Most Entire Treatment Plans Cost Less Than an MRI!!!!
A new patient came in to the office today after reading my blog. Not having insurance, he was a bit concerned about how much it would cost to be treated in our clinic. This is always a difficult question to answer because it depends on many factors, including the overall health of the patient, the severity of the condition, and so on.
As with every new patient, the first thing I did is a consultation, where I talk with the patient and get an initial idea of what’s going on. (We never charge for this, by the way, even if you have the best insurance plan available) During this consultation, the patient related to me that he had been to a medical clinic where they did x-rays. The x-rays showed “nothing,” (there’s a reason why nothing is in quotations — that discussion is destined to be the next blog) and the doctor wanted to do an MRI. If you don’t have insurance, an MRI of the lumbar spine is at least $1,000!
Obviously, my patient was concerned that I might want to send him for an MRI also.
After examining the patient, I found that his condition was significant, but definitely not so advanced that I would need an MRI scan to figure out what the problem was! I see cases just like his and much worse, as a matter of fact, and I can usually help them with out the aid of an EXPENSIVE MRI scan!!
Then I got to thinking . . . for the average patient in my office, the ENTIRE cost of their treatment plan is less expensive than one MRI scan!! A few plans are more, but most are even LESS!! And also, you must bear in mind that AN MRI DOES ABSOLUTELY NOTHING as far as getting you better. It’s just a picture which, more times than not, doesn’t show what’s going on any better than my bare hands or a plain, old fashioned, cheap x-ray! I know that’s hard to believe, but recent studies show that MRI findings correlate directly with pain findings only 5 – 10% of the time!
Ok, occasionally I send someone for an MRI. But truthfully, it’s very, very rare. When I send a patient for an MRI, it means that 1) After the patient’s initial examination, I think they may have a condition that may require surgery or other medical intervention that is not provided in our clinic, or 2) they are not responding to our treatment, and I’m truly worried that there is something potentially dangerous going on. For those cases, I’m very thankful for MRI technology.
So, here’s the take-home message: Most primary care providers aren’t that great at diagnosing and treating most spine and joint problems. Don’t get me wrong, I love primary care providers. I even married one!! If you are a diabetic with a new burning sensation in your foot, or you have severe hypertension, PLEASE don’t call my office! That’s not my area of expertise! But, if your back or neck keeps bothering you, or you keep having headaches (most of those are related to the neck — I’ll tell you if they’re not) . . . CALL ME!! Or, if you prefer, you can go to your PCP, PAY FOR AN MRI, try some pharmaceutical treatment which rarely works, and THEN call my office!!
I Want to be Your PCP . . . For Your Spine and Joints
The word chiropractic comes from two words, “chiro” means hands and “practic” is from the same root word as our modern word “to practice.” So, in short, a chiropractor primarily uses his or her hands as their main treatment “instruments.”
While your primary care physician’s chief focus is on your biochemistry, your chiropractic physician’s primary focus is on your biomechanics, that is, your frame and movement.
Chiropractors work on your spine and joints. Because the spine is made up of 24 separate bones with very intricate joints, it gets most of the attention in a chiropractic office. Furthermore, the spinal column contains your spinal cord, which keeps your brain in constant contact with the rest of your body. When the spinal joints fail to work properly, it can create a long list of problems. The chiropractor also diagnoses and treats problems with the feet, ankles, knees, hips, shoulders, ribs, elbows, wrists, and fingers.
The chiropractor can detect deficiencies in the position and function of the spine and joints and make corrections to these movement patterns through a series of “adjustments.”
Some spine and joint problems require other interventions. Your chiropractor will know exactly who to refer you to for the help you need, just as your primary care physician may refer you to a dermatologist for a suspicious-looking mold on your skin.
Think of the chiropractor as a PCP for your spine and joints!
A Message to “Do-It-Yourselfers”
I am a do-it-yourselfer. I try to do EVERYTHING! I don’t really think that’s the worst trait in the world. I think it’s OK to be a sort of McGuyver. I am learning, though, to sometimes just let a pro do it.
My wife and I recently purchased a house here in East Nashville that needed some work. We needed a new kitchen and we needed to update the entire main level of the house. My first instinct was to do it all myself, because I’m a pretty smart dude and I can figure it out. And I was right. If I really set my mind to it, I could design and install a whole kitchen. It would function well and probably even look decent.
After a month of pulling out old carpet, asbestos tile, and dilapidated kitchen cabinets, my wife and I made one of the best decisions we have ever made — let a pro design it, and let a pro build it. It was actually a difficult decision. Professionals are EXPENSIVE!!! AND I’M SMART!!! I CAN DO IT MYSELF!! (said the cheap-skate voices in my head).
Our designer interviewed us. I, being the visionary, told her what “we” were thinking, and she went to work. A few days later, she e-mailed me with these computerized drawings of our new kitchen. It was unbelievable! It was similar to what I had envisioned but so much better! And the colors she picked out for the entire house are just incredible!! I would have NEVER picked those colors or even known how to go about matching all these things based on how the light from a window hits a certain surface or how things look from certain vantage points where you can see several rooms at one time.
And we hired a contractor who unlike me, has built many kitchens. When I embark on any d.i.y. project, I spend more time driving to Lowes and Home Depot than I do actually working on the project! Well, my contractor knew exactly what to buy, and even carried all of the tools he needed WITH HIM (what a novel idea!).
So, I figure, it would take me at least a year to do what they accomplished in 3 months. My wife and I would live in a house with an unfinished kitchen for that long. And then, It would look like a normal, boring kitchen. And, the walls throughout the house would be boring.
BUT WE WOULD HAVE SAVED A LOT OF MONEY!!! Probably not! By the time I drove to Lowes and Home D about 5,000 times, ate out most of the time (no working kitchen), tore down and rebuilt things that didn’t fit . . . I’m sure we came out ahead financially.
So the question is, will I EVER pick out paint colors again? NO WAY!! Will I pay somebody handsome bucks to do it for me? YOU BETCHA!!
My area of expertise is the musculoskeletal system (spine and joints). So many people think that they can solve their own back problems. Example: “I don’t need no chiropractor, I can pop my own back.” OK, there, Mr. Expert! Why is your problem getting worse over time instead of better? Why do you feel the need to “pop” your back 25 times per day? Another example: “My back kills me, but it’s my mattress.” Further questioning reveals that they have been through 4 mattresses, some of them costing upward of $2,000, in the last year. OK, there, Mr. Expert!! Why does your back still hurt!! Maybe you should spend $10,000 on a mattress! Certainly THAT would solve your problem!! The truth is, an average treatment plan in our office NEVER crosses the $2,000 mark! In fact, it’s usually much less than that. Furthermore, Mr. Expert, if you leave the problem alone long enough for it to become a crisis, will it be any “cheaper” to address it then?
I can usually tell you in just a few minutes what your musculoskeletal problem is. I can usually help you with it. I know pretty quickly if it’s something I can’t help and I know where to refer you if that’s the case. I’ve worked on THOUSANDS of spines and joints! How many have you worked on?
So, don’t be afraid to hire an expert. There is a cost involved, but believe me, It’s worth it!!
Seven Years (Why I Became a Chiropractor)
Seven Years
Seven years. That’s how long I lived with lower back pain.
It started my senior year of high school in weightlifting class. I was a pretty small dude and I wanted to bulk up some. I worked very hard in that class and did bulk up a little bit, at the expense of my back.
The pain was in the left side of my rear-end and radiated to the back part of my thigh, all the way to the knee. Sitting was excruciating. Bending was very limited. Standing up after being seated was a 5-minute ordeal. I was moving like an old man and I was only in my early 20’s!
I went to a walk-in medical clinic. The doc prescribed a muscle relaxer. It didn’t help. I went back. He prescribed a narcotic pain-killer and gave me a page of back stretches to do (which I found nearly impossible to perform). The pain- killer made me feel great at least while I was on the painkiller. Maybe a little too great. I found myself well on my way to becoming a narcotic addict. I went back to the doc and asked him if I should go to a chiropractor to which he responded “absolutely not! Chiropractors paralyze people!” I took the advice of this misinformed doctor and just lived in pain.
My first run-in with a chiropractor took place at church. I had gone on a two-week tour of Israel and one of the other tourists was the wife of a chiropractor. She became like a second-mom. I started hanging out with this family after church and even went to their house for Easter dinner (in 2000). It was on that day that Dr. Don noticed that I was walking with a limp. He said “I bet you have pain in the left butt and it goes down the back of your thigh about to your knee. . .” I was flat-out impressed that someone could figure that out just by seeing me walk. He invited me to come “hang out” in his office and see what chiropractic was all about.
To my amazement, I didn’t see anybody get paralyzed! I heard no screams. In fact, people actually felt better immediately after treatment without being high on drugs!
I decided it was worth a try. On my first visit as a chiropractic patient, I was so impressed with this doctor! He did a series of orthopedic and neurological tests and a set of x-rays. He showed me exactly what was wrong and told me what it would take to get me feeling better.
After two weeks of chiropractic treatment I was a new man! I had nearly full, pain-free range of motion in my lower back. He found some things in my neck that weren’t working quite right either and got that taken care of. (I just thought it was normal to have a very stiff neck and not be able to turn my head after sitting in the car for about 30 minutes) I was sleeping better because I could turn in bed without pain.
This was also a point in my life where I really needed to make a career choice. I was a psychology major in college and was pretty sure I didn’t want to be a psychologist. I was interested in medicine, but not that impressed with how conventional medicine treated me and my condition. The logical choice, then, was to become a chiropractor. I finished up some pre-med requirements, and off to Logan University in St. Louis, where I graduated as a Doctor of Chiropractic just four years later!
I love doing what I do. Now I can tell people where they hurt just by watching them walk. Now I can alleviate most headache syndromes, help fathers and mothers regain their ability to lift their children into their arms again, get runners back in races, help students with tight necks and shoulders focus on their professors rather than on how to get comfortable . . . I could go on and on about how I’ve been able to change so many lives.
So when it comes down to it, I’m glad I had those seven years of pain. It was a great lesson. It taught me to truly sympathize with my patients. When I realized how quickly my problem could be alleviated, I was introduced to an excellent career!
The Real Deal
Chiropractic medicine has been around for just over 100 years. For most of that time, there has been no “hard scientific evidence” of its efficacy. Hard scientific evidence refers to university-based randomized controlled trials, the gold standard of determining the efficacy of any medical intervention. Most chiropractors could give a thousand examples of how they have helped patients. Most chiropractic patients could write a glowing testimonial about how chiropractic treatment “cured” their neck pain, back pain, etc. Without randomized controlled trials, however, the scientific community could easily write off this testimonial evidence as coincidence, placebo effect, quackery, voo-doo, and a host of other negative terms.
The last 10-12 years have seen many changes in this line of thinking. Hundreds of RCTs have been carried out offering volumes of information on the efficacy of spinal manipulation (the main treatment used by most chiropractors) on the treatment of a myriad of health problems. We now have hard scientific evidence that chiropractic treatment is great for some things, good for some things when combined with other therapies, inconclusive for some things, ineffective for some things, and makes some things worse — just like pharmacotherapy and surgery. We also have hard evidence that chiropractic treatment is superior to pharmacotherapy, surgery, and non-manipulative physical therapy for several conditions.
A brand-new literature review by Bronfort, et. al compiles and summarizes ten years worth of research on the efficacy of manual therapies. Manual therapies include chiropractic and osteopathic manipulation, physical therapy, and massage therapy. Here’s a link to the study: www.chiroandosteo.com/content/18/1/3
Here is the conclusion paragraph of the abstract:
Spinal manipulation/mobilization is effective in adults for: acute, subacute, and chronic low back pain; migraine and cervicogenic headache; cervicogenic dizziness; manipulation/mobilization is effective for several extremity joint conditions; and thoracic manipulation/mobilization is effective for acute/subacute neck pain. The evidence is inconclusive for cervical manipulation/mobilization alone for neck pain of any duration, and for manipulation/mobilization for mid back pain, sciatica, tension-type headache, coccydynia, temporomandibular joint disorders, fibromyalgia, premenstrual syndrome, and pneumonia in older adults. Spinal manipulation is not effective for asthma and dysmenorrhea when compared to sham manipulation, or for Stage 1 hypertension when added to an antihypertensive diet. In children, the evidence is inconclusive regarding the effectiveness for otitis media and enuresis, and it is not effective for infantile colic and asthma when compared to sham manipulation. (Bronfort et al. Chiropractic and Osteopathy 2010, 18:3)
This is well said and very clear. It seems to be consistent with my own experiences in practice. I am pleased to have such a well-written review with a bibliography of over 300 peer-reviewed journal articles to refer to. I encourage all who are interested to follow this link and read the article for themselves.
