Narrative Chiropractic
PRACTICE MANAGEMENT
By Mark Studin DC, FASBE(C), DAAPM, DAAMLP William J. Owens DC, DAAMLP
Since 1895, chiropractors have focused on treating the patient without the use of drags or surgery in a paradigm where repeated visits are typically clinically indicated to make structural or spinal biomechanical changes. During these repeated encounters, we as a profession have gotten to know our patients’ stories or life narratives better than our counterparts in the medi-
cal community—more similar to “old-time” family practitioners. Our relationships aie consistent with L 1 physical therapists and occupational therapists who have an emotional understanding of patients along with physical contact to get a better sense of a patient’s level of well-being. The difference is that chiropractors, by license, are considered primary healthcare providers—a portal of entry into the healthcare system—who aie required to diagnose all conditions, or at the very least understand that there is a potential pathology and then triage accordingly.
On the other hand, medicine has become so subspecialized that often the patient’s story or life narrative gets lost. So the patient’s encounter is focused solely on the very specific pathology, and the patient is reduced to a lab result or diagnosis, not taking into consideration any other aspect of the person’s life. In addition, with the shortage of primary care medical doctors nationally, which in a large part is due to the economics caused by insurance carriers that have shifted too much profit to themselves at the expense of the primary care MD, volume has become the operative paradigm as an economic mandate to survive. The electric bill must be paid! The outcome is a series of very brief encounters that has the primary care provider looking at his or her computer tablet or laptop dining most of die patient’s visit because documentation regulations have forced the MD to focus on computer entries more than the patient.
^Chiropractors, by license, are considered primary healthcare providers—a portal of entry into the healthcare system—who are required to diagnose all conditions, or at the very least understand that there is a potential pathology and then triage accordingly. 5 5
Columbia University describes narrative medicine (NM) as:
The care of the sick unfolds in stories. The effective practice of health care requires the ability to recognize, absorb, interpret, and act on the stories and plights of others. Medicine practiced with narrative competence is a model for humane and effective medical practice. It addresses the need of patients and caregivers to voice their experience, to be heaid and to be valued, and it acknowledges the power of narrative to change the way care is given and received.
Columbia University continues to report:
Health care and the illness experience aie marked by uneasy and costly divides: between those in need who can access care and those who cannot, between healthcare pro-
fessionals and patients, and between and among healthcare professionals themselves. Narrative medicine is an interdisciplinary field that challenges those divisions and seeks to bridge those divides. It addresses the need of patients and caregivers to voice then experience, to be heard and to be valued, and it acknowledges the power of narrative to change the way care is given and received.1
According to Cindy Smalletz, director of the program of nar -rative medicine at Columbia University:
Narrative medicine is clinical practice fortified with sophisticated narrative skill so you can hear what patients tell you and what you tell yourself. Narrative medicine provides a sophisticated means for clinicians to absorb attentively what they witness in health care and to come to understand something of the meanings of tlie events in which they participate. The encounters that occur with clients aie not bureaucratic or technical encounters, but creative, singular, exposing human experiences. The two of you involved—you and your clients—aie irreplaceable in the event. What happens as a result of your meeting will never happen again.
And so the duty of each of you is to be there, fully present, eyes wide open, self on loan to die other to attend to the matter at hand, to perceive as fully as possible, to absorb, to brood on, and to join tlie other in trying to make things better. There’s lots of protecting going on—if only just horn the sadness, part of the work we
do in NM is to equip people with some kind of moral courage, to be able to stand on the side of tlie solution, and not the problem.
Medical academia has recognized that with advanced testing, subspecialists, legal issues, ethical boundaries, and ever-changing technology the relationship between the provider and the patient has been fragmented and reduced to test results and statistics. Medicine is stalling to comprehend what chiropractic has understood for more than 120 years, and that patients need to be treated based upon the totality of then lives and health condition, not just a single condition. This is why the chiropractic profession has been identified with wellness versus disease care, and rightly so.
However, along the way, too many chiropractors became stuck on personal agendas, such as philosophy, treatment techniques, and public health policies, and not in partnership with their patients’ needs. Narrative chiropractic is about hie balance of under standing hie patient’s needs based upon the patient’s life experiences, and then by listening and understanding, combining your (the doctor’s) life experiences and professional training to meet the needs of the patient and formulate a winning treatment strategy.
Medicine is using literature, ait, film, and other similar approaches to help train providers and realize through metaphor the narrative or “trae story” of the patient to help the patient make the right choices for his or her life. In medicine, tins has helped provide higher levels of compliance and better outcomes even when the ethics of end-of-life decisions need to be made.
^Medicine practiced with narrative competence is a model for humane and effective medical practice. J J
Our goal is to either bridge that gap or fill in the gaps in understanding the patient’s needs, and then put that into practice to meet the patient’s overall healthcare goals without compromising the patient’s belief system or going beyond any perceived ethical boundaries. If we study fictional literature, there aie many examples in pop culture where a movie’s story line will bring you to tears or leave you exalted simply based upon the narrative of the story, but only if you ai e invested in tlie plot and understand the nuances of intent of the message. It is the same with patients, but aie you creating that plot mutually with your patients or aie you imposing your agenda onto them? Aie you truly listening to what the patient is saying or aie you busy writing or thinking of your agenda?
It starts with listening—really listening and healing what the patient is saying beyond the PQRST. Listening beyond when the patient says, “It hurts.” How does the patient feel about chiropractic and getting well without the use of drags or surgery? How does the patient feel about not working in conjunction with his or her primary care MD? How does the patient feel about not seeing a medical specialist? Did the patient read something that concerns him or her about your care or have a previous negative experience
with chiropractic? These questions usually aie not unearthed in a single encounter, but they aie the goals of the relationship, just short of being a therapist, which you aie not. However, by getting into tlie patient’s narrative, you will gain the patient’s trust and meet his or her needs at a more meaningful level to foster a relationship that will help the patient at a greater level and concurrently increase your possibilities for more referrals. More often than not, people just want to be heard.
We have built a profession on these types of relationships, and as we see organized medicine now moving towards us, we need to ensure that we do not forget what has made chiropractic part of our culture. Our place in our culture has been built on understanding tlie patient’s narrative or life story and having that take front and center as paid of tlie patient’s care.
References:
1. Retrieved from: http://sps.columbia.edu/narrativemedicine ?utm source =google&utm medium =search&utm campaign=NMED-Mgoogle search&gclid=CjOKEOjw 6M y4BRD4ssKGvYvB-YsBEi0AJYd770igHMrZogtNWpZ9dYuJ2vNNu64cqDi 14PAp 70uSMaAsdF8P8HA O
Dr. Mark Studin is an adjunct associate professor of ™ chiropractic at the University of Bridgeport College of ■fchjy/'. Chiropractic; an adjunct professor of clinical sciences \ À at Texas Chiropractic College; and a clinical presenter - WT , for the State of New York at Buffalo, School of Medicine and Biomedical Sciences for postdoctoral education, teaching MRI spine interpretation, spinal biomechanical engineering, and triaging trauma cases. He is also the president of the Academy of Chiropractic teaching doctors of chiropractic how to interface with the medical and legal communities (www.DoctorsPIProgram. com); teaches MRI interpretation and triaging trauma cases to doctors of all disciplines nationally; and studies trends in health care on a national scale. (www.TeachDoctors.com). He can be reached at DrMarkIfA cademyojChiropractie. com or at 631-786-4253.
Dr Bill Owens is presently in private practice in Buffalo and Rochester, New York and generates the majority of his new patient referrals directly from the primary care medical community. He is an associate adjunct professor at the State University of New York at Buffalo School of Medicine and Biomedical Sciences as well as the University of Bridgeport, College of Chiropractic and an adjunct professor of clinical sciences at Texas Chiropractic College. He also works directly with doctors of chiropractic to help them build relationships with medical providers in their community. He can be reached at dr owensIf academy of chiropractic, com, via www.mdreferralprogram.com, or at 716228-3847.
