E.R. D.C.

65898_emergency_room[originally published in KCN, November 2002]

They say that the popular television drama “ER” is based on actual Emergency Room experiences.  That’s probably why it  seems so realistic and has allowed the show to remain at the top of the ratings.  So don’t be surprised if they write in a part for a chiropractor to stand alongside of Noah Wyle.  Well, actually, I would be very surprised.  But it’s not as far fetched as it sounds.  It’s happening everyday at Meadowlands Hospital Medical Center in Secaucus, New Jersey.

For two years now, chiropractors have been working on an “on call” basis in the Emergency Department of this New Jersey hospital.  Patients that are brought into the ER with neck or back pain are first seen by the attending medical doctor, as they usually would be.  Necessary diagnostic tests are ordered to determine the extent of the problem — ruling out serious pathology, fracture, neurological deficit, etc.  Sometimes the expertise of orthopedists, neurologists, or neurosurgeons are called in.  But when no serious pathology is identified, the standard regimen has been to send the patient home with prescriptions.  Sometimes this helps — but unfortunately, sometimes it does not.  And when it doesn’t, both patient and doctor alike don’t feel very well.   With the “chiropractor-on-call” program, however, the emergency room physician at Meadowlands Hospital Medical Center now has the option of picking up the phone to bring a chiropractor in for a consultation — an effort that may bring his patient  the additional relief they are looking for.

In a recent article in one of our chiropractic publications, Dynamic Chiropractic, John Cerf, D.C., the hospital’s Chief for the Department of Chiropractic,  reported that the idea came about in an effort to satisfy a mandate passed down from the Joint Commission on Hospital Accreditation to better address pain management.  In their effort to satisfy this mandate, they have found that ultimately it is the patient that ends up satisfied.  Dr. Cerf recounted such a case of when a gentleman was brought in for a  back injury.  The man was experiencing lower back pain with tingling in his left leg down to his foot.  Apparently he had lifted a heavy airplane tire at work.  The incident quickly found him flat on his back of the cement-floored airplane hanger.  Realizing, after four hours, that he was not going to be able to get up off the ground, his coworkers called an ambulance.

After evaluation and x-rays, the E.R. doctor injected him with the medications Toradol and Flexeril to reduce his pain and muscle spasm.  Due to his persistent inability to move, a shot of Demerol, a narcotic analgesic, was given.  When it was clear that none of this was working, the E.R. doc grabbed the phone and paged the chiropractor on call.

As we wait for chiropractor John Cerf to respond to the page, I would like to take a time out and fill you in on a little background.  I sense many reading this article might be a bit confused — thinking that chiropractors and hospitals have about as much affinity for each other as a stream of water on a freshly waxed automobile.  While integrating chiropractic services in the emergency room setting is a relatively new concept to my knowledge, chiropractic’s involvement in the hospital setting is not.

For well over a decade now, more and more hospitals have been adding chiropractic departments to their arsenal of healing agents to better serve their clientele, while adding a much needed additional income stream to the ever challenging health care financial game.  A survey of 240 hospital chiefs, taken back in 2000, found that 16% were planning on implementing chiropractic in their hospitals within the next 12 months. And a 1990 report by the Wisconsin Hospital Association told of a Detroit hospital that realized a nearly five-fold increase in outpatient  revenues within two years after adding 14 chiropractors to their staff.  This is interesting when you stop to consider that it wasn’t too long ago that hospitals wanted nothing to do with chiropractors.  This sentiment was clearly spelled out in a 1983 policy regarding chiropractic from Central Dupage Hospital.  Their policy stated that because  chiropractic’s theory and treatment was “philosophically incompatible” with the type of medicine they practiced,  allowing chiropractors access to their diagnostic and treatment facilities “could create confusion in the minds of patients” and thus result in “suboptimal patient care.”

Nowadays, interested chiropractors are actually gaining staffing privileges at hospitals and are able to admit patients — usually in conjunction with an M.D.  While policies most likely differ amongst hospitals, at one hospital the chiropractor will “co-admit” their patient in need of hospitalization with a medical doctor.  If the patient is suffering from a medically recognized chiropractic condition, such as back pain, the chiropractor will call the shots.  If, on the other hand, the patient is admitted for a non-chiropractic complaint, the medical doctor will be in charge of the case, but the chiropractor will still be able to see his patient and provided necessary adjustments and treatment.

Chiropractors and medical doctors have also been teaming up over the past decade to provide a specialized surgical procedure known as “manipulation under anthesthesia” (MUA).  George Ronald Austin, D.C., Ph.D., director of chiropractic at Coast Plaza Doctors Hospital in Norwalk, California, reported that MUA is a technique that is designed to help patients who have chronic neck or back pain with little or no pathology by combining “the best of chiropractic and surgical care in one simple procedure.”

“Using the manipulation expertise of the chiropractor, the MD’s knowledge of the operative setting, and the anesthesiologist’s ability to anesthetize and monitor the patient’s vital signs,” Dr. Austin explained,  “MUA has opened a niche for those patients beyond the help of traditional chiropractic or allopathic medicine….  In the procedure, the patient is anesthetized (totally unconscious) making it easy for the chiropractor to perform the necessary stretching and manipulations needed to restore function. The procedure lasts about 15 minutes or less. Many medical practitioners, who might have once been wary about working with chiropractors, are now comfortable with both the procedure and their new colleagues. Many have developed a new respect for the chiropractors after collaborating on some difficult cases.”

According to Dr. Austin, “The number of patients who respond favorably to MUA is high. Institutions which pioneered the technique report that 90 percent of the patients who have undergone the procedure report an improvement — some of major significance — in their conditions.”

We are also seeing more teaching hospitals teaming up with chiropractic colleges to give chiropractic interns the opportunity to rotate through Grand Rounds and surgical settings — not so they can become pseudo medical doctors, but so they can gain an appreciation for what the other profession is capable of doing. (Incidentally, I was in the first group of chiropractic students from my college to participate in such a hospital rotation during my internship in 1995.)  In much the same way, we are seeing chiropractors being asked to lecture in medical schools.

In an attempt to do this “chiropractic and hospitals” article justice, there is a bit of chiro trivia that I should mention.  Back in the 1930’s and 40’s, the chiropractic profession owned and operated a number of “chiropractic hospitals.”  It seems contradictory, but back then, broad practice rights existed which saw some chiropractors practicing minor surgery, obstetrics, and orthopedic procedures such as casting and splinting.  Some chiropractors even “specialized” in gynecology and proctology.  Interestingly, while state scope of practice laws now prohibit us from doing these procedures, even today, chiropractors in the state of Oregon technically still can do most of these things with additional postgraduate training — although you’d be hard-pressed to find one that does.

The largest, and probably most well-known, chiropractic hospital was the Spears Chiropractic Hospital in Denver, Colorado.  With 600 beds, this particular chiropractic hospital had a commitment to “natural healing” and provided neither drugs nor surgery.  This chiropractic hospital, like the others, provided chiropractic students a chance to increase the breadth of their classroom experience through internships.  The Spears Chiropractic Hospital was very popular too.   According to a chiropractic history text, one former chiropractic intern recalled that “there were so many patients that they occupied beds in the halls….  The pediatrics ward always had a waiting list.”  The Spears Chiropractic Hospital, unlike the others, survived for quite some time, finally shutting its doors in 1984.

Let’s return now to the emergency room of Meadowlands Hospital Medical Center.

Dr. Cerf arrived, and consulted with the attending medical physician.  He then reviewed the chart and x-rays.  After meeting with the patient, who still was unable to move, the chiropractor performed a thorough history and examination.  He recalled that while it was rare for him to see a patient in this much pain in his office, this particular case was a good example of a “minor injury”  — albeit with a lot of pain — by emergency department standards.

Having determined that chiropractic care was both safe and warranted in this case, Dr. Cerf proceeded to begin his treatment.  Electrical muscle stimulation was first applied  to the lower back to help reduce pain and muscle spasm — supplementing the effects of the medications already given and to ultimately prepare the patient for the chiropractic adjustment.  A side-posture chiropractic adjustment was then given to the patient.  Following the treatment, Dr. Cerf stated the patient appeared “surprised,” in that his pain had lessened significantly and the sensation in his left leg was gone.  The patient was then able to get out of bed, dress himself, and be discharged from the hospital.  On his way out, he stopped by the nurse’s station.  They were equally surprised to see him leave under his own power.

“Not only had the patient improved,” Dr. Cerf emphasized, “but the improvement was witnessed by our medical counterparts.”

Dr. Austin, from the hospital in Norwalk, California,  feels this is a key element in bridging the communication gap that exists between M.D.’s and D.C.’s.   The fact is, as Dr. Austin reported in an article, our medical counterparts have  “little or no understanding of what chiropractic can and cannot do.  If anything, they believe it can contribute nothing of true or lasting value.”  By using the avenue of the hospitals, Dr. Austin maintained that not only can we explain, but “we can show what we do and why.”

It’s always nice to see health care professionals from different disciplines (and sometimes philosophies) come together on common ground — pushing egos aside — to achieve the shared goal of helping the patient. …. I don’t know — being that chiropractic and medicine will probably always maintain a certain amount of health care sibling rivalry, the television writers for “E.R” might want to really run with the idea of adding a D.C. to their lineup.  It might make for some pretty exciting television!

__________

sources used for this article:
Austin.  Chiropractic and Hospitals — part I.  Dynamic Chiropractic.  12 (21). 1994.
Austin.  Chiropractic and Hospitals — part II.  Dynamic Chiropractic.  12 (23). 1994.
Central Dupage Hospital.  Policy Regarding Doctors of Chiropractic.  Dynamic Chiropractic.  8 (2). 1990.
Cerf.  Emergency room chiropractor.  Dynamic Chiropractic.  20 (21). 2002.
Doctors’ hospital of Stanten Island opens chiropractic division. Dynamic Chiropractic.  15 (9). 1997.
The future of chiropractic in hospitals: survey of hospital chiefs on alternative care.  Dynamic Chiropractic. 18 (19).  2000.
Mills.  The proliferation of MUA programs.  Dynamic Chiropractic.  10 (26). 1992.
New Jersey hospital is first in state to bring dcs on staff.  Dynamic Chiropractic. 13 (11). 1995.
Peterson and Wiese. Chiropractic:  An illustrated history.  Mosby-Year Book Inc. St. Louis.  1995.
U. of Colorado is 1st American medical school to offer rotations to chiropractic residents. Dynamic             Chiropractic.  14 (4).  1996.
What hospitals are saying about chiropractic.  Dynamic Chiropractic.  8 (3). 1990.
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