The current opioid epidemic in the United States brings long overdue attention to nonpharmacological approaches to managing pain. Among the recommended therapies for low back pain by the American College of Physicians, for example, are spinal manipulation, acupuncture, yoga and cognitive behavioral therapy. While it may be clear why body-based therapies were recommended, the inclusion of a psychological approach, such as cognitive behavioral therapy, may raise some eyebrows. Researchers Margaret Chesney, PhD, and Christine Goertz, DC, PhD, explore how psychological factors play a role in the experience of chronic pain as well as what patients and their providers should know.
It has been just over a year since many in the chiropractic profession first learned that the American Chiropractic Association (ACA) joined more than 80 medical specialty society partners to participate in an initiative that is sponsored by the American Board of Internal Medicine Foundation. This initiative’s mission is to “promote conversations between clinicians and patients by helping patients choose care that is supported by evidence, not duplicative of other tests or procedures already received, free from harm, and truly necessary.” It is called the Choosing Wisely campaign1 and it has generated more spirited discussion among doctors of chiropractic than I can recall since release of the Mercy Conference Proceedings in 1993.
According to ACA Senior Scientific Advisor Christine Goertz, DC, PhD, the most common issues raised by those outside the chiropractic profession relate to the quality and consistency of chiropractic care delivery. The second most commonly asked question invariably pertains to the costs associated with chiropractic care. While there is no definitive answer and more research is needed, Dr. Goertz reveals what the evidence we have to date tells us about the costs associated with chiropractic.
In her open letter to the National Center for Complementary and Integrative Healthcare, ACA Senior Scientific Advisor Christine Goertz, DC, PhD, offers suggestions to NCCIH on how to meet some of today's pressing healthcare challenges and, in particular, how complementary and integrative health care can play a role. She writes, "We desperately need a healthcare delivery system 1) that is able to consistently provide evidence-based, patient-centered care to the right individual at the right time, 2) for which the patient care trajectory for chronic conditions begins with the safest, most conservative, effective option available and, 3) that empowers patients and providers with the knowledge and tools they need to make informed decisions that are deeply rooted in disease prevention and health promotion. Much work lies ahead in identifying how CIH practices can best contribute to this effort."
It's been 30 years since ACA senior scientific advisor Christine Goertz, DC, graduated from Northwestern Health Sciences University. As she prepared to give the commencement address to the NWHSU class of 2018 this spring, Dr. Goertz couldn't recall the words of wisdom from her own commencement day...but, looking back, she knew exactly what she wished someone would have advised her as she embarked on her career in chiropractic. Read her Top 10 list of recommendations for this year's new graduates.
Driven by rising health care costs, the constant barrage of new research knowledge and the increasing integration of technology, the way in which all health care providers take care of patients in this country--in this world--is changing rapidly. This evolving health care environment means that, while we remain steadfast at the core of who we are and what we do stand for as a chiropractic profession, expectations regarding some of the ways in which we practice are beginning to change.
The #MeToo stories that have flooded social media in recent weeks have initiated a much-needed conversation across the country, a conversation that illustrates the very different experiences that men and women can have in male-dominated professions. In her latest blog post, ACA Senior Scientific Advisor Christine Goertz, DC, PhD, notes that, as one of a very small handful of women who has served in chiropractic leadership roles since she was a student, she has had a great deal of experience navigating the awkward and sometimes very uncomfortable waters generated by gender bias.
It’s pretty difficult to open up a newspaper these days without seeing an article on the devastating public health impact of the opioid epidemic in the United States. While there appears to be general agreement on the scope of the problem, there is less consensus regarding what can be done to solve it. Policy-makers and professional associations taking on this challenge have tended to focus on mortality statistics and/or expert opinion. These are obviously critically important pieces of the puzzle but it is also important to take a patient-centered approach. To facilitate discussion on this important topic, Gallup held a research release event on Sept. 12 in Washington, D.C., titled “Addressing the Opioid Epidemic With Drug-Free Pain Management.”
The first ACA Choosing Wisely® recommendation states: In the absence of red flags, do not obtain spinal imaging (X-rays) for patients with acute low-back pain during the six weeks after the onset of pain. Some doctors of chiropractic may be surprised that ACA included this recommendation. There are many DCs who are committed to delivery of high-quality patient care that currently take or order X-rays on a majority of their patients because they believe that X-rays are a necessary component of the examination process. There are a number of reasons why this is the case.
Long before many of us can remember, there were only two people sitting in the chiropractic treatment room – the patient and the doctor. Gradually, the state licensing boards starting showing up. They were joined by the insurance industry. Then health policy makers like Medicare and Medicaid. Followed by more members of the insurance industry. Then scientists made an appearance, talking about evidence-based clinical practice. Now this already very crowded room may become even more crowded if we open the door to the ever-loudly-knocking performance measurers. We have had time to get at least somewhat used to the state and national boards, insurers, policy makers and even the scientists, to some extent. But what is performance measurement and how might it be beneficial to the practice of chiropractic?