctors, interns, residents, hospital corpsman, and technicians. I was treated like any other medical resident during my rotations. I went to 6 AM departmental grand rounds, did assigned homework, read vast amounts of medical and chiropractic literature, and answered all spontaneous questions to my best ability.

Some MDs are very surprised to see how skilled chiropractors are with patient examinations. They asked questions about our profession and how chiropractic can help their patients. This was another benefit of the fellowship, which exposed the medical profession to chiropractic and educated them by using their patients as case examples.

I started gaining referrals to the chiropractic office for spinal-related problems and soon successfully saw extraspinal referrals as well. I was in neurosurgery when a patient presented with low back pain and a new foot pain believed by the referral to be correlated. Examination revealed that the patient was not having referred pain to the foot but plantar facial pain. The referring doctor asked if I had knowledge of treating the patient’s symptoms and after a brief discussion, the patient was referred to the chiropractic office. The neurosurgeon had no idea that chiropractors could effectively treat plantar fasciitis because he had stereotyped chiropractors simply as low back docs.

My experience exposed and increased my knowledge of medical procedures with which chiropractors seldom have firsthand experience, such as spine and joint surgeries, pain management injections, casting, splinting, EMG studies, and ER procedures. All of this has made me a better chiropractor because I understand the best type of doctor to refer to and why and what the patient will expect at the referred appointment, and I can talk to my patients with confidence about the referral and possible treatments.

The fellowship opened my eyes to the vast amount of office procedures along with the multitude of hospital procedures and requirements. Most field doctors establish office procedures over which they have unmitigated control. In a military hospital, the DC establishes the office procedures along with the departmental, hospital, and military procedures and requirements.

The first test is the extensive credentialing process and establishment of core privileges. In addition to HIPAA standards, an education of endless Joint Commission on Accreditation of Healthcare Organizations requirements presents itself.

There are numerous amounts of codes and emergency procedures vital to daily hospital life. Each department has mass casualty drills, safety education, participation in graduate medical education and research programs, and numerous collateral duties.

Even patient charting presented as a new experience. Each chart and soap note has required information, not to mention the need to learn the appropriate symbols and abbreviations allowed in chart notes. For instance, DC is commonly used in medical charting meaning discharge and not doctor of chiropractic. Also, many of the abbreviations taught in chiropractic colleges are not on the list of approved abbreviations. Chiropractors use CMT for chiropractic manipulative therapy and EMS for electrical muscle stimulation, while MDs use the abbreviations to mean contingency medical treatment and emergency medical services, respectively.

I had to grasp numerous military requirements and procedures, which are impossible to learn overnight. Note that basic training is a 9-week course in the basics of military life. Chain of command, insignia, and government forms/paperwork play a fundamental role in the military. Understanding military training, verbiage, and physical requirements is essential for a doctor working within a military hospital. These are all taken into account when taking histories or prescribing recommendations of care. The physical requirements of these men and women are much greater than the average population, and the stigma for staying healthy is even greater. I have seen soldiers develop neurological symptoms before they finally seek medical care. A limping young marine said, “A broken soldier is of no use. Going to the doctor is admitting defeat.”

The Integrated Medicine Fellowship has not only provided me with an exceptional education, but has simultaneously exposed MDs and their patients to chiropractic medicine. The fellowship has created a need for chiropractic in the multidisciplinary team approach found in hospitals. CP