This topic contains 9 replies, has 2 voices, and was last updated by Matthew Buffan January 12, 2019 at 5:36 pm.
December 17, 2018 at 9:02 am #2727
William Brady, DCParticipant
Ever since I started ID in 2006 I have semi-regularly been perceived as “bashing” other chiropractic techniques. I honestly see the data and perspective I provide as helpful technique critiques. Providers have very important and difficult decisions to make regarding where to spend your time and money- which techniques make the cut for you.
Example: I taught ART for 10 years. The lack of diagnosis (everything is adhesion and nothing is measured), the treatment shortcomings (rectus major and minor are treated as the same structure and involve cervical flexion, for example), the lack of predictable results and the huge amount of provider physical work (treat 15 structures) are points I regularly try to make. Should someone be considering ART vs. the ID system it is my duty to inform with detail. I lived and practiced strict ART for 5 years and wouldn’t want anyone to have to go through what I went through.
I can make similar arguments for any technique.
My point is this: How do I say there is a better, actually far superior, ways to diagnose, treat and communicate without the perception of technique bashing? I usually start with “Ok, tell me one point of fact you disagree with or can prove wrong with what I said?” No one has yet, but they are still upset with me (or with the reality that school and techniques ripped them off and are suffering from a little bit of shoot the messenger thinking).
The culture of chiropractic is “we can all do what we want, it all works.” Then I come along, counter culture, and say if two people disagree about a fact one or both of them are wrong. My mission is to have a system so complete and accurate that we get diagnostic agreement among providers! Then we can talk about treatment. Then we can talk about results.
Healthcare should be more like math than opinion based on training or provider preference. 2+2=4. If one group says it’s 3 and another says it’s 5 will it be painful for both of those groups to learn it’s 4? Yes.
My question for the group is: How do I lessen this pain?
This is a very important discussion for the future of our profession. Thank you for reminding me that I have more work to do.December 17, 2018 at 12:57 pm #3006
Scott King, DCParticipant
I wouldn’t spend a second mentioning the existence of other techniques. Instead, focus on combining the hypoxic pathway thesis with the tension on collagen studies to present people with something that actually has rock-solid scientific theory, and immense objective and empirical evidence laid out in dozens of ID providers clinics daily.December 17, 2018 at 3:38 pm #3007
Carl Nottoli, DCParticipant
In addition to Scott’s comments and something we chatted about at our instructor meeting:
Connect the research we use to the objectivity of the measurements we use. These aren’t arbitrary–and in my experience no one else measures with the focus we do, some don’t measure at all, and some measure extraneously.December 17, 2018 at 3:57 pm #3008
Adam Holen D.C.
I agree with Scotty, it’s more important to focus on what is ultimately going to change healthcare in the end than concern yourself with others feelings. Unfortunately, school (DC, PT, or MD) has created a core of indoctrination to a singular ideology. Whether that be medication, surgery, adjustments, e-stim, stretching, strengthening, etc. everyone has their view and experience to justify the means. As you said, if 2 people disagree on something, 1 or both of them is wrong. That doesn’t mean, however, that one or both will ever admit to being wrong. Does it suck to be considered someone who ‘bashes’ other trains of thought? Of course, but ultimately we’re talking about the difference in patients quality of life which, to me, their pain is worth making others uncomfortable.
There are ways to soften the blow of pointing out that someone is wrong or could stand to benefit from learning something new, which is what the other forum post is for (how to explain ID). Ultimately though, until ID is proven scientific knowledge, only those who are built for what ID entails will gravitate towards it. Everyone else will either scoff, be offended, or think they already do the “same” thing. There’s a reason hundreds/thousands of people have been exposed to ID and yet there are maybe 50 providers worldwide who get it and work their ass off to provide better care.
“Wrong does not cease to be wrong because the majority share in it.” You can only present people with the truth, how they react to that is not your concern.December 17, 2018 at 8:12 pm #3009
“My mission is to have a system so complete and accurate that we get diagnostic agreement among providers! Then we can talk about treatment. Then we can talk about results. “
This has been what i’ve been seeking for along time, and found with ID. To me this says to a patient, that you are on the “right path” now it’s just left to the skill set of the doctor. This is what most fear, is accepting that as doctors we can suck. It’s easier to cover it with a bunch of technique names that we are certified in and then we gain instant credit with the patient, and in some cases other doctors.
My response is a little different than the research approach, although I completely agree that is the big picture.
In the US Air Force, I used to be a medic, which is an 8-3:30 day, and you get full weekends off. I used to be concerned about how “cool” the Special Dude’s uniform looked. I remember asking friends, ” I wonder what goochie shit they have on their M4, or what the green radio was (Harris PRC/152), or blah blah….. after 9/11 I had a mission to get revenge. I x-trained and joined a different job. It put me in front and with a different group of people, all ranks, all services, with one shared goal in mind, to Maximize ALL US Military power to the enemy. Overtime I realized the uniform, the goochie gadgets, the rank, the titles, the etc… were not important. The Mission was. The outcome was, the minimizing collateral damage was. Therefore the big picture was the only important thing. didn’t matter environment, cold, rainy, hot, sunny, all those were just things that you went through to get the mission done. The goal was emptying an AF fighter jets complete ordinance, as fast, safe, and effective as possible. What a goal right! Once I was on the opposite end of the Air Force from where I started, and only then did it all click. That’s when I realized, wow this is the reason the Air Force exists and even more important, why all other AF jobs exist. You would think everyone in the that service would know, but they don’t, it’s only when you get the taste of the other end, and even then you still strive to be better.
ID is this. It is a serious group of people that have one goal in mind. I really dont think it is for everyone because you have to let go of many things along the way and that letting go is sometimes slow and can be fast. But the realization that your trading them for new, improved, polished, ideas. The goal of ID providers is to diagnose, treatment type is to safely and effectively achieve the highest result. Once you taste the other end of this field, only then will you appreciate it in full, and then continue to work harder.
The prospect doctors are out there and are doing all techniques. I’ve had many conversations in passing with other doctors, with me praising ID, only to have one say, ” yeah i do something similar.” Then I say, well you should at least look at the online material you might learn a more efficient way to do what “you already do.” I then let them know how I use/used several techniques, and ID, was the missing piece, that taught me how and when to use them better and more effectively. Realizing that only a few even care to be in that conversation by that point.
Locally I have several straight chiro’s, who sent me several patients. They send them as if it’s a step in between them and a PT, or Orthopedist. Really it’s because they know that I will take the time to assess them and give a thorough opinion for their problem. I feel this makes ID a specialty. A specialty is only going to appeal to a certain type of doctor, but I feel a young doctor if given the choice, would choose the “special” vs. the conventional.
This is where the recruitment key is. People are looking for better, more effective, more efficient ways to be successful, even when on the sidelines, doing straight Chiro or ART, they are looking, watching, and locally referring. The fact that ID is not at an Ironman or Marathon finish line, is appealing to a certain type of patient and doctor. Therefore the recruitment I feel must be slow and only pertain to a certain type of person. Not all are ready to be part of such an elite group. So, invitation only, is what i’m suggesting! jk. But damn near! Wait, I may not have been invited then!December 18, 2018 at 5:00 am #3010
I think it’s our psychology.
When we touch people’s discomfort or identity, walls go up and claws come out.
As soon as we do that, we LOSE the opportunity to touch that person.
I asked a spiritual teacher several years ago, “Why don’t monks or the Dalai Lama curse?” She said, “Their goal is to affect 100% (or as close as possible) of the population who is in the space. If they curse, arguably, 20% of them, are immediately triggered, clammed up, and lost.”
I still curse, but this has always stuck with me to be mindful of how I present myself.
I’ve been experiencing some pain recently at my own bashing of techniques on instagram that my current coach helped put a “period” at the end of this week. He told me he grew massively when he stopped having a “Me against the world approach”.
I can see how I’m probably turning people off by me being “elitist” and saying “This is better than everything else”.
My current goal is to have a powerful message for as many as people as possible that allows people the wiggle room of including therapies or techniques they perceive as having helped them. In sales, the masters say, “Agree with the prospect First. ‘Yes … AND X.'”
My recent mantra is “Speak softly, but carry a big stick.”December 18, 2018 at 2:14 pm #3011
If it all has to start with some common ground, and any good conversation should, I think it all starts with adhesion….
So many providers have no clue. If they still think your just inhibited…. its wasting time. It they just have a short leg… waste of time. Bone out of place, yup.
So until we can get people to recognize that adhesion is the real ultimate reason that we all degenerate too fast, become disabled too soon, and develop chronic pain, removing adhesion is just going to seem like another tool in the tool box that isn’t any different than what they already use.
It sucks that I cannot put ‘myofascial adhesion’ down as an ICD-10 code. It sucks there is ‘hidden research gems’ that are out there… but not mainstream.
As my chiropractic friends like to tell me, “Matt what you do works (soft tissue), but so does mine (CMT).”
I think adhesion becoming mainstream is the tipping point.January 8, 2019 at 7:04 pm #3013
Brandon Cohen DC, CSCSParticipant
I love this topic. This is another thing I wanted to put together before the end of the year, so I’ll try to bring the thread back a little bit.
One thing that I notice, and am guilty of, is that during live seminars there are many of us who regularly see each other and are friends and very familiar. This can lead to casual comments and jokes (I’m not sure who’s making jokes during seminars, but I’m sure they are out there) that might be received as bashing. I’ve been misunderstood before and will be again, but I think its worth being careful. I need to remember that because I know that KT tape is garbage, there might be others in the room who believe it has some merit and benefit and may use it on their patients. I went to a KT seminar in school. I did ART for 2 years longer than I should have, and it wasn’t until sharing my last seminar story with other ID providers did someone say, “Now you never have to do that again.” that I even considered not recertifying. I would hate to lose a provider who’s motivated to do best by their patients because I make a hilarious joke that is not well received. Emotions play a big part in many providers treatment decisions.
Dr. Brady doesn’t understand, because he’s the most rational person I’ve ever met, but most of us are very emotionally connected with our results and the way we get results. Its emotionally difficult to learn that what you thought was great may not be so. Why did I continue to adjust patients for years after starting ID? Patients expect it, I thought it was what people wanted, it provided an improved range of motion, it feels good to the patient, adjusting is fun. These are the reasons, and none of them are very good. When you only deal with facts things are easy, but I think the majority of people also consider their feelings and emotions (maybe more) in addition to the facts.
When talking with my children and getting them to make good decisions, I frequently use a technique that involves agreement. When my 4-year-old needs to clean up we talk about why cleanliness is important, or how there’s yoghurt on the other side of cleaning, or whatever it is. I think we can agree that most providers want to do the best thing for their patients, and would like to know that they are doing just that.
One way we know is by measuring objectively (I just read the other answers and see there is some consensus with this). Also, there are many people who are unwilling to admit they could make an improvement, and those people we will never convince.
Years ago, we talked about an Ultimate Fixing Championship, and while interesting to me and you, there’s not a wide TV audience for that kind of thing. It also puts an Us vs. Them dynamic which we don’t need.
ID has produced the greatest doctors I have ever seen. There are special people here, and it takes a special person to do it. It has turned my practice from a “general chiropractic practice” where I take anybody for anything into a specialized, “hard to fix chronic case practice, with exceptions.” I think one issue is that I didn’t know that’s what I wanted to be, nor what I was looking for when I found the group. I was just wanting to be a better doctor.January 8, 2019 at 7:18 pm #3014
Brandon Cohen DC, CSCSParticipant
I also agree with Matt, Adhesion is a big deal.
Every once in a while when I feel like screaming at a screen, I will watch youtube chiropractors. My wife loves it because I yell and mumble at the same time. Its the best. The point is several of them mention adhesions in passing. They will say things like “That will take care of all your adhesions” or something like that. The image is still that of adhesions not being a big deal. I know that what they are doing isn’t addressing the adhesion, but if what exists on youtube is any indication of how treatment visits look, most of our colleagues utilize a “kitchen sink” approach.
Ignoring the Pain Science crowd, how do we help people understand the magnitude of adhesion? I think the deep gluteal nerve and other videos are a good start.January 12, 2019 at 5:36 pm #3015
Great points in this post by everyone. This is a difficult concept for the average provider who runs on emotional reactions, takes things personally, is short sighted and generally ignorant of anything outside of their training. Whereas ID providers are open to look deep and do the work to improve.
I agree that the focus needs to be on ID’s core benefits. The simplicity of ID as a complete system and it’s principles have to be seen or felt to be believed. Showing the patient and provider’s results in pictures and people’s emotions. ID is different, details matter and we collect the most important details to guide decisions. Range of motion tests are measured and impact of adhesion is real. Accurate tissue specific diagnosis, no “-itis” or “-algia” are acceptable. Biomechanics are the reality of motion. Individual tissue and global applications of load and capacity. Taking the time(slow down) and responsibility to be the one to figure the diagnosis out by evaluating the outliers.
Highlight the flaws of a technique/ approach, without naming the technique (if possible) and only discuss how ID solves or accounts for that failure/ limitation.
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