April 2009

Maintenance care

by Ogi Ressel

I've had this on my mind for some time and after a few months of deliberation I've decided to let it rip!

I want to talk about the issue of "maintenance care" or just plain old "maintenance." This issue seems to be elevated to the level of a chiropractic sacrament by many. What is this exactly?

The vast majority of chiropractors across the globe schedule their patients (adults and kids) for their once-a-month maintenance adjustment (visit). And patients are sold on the idea that this monthly maintenance visit will then help prevent and allay many problems they'd be saddled with if they didn't follow this preventative measure.

Patients look joyously to the end of their "corrective" care and the start of their maintenance care. They've graduated, paid their dues. Their subluxations are corrected and are no more. Now, life begins!

So, patients are seen on a monthly basis because it's good for them -- that's the mantra. And most DCs are adamant about their patients following this protocol. It makes total sense, not only for the benefit of the patient, but also for the benefit of the doctor. Right?

Of course!

There's a financial benefit for the doctor in that he or she can count on and be certain of a steady income stream from maintenance patients. There are other benefits to the doctor as well. We all like to see our patients return and happy to see us. It's like a party. The ego boost is amazing! The office is busy, there's lots of energy, excitement, the sun is shining, skies are blue, and everything is wonderful, fabulous!

What about the benefit to the patient?

Now, that's a little more difficult to quantify, isn't it? They're getting great care from you, aren't they? And you're preventing all those future "nasties" from rearing their ugly heads, aren't you?

Well, aren't you?

Hmm... All of a sudden, your certainty has dropped a few notches, hasn't it?

Alright, let me ask you, are you really delivering what you promised? Are you truly able to prevent/allay a patient's future health problems with your monthly maintenance program?

Are you? Not so certain anymore? I understand completely.

I want you to know that I am not at all against maintenance care, although from the tone of this column you probably felt that I am.

But, here's the reality of maintenance from my perspective.

Most of us recommend to our patients that our monthly maintenance program is of great benefit and that it will prevent this and that from happening to them in the future. Before I retired to teach my program, I also recommended to my patients, a regularly timed wellness visit.

This is very difficult for me, but I am highly committed to the growth of our profession and so I must confront you with this reality. In essence, when most chiropractors place a patient on a monthly maintenance schedule, they're simply maintaining their problem -- but their symptoms are gone!

That's the reality. I'm sure I've just pushed a gazillion buttons. Yet, any way you slice and dice this, that is the reality.

Here's my reasoning.

First of all, research done by Tapio Vidman a number of years ago, tells us that a subluxation, once formed, will cause an inescapable degenerative progression if it's allowed to remain for any longer than two weeks. This means that a monthly maintenance visit to your office will absolutely ensure your patient will get worse over time.

And they'll confront you at some point in the future and ask you, point blank, why you've allowed them to get worse when they've paid you all their money over the last few years to prevent this problem and keep them healthy. And you'll begin to blabber something about "limitation of matter" -- just what patients want to hear.

Most doctors don't see their patients on an appropriate schedule of care in order to be able to really correct their subluxation pattern -- and it is a pattern. It's a neurological habit the body becomes accustomed to that most often starts in childhood (if you'd like more information on this, you're very welcome to write to me or call me).

Most doctors see a patient on a schedule they feel a patient will accept, one that's "reasonable," whatever that means. This translates into patients being placed on monthly maintenance once their symptoms are relieved -- nothing more -- although they're often told otherwise.

I can't tell you how many patients I've had in my office over my practice lifetime who were on a monthly maintenance schedule with their former doctor, when their examination revealed many problems they thought they no longer had. This isn't good, either for their health or your reputation.

Patients often need to be placed on a schedule of care that will actually cause their subluxation pattern to be broken. The schedule that many doctors use (for example: 3x/week for three weeks, then 2x/week for four weeks, and 1x/week for six weeks) will absolutely not do it.

So, I recommend that you see your patients on wellness care -- every two weeks at the very most, especially children, but only after their subluxation patterning is changed. The correction of subluxation patterning is most important in children.

And tell your patients the truth. Explain what you're doing, and give them the reasons why it's so important. They'll be with you totally, and money will never be an issue.

Now, get out there and be the doctor you were meant to be.

(Dr. Ogi Ressel, author, researcher, and an x-ray and pediatric specialist, teaches The Practice Evolution Program, the "fastest-growing coaching program on the planet." Visit online at www.practiceevolution.com and take the Practice Health Mini-Checkup. Dr. Ressel may be contacted by e-mail at drogi@practiceevolution.com or by calling 800-353-3082. Interested in receiving his weekly THOTS "on seeing tons of children and families in your practice?" Send him an e-mail and asked to be added to the list.)