March 2004

The model office

by Dr. Jeffrey Shay

Recently, I was reading an article in one of our chiropractic publications discussing designs for chiropractic offices. The article concerned itself with the proper number of treatment rooms, design of the business office, examination rooms, x‑ray and dark room, and reception room (not a waiting room, mind you; we don't want the patients to think that they're waiting for anything). The story rambled on about proper facilities for handling paperwork and some musings about the importance of a professional and business‑like appearance.

Well, perhaps. But it got me thinking about visits I made to other offices in recent weeks, comparing their office decor to my own place of business.

I recently made an appearance in my dentist's office, courtesy of a lower molar I broke in half while eating a mushroom pizza (don't ask, I don't understand it either). While waiting for my turn in the barrel, I listened to him happily drilling in the next room, and imagined that I saw the lights dim.

The furnishings were fairly stark, with only by some chairs opposite the front desk and a table with several periodicals, including a golf magazine and the local newspaper which was fashionably a day old. It wasn't too bad overall, but not a particularly friendly environment. The dentist himself isn't a bad guy ‑‑ he always does a good job and laughs at my dental jokes. His reception area, however, is a bit cold and forbidding. His secretary is only interested in asking if you're going to come back for more, and not interested in my analysis of the Packers game (probably a Bears fan).

Two weeks ago, I drove a family member to a dermatology practice in the Quad Cities. Those who attended Palmer know that "Quad Cities" is a term referring to the four cities surrounding the Fountainhead. In this case, the office is in Rock Island, also referred to as "Little Chicago" for its ambience, gaiety, and late drinking hours.

I had to sit for nearly an hour in this doctor's reception area. It was even more barren than the dentist's office, and more forbidding. The room was fairly large and empty, with only some chairs and a few magazines on a table, which were uniformly awful, consisting of three different publications devoted almost entirely to J‑Lo and Ben and two issues of Rolling Stone.

There was a television in the waiting room tuned to Judge Judy. I had always been able to avoid exposure to this show before. After viewing the whole program I could see the value of assembling firing squads for everyone in the courtroom. I suppose the doctor was catering to his base audience ‑‑ namely the face‑lift and tuck crowd ‑‑ but for anyone else this looked like the waiting area for the Inquisition. The other chairs gradually filled with his female clientele ‑‑ in skin‑tight slacks, with tattoos, and sporting makeup that had to have been applied with a paint sprayer.

The front desk was set off by a glass window consisting of mostly empty space, except for a filing cabinet and a few empty counters. Everything was painted white, and looked suspiciously like the final scene from "2001: A Space Odyssey." The tables behind the glass were all large and empty, reminding me of all the good times I had in gross anatomy at Palmer, except here all of the bodies were sitting up. Frankly, I was glad to hit the pavement just to put some distance between me and his office staff, who were dressed in mandatory white smocks. All in all, there was all the ambience of the CDC in Atlanta.

Which brings me to my own office. We have a fairly large office nowadays, with adequate treatment rooms, an x‑ray area, etc. The building is certainly nicer than our old office.

Until 1979, our office was the lower floor of an old residence. When my father moved into the building in 1961 the neighborhood was respectable and safe, but things change. By the time we moved into our new digs the area had aged and regressed. Even the building was getting hard to keep up. One day I opened the door to the dark room and it fell off and hit me over the head. The week before that, a large bat flew into the waiting room and chased a couple of the patients down the hall screaming something about rabies. Also, the new tenants upstairs put a potted plant in the window, a real potted plant ‑‑ marijuana. The police never noticed it for a week, even though the station was just across the alley. So, it was time to move.

Our new office is up the street out of the war zone and only a block from the hospital. In fact, the hospital tried to block our office construction with the argument that the area was only zoned for health clinics, while chiropractors were just a business.

My reception room has a picture of D.D. giving the first adjustment, as well as portraits of B.J. and D.D. (the Founder and Developer, if you will). My father, on the other hand, doesn't care for a few other design improvements that I made, especially the train clock with a whistle that goes off on top of each hour. Also on his list of dislikes is the framed picture of dogs playing poker in one of the treatment rooms.

Actually, the patients complained when the batteries "disappeared" from the train clock (I am following several clues for the culprit's identity). It made the office a little more interesting. Other chiropractors I know have done similar things. One D.C. in town is a big fishing enthusiast, and has a big hammerhead shark mounted in his waiting room. A friend of mine in Wisconsin had more of a baseball motif.

All this means that chiropractic offices are more human. One patient told me that his 10‑year old likes my office because it doesn't look like the medical offices that he is afraid of. The human touch in many offices is one of the good things about this profession. A chiropractic office is not just another place to have a blood test and a finger wave.

Comment

A note about the recent vote on the direct access issue for veterans. The majority of the chiropractic members of the Department of Veterans Affairs voted to recommend that chiropractic care not be made available to veterans by direct access. This means that chiropractic care will only by available by medical referral.

Voting against direct access were the medical members of the committee, a member of a "chiropractic medicine" splinter group, and three members of the ACA. The medical people I understand, although I may not like their attitude. The guy from the splinter group I look upon as a quisling (we have enough of them in our profession). As for the ACA guys, I just don't get it.

I'm aware of the argument, that ostensibly the VA is a primary care (PCP) model, and we just have to be team players. I'm aware of it, but I just don't buy it. Does anyone really foresee a scenario where these guys compete to see who can make the most chiropractic referrals? Opting for a referral system in this case is like agreeing to shine someone's boots so they can give you a swift kick.

After 26 years in practice, I am still waiting for my first direct referral. I have had a handful of cases where an M.D. suggested that a patient try a chiropractor after unsuccessful medical care. This was hardly a ringing endorsement, since the doctor also said that he would deny his "referral" if necessary, since he had to work with other medical professionals.

I really don't like to get political about issues like this, and I don't necessarily disagree with ACA all the time, being an ex‑member. But this vote does no service to our profession and smacks of trying to "get along" with the big guys. The issue reminds me of how hard the hospital fought to keep our clinic off of "their" street, and of times when I referred patients to a specialist for a second opinion, only to have them told that they would not be seen at the medical clinic if they persisted in seeing chiropractors.

Maybe that's my problem ‑‑ too many memories. If my memories aren't bad enough, what about the older chiropractors who were jailed for adjusting patients (it even happened to D.D. himself), or refused business loans and generally ostracized because of their profession? They probably have a long memory too. Maybe the ACA members who voted just haven't had these experiences. Maybe they've spent their quality time under a rock. Maybe the party line is just too easy to follow.

Voting for direct chiropractic access were the delegates from ICA and WCA. All of us owe a debt of gratitude to these organizations for at least standing up for the profession, and a personal thanks to Dr. Leona Fischer (WCA) and Dr. Michael McLean (ICA). If nothing else, this makes me proud to be a member of the World Chiropractic Alliance. If you don't see any other reason to join WCA, this issue would be enough.

(Dr. Jeffrey Shay, a graduate of Palmer College of Chiropractic and the WCA's 1996 "Chiropractor of the Year," is the World Chiropractic Alliance Director of Insurance Relations. He welcomes comments or questions regarding any insurance‑related subject appearing in this column. Dr. Shay is available to speak to your state or local organization. Contact him at 1300 Cedar St., Muscatine, IA 52761, or the WCA offices, FAX 480/732‑9313.)