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Billing One-on-One, Direct Patient Contact
This is often misunderstood and leads to trepidation when documenting and subsequently billing timed services.
News in Brief
NYCC Aggregates Degree Programs in New School; Palmer Chancellor Receives Education Award From ICA; Oklahaven Announces "Have a Heart" Winners.
Sleepless nights, anxiety, mood swings, euphoric energy bursts, obsessive thinking, and a strange feeling in his chest. That is what Matt was experiencing when he first entered my practice. Rather than being concerned, he was loving every minute of it.
With Low-Back Pain, Sometimes Little Things Matter
Typical treatments for low back pain involve large muscles like the quadratus lumborum, iliopsoas, and piriformis. However, there are situations when a very small muscle, the multifidus, can play a significant role in the diagnosis and treatment of low back muscular or spinal injury.
Billing Timed Services
Q: I do not always use physical medicine services but in my state I do have a scope of practice that allows me to provide many of these services. I am trying to understand what "direct one-on-one patient contact" means in relation to physical medicine services.
Holistic Skin Care and Modern Technology
Anti-aging is a concept that we hear in reference to skin rejuvenation and growing older on a daily basis. Aging begins as soon as we are born; therefore "pro-aging" is embracing all stages of life gracefully, with vitality, wisdom, joy, and gratitude as the goal.
The Need for Standards
ISO-TC-249: You may look at these letters and numbers and wonder what they are and what they might mean. They turn into: International Standards Organization- Technical Committee – 249. There is a global organization called The International Organization for Standardization.
Finger (Pad) Pointing: Repetitive-Use Injury Waiting to Happen
"My wrist and hand hurt. I spend all day working on computers and then I come home and spend more time on a computer, usually playing video games."
A Different Way of Looking at It
The way you and your chiropractic colleagues access information has changed over the past decade. According to a recent survey conducted by Dynamic Chiropractic, almost half (48 percent) of DCs read online articles on their personal computer or laptop daily.
Transforming Las Vegas
On a warm spring day in Las Vegas, Sonia Kim, clinic front desk staff, is busy preparing for a full day of intern shifts at Wongu Health Center. She greets patients, makes sure documents are properly signed, and lets the interns know that their patients have arrived.
Hip Flexor Contractures & LBP in Above-the-Knee Amputations
Patients with above-the-knee amputations (AK or AKA) are particularly prone to developing hip flexor contractures. Not to be confused with muscle tightness, contractures are a permanent shortening of tissues which cause deformity or distortion.
A Whole-Body Approach to Chronic Tension Headaches
Nearly every day in our practices, we see patients with chronic headaches that have not responded to traditional treatment. They present in our offices with a feeble hope that "maybe" a chiropractor can help.
Distal Style Treatment of Neurogenic Pain
Treat locally or distally? This question has frequented my thoughts for the treatment of pain throughout my acupuncture career. Each style has strengths and weaknesses, thus the versatile practitioner would do well to forgo dogmatic adherence to any one style in deference to the needs of the individual patient.
How to Reach Your World With the Chiropractic Message
My latest effort to share chiropractic occurred in mid-May while I was sitting at an introductory parent information night for high schoolers. The IT instructor informed us that each student would be receiving a computer for all their studies.
Constructing Our Reality, Part 2
My last article discussed perception and its relationship to the primary channels. Before we get to the channels most commonly used to treat sensory disturbances, the small intestine and triple heater, we should first talk about the bladder channel.
Low Fat vs. Low Carb & the Power of Protein
A science-based website recently posted a nice summary of 23 randomized, controlled trials from peer-reviewed journals pitting low-carb diets against low-fat diets.
In This Current Age of Anxiety
Anxiety, also referred to angst or hysteria, goes by many names. One, popularized by the sagacious Zhang Zhong Jing, who many practitioners of Chinese Medicine may be familiar with, is known as Restless Zang/Fu disorder.
Living Well: Lessons From Our Oldest Old
Aging is a significant public health problem, important to chiropractors in practice and important to DCs who teach students training to become chiropractors.
Streamline Your Front Desk
Your front office can be your greatest source of efficiency or it can be a constant bottleneck. Increasing the productivity of this area, while not sacrificing the quality of patient interaction, can be a little tricky. However, with some focused effort and intention, your front desk can keep your practice running smoothly.
Parker University Embraces New Era
Change is in the air at Parker University, which recently announced the selection of both a new president and a new consultant for its seminar program.
Prostate Cancer Risk
A large study published in January 2016 in the American Journal of Clinical Nutrition showed that men who are vegans had a 35% lower risk of developing prostate cancer compared to non-vegan men. The study followed more than 26,346 men who are part of the Adventists Health Study-2.
Building Bridges with Discipline
As practitioners of traditional Chinese herbal medicine, our role is to educate patients and medical practitioners about the various safety aspects of our medicine. Medical doctors that embrace Chinese medicine want to collaborate and include Chinese herbal medicine in more aspects of clinical care to support their patients.
Understanding Levels of Evidence
The concept of levels of evidence is a cornerstone of research literacy and a great starting point for understanding basic principles of how research works.
Discovery: Finding Insights and Each Other in Different Disciplines
Recently I've been thinking about all sorts of things which are hidden from our daily direct experience. That general category is what links nearly everything that catches my attention and then demands some kind of investigation.
Keeping Malpractice Allegations at Bay
It has been suggested that in the litigious environment in which we live, the practice of chiropractic should be defensive and practitioners should constantly be watching their backs. An element of defensive practice is a good idea.
June, 2006, Vol. 06, Issue 06
Truth: The Golden Thread, Part One
By John Upledger, DO, OMM
One element shared by all effective healing methods is the process of leading the patient through honest and truthful self-discovery. In my experience, this "Golden Thread" is necessary for the initiation and continuation of self-healing, because it is only through self-healing (as opposed to curing) that patients can experience both permanent recovery and spiritual growth.
Before exploring the issues of self-discovery and self-healing, let's examine the differences between healing and curing.Surprisingly, both words share essentially the same dictionary definitions: that of being a method or course of treatment that aims to restore health. Yet the definitions don't capture the implications the two words have in today's health care world.
Healing often refers to what is done by the patient or the patient's body to resolve a problem of the body, mind or spirit. Curing usually refers to what a physician or therapist does to the patient. Thus, we frequently speak of patients needing to heal themselves after a disease has been cured. Surgically removing the gallbladder, for instance, might cure the gallbladder disease. But the patient must then heal the wound and adapt to the organ's absence in order to achieve full digestive-system function.
The reason we need to clarify the difference between healing and curing is quite simple: Effective therapy, whatever its outer form, initiates, facilitates and supports the patient's own healing efforts; whereas the curing process provides a more temporary and perhaps only palliative effect. Although curing might remove the symptoms of a disease from the outside, so to speak, it usually leaves the underlying causes of the symptoms untouched.
For example, a physician might cure hemorrhoids by surgically removing them. However, if the hemorrhoids are secondary to liver congestion due to chronic alcohol abuse, the problem will not be healed until the patient resolves the underlying reason for the alcohol abuse. Perhaps it would even be better for the surgeon to leave the hemorrhoids intact to remind and motivate the patient to pay attention to the alcohol abuse. In this way, the real cause of the problem might be eradicated.
One of my friends, a general surgeon with more than 30 years of experience once confided to me that, in retrospect, he felt most of the surgeries he had performed might better be classified as excisions of the vocal apparatuses of his patients' inner selves. By removing certain organs or tissues, he believed he was eliminating the bodily voices that were trying to focus attention on the source problem.
Going back to our patient with the hemorrhoids, if they are removed, yet the alcohol abuse continues, the inner self has no choice but to select another organ as an attention-getter. The next target might be the gallbladder, which the surgeon might then need to remove because it becomes full of stones.
So, now we have a heavily drinking patient without hemorrhoids or a gallbladder who still has little or no idea why he's abusing alcohol. Perhaps he's using it to escape feelings of guilt one of his parents instilled in him when he was a child. Whatever the case, if the issue is left unexplored and the abuse continues, eventually the liver function will once again falter.
When such a case of deterioration continues, the inner voice of the body's wisdom will feel an increasingly urgent need to contact the patient's conscious mind. You might even see varicose veins develop in the esophagus. Now the situation is life-threatening, requiring internal medicine specialists and surgeons to co-manage the process. Once the veins are surgically dealt with, there might be little remaining that can be removed except the liver itself, in which case a transplant would be necessary. Usually, though, the internist must support the abused liver until death takes over.
Now, let's backtrack a bit. Somewhere along the line, a psychiatrist might have been called in to deal with the alcohol abuse. Or perhaps by now the patient is believed to be suicidal. In either case, most of the drugs prescribed by the psychiatrist will probably have both mind-altering and hepato-toxic (liver-poisoning) qualities. So the inner voice has even less of a chance to communicate with the drug-compromised mind about the reason for the alcohol abuse. And the liver function will be further impaired due to the toxic nature of the drugs.
What might we expect from such a scenario? Most likely, premature death. The cause would probably be recorded as liver failure due to alcohol abuse. But from our perspective, it might be just as accurate to say the patient died from a hemorrhoidectomy thoughtlessly performed without having searched for an underlying message. Or, we might consider the death due to the second excision of the inner voice that was attempting to speak through the gallbladder.
Becoming aware of this inner voice is what I mean by self-discovery that leads to self-healing. In the case I just outlined, treatment not only failed to make the patient aware of the inner voice, it ultimately suppressed it. This led to a self-perpetuating cycle of deterioration.
Short of a miracle, the process probably was irreversible once the varicose veins developed in the esophagus and the brain was numbed with mind-altering drugs. After all, what chance does the inner voice have against an onslaught of modern surgical technology and psychopharmacology?
Of course, a myriad of health approaches and philosophies have been created in response to the failure of traditional curative methods. Therapeutic massage, meditation, exercise, nutritional therapy, herbal therapy, homeopathy, acupuncture, manual medicine, rebirthing, counseling, primal scream, CranioSacral Therapy, SomatoEmotional Release and biofeedback, to name a few. Although outwardly different, each of these systems facilitates the self-discovery that leads to self-healing.
When considering how the process of self-discovery works, it's important to remember our self-image constantly is changing. It seems the closer our perception of self approaches the truth, the deeper becomes our capacity for self-healing. When there is a close correspondence between self-image and trust, our self-healing power may be virtually unlimited, capable of producing the "miracle cure."
That's why, as a therapist, your main responsibility is to help the patient develop a truer (more accurate) self-image. You must become an accurate reflecting mirror - a medium through which the patient's real self can be perceived more clearly. You must be an unbiased facilitator, understanding the patient's true self-image might not be compatible with your preconceived notion of the problem.
When you release any ego-based tendency you might have to engage in dogmatic symptom classification, you can become a clear, reflecting medium that ultimately permits no illusion, delusion, camouflage or facade. Then, and only then, can you and your patient both discover the truth.
As a facilitator, you also must not force too much perception of truth at one time. Otherwise, you run the risk that the patient will turn away from his own reflections. You must be a very sensitive mirror, reflecting only as much as the patient is able to deal with at any given moment. Still, you must reflect enough to prevent stagnation and keep the self-discovery process moving forward.
The art of therapy is in sensing how rapidly the process can move without turning the patient away, and in allowing the patient to make his own discoveries. This requires you to avoid suggestion and leading. It also involves connecting with the patient at a nonconscious level. The process of self-discovery might continue with or without words. I wish you well as you continue to weave the Golden Thread throughout your therapy.
Editor's Note: Part Two of "Truth: The Golden Thread" will appear in the July issue of Massage Today.
Click here for previous articles by John Upledger, DO, OMM.
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