- Care of acute conditions - Medically necessary care of acute conditions is care that is reasonable and necessary for the diagnosis and treatment of a patient with a health concern and for which there is a therapeutic care plan and a goal of functional improvement and/or pain relief. The result of the care is expected to be an improvement, arrest, or retardation of the patient's condition. Initially, the care may be more frequent, but as levels of improvement are reached, a decrease in the frequency of care is to be expected. A patient may experience exacerbations of an acute injury/illness being treated that may clinically require an increased frequency of care for short periods of time. A patient may also experience a recurrence of the injury/illness after a quiescence of 30 days that may require a reinstitution of care.
- Care of chronic/recurrent conditions - Medically necessary care of recurrent/chronic conditions is care that is provided when the injury/illness is not expected to completely resolve after a treatment regimen but where continued care can reasonably be expected to result in documentable improvement for the patient. When functional status has remained stable under care and further improvement is not expected or withdrawal of care results in documentable deterioration, additional care may be necessary for the goals of supporting the patient's highest achievable level of function, minimizing or controlling pain, stabilizing injured or weakened areas, improving activities of daily living, reducing reliance on medications, minimizing exacerbation frequency or duration, minimizing further disability, or keeping the patient employed and/or active. Chronic/recurrent care may be inappropriate when it interferes with other appropriate primary care or when its benefits are outweighed by its risks, for example, psychological dependence on the physician or treatment, illness behavior, or secondary gain.
- Care for wellness - Achieving wellness requires active patient participation. Wellness is a process of achieving the best health possible, given one's genetic makeup, by pursuing an optimal level of function. “Optimizing levels of function” may include a combination of health care strategies such as chiropractic adjustments, manipulative therapy, manual therapies, exercise, diet/nutrition counseling, and lifestyle coaching.
These definitions are exactly what practitioners need in my opinion. It seems there is a lack of unity among our colleagues as to what it is we do. Some are musculoskeletal doctors and follow the evidence-based orthopedic and neurological exams taught in school. Others throw all they learn in school out the door and buy into some ridiculous way of diagnosing and treating patients. That is what I don't get with some of the people in our profession. We go to school for thousands of hours studying evidence-based physical exams and diagnostic criteria and when they get done, they chuck it all and go running for pseudo-scientific marketing gimmicks. It doesn't make sense.
There are folks out there that are working hard to end chiropractic because of the handful of practitioners who buy into BS versus science to treat their patients. They put their needs first before the patients by convincing the person that subluxations are the root of all disease. These people should be weeded out by sanctions and some kind of punishment for fraud.
Interestingly, I was on a plane the other day and was writing this blog entry and the lady next to me asked if I was a student. I told her I was and she asked what I am studying and I told her chiropractic. Her body language shifted to a very negative, stand-offish persona and our conversation stopped. I can assure you my breath was just fine with a fresh stick of gum so that was not the offender.
If this lady knew our training included only medical orthopedic tests and neurological tests to diagnose REAL problems which ALL orhopedic doctors use, she'd probably have no problem with me. Since she thinks chiropractors lack authority and our education is untrustworthy, she'll go on to believe we are all quacks. This issue is real and will be quite difficult to navigate when trying to get new patients in the door to our practices. I believe this is why DC's buy into these dubious practice methods because they are easy to implement and require no logical thought at all. The motto of, "convince them they have subluxation syndrome and need regular care 3 or more days a week forever", takes the pressure off of diagnosing anything because they all have subluxations and these subluxations are causing ALL disease.
No need to diagnose a disease when the diagnosis is a simple subluxation. Get it?
On the flip-side, the orthopedic tests and neurological tests we use to diagnose musculoskeletal issues are quite expansive and do a great job forming a differential diagnosis list. We can order imaging for certain cases which can be helpful at ruling in or out a suspected issue. If the case is one that would benefit from chiropractic care, then a treatment plan is built and office visits are scheduled.
Now when you look at wellness care, this may look a lot like subluxation theory. I assure you, it is not. Wellness care is used to prevent an old problem or new problems from occurring through regular care. Aging is horrible on joints and regular chiropractic care can keep things moving optimally. Some of the less science-based practitioners would say wellness care is doing the same as subluxation care. They are incorrect because wellness does not put so much emphasis on chiropractic adjustments. Wellness care utilizes fitness training, massage therapy and proper nutrition to improve health. No convincing beyond stubborn lifestyle vices are needed with wellness care. On the other hand, subluxation theory suggests that with a subluxation free spine, the nervous system will operate optimally and the person can literally eat out of a garbage can and still be healthy. Sounds a bit quack-like eh?
To end, I will say that the ACA and the CCGPP did a great job putting together a defining model we can integrate into our practices.
Thanks for reading
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