Communicating Chiropractic in an Integrated Healthcare Setting

Five years ago, as a second-quarter student, I attended my first National Chiropractic Leadership Conference (NCLC) in Washington, D.C. The conference not only serves as a meeting place for the Student American Chiropractic Association (SACA) and the House of Delegates, but also involves lobbying on Capitol Hill for chiropractic-focused bills. It was here that I began to appreciate the necessity of communicating chiropractic clearly and accurately, an essential skill for anyone practicing in an integrated healthcare system.

My first lobbying visit was with Sen. Richard Blumenthal’s office. Along with the senator’s aid, I was seated at a table with Vern Saboe, DC, ACA delegate for Oregon, Joseph Brimhall, DC, president of the University of Western States, Elise Hewitt, DC, then president of the ACA Pediatrics Council, and several of my peers. The first issue we discussed was veterans’ access to care. My issue. To make a long story short (and to save the cringe-worthy trip down memory lane for myself), I walked out of that meeting, sweaty hands and all, dumbfounded at how difficult it was to explain chiropractic care to lay persons. It is because of this experience that my SACA chapter executive board and I developed an NCLC training program that involved coaching our student attendees on how to explain chiropractic in less than two minutes.

Fast forward two years: As a resident in the VA healthcare system, I present information on chiropractic, both formally and informally, to addiction/pain fellows, neurosurgeons and internal medicine residents within an integrated healthcare setting. Each presentation I give, as well as the many I have the opportunity to attend in the VA, helps me to be a better communicator.

VA Presentations: A Learning Tool

The curricula for the Department of Veterans Affairs (VA) residency has three facets: supervised patient care, interprofessional rotations, and scholarly activities. The largest emphasis is expectedly placed on delivery of chiropractic care to patients, with the remaining time divided evenly between relevant rotations (such as pain medicine) and scholarly activities. The scholarly piece of the curricular equation includes two online courses, two group assignments, optional research projects, and attending and giving presentations.

Although comprising only a small percentage of the chiropractic residency program, giving presentations challenges one’s ability not only to discuss chiropractic, but to do so at multiple levels. Following is a sample of the presentations I have attended, and given, during my time in the VA:

Presentation: “Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center”

The PRIME Center at the VA in West Haven, Conn., is charged with conducting research to promote improved pain care. The center hosts weekly lunch-time lectures, typically presented by fellows from VA Connecticut or Yale University, that offer a view into what the current literature shows for a multitude of conditions. To get a better understanding of the types of topics covered, here is a sample from June: “Novel Non-opioid Treatment for Chronic Low Back Pain,” “Chiropractic Management for Veterans” (presented by our own medical informatics fellow, Kelsey Corcoran, DC), “Military Sexual Trauma in Recently Returning OEF/OIF Veterans,” and “PTSD, SA, and Risk of Suicidal Behavior Among Veterans.” The goal of each of these scheduled sessions is to identify current research initiatives, how they may be applied in a clinical setting, and discuss where more in depth investigations are warranted to develop expertise in this area.

Presentation: “Specialty Care Access Network-Extension for Community Health Outcomes (SCAN-ECHO)”

Another staple within the VA healthcare system is SCAN-ECHO, a video conference that occurs at multiple times throughout the week. The pain-specific lectures are at biweekly intervals and presented by a spectrum of practitioners, including residents, fellows, attending physicians, and section chiefs. Topics have included the process and indication for epidural steroid injections, complex regional pain syndrome, and the role of chiropractic care in chronic neck pain management. Like the PRIME Center lectures, each presentation aims to cover the most recent, evidence-based information to enhance the services provided by health professionals.

In April, I had the opportunity to present the clinical practice guidelines (CPGs) for low back pain as outlined by the Lancet series of papers and the American College of Physicians, with a focus on chiropractic care as a non-pharmacological approach. The time and rehearsal required to prepare for this presentation afforded me the opportunity not only to gain a deeper understanding of what the guidelines support, but also to extract the pertinent take-away points and distill the applicable information into a concise presentation. My preparations elevated my ability to speak to the benefits of chiropractic care in the treatment of chronic low back pain to an audience primarily consisting of medical doctors. In May, I adapted the presentation for the students at University of Bridgeport. Instead of focusing on the basics of chiropractic as a treatment approach, I changed the end of the presentation to focus on why keeping up with CPGs is important for early practitioners and how it contributes to becoming a competent member of a patient’s healthcare team.

Hospital In-service Presentations

The hospital provides a variety of onsite ad hoc lectures throughout the year. In the winter, I was invited to attend a presentation on “Unconscious Bias” as part of the Psychology Colloquium Series. This presentation covered the biases we have–unbeknownst to us–in regard to hiring processes and our initial reaction when working with patients. Although not directly related to treatment strategies, initial thoughts about patients can influence the delivery of care. Information from a patient’s chart such as name, sex, race, age, and comorbid conditions can all potentially impact initial encounters and subsequent visits.

I have also had the opportunity to give presentations within the hospital, aside from SCAN-ECHO. In February, I spoke to the prosthetics department on chiropractic care and the most commonly utilized prosthetic equipment. I was given a tour of the prosthetics department and had candid conversations throughout the presentation about what products they had, what they no longer ordered, and what things we may consider ordering in the future.

In May, I delivered an adaptation of that presentation to the fellows in the addiction and opioid reassessment clinic on the role of chiropractic care in chronic pain management. This is a standing invitation and given alongside the physical therapy department. I opened by asking who in the group had been to a chiropractor or had an experience working with a chiropractor. Of the 15 in attendance, about a third raised their hands. This provided me with insight as to how much or how little I should expand on the information I provided in the handouts, as well as mentally prepared me for what kinds of questions might arise. At the end of the presentation, one of the fellows raised her hand and said, “I just want to say thank you. I knew very little about chiropractic and what services you provide. I feel like I learned so much in these 30 minutes and can immediately apply it to patients.”

The VA presentations, both the ones I attended and gave, vary drastically from setting to setting and from residency site to residency site; however, the differences in the background of the audiences in each of the settings—ranging from a cognitively impaired veteran to the chief of neurosurgery–helped to increase my confidence and competency to discuss chiropractic care. Likewise, integration into mainstream medical systems requires chiropractic physicians to deliver information about who we are and what we do with equivalent confidence to our peers, interprofessional colleagues, and our patients.

Next time: Communicating Chiropractic: An Algorithm to Answer the Difficult Questions.

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.