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Thursday, July 19, 2018

Communicating Chiropractic: An Algorithm to Answer Difficult Questions

By Stephanie Halloran, DC

Although the culture of health care is shifting and complementary and alternative options are being implemented in hospital and primary care settings, many allopathic practitioners are not necessarily familiar with the common conditions chiropractors treat or the mechanism behind manipulation. My  previous post focused on a relatively controlled environment in which presentations are provided within a healthcare setting. Those situations allow for deliberate content to be presented and preparation for potential questions that may arise. During interprofessional rotations, however, questions present organically, making it difficult to prepare or predict ahead of time.

These rotations may involve observation or interaction with residents, fellows, seasoned attending physicians or department chiefs, each having varying degrees of exposure to chiropractic care. This means these interactions may not only result in the chiropractic resident learning about the specialty, but the department learning about chiropractic care, as well. Frequently asked questions cover subjects such as:  

  • typical conditions treated by chiropractors and specific treatments utilized
  • contraindications for treatment
  • the mechanism of manipulation and/or acupuncture
  • and adverse events from chiropractic treatment, including post-treatment soreness and cervical manipulation and stroke.

With the recent release of the American College of Physicians guidelines on low back pain and the subsequent series of papers by The Lancet, now more than ever, interprofessional communication is a crucial piece in the continued advancement and implementation of the chiropractic profession within the larger healthcare system. This equates to preparing a succinct, professional, and diplomatic answer to questions addressing the common topics mentioned above.

This post is not intended to provide an outline for each of those topics, but instead to present an approach to answering them that was developed and taught to me by my site director, VA Chiropractic Program Director Anthony Lisi, DC.  You can use this approach as a guide to develop your own comprehensive answers.

1. Have a Great Depth of Knowledge

First and foremost, you must have an extensive understanding of what you are being asked. Whether the inquiry is as vague as “What is chiropractic?” or more specific, such as “What is the physiologic mechanism of manipulation?” or more sensitive, such as “Does cervical manipulation cause stroke?” it is imperative to know what the evidence does and doesn’t support. This involves the ability to synthesize high-quality papers or studies that have been conducted and the outcomes they demonstrate.

2. Selectively Present that Knowledge

Although it is important to thoroughly understand these topics, presentation of the material is equally important. Generally, answers should be distilled down to pertinent information and expanded on as further questions arise. For example, spinal manipulation can be described briefly as a high velocity, low-amplitude movement that allows for increased motion and decreased pain. For some, that answer may be sufficient, but if asked to expand, the neurophysiological effects can be addressed in more detail.

3. Be Mindful of an Appropriate Stopping Point

The chiropractic profession, as a whole, tends to play the role of the misunderstood red-headed stepchild of the medical family. After rotating in multiple departments at the VA hospital, however, it is evident to me that these sentiments are not isolated to chiropractors. Every department has been made to feel inferior to another department in some way, at some time. Much like with chiropractic, previous information acquired during medical training or a negative experience with a physician while in practice can impact a provider’s overall perception of a specialty. It is reasonable to assume that an encounter will occur at some point with a specialty physician possessing unwavering negative views of chiropractic treatment, and the reality is some will not be swayed despite the evidence presented. The goal of the interaction is to present the evidence, to meet them where they are, and to leave the door open for further conversation at a later date.  

4. Remain Altruistic Throughout

The University of Western States’ motto, “For the good of the patient,” encapsulates this point perfectly. In the United States, the medical system awards extensive office visits and treatment plans with financial gain. It is important to stay focused in these instances on the true overall goal of health care: to increase functional outcomes, improve quality of life, and provide the best care for patients. With this in mind, one should assume all inquiries (in regard to chiropractic medicine, conditions treated, and treatment processes) from other physicians or from patients are rooted in an effort to understand and identify a comprehensive plan for care. Additionally, chiropractors should prepare to address these topics honestly, selflessly, and with the patient’s best interest in mind.

In respect to success in integration, my biggest take-away from being exposed to interprofessional collaboration on a day-to-day basis in the VA is the need for chiropractors to prepare answers to questions regarding what chiropractic care is, common conditions seen, neurophysiological effects of treatment, and the incidence of adverse events. These answers should be instantaneous and provide evidentiary support. One must also be prepared to hit the brakes when met with substantial resistance and to admit lack of familiarity with a topic, when appropriate.

As further integration occurs, and chiropractic physicians are incorporated into more facilities, it is imperative that we all strive to work as part of a team.

Dr. Halloran is the chiropractic resident with the VA Connecticut Healthcare System under site director, Anthony Lisi, DC, and concurrently working towards her Master of Science in Human Nutrition and Functional Medicine through the University of Western States (UWS) as well as her diplomate in Diagnosis and Internal Disorders through the ACA. Dr. Halloran’s professional interests include advocacy and toxic exposure, nutritional deficiencies and chronic musculoskeletal pain within the veteran population.

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1 comments on article "Communicating Chiropractic: An Algorithm to Answer Difficult Questions"

Theresa FitzGerald

8/24/2018 4:47 PM

I appreciated your highlighting the main questions asked by others in on the health care team and your sharing Dr. Lisi's approach to answering them. His approach is respectful and confident. I like the simplified description: "spinal manipulation can be described briefly as a high velocity, low-amplitude movement that allows for increased motion and decreased pain".

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