ChiroView Presents - Back Pain Goes To School... (www.ChiroViewPresents.com) By: Sigmund Miller, DC I've been in practice since 1978. And yes I admit that my primary focus during the earlier years was on patients with chief complaints of neck, back and joint pain. At that time, I knew it made good business sense to market my services in a way that leveraged the general public's opinion as to what they believed I did as a chiropractor. Now before you get all crazy about my strategy, remember I said "what I did as a chiropractor", and not what you should do. Once patients were in my office and I was able to build a strong doctor-patient partnership, I could then introduce other ideas as to what chiropractic had to offer - ideas that would serve to improve the quality of their lives. Simple, yet I believed effective. Allow me a little latitude before moving on. In those previous sentences, I am referring to one of my "core" beliefs. That being I believe that my sole purpose as a chiropractor "was to improve the quality of my patient's life". I define a core belief in a way that "no matter what, no matter what the circumstance, no matter what the situation, one's core beliefs never change". Another of my core beliefs is, above all, to maintain the highest level of integrity, to be honest, and to always keep your promise, no matter what. I have several core beliefs, and whether I'm in a business relationship or just sitting around the dinner table with my 14 year-old triplets, my behavior, which reflects my core beliefs, never changes. Regarding my core belief in improving the quality of my patient's life, I found no better "long term" solution, then to introduce to them the concept of Back School. I had the good fortune of working with two wonderful chiropractors while at Palmer-West during the mid 1980's, Sandy Dutro, DC and Lindsey Wheeler, DC. We put together a Back School Program for chiropractors which was designed to better serve their patients. To this day, I believe the overall program to be extraordinary. For many years I had been involved presenting formal Back School Programs to my patients and to industry, such as Owens Corning. Most importantly I presented on weekends, to chiropractors 12- hours of information so they too could teach these same concepts to their patients. I reviewed the entire Back School format that included pre and post "obstacle course" evaluations, along with three formal 1-1 1/2 hour classes. Each Back School series of classes consisted of 10 participants. Back School classes are designed to present to patients basic concepts regarding ways to improve body mechanics, posture, and to initiate a program to increase flexibility and overall spinal stability. Most importantly, patients were required to actively participate in order to learn how to problem solve, what to do and what not to do, and how to go about it. Without active participation though, the program fails. Dr. Dutro, Dr. Wheeler and I developed more than 200 slides that would help explain and demonstrate the many ideas and concepts presented during all three Back School classes. We offered each participant a Back School workbook that supported each concept. If you can believe this, patients would even have to complete homework assignments before the next class. We were tough! Of interest, chiropractors in the community, along with other physicians and therapists referred their patients to attend our Back School. Other doctors that I trained to present the program reported similar experiences. The general Back School format was as follows: During the initial Back School visit involving an established patient, after consulting with them, they would then complete an "obstacle course" evaluation. An obstacle course assessment would allow me to establish a baseline score as to how they performed various activities such as pushing, pulling, lifting and side lifting, sleeping, sitting and standing from sitting, one and two-handed reaching, carrying, climbing, and many more. There were about 20 different activities. After getting proficient at performing the obstacle course evaluation, it took me less than 10 minutes to complete. I can't give away the slide program, but I can send you a copy of the obstacle course evaluation form. Just let me know and it can go out as an e-mail attachment. After patients complete the three classes, they would return in one- month follow-up to consult and repeat the obstacle course. The improvement in their overall body mechanics and posture was significant. Most importantly, many patients after mastering some of the more basic Back School concepts, were then able to better control their chronic pain. Or better yet, they learned more effective ways to avoid injury. Knowledge is power, but you already knew that, eh? It just came down to good common sense. Teach the patient, give them opportunity to be more in control, get them excited and motivated --- The outcome can be nothing but good! One final point. Back School allowed me to generate a significant revenue stream which, in my opinion, was well earned. For example, for pre and post obstacle course evaluations, I used code 99212 and charged $65 per session. If it was a new patient, then I used code 99203 or 99204. For each Back School class, code 97150 x 6 [15 minutes x 6 = 1 1/2 hours] was used and accompanied a fee of $75/class. Code 97150 was defined as "using therapeutic procedures in groups of two or more. Those procedures include therapeutic exercise and neuromuscular re-education. The cost for each participant to complete the entire program was $355 x 10 participants = $3550. I typically scheduled a group of 10 patients, once monthly, to complete the program. I trained many chiropractors who reported to me that they eventually had several series of programs running concurrently each month. I guess you could say they were really cooking! What I would like for you to walk away with from this broadcast is that there are many ways one can, as a chiropractor, improve the quality of their patient's life. I found nothing more rewarding then when a patient, who after completing Back School, would tell me straight up that "this really made a difference". That combining spinal adjustments, along with a back management training program, provided patients more long-term benefits, and an ability to return to more normal activities of daily living which resulted in an improvement in their quality of life. There you go - back again to one of my core beliefs, to improve the quality of one's life!