Written by Albert Stabile, DC
Tuesday, 15 February 2005 01:39
TAC: How did you become involved in chiropractic, Dr. Stabile?
Stabile: I was injured in an automobile accident in 1964, and was having extreme lower back pain. One of my college friends, who was planning on attending chiropractic college, advised me to see the chiropractor that he was being treated by. I had been to numerous medical providers, including two orthopedists, two neurologists, and a neurosurgeon, and had had physical therapy.
After over a year of treatment with little to no results, I took my friend’s advice and saw the chiropractor. After an examination and X-rays, he advised me to begin chiropractic treatment. I felt that I had given the medical community ample opportunity to help my condition, with no positive results, so what did I have to lose by giving chiropractic a chance.
After 6-8 weeks, I was so impressed with the improvement that I decided to investigate a possible career in the chiropractic field. I called Columbia Institute of Chiropractic and spoke to Dr. Marty Greenberg, who made me an appointment for an interview. For me, that was the beginning of the most rewarding career that any human being could ever dream of or hope for.
TAC: What type of patients do you generally treat or attract?
Stabile: The patients we attract in our office are varied. We have a family practice, so we get all types. We see lower back, neck, mid back, headache and extremity pain patients. It is emphasized that they have problems due to subluxations, which were caused by injuries, poor sleeping habits, repetitive trauma, poor dietary habits, lack of exercise, attempting to perform tasks that they are not physically capable of doing, stress and a host of other causative factors.
TAC: What techniques do you use?
Stabile: We use Cox, Activator, Palmer, Diversified, S.O.T., Flexion Distraction, Applied Kinesiology, Pearce-Stillwagon and Grostic, as well as some other techniques, which are modifications of the standard ones. The reason for using so varied a number of techniques is based on the specific needs of the patient, their tolerance to force or non-force techniques and the desired result. Not every patient reacts the same to every technique. Just as medications affect different individuals differently, so does the administration of chiropractic adjustments. You must take these differences into consideration when developing a treatment plan. The desired goals are positive results for the patient. To achieve this result, we must use all the tools at our disposal.
TAC: What type diagnostic testing procedures do you use?
Stabile: We X-ray every patient, excluding children (unless they had trauma), whom we X-ray based on their individual circumstances. X-ray is essential to establish the presence or absence of pathologies, such as arthritic changes, fractures, genetic idiosyncrasies, and a host of other information that is necessary in the proper determination of what techniques would be most beneficial to the patient. X-ray is a window into the body that will reveal a multitude of information, if properly used.
We also use the MicroFet Muscle Testing Machine to establish baseline muscle strength, as well as retesting to evaluate the improvement the patient is making with treatment.
The Millennium 2000 (see tool kit) is used on every patient, man, woman or child. This diagnostic equipment is used to determine spinal range of motion, thermo-graphic and surface electromyography. These tests are used to establish a range of motion, muscle function and nervous system function benchmark, which will enable us to assess, objectively, the outcomes resulting from chiropractic treatment.
The MicroFet X-ray and the CLA Millennium 2000 are also excellent means of patient education.
The explanation of results of these tests has proven to be of immeasurable help in educating the patient. With X-ray they can see first hand what structural and functional changes have resulted to the spine due to their condition.
TAC: Tell us your most amazing patient success story.
Stabile: There have been many amazing patient success stories over the past 35 years. I have treated over 18,000 patients. I had a patient that was referred to me by his wife. He was suffering from long-time severe neck pain and stiffness, and also had been totally deaf for over 10 years. He began treatment and, after 4 or 5 weeks of treatment, he was extremely improved. He had a Friday appointment and, when he left, he made another appointment for Monday morning. That Monday, his wife called and changed the appointment to 3 p.m. that afternoon. She came in with her husband and asked if they could talk to me privately in my office. They then began to recount the happenings of the previous Friday and Saturday.
The wife explained that, on Saturday morning, when she went down to the kitchen, she and her husband were having coffee when her husband stated that he was hearing a strange clicking sound. He had become very adept at lip-reading and, because he had previously had normal hearing, he would read lips and his mind would hear the voices. This time, his wife noticed that when she answered his question about the clicking sound coming from the clock, he was not looking at her and he could not have read her lips. They explained that they went to the ear specialist on Monday morning, who confirmed that he had regained his hearing. He said that he’d noticed something different on the Friday afternoon after having his adjustment and, by Saturday morning, he was able to hear very clearly.
TAC: What marketing strategies do you use to attract new patients and to keep current patients?
Stabile: We use a short, but concise, Web-site, which we have both as our own and the Verizon Web Page. We are in the Verizon Phone book, the Yellow Book that is from Gannett Publishing Co., and we have newspaper ads in the local papers. We also mail to all the new residents of our city and the surrounding areas and we use a company that allows patients to go on the Web and ask for a chiropractor or chiropractic, and it prompts them to put in their zip code, which causes it to return with a chiropractor in their area as well as a link to our Web-site and a number of other similar programs. We also participate in the better insurance plans.
We do new patient lectures in our office and we offer a coupon to the attendees allowing them or someone they know to receive a Millennium 2000 scan, necessary X-rays, and a complete chiropractic examination. This has enabled us to bring in new patients without the burden of the large initial expense, which often times keeps people from entering a practice.
The best way to get patients is by referral, because they are already somewhat educated as to the benefits of chiropractic, due to the results and enthusiasm that the referring person will instill in them.
Keeping patients has become an ever-increasing problem. We have established a number of financial options for patients in our office. We have established plans ranging from prepaid treatment plans, family payment plans, monthly payment plans, etc., to enable people to receive the necessary care, while lessening the financial burden.
When all is said and done, the most important factor involved in patient retention is patient education.
TAC: With your practice being a Family Practice, can you give our readers your advice about setting up and maintaining such a practice in today’s healthcare system?
Stabile: With our practice being Chiropractic Family Practice and with today’s economic climate, we must be ever aware of the need to be creative with the financial needs of the patient as well as the ability to offer various methods of payment. We accept all the major debit and credit cards, checks and, the almost forgotten, cash.
The advice I can give regarding setting up and maintaining such a practice in today’s healthcare system is to do as I have done. PUT THE NEEDS OF THE PATIENT FIRST and ALL ELSE SECOND!!!!
When setting up a practice, be sure you equip the office with whatever equipment is necessary to deliver the best chiropractic healthcare possible. Choose reputable manufactures and distributors that will stand behind the equipment and will educate you and your staff on its proper use.
Choose a reputable computer equipment vendor that will only recommend what you need and not what he needs to make the most money. The most invaluable part of a computer system is the technical support necessary in the initial set-up and educational process. Follow-up technical support on a daily basis is also invaluable. Life System’s (see tool kit) technical support has proven to be the most reliable, with capable, qualified and friendly employees.
To function efficiently, an office must have rules and procedures. Set up a list of office tasks and identify the responsible person to perform the various tasks. Develop a set of detailed instructions, which outline the proper steps involved in performing the various tasks. Cross-train employees, so that, in the event of illness or vacation, the office will be able to function efficiently. Have a patient education plan in effect. Have a patient office policy statement, which the patient reads and signs on their first visit to your office. This should contain all the information necessary to insure the patient knows what they are responsible for and what the office responsibilities are. Give the patient a copy of this when you give your report of findings. This one document can prevent an immeasurable amount of grief, if the patient does not follow office policy.
TAC: What do you foresee in the future of chiropractic?
Stabile: There is nowhere for chiropractic to go but up. With the historic never-ending struggles that chiropractic has endured and has successfully overcome, if we continue to present a united front, we will endure the storms and become stronger. If we maintain our positive attitude, are truthful and steadfast with our beliefs, we will be successful in one of the most positive impacts on the better health of mankind.
TAC: Any final words for our readers?
Stabile: We must first educate ourselves, our patients, other professionals and the public about chiropractic and the subluxation complex. We must educate the patient about the chiropractic adjustment and how it restores nerve function and aids the body in healing itself. Chiropractic has been around for over 100 years without being destroyed. I can only remember a quote from B. J. Palmer that goes something like, “You are not to fear the medical community. They will not destroy chiropractic. Chiropractors will be the ones to destroy it.”
If we unite, love chiropractic, and respect its art, philosophy, and science, and practice what we preach, then we have nowhere to go but up.
Clinic: 3000 square feet facility in Teaneck, NJ.
Office Hours: Mon. & Wed., 8 AM to 1 PM & 3 PM to 7 PM; Tues. & Thurs., 3 PM to 7 PM; Fri., 8 AM to 1 PM. Emergency service available 24/7.
Techniques: All recognized and popular techniques are available, including Cox, Activator, Palmer, Diversified, S.O.T., Flexion distraction, Applied Kinesiology, Pearce-Stillwagon, Grostic, as well as some other techniques, which are modifications of the standard ones.
Staff: 3 DC’s, Office Manager, 2 CA’s, 2 Insurance Administrators
Patient Demographics: 40% Male, 60% Female, 10-15% Children, 30-40% Families, 10-15% Elderly.
To give you a clear idea of what an amazing chiropractor uses to run his practice, we’ve asked Dr. Stabile to share with us some specific products & equipment that he uses to reach his practice’s goal of bringing health into his community.
2-Zenith Hi-Lo with drop pelvic and headpieces
1- Flexion Distraction Table
3-DC 101 Tables
CLA Millennium 2000 range of motion, thermal
and SEMG scan
MicroFet hand-held electronic muscle tester
1-Spinalator Inter-segmental traction table
2-Chattanooga combination EMS and Ultrasound Machines
1-Medx Low Level Laser
4-Chattanooga EMS machines
1-Chattanooga high volt galvanic and interferential machine
1-Anatamotor combination static intermittent traction and Inter-segmental traction table
2-Ergowave Inter-segmental traction tables
2-G5 Percussive massage units
The Chiropractic Practice Ace and the regulations which have been established as a result of legislation do not permit the recommendation, sale or dispensing of nutritional supplements in New Jersey. We are permitted only to advise patients on general nutritional matters.
Physician Desk Reference CD: We give our patients a printout of the medications they are taking and their use, contraindications and side effects.
Rehabilitative Physical Exercise CD: We develop and print patient exercise tailored to specific patient needs.
Life Systems: ChiroOffice, Chiro and ChiroPad: We do our billing and patient record keeping with this software. It is the essential and premium software for chiropractic office management. I would recommend it most highly. See Ad on pg. C-2
Paraphrase is a drag and drop user customized data base program which comes as a stand alone or can be used in conjunction with ChiroPad.
Bennett Accu-Tech (Terry Yochum) X-ray unit.
Konica X-ray Film Processor
OTHER COMPANIES I LOVE:
Harlan Equipment: Medx Laser
Dale Surgical Supply—Therapy equipment and supplies: Headrest paper and patient supplies.
Medical Arts Press: Business cards, stationary, envelops, HICFA forms, etc.
New Jersey X-ray
Emerson X-ray Solutions
Chirotech Table Repairs
Foot Levelers: Spinal-Pelvic Stabilizers.
You may contact Dr. Albert Stabile, Jr., D.C., F.I.C.C., C.C.P.C.P., at Associates in Chiropractic Family Health and Wellness Center, P.A,, 381 Park Street, Hackensack, NJ. 07601 or call 201-342-6111; fax 201-342-9117.
Written by James Mathis
Sunday, 14 November 2004 22:51
James J. Mathis has been employed in the insurance industry for more than fifteen years. Formerly with Allstate Insurance and State Farm Insurance, during that time, he was also a claim representative as well as a manager in charge of all Med-Pay claims and Personal Injury Protection claims in the State of Washington. In addition, he was designated the company representative in class action lawsuits brought against the insurance industry for refusing to pay or reducing the amount paid for chiropractic treatment.
Mathis has been sought as a speaker for trial lawyers associations and chiropractic associations throughout the United States and Canada on the issue of insurance industry philosophy and procedures involving medical treatment provided by chiropractors. In the last four months of this year, he will be speaking at such seminars in more than 27 states, providing two- and three-day seminars and workshops for chiropractors who may be interested in knowing how to avoid the delays and denials by the insurance industry.
In an interview with The American Chiropractor (TAC), James J. Mathis describes the growing conspiracy against chiropractors by the insurance industry, and offers suggestions for chiropractors to help you “take back control” of your future.
TAC: What did you learn while working with Allstate and State Farm Insurance that would be of the most interest to chiropractors?
Mathis: While employed in the insurance industry, I was made aware of the adversarial attitude toward chiropractors by the insurance carriers. The employees of the insurance industry are actually trained to suspect all treatment provided by chiropractors. There exists a discrimination of the chiropractic profession, which results in chiropractic treatment and billing being denied, in part and in whole. The insurance industry determined that one of the largest areas in which claim cost could be controlled was the chiropractic care provided to injuries sustained in accidents. By significantly and successfully reducing or denying this medical cost, the industry would realize a reduction of claim payments. This would, naturally, affect the overall profit sought in the claim departments of the individual insurance carriers. Chiropractic care is targeted because of the large number of claims which experience this type of treatment.
The purpose of this claim-handling philosophy and procedure was to recapture billions of overpaid claim dollars as determined by the insurance industry. In fact, there appeared insurance industry slogans during this time period such as, “Bring Back a Billion”. Insurance industry claim departments were viewed as profit opportunity entities. Goals were developed to produce billions of dollars from a reduction in claim payments. To ensure the success in achieving these goals, the individual claim representative, associate or processor performance was determined based on their individual contribution to realizing these goals by their claim handling.
TAC: What do you discuss in your television and newspaper interviews with the likes of NBC Dateline and The Wall Street Journal about the insurance industry?
Mathis: I have been interviewed, video taped and quoted regarding the insurance industry’s use of “Captive Vendors” to perform reviews of medical treatment provided to their policyholders for the sole purpose of reducing or denying the duration, frequency, type and cost of medical treatment received for injuries sustained. These vendors would be sent, by insurance carrier, the chart notes and medical billings of a policyholder. Subsequently, the vendor would return an opinion that the treatment type, duration, frequency and/or cost was unnecessary or unreasonable and should be denied. The insurance carrier would rely on this opinion to deny the payment for medical treatment.
This practice of “Captive Vendors” was one of the most egregious processes used to reduce payment of policyholders’ claims and generate profit for the insurance industry. This secret practice by the insurance industry was kept from the community of policyholders throughout the country. While the insurance carriers were realizing profits from non-payment of claims, the policyholders were being denied treatment. The treating physicians (mostly chiropractors) were being denied payment for the treatment provided. The relationship between the treating physician and the policyholder, as a patient, was strained, if not completely obstructed.
If a policyholder or treating physician complained, they would be provided with scripted responses so as to dissuade any disagreement with the opinion of the vendor. Should a policyholder or treating physician seek the assistance of an attorney, they would be dealt with by defense counsel prepared to harass, intimidate and prolong the process to the point of complete frustration by the policyholder or treating physician. Ultimately, most complaints by policyholders and treating physicians would be forsaken. The economic strain, emotional intimidation, as well as the long delay, would finally force the policyholder and/or treating physician to abandon the disagreement. The insurance carrier was well aware that this would be the result of these com-plaints. Those few instances where the issue was taken to the final outcome (trial and judgment by jury) and a victory for the policyholder and/or treating physician was realized were not an economic deterrent to the insurance carrier. The savings of claims not paid far exceeded those too few legal losses.
TAC: When did you stop working with the insurance companies and how did your relationship with them end?
Mathis: I stopped being an employee of the insurance industry in September of 2001. I had been working at Allstate in their “Represented Unit”, and made the decision to continue to work as a consulting expert and begin the initial steps of creating the software corporation, Sequoia Visions, Inc.
TAC: What important trends do you see happening in the insurance industry and its relationship with chiropractors in the future?
Mathis: There is a trend by the insurance industry to rely on computerized programs in the determination of reasonable and necessary duration, type, frequency and cost of medical treatment provided for injuries sustained in accidents. These computer programs remove the human element and human intelligence previously associated with the handling of medical claims. This trend also has allowed the insurance industry to reduce their claim personnel. Now, more claims can be handled by fewer people. The claims no longer involve the process of intelligence or decision-making. Also, the claims no longer require that experience of the claims handler be a factor. This has allowed the insurance industry to replace many seasoned and experienced claim handlers with computer data processors.
The insurance industry is realizing additional savings by centralizing the handling of medical claims, increasing inventory levels of processors and eliminating the need for higher salaried employees.
The future will be dictated by the adaptation of the computer programs and electronic services available to the insurance industry. Many treating physicians will be offered immediate payment in exchange for a 20% discount. This discount will increase each continuing year so as to represent another considerable savings for the insurance industry. The treating physician will be tempted to accept this offer in lieu of realizing months of delay, or even eventual denial, if they don’t.
The only recourse available is for all treating physicians to demand all that is owed in payment for treatment provided and to continue to suffer through the obstructive tactics by the insurance industry. But, even more importantly, the chiropractic physician needs to understand how the electronic processes, procedural requirements and practices of the insurance industry actually work. With this information, the treating chiropractor can successfully receive full payment for all treatment without denials or delays. It is possible, without an agreement of a reduction of payment, if an understanding of the processes and an application of significant practices occur by the chiropractor.
TAC: Tell us about your software program and how it can be used in the chiropractic clinic.
Mathis: Sequoia Visions, Inc., has developed software which allows the treating physician to realize success in dealing with the computer programs being utilized by the insurance industry. It has developed software for the legal community as well. All the software is compatible with each other. This means that the successes realized by the treating physician in having the insurance industry accept frequency, duration, type and cost of medical treatment results in more reasonable settlement offers for the claims of their patients.
The medical software is used by the chiropractic physician to document all the aspects of their patients’ injuries, symptoms and manifestations in the correct terminology, phraseology and sequence, so as to respond directly to the insurance industry programs. The program leads the chiropractor sequentially through their patients’ injuries in a very user-friendly style. Medical Report Expert, at the click of a button, will produce a medical report (Initial, Interim or Final) which will translate all medical documentation into the correct terminology, sequence and with the acceptable drivers for the insurance industry.
TAC: Do you have any final words or advice for our readers?
Mathis: Now is the time for all treating physicians, especially chiropractors, to take back control of their future. Failure to realize the importance of this opportunity will only result in the continuing discrimination by the insurance industry. As a result of the adaptation by the insurance industry of these computer programs and the procedural requirements surrounding their use by insurance employees, the window of opportunity exists to establish acceptable treatment frequency, duration, type and cost. The sole defense to future decreasing reimbursement for medical necessary and reasonable cost is knowledge and concerted effort. I would encourage all chiropractors to acquire the necessary knowledge and participate, as a group, through active communication.
James Mathis can be reached for questions or additional information by contacting Sequoia Visions, Inc, at www.sequoiavisions.com; phone (888) 737-8642 / (775) 849-8400; or snail-mail James Mathis, 205 Scotch Pine Rd., Reno, NV 89511.
Written by Dr. Rand Swenson, MD, DC
Sunday, 14 November 2004 22:48
Dr. Rand Swenson, a second-generation chiropractor, received his chiropractic degree summa cum laude in 1976, from the National College of Chiropractic. He subsequently entered the graduate program in the Department of Anatomy at Loyola University Medical Center in Maywood, IL. His graduate research was in the field of neuronal plasticity and he received his PhD in 1981.
After a two-year post-doctoral fellowship investigating autonomic nervous system neurophysiology, he became a visiting professor of physiology at the Tokyo Metropolitan Institute of Gerontology, investigating autonomic nervous system responses to sensory stimuli, especially pain. During his time at the University of Illinois College of Medicine in Chicago, he was named a James Scholar and to the Alpha Omega Alpha (AOA) Honorary Medical Society. Dr. Swenson is currently the Associate Professor of Medicine (Neurology) and Anatomy and Acting Chairman of Anatomy Dartmouth Medical School.
This past year, Dr. Swenson became an active Advisory Board member of Diagnostic Testing Centers of America (DTCA). DTCA serves as a national network of affiliated physician practices providing on-site precision diagnostic testing services.
In an interview with The American Chiropractor (TAC), Rand Swenson, D.C., Ph.D., M.D., discusses the growing trend toward bridging the differences between the chiropractic and medical communities. As an expert in neuroscience and neurology, Dr. Swenson explains how neurological evaluation can be of importance to the chiropractor.
TAC: Being a chiropractor, what made you decide to attend medical school?
Swenson: There are several reasons why I entered medical school. In the 1980’s, it was apparent that there was growing interest, in the medical and chiropractic communities, in finding appropriate ways to integrate orthodox medicine with several “complementary and alternative” (CAM) practices. It was really during that decade—and during the early part of the 1990’s—that medicine was confronted with the widespread use of these practices, largely forcing their attention to this issue. Of course, there was not a great deal of expertise or understanding in the medical community as to what it is that CAM practitioners could contribute to patient care, much less how such care could be understood and integrated. I felt that there was (and continues to be) a need for practitioners, particularly in medical academic settings, who have an appreciation for both sides.
TAC: How do medicine and chiropractic complement one another?
Swenson: First of all, most of the patients who are most effectively cared for by chiropractors are patients for whom medicine has no clear or easy answers. This should be an ideal ground for synergy, and that is evolving, in many quarters. Of course, not all patients are good candidates, for one reason or another, for chiropractic care. Also, some need further investigation of potentially serious complicating problems before chiropractic treatment. It is in the latter area that medical physicians should be particularly skilled. Therefore, I do not view these two professions as inherently antagonistic (history notwithstanding), but rather complementary. All of this should be directed toward the maximum benefit of patients
TAC: What advances have been made and/or are being made to integrate both chiropractic and medicine in today’s patient care?
Swenson: I have seen major changes in the involvement of chiropractors in the medical system over the past 15 years, along with major changes in attitudes— both by patients and medical practitioners. I have been invited to give presentations at major medical schools, state medical society meetings, as well as national specialty society meetings on chiropractic. I don’t believe that this would have happened 15-20 years ago.
The predominant attitude that I notice from my medical colleagues, and particularly from the current medical students, is one of curiosity—curiosity about what it is chiropractors do and what they treat. Some of this curiosity has been motivated by an increasing willingness on the part of patients to report that they are seeing or have seen a chiropractor. I believe that there will be a day when chiropractic will be included as a part of most multispecialty clinics and, particularly, those clinics that focus on orthopedic issues and rehabilitation. I think that these types of clinics will be the entrée to broader interactions.
I believe that the studies conducted by Dr. David Eisenberg’s group at Beth Israel Deaconness Medical Center were the studies that truly motivated a lot of the increased interest on the part of medical practitioners in chiropractic and, indeed, complementary and alternative therapies in general. The most impressive thing to me is how few of my medical colleagues realize the number of their patients who are already utilizing chiropractors, mostly for conditions that are not very responsive to medical management.
I will never forget giving a presentation on chiropractic to the state medical society about seven years ago. One of the points that I made was that it was critical for medical practitioners to be sure that they understood about their patients’ use of all kinds of complementary and alternative therapies, including chiropractic treatment. I was asked how a medical practitioner could identify who were the most effective chiropractors in the area. I told them that their best resource was their patients, if they would listen to what they had to say about their experience with chiropractic care in a nonjudgmental way.
I—along with most of the other participants at the conference—was floored when one of the doctors jumped up immediately and said that no patient of his had ever been to a chiropractor. This, of course, was patently absurd, and it was apparent that he had simply intimidated his patients into silence. The interesting thing to me is that everyone else in the room recognized this absurdity except, of course, the person who made the statement and, fortunately, this attitude is dying. The old joke in medicine is that attitudes change one funeral at a time, but I have observed changes that are substantially more rapid than that.
TAC: What is the relationship between the orthopedic and neurological examination?
Swenson: Orthopedic and neurologic examinations are complementary. The orthopedic examination is a structural examination and the neurologic examination is a functional exam. The orthopedic examination is designed to determine the tissue that is causing problems. By and large, it involves determining the particular positions and motions that reproduce the patient’s symptoms and signs. The neurologic examination is designed to test the integrity of the nervous system and neural responses.
TAC: Why is neurological evaluation interesting for chiropractors and how can it help them in practices?
Swenson: There are several reasons why the neurological examination and evaluation should be of interest to chiropractors. Firstly, patients expect, and have a right to expect, a thorough assessment of their conditions. Secondly, patients often have unrecognized problems that warrant further evaluation or that can complicate treatment. Thirdly, appreciation of the nervous system expands appreciation of the processes that attend dysfunction of any part of the body—these processes are not mysterious, although they may seem so at first. Finally, in discussing and sharing patients with professionals of other disciplines, it is critical to have some common understandings as well as our own unique perspective. It is not important for chiropractors to be neurologists, for example, but it is important to recognize what is and isn’t normal, how that can impact treatment and what can or should be done to follow up on such abnormalities.
TAC: What is your position on neurodiagnostic testing?
Swenson: There are limitations to the ability of the clinical neurologic examination to fully evaluate the nervous system. This is particularly true in the peripheral nervous system and in the sensory system. Since the nervous system works on the basis of electrical responses, electrical examination is appropriate. Electrodiagnostic testing is an extension of the neurologic examination, objectively answering the question of whether elements of the peripheral and sensory systems are intact, when the clinical exam cannot answer the questions with certainly. It also often uncovers additional levels of injury that are unrecognized clinically, due to the dominance of certain symptoms. Nonetheless, these additional problems may affect recovery and may necessitate different or additional therapy in order to hasten recovery. Finally, it is a fact of life that objective findings are always treated with greater deference than are subjective complaints. This may be in terms of explaining why patients have symptoms or even in answering questions such as, “Why is recovery taking longer than expected?” or “Are there additional problems complicating this patient’s response?”
TAC: Any final words for our readers?
Swenson: Try not to let the many pressures inherent in practice today distract you from your focus on patients.
Our sincere thanks to Dr. Swenson. He may be reached at HB 7100, Dartmouth Medical School, Hanover, NH 03455.
Written by Jeff Spencer, D.C.
Tuesday, 14 September 2004 22:08
Dr. Jeff Spencer is a former champion cyclist who competed on the 1972 United States Olympic Team as a sprint cyclist and currently serves as chiropractor for the United States Postal Service Professional Cycling Team. A 1975 graduate of the University of Southern California (USC), Dr. Spencer graduated summa cum laude from Cleveland Chiropractic College at Los Angeles in 1988. He then set up a “regular” office in Montrose, CA, then Grants Pass, OR, and, finally, Scottsdale, AZ, where he practiced for 12 years, until a debilitating case of dental mercury amalgam poisoning made it impossible for him to keep regular office hours.
What to do?
Since his practice had a heavy sports medicine clientele, he went mobile. That’s right! He hit the highway, seeing his patients on the road, and he’s been there ever since.
His clients include Lance Armstrong, Tiger Woods, Troy Glaus, Kendall Gill, Tara Daketis and Chad Reed.
In an interview with The American Chiropractor (TAC), Dr. Jeff Spencer shares his unique experience as a sports chiropractor on the road, and the winning philosophy that has made all the difference!
TAC: What influenced you to become a chiropractor?
Spencer: When competing as a world-class athlete, I never felt that my pre-competition, injury prevention and injury management strategies were sufficient enough to allow me to reach my full potential. After graduating from USC, I became a fitness consultant to athletes and found they echoed the same concerns, so I decided to become a licensed health care provider to learn the skills needed to address the comprehensive needs of the athlete. I chose chiropractic because it afforded great flexibility in assessment and treatment protocols and allowed me to work with my hands.
TAC: What kind of practice do you have?
Spencer: I presently practice solely in the professional athletic world. Athletes come to me; I go to them. I spend considerable time traveling to competitions. My clinical objectives are to prepare the athlete for top competitive performances, limit their risk of injuries, minimize injury downtime and extend their careers. I’m not limited by time or resources. My clients contract me to do whatever’s necessary to get the job done.
TAC: What techniques do you use?
Spencer: Identifying the mechanical, biochemical and energetic needs of my clients is my first priority. I then select the appropriate techniques, modalities and nutrition to produce the desired clinical outcome with the least time and effort. My principle tools are diversified and non-force full body adjusting, Erchonia cold laser and kinesiotaping techniques. In addition, I use frequency specific microcurrent (FSM), autonomic response testing (ART), Scenar, earthing, the “Stick”, herbs, nutiritional supplements, homeopathics and active rehabilitation exercises. I’m super aggressive. I’m very dedicated to learning leading edge concepts. If there’s a better way to do something, I’m first in line to want to learn it. I’m always scanning the landscape for new things.
TAC: Have you ever worked in a “regular” clinic setting? If so, how did you “go mobile”?
Spencer: I held regular clinic office hours for 12 years before going mobile. The switch came as the result of my having a very seriously debilitation case of mercury poisoning from my dental mercury-silver fillings. While poisoned, I was physically incapable of maintaining regular office hours—let alone doing anything else. I could barely function.
However, the silver lining from the mercury poisoning was that I spent two years researching and doing everything I could to recover from a chronic illness and, in the process, learned an extra, extremely important dimension about acquiring and maintaining ultimate health and fitness—something every athlete needs, yet few practitioners have clinical knowledge of.
TAC: Do you see a lot of need for more "mobile" sports chiropractors like yourself?
Spencer: Absolutely. Top athletes are busy, have very little travel flexibility, know they need this added dimension and have the resources to acquire it. The sky’s the limit on what’s possible. We’re only limited by our creativity and clinical skill.
TAC: What would you recommend chiropractors do if they're interested in being a sports chiropractor like yourself?
Spencer: Become the best clinician possible and develop a wide diversity of skills to address the comprehensive needs of the athlete; master manual techniques, energetic modalities and nutritional supplements. It’s also critical to understand the athletic experience and become a representative of it by being an athlete yourself. Give presentations about what you do and why you’re different from other healthcare providers. Give people a reason to come to you. If you’re just like every other chiropractor, there’s no reason to come.
TAC: How is your income level now in comparison to working a "steady" job in the same clinic every day?
Spencer: The gross is easily three times what it was in a “stationary” practice, with the added bonus of absolutely no overhead. There’s lots of room for exploration, creativity and innovation that comes with the freedom of being mobile.
TAC: Tell us about your involvement with The Tour de France.
Spencer: I’ve done all six of Lance Armstrong’s Tour victories with him. During the Tour, I take care of the entire nine-rider team. My job is to prepare the riders’ bodies for each day’s stage, prevent injuries, resolve injuries when they do happen, and accelerate post competition recoveries. It’s a 24-hour a day job to get it all done. Common problems seen include tendonitis, abrasions, lacerations, muscle tears, muscle inhibition, joint fixations/trauma, postural strain, hematomas, and everything else that pertains to the neuromuscular system. It’s awesome to have so much proactive and treatment diversity compressed into three weeks. To manage these conditions, I do a lot of adjusting, kinesiotaping, Erchonia lasering and energetic modality procedures. It’s awesome.
TAC: How can the things you've learned practicing on the road be incorporated into other doctors' practices to equip them to achieve better results for their own patients?
Spencer: The body’s the body, whether you’re an athlete or non-athlete; and the same principles of prevention, remediation and recovery apply to both athletes and non-athletes alike. There’s absolutely no difference. All things done in the athletic world should be incorporated into regular clinical practice. The most important thing for the average patient is to get regular pro-active care and see someone immediately when a problem arises. Waiting for care can lead to improper healing and secondary problems. To get and stay healthy, people have got to change the way they look at health.
TAC: With the traveling you do for your job, what tendencies do you see for the future of chiropractic and health care in general?
Spencer: The future of chiropractic will be determined by how effectively the profession defines its scope of practice. The literature clearly demonstrates that the body has mechanical, biochemical, nutritional and energetic needs that, when appropriately met, create consistent, optimal physical performances, both in tasks of daily living and on the playing field. In my experience, the body doesn’t care about what we think its needs are. It only cares if we can give it what it needs to build and maintain itself. If we fail to provide the body with what it needs to repair and maintain itself , regardless of our intention and belief, it will never be able to obtain optimal health or achieve top performances.
Today’s health consumer knows there’s more to health than just receiving a memorized treatment algorithm for a given diagnosis. 300 million Americans all need regular proactive and remedial chiropractic care. Chiropractic’s scope of practice and clinical competency will determine how successfully we provide the extraordinary health care experience for the consumer that enables them to embrace life to its fullest, and our profession to grow.
TAC: Do you notice chiropractic being treated differently in different places in the US? In the world?
Spencer: There is certainly a regional difference. You see it more in the athletic and medical institutions than in individual athletes and patients. American teams and health care establishments, by nature, are slow to embrace innovation, and there’s a distinct hierarchy among the health care providers that often slows the dialogue and implementation for groundbreaking technologies. In my experience, it can easily take a decade or more for important innovations to make it onto the radar, if ever. The loser in this is, unfortunately, the patient.
In Europe, innovation is more rapidly embraced. In the Tour de France, I have complete freedom to do whatever I want and to use a variety of very new innovations that have passed the acid test, both clinically and scientifically, yet very few people know anything about them. It’s the ultimate clinic!
TAC: Do you have any secrets to your success in practice? In life?
Spencer: Yes. Don’t let the fear of thinking you don’t know enough get in the way of implementing new clinical procedures. Learn as you go. No truly masterful, happy, successful practitioner ever feels “they’ve arrived.” Follow your path of inquiry. Make your decisions on what you stand to gain, not what you stand to lose. Trust your clinical instincts. Never get too comfortable with what you know. Once you think you’ve arrived, stagnation sets in, enthusiasm drops and clinical performance declines. Keep learning and experimenting. It’ll keep you fresh and young at heart.
TAC: Do you have any final words or advice for your readers?
Spencer: Create the practice of your dreams by doing what Lance does: Seek the council of trusted people, listen to what they have to say, decide what you want to do and do it. There are no rules. Be creative. Find a way to make what you want to do work. Don’t let the fear of failure get in the way. Don’t try to control things too much. Look for the opportunity in the moment and change course when there’s a better way. Make spontaneity a daily requirement.
Our sincere thanks to Dr. Spencer! He may be reached by email at
Written by Harold McCoy, D.C.
Tuesday, 14 September 2004 22:05
With almost 30 years of experience in practice, Dr. Harold McCoy has established quite a track record in incorporating chiropractic to achieve optimal sports performance in world-class athletes. It all started in the 80’s, when Dr. McCoy treated Olympic athletes like Evander Holyfield and served seven years at the University of Washington as part of the Multidisciplinary Sports Medicine Staff, where his job was to provide protocols on how to improve athletic performance using chiropractic treatment. Today, Dr. McCoy’s tireless efforts to help change the chiropractic industry perceptions, practices, and standards have taken a different tenor. To that end, over the last ten years, he has developed two companies, Myo-Logic and Spinal-Logic Diagnostics, Inc., based upon his Sports Medicine and clinical experience. Both companies directly sponsor or co-sponsor over 100 seminars and symposiums per year, such as the Bulletproof Seminars with Dr. Gregg Friedman, focusing on evidence-based documentation.
Further, during the past year, he has been investigating and is in the process of developing international collaborative research projects with major universities in the United States, and the world’s largest pain research center, located in Europe.
A 1975 graduate of Palmer Chiropractic College, Dr. McCoy is a member of the International Chiropractic Association (ICA), was elected a Fellow this year, and is still in practice fulltime in Kirkland, WA.
In an interview with The American Chiropractor (TAC), Dr. Harold McCoy discusses his distinguished career in chiropractic and his passion for providing evidence-based documentation on the efficacy of chiropractic care.
TAC: What influenced you to become a chiropractor?
McCoy: While in the military, my neck was injured and I suffered with severe daily neck pain. I was prescribed physical therapy and drugs for 4 years and it didn’t help. Out of desperation, I went to a chiropractor and, after one week of cervical spine adjustments, I was pain free. This inspired me to become a chiropractor.
That’s still the best part of my job...helping other people who are in pain and ill health like I was. I have a full time practice in Kirkland, Washington, and retirement is out of the question. I have a love and passion for what I do. I couldn’t imagine doing anything else.
TAC: Tell us about your experience helping athletes achieve greater results through chiropractic care.
McCoy: While working 7 years for the University of Washington Intercollegiate Athletic Department as part of the Multidisciplinary Sports Medicine staff, my job was to help develop protocols on how to improve athletic performance without using drugs. In addition to pain management strategies, our treatment protocols (including chiropractic adjustments) were developed to functionally improve flexibility, spinal and extremity joint range of motion, and muscle strength in our athletes.
I have served in over 30 International sporting events. In 1983, I was assigned to the Pan Am Games in Caracas, Venezuela, and, in 1984, I was assigned to the U.S. Olympic Boxing Team in Los Angeles.
Evander Holyfield was on our Olympic boxing team that year. That team won 11 medals in the 12 weight categories—9 gold, 1 silver and 1 bronze. Evander and four other young men on the team went on to become professional World Title holders in boxing. I was, and always will be, very proud of our young men. It was an experience I will never forget.
TAC: What have you learned from your experience with athletes that would be useful for chiropractors dealing with their not-so-athletic patients.
McCoy: The examination and treatment protocols I used on athletes were primarily designed to improve athletic performance by using chiropractic care to improve neurological function, range of motion and muscle strength. We focused on an objective evidence-based approach to determine spinal and extremity range of motion limitations and muscle weaknesses and how to improve or correct them, instead of focusing on pain.
As chiropractors, we need to be educating our patients that our job is to improve their neurological and physiological function, health and quality of life. Pain reduction is just a byproduct of what we do for them.
By moving our patients from the pain model to the functional and quality-of-life model of chiropractic care, I have found that they are much more likely to follow through with our active treatment and supportive care recommendations.
We need to have our patients accepting chiropractic care on an objective (“I understand”) system rather than a subjective (“belief”) system.
TAC: Tell us about your involvement in developing an Evidence-based Outcome Assessment System and what this means for chiropractors.
McCoy: Our Myo-Logic Diagnostics company has developed a wireless evidence-based outcome assessment software and hardware system called the MSM-7000. The purpose is to prove medical and chiropractic necessity and demonstrate the need for and the efficacy of our chiropractic care, using HCFA, AMA and ICA Guidelines.
Our wireless system incorporates computerized range of motion, muscle strength, algometry and pressure/pain threshold testing.
This objective data is incorporated with pain-and activities-of-daily-living-questionnaires and automatically downloaded into our software narrative writing capability.
Our sister company, Spinal-Logic Diagnostics, provides a computerized digital biomechanical analysis of our doctors’ X-rays, using the AMA measurement system to determine the exact spinal levels and extent of ligamentous damage to the discs and facet capsules, as the result of trauma.
By giving the Gold Standard of documentation—accepted by all professions measuring functional and structural impairment and the response to care—a numerical value, we can communicate with any professional of any profession in the world. Numbers are an international language.
We can also prove, objectively, the value of the care we provide.
My goal is to introduce more objective evidence-based scientific chiropractic.
TAC: After some 30 years working in and for the chiropractic profession, what motivates you to keep on keeping on?
McCoy: Much of my clinical and sports medicine experience has led me to realize that there are huge gaps in our delivery of service; so, over the years, I pursued my own partnership for chiropractic to work with other health care professionals. We have to help our profession move forward and gain the respect of the research world as we also move toward more scientific evidence-based chiropractic. That’s one reason why I developed Myo-Logic and Spinal-Logic Diagnostics, and why I invest in sponsoring top research and informational seminars and symposiums. My career path has taken me full circle to the realization that my own pain and ill-health experience, and those of millions of others, require that we partner with other professions to really do what’s best for the patient. Doing what’s best for the patient is still what motivates me to keep going in my practice and in my research.
TAC: You have already formed many strong alliances with very important people, both in and out of the profession. Tell us something about these relationships and what they mean to you and the chiropractic profession.
McCoy: I am proud to know and work with doctors (DC’s, MD’s, PhD’s) like Dan Murphy, James Robinson, Lars Arendt-Nielsen, Thomas Graven-Nielsen, Art Croft, Gregg Friedman, Jeff Spencer, Michael Freeman, and Dennis Woggon. These doctors are dedicated visionaries who keep themselves abreast of current research, scientific literature, and methods to help raise the knowledge and standards for all professions. Their work and lectures to other professionals internationally influence the lives and well being of many millions of people worldwide.
I have had the pleasure of traveling with Dr. Dan Murphy, Vice President of ICA, for presentations at symposiums in Lisbon, Portugal; Rome, Italy; and Christchurch, New Zealand. In a recent Internet poll, Dr. Murphy was selected as the Number 1 most respected educator and sought-out chiropractic speaker in the world.
By the way, the ICA is hosting an International symposium in Athens, Greece, November 19-21, 2004. Five of the featured speakers are Dan Murphy, DC, DABCO; James Robinson, MD, PhD, University of Washington Multidisciplinary Pain Center; Lars Arendt-Nielsen, Dr.Sci.Med, PhD; Thomas Graven-Nielsen, PhD, Center for Sensory-Motor Interaction, Aalborg University, Denmark; and Dr. Dennis Woggon, giving a Whiplash & Scoliosis presentation. (Please call ICA at 1-800-423-4690 for details.)
TAC: Do you have any secrets to your success in practice and in life?
McCoy: I would tell other chiropractors to build a passion for what you do in life, while doing it for the right reasons. My belief in chiropractic spurred me on to objectively prove to anyone in any profession that the chiropractic care I was providing was making a difference in my patients’ lives. I also feel that associating with and knowing people of like-minds helps me stay on course. That’s why I respect Dan Murphy. He inspires me and many thousands of other doctors to stay focused on why we became chiropractors.
TAC: Do you have any final words or advice for our readers?
McCoy: There’s a new era dawning in chiropractic. Evidence-based health care is becoming the Gold Standard in all the other professions. In order for things to get better, we need to get better. In order for things to change, we need to change. I challenge every DC out there to go back to the basics and ask yourself if you are ready to truly defend your work and prove to your patients that you make a difference in their health. Now is the time for us all to be accountable. Do whatever it takes to rethink the way you are conducting your practice, so that you can objectively show and prove to your patients, yourself, other health care professionals, and even the insurance establishment, that your work makes your patients healthier and improves the quality of their lives.
And, lastly, never, never, never forget that our mission is to serve and heal.
Our sincere thanks to Dr. McCoy!! He may be reached by phone at 1-800-768-7253, Ext. 2; by e-mail at
; or visit www.myologic.com, www.spinallogic.com, or www.bulletproofseminars.com.
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