The CIC is a whole different animal of patient care. When people are paying for services the service being provided must be worth the money or else the patient will not follow the treatment regimen. This new level of care pushes new interns to up their game.
Dr. Roberts is quite good at what she does at the CIC. Her dexterity is amazing. She can find restricted motion insanely fast and has the patient adjusted before you can blink an eye. The interesting thing about her skills is that she expects us to be at her level. The funny thing is that I felt pretty confident going to the CIC in October this year and I have been humbled many, many times by her. I do believe her intentions are to help us become better at what we do and to also provide excellent care to her patients she has worked with for nearly 30 years. However, this can be intimidating at times.
The interesting thing about going through the clinic phase program last year and correlating it to the process of interviewing a new patient at the CIC is that the training didn't help. Dr. Roberts does things quite different which can leave you flustered and looking foolish if you don't expect it. For example, we were trained to write our own history and utilize the written information to not only keep us on track with the interview but to also weed out further information. In the CIC, you do not write a word during the history. You are expected to keep track of your whereabouts by simply remembering. And when you have two people asking questions, it is very challenging to know what has been asked. The end result is we look dumb and the patient loses respect for us. The physical exam and treatment is where I personally make up for my losses. Hopefully, this new skill will be learned soon!
Ending the term with 3 new patients and a handful of primary visits was plenty. If there was any more added to the list, I believe I would have imploded!
As far as patient care and new treatments go, I feel as if I picked up quite a few useful things. One useful tool in particular was the use of a drop table for fascia restrictions. I am still quite surprised this even works! For example, a patient with back pain had a prior LCL injury and was scheduled for surgery next year and the limping induced back and neck pain. When working on the patient, I could not do the normal rotatory adjustments on the lower back due to the knee being in a splint. So we utilized the drop table. Initially, we intended to move the joints with several adjustments to the pelvis and spine and then Dr. Roberts moved onto the fascia. Essentially, we found fascial tightness, pushed it into a "relieving" vector and impulsed through with the aid of a drop table. Re-palpate the fascia and it changes instantly to a more pliable tissue. Very interesting stuff.
Another important lesson learned is cost control and results. Nobody wants to pay $75 per visit for chiropractic care. Some may if an end with care is provided up front, but most would not. In order to keep costs affordable and patient care high, there are services that are provided that are not charged. All the therapy is documented and legal but the patient is only charged a fraction of what it really costs for the elaborate treatment. At the CHC we were taught to document everything we do so the front desk can keep things tallied, but no costs were associated with any treatment because they were all students. Being that students get free care at the CHC, all the route slips were carefully filled out. Not so at the CIC. To retain patients in the real world means keeping costs down for cash paying patients. It sucks but it is true. And without results, we have no patients so that means we absorb the costs!
What does this mean? This means we must be really, really skilled with adjusting and soft tissue therapies that do not cost us much money. Using a modality will cost money, using heat will cost, ice and K-tape also cost money. This is why Dr. Roberts forces us to become excellent manual therapists.
I am very happy to be at the CIC! Even though it can be stressful and humiliating at times, I do believe my skills have improved and my tolerance for conflict has improved. This all leads to greater confidence in the end and eventually less reliance on a veteran chiropractic expert.
All for now
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