Dr. Lane Tells It All: About Chiropractic

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I am a chiropractor, or chiropractic physician as we like to be called these days. We are physicians as much as any other medical professional is a physician in that we attended fours years of medical school, took national board exams, and studied the exact same material for the first two years of school.
I want to be clear to all readers that you just read something important for your understanding of chiropractors – we have taken exactly the same coursework as an MD or DO for the first two years, as do dentists and podiatrists. It is in the next two years that coursework becomes more specific as to what your profession is going to concentrate on. For chiropractors it is the muscles and skeleton, otherwise known as the musculoskeletal system. We also study a great deal of neurology since the spinal cord that our work impacts on is an extension of the brain which is where all the healing of the body takes place.
When I was in school we added another word and we used it comfortably, that made it clear that we affected the neurology of the body as well, so we stated we were studying the neuromusculoskeletal system (NMS) but speaking only for myself I am not 100% comfortable that I always impact the neurology of the body as much as I know I impact the musculoskeletal system.
This is not to say that I don’t get incredible results on impacting the digestive system, adrenals, or urogenital systems of my patients. I just am not comfortable stating that I will always get those results if I promise them. If your chiropractor states he can do this (and is confident that he can) then I am fine with his confidence and maybe he can, I just prefer to stick to the results I know I will always get with the musculoskeletal system.
Before I opened my own office in December 2012, I worked in many offices of other chiropractors. All I can say is that I saw things that were both positive and negative about those operations and I learned from each of them about what I wanted to do in my own office when I opened it.
  1. I worked for a day in the office of a chiropractor, Dr. Def. I never finished the one day there because he had strict rules that I was not to actually talk to the patients. I was fine with this rule until I actually met the patients. These nice people were starved for information that Dr. Def should have been open about informing them about, concerning their condition and their treatment. The only image I can suggest to my readers were that the patients acted as if they had been held prisoner and wanted information about the outside world.
One patient had a issue in the cervical spine (neck) that the doctor, Dr. Def, had been “treating” for six weeks. First of all, no one should continue to have a cervical issue for six weeks that was not preceded by a trauma or other outside influence. I knew the procedure to do and suggested that the patient speak to Dr. Def about it.
What happened next was very telling about this doctor. Dr. Def called his office from his vacation in California within minutes, screamed at me about suing me and demanding all the information he could get about me so he could hunt me down and either kill me or sue me or both. He was raging and angry.
What was he angry about? His words, “if this patient leaves my office, are you going to pay me the $5, 000 he paid me for his treatment?” This patient was a cash plan patient and the doctor needed the patient’s neck to stay untreated and unrepaired until he used up all the money!
From what I could figure out, this doctor did only large cash plans for his patient, very little insurance money and made his patients “true believers” who could not hear any outside influences about their care so that he could keep them paying him!
Dr. Def planned retreats for his staff to keep them loyal and “on message”, he had his patients coming in the evenings for discussions of chiropractic philosophy, and many other marketing and branding ideas more from the books of Donald Trump than Liebenson or Hammer (authors of books on rehabilitation and soft tissue, respectively).
  1. Philiosophy was the heart of chiropractic for many years as it built itself up from a reviled profession that the authorities stated “practiced medicine without a license” (in the early days chiropractors were not licensed because no state would allow them to be licenced thereby guaranteeing that they could lock them up in jail for treating patients) that DCs used to distinguish themselves from other forms of medicine. Much of the philosophy was written by Bartlett Joshua Palmer, otherwise known as B.J. Palmer.
Dr. Palmer was a great man who launched the profession by sheer will, excellent marketing, and showmanship. It also helped that he invested early in radio and television and was able to subsidize the Palmer School through ownership of a few media stations.
Much of his philosophy is still taught in chiropractic schools and it rests around the concept of subluxations. The problem I have always had with the “subluxation model” is that I was informed that subluxations could not be seen, could not be detected, and were life-threatening. That sounded more like religion than medicine.
I worked in an office of a doctor, Dr. Add, who actually had patient hold his hands and prayed with them to have (a higher power) remove these subluxations from their bodies! All I can say is, I am not your spiritual leader, I am a doctor. I will help you whether you believe in the basis of my skills or not.
Except for the detection part, if you exchanged the word “subluxation” for “hypertension” it read the same for posters I saw growing up in the days before getting your blood pressure taken became a routine part of a medical check-up. “Hypertension is the silent killer” those posters would read and they were right – high blood pressure can impact on all organs of the body and that was real. My feeling about subluxations were not the same.
Just for the record, I only applied to one chiropractic college and I had no idea about philosophy when I went there but my school taught philosophy only so you knew enough for the exam but we did not stress it as the basis for the conditions we treated. While I am sure that failure to acknowledge the subluxation model was probably grounds for expulsion at some chiropractic colleges, at UBCC we were science- and evidence-based and subluxations did not have a basis in anything provable. Sure, we had students who openly espoused a belief in subluxations but the school neither supported or condemned them for their ideas.
Now read what I just wrote, “belief”, “ideas” does that sound like… faith and religion? B.J. Palmer needed fervent believers to stress the good things chiropractors could do so he was keen on getting his patients, followers and acolytes to see chiropractic medicine as a belief system that could improve their health.
It was good for the time, good for the growth of the profession, and good for the patients at that time but those days are over. It is the modern world and many of us already have a religion we ascribe to so we don’t need a chiropractor to demand our faith in him as the sole road to health and wellness.  We just need to get that back pain, should pain, or neck pain resolved.
This was why Dr. Def was so scared of me talking to his patients – he needed them to remain ignorant and faithful so he could frighten them into supporting him and his lifestyle.  While I am sure that he truly believed in what he was proselytizing, he was taking an approach that was detrimental to the profession of chiropractic medicine. We are a field of medicine, not religion.
Yes, this is a profession, not a religion. We treat you until you get better not until you  “see the light.”
  1. Now, about the myth of “once you see a chiropractor you need to see them forever.” This idea has to end here. If your doctor tries to prove to you that your condition has to be seen forever because you can never get better without three times a week for the rest of your life, find another doctor.
There are conditions that arise from trauma that take many weeks to resolve, there are chronic conditions that need to be stopped and alignment corrected to improve but routine problems need routine care of a limited timeframe.
One thing for certain, the patient need to be informed of (a) what their problem is, (b) what need to happen for improvement to occur, (c) where the patient themselves are part of the resolution of the problem (my patients are given exercises and stretches to do between visits that are uniquely designed for them after a few visits with me – just enough time for me to see their capabilities and limitations as well as what they can do unsupervised), (d) how much improvement can be expected.
In my office at Chiropractic Lane, many of my patients start to see me for a musculoskeletal problem, that problem is resolved, and they stay for other issues without my demanding it. An honest relationship with your patient often results in their desire to continue treatment as other issues arise! I have a patient who’s musculoskeletal issue was resolved and he continues because my care has improved his digestion (as much as I will not state emphatically that chiropractic will always help neurological issues, I am well aware that it can do just that).
  1. One of the issues that chiropractors face is how much the profession has changed in the last 30 years. Many of the modern techniques and science and evidence-based ideas didn’t exist back in the 1980s when the subluxation-based philosophy dominated the education. Getting the patients to believe in chiropractic had more to do with finding a way to link chiropractic to their core faith in something else and less to do with actual research or adjustment-based skills.
In addition, health insurance was more liberal in the 1980s and payment was based on scant notes, called “travel cards.” When I look at these cards today I have trouble understanding how any doctor could prove his treatment was necessary when there is not more than 10 words, usually illegible, on a card and in a code only he knew or understood.
Today, I am required to write volumes of notes explaining everything I do, why I do it, and what the expected outcome will be. Every patient, every visit. If something is not working after a few visits, I need to re-diagnose and try other treatments until the expected result is reached. This was not expected back in the 1980s.
No good notes, liberal payments from insurers, no co-pays (the amount the patient is expected to pay at each visit because they have insurance), no deductible (the amount the patient must pay to the doctor even if they have insurance before the insurance will pay for anything. These can be as small as $100 or as much as $5,000). Chiropractors call this “the Mercedes 80s.” This was not unique to chiropractors, all medicine had this time of great earnings.

NEW 8/12/2013: The oddest experience I ever had working in a chiropractic office was for Dr. Peter.  I took this job because it was walking distance from my new apartment, where I lived with my girlfriend.  First of all, this was an office devoted to auto accidents so he had about 65-100 patient coming through there a day, so 5 minutes was all I was allowed.

Next, he had the office on close-circuit TV so he could watch us all in the office even when he wasn’t there.  He also had the office miked, so he could listen to us all as well.

I was assigned room 1, where he had a camera on me, as well as a one-way mirror into his office, as well as having me watched by the woman who sat at the front desk which was in from of my (always open) door.

I lasted there until I inadvertently made him angry: we had made arrangements for me to be paid each day of my work, all day Monday through Friday and four hours on Saturday.

When I got my first paycheck I saw that my pay for Saturday pay was missing!  When I inquired about this he became furious!  It seems that his arrangement with any doctor who worked for him was that he paid them for 5 days a week and the “gave him” Saturday for free!  I was expected to work for free on Saturdays in order to be (badly) paid for Monday through Friday!

I estimated that this office made about 3.5 million dollars a year and the owner earned about $1M personally, but he expected his staff of doctors to work for him for free!  

He fired me after I insisted on being paid for Saturdays.
To be fair to chiropractors they were not the big moneymakers back in the 1980s, medical doctors back then often owned the labs that did the blood analysis or the MRI that they sent the patient to, ensuring that their referrals to their other businesses made them more money, whether that lab work or objective test was necessary for the patient’s care. In my opinion, this was much worse for patients since many of these tests may have been both expensive and unnecessary and possibly harmful to the patient.
Those days are over but I still have many chiropractic colleagues who are certain that if they wait long enough, those days will come back. Instead of downsizing their offices, or finding specific areas to concentrate their practices on, they continue to have oversized offices with equipment that they don’t use and staff that are underutilized.
If you ever meet my patients, they will inform you that I have a small office where
every inch is used for patient treatment and care. Staffing is minimal and the time
I spend with them on their issues is quite long, upwards to 45 minutes per visit.

  1. If your chiropractor is spending less than five minutes with you, passing all the care off to other staff, and seeming to be in a hurry when they are with you, just find another doctor. You pay for his care, not a staff person who doesn’t understand your problem or even have a medical background! Wearing scrubs doesn’t make them a medical  professional any more than wearing a habit make someone a nun!

    I worked in the office of Dr. Piddy who didn’t even bother to see any patients!  After 30+ years he passed all the work to anyone but himself.  Patients came for his services and didn’t get them!  I saw those patients and when I left the patients tried to follow me (which would be expected since they had reason to stay with him).  Dr. Piddy sued me to get “his” patients back!  We reached an agreement about that issue which will allow those patients to see me after November 30 of this year.

    6. On the issue of attire, I personally can’t see wearing a tie on the job since my work with my patients involves a great deal of manual treatment, getting on the ground, and bending over them – all actions where a tie would be in the way. As any doctor will tell you, a tie is a reservoir for bacteria and viruses that you can spread from one patient to another so that is a pretty good argument not to wear them.

    7. When it comes to new graduates versus older doctors, or education versus seniority, this is a personal choice that every patient must make for themselves. There is no right answer except for your opinion about these: do you like this doctor, do you trust this doctor, do you think he can help you? Younger doctors may have more insight on techniques since they just finished learning all the latest ideas, but an older doctor has probably seen your kind of case before, and your body type before. There is no way that a student can see as many patients or conditions in as many ages and body types while they are in school as an experienced doctor can see in practice.

    8. Up to this point I have written about my own profession. What may appear to be a bashing from an insider, it is, in my opinion, a series of reasonable thoughts about a profession I love. I view each patient as a challenge to my skills that can only be met through a cooperation between us to reach a resolution of their complaint.
Good results in chiropractic care can only be reached through an active patient who cooperates in their own care, not through a belief in philosophy does not have anything to do with their care. Real medicine works whether the patient believes in it or not.

9) This brings up a problem in medicine in general. All doctors, chiropractic, allopathic (MD) or osteopathic (DO) have been told they must be all things to all people. Simply, this is neither possible or true. MDs cannot resolve back or neck pain as easily as a chiropractor. They typically resort to the only things they know: pills or surgery. That is their training.

A chiropractor cannot get parasites out of your body, fix a broken bone, remove your appendix, or cure your glaucoma. MDs practice the kind of medicine that can do this and we should all trust them to do this.

In addition, I cannot remove your bunions or remove toenail fungus, please go to a podiatrist. Your MD will give you powerful drugs for toenail fungus that involve monitoring of your liver because of how dangerous those drugs could potentially be for you. Feet are what podiatrists do so put your feet in their hands (a little foot joke there)!

Still, please be aware of what medicine really is: a trained professional trying to restore your body to a state where it can take care of itself, like most people were designed to do from birth.  For some of us, care will be short-term, and for others it may have to be for the rest of their life. Your body is designed to work with minimal interference.

10) By now you have come to understand that of any medical profession, chiropractic has come the furthest in the shortest period of time. Your modern chiropractor is very well-trained, licensed by your state and tested nationally so all DCs have proved that they can be your treatment of choice for all your musculoskeletal needs. We use proven ideas that allow your body to heal with the least amount of outside materials or influences.

Any medical professional you allow to treat you is an individual and in that respect they are different people. You should be pleased with your care or leave that doctor and find someone better for you.

If something is not right for you when this doctor treats you, or the staff is not right for you, please talk to your doctor. If it never gets resolved, go somewhere else. There are too many good practitioners of all professions for you to feel trapped by a bad one.

As always, I welcome all new patients at 290 Ferry Street in Newark, NJ and I hope this essay will show you that I care. At Chiropractic Lane will always be good, professional, and we encourage constant communication between us as we work through your problems.

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