Lost A Sale, But Initial Phone Consultations — A Big Part Of Brilliant Customer Service
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Treat Every Patient as an Athlete
Frontal-plane movement pattern dysfunction can set the stage for musculoskeletal injury. Frontal-plane stabilization is essential during the normal activities of daily living: think single-leg stance and gait cycle.
Data: The New Frontier in Health Care
Your practice is empowered with the data you need to improve patient health, run a more efficient (read: profitable) practice, get paid in timely fashion and help show the efficacy of chiropractic on the national stage in the midst of sweeping changes in health care!
Acupuncture Treatment of Trauma in the Canine
From 1972 until 1976, John Ottaviano and I were treating dogs at five different veterinary clinics in the Los Angeles county area. Usually, we were at a clinic for seven to eight hours.
Exercise Recommendations for Healthy Aging
Aging is inevitable, but how you age is not. Common physical signs of aging include decreased muscle mass, decreased muscular power, increased body fat, and decreased aerobic (lung) capacity.
An Unexpected Superfood: All About Eggs
About 40 years ago, excessive dietary cholesterol was labeled a public health concern. Specifically, it was thought that there was a causal link between consumption of cholesterol-laden foods and increased risk of heart disease.
Online Marketing Basics: Website Creation
The various online marketing options make it a challenge, especially when all you want to do is help your patients feel better. With such a broad topic, I'm going to share some basics you should know about website creation.
Healing Trauma: Cultivating Resilience and Presence Through Mindfulness, Part 1
All humans, by the very nature of being human, will experience moments of trauma and suffering. What, then, makes the difference in how the individual who experiences trauma, suffering, and spiritual loss reacts to such experiences?
Patient Retention Techniques
When talking about techniques to grow your business, we tend to focus on the "large" aspect of the patient base, that is, on strategies to attract new patients. However, it is important to remember that "loyal" is equally, if not more, important.
Preaching to the Choir: How to Extend Our Reach Beyond the CAM Community
Professional conferences offer unique opportunities to network, be exposed to cutting-edge innovators, share your interests and work, and be inspired.
ASA Ready to Impact Profession
The American Society of Acupuncturists (ASA) is a 501(c)6 (pending), not-for-profit collaboration among state based, acupuncturist professional associations.
What to do When Today Sucks
Have you ever had one of those days when nothing went the way it should have? The patient with migraines got worse instead of better from a treatment similar to one you've effectively used on him before.
The Ethics of Herbal Prescribing
While teaching ethics classes, I often encounter licensed acupuncturists who are surprised that our use of herbs and supplements has a specific section in the material. It is often an aspect within ethics that clinicians don't think of in practice.
Lower-Extremity Overuse Injuries: Primer on Causes and Corrections
From ankle sprains to stress fractures, shin splints to plantar fasciitis, the research is clear: These common overuse injuries of the lower extremities – among dozens of others – may be related to abnormal foot function in your patients.
It's Time to Wake Up
It is time for this profession to wake up and tell someone about the healing benefits of acupuncture. This is the time for Asian Medicine. Its popularity, growth and unusual acceptance is nothing short of amazing.
News in Brief
Support of F4CP Continues With Latest Donations; Walter Reed Honors Dr. William Morgan; Recognizing 40 Years of Public-Health Activism; Allstate Decision Reversed.
ICD-10 Is Not Scary (and Not About Billing)
In my 13 years of consulting with doctors on billing and coding matters, ICD-10 has aroused the biggest combination of misguided fear and ignorance I can remember.
Relationship Marketing: A Modern Approach
Remember when you used to get real letters in the mail? Not the automated type, but the real deal, hand written with a personal message just because someone was thinking about you? You know what I'm talking about.
Aetna Updates 97140 Policy
In a development the Association of New Jersey Chiropractors is calling "a resounding victory for chiropractors nationwide," Aetna Insurance Company has updated its national reimbursement policy regarding 97140 (manual therapy), reaching an agreement two years after the association filed a declaratory judgment suit in federal court against the insurer.
Fish Oil: A Key Component to Positive Clinical Outcomes
Patients seem to be presenting with more complex problems, and many are responding to care more slowly or have completely unexpected results. Why?
Integrative Sports Medicine
One of the most rewarding and challenging clinical scenarios is the treatment of athletes.
A War You Can Help Patients Win
The average American consumes approximately 60 percent of calories from sugar, flour and refined oils. A donut is a good example of a so-called "food" that represents these calorie sources.
Healing the Core: AWB Nepal Earthquake Relief Project
With almost 9,000 people killed during the earthquakes in April and May, another 23,000 suffering injuries, hundreds of thousands left homeless when entire villages collapsed, and many sacred sites destroyed, no one in this country of approximately 28 million has been left untouched by the disaster.
Technology Meets Practice: Chiropractic Every Day
About a year ago, I had an interesting conversation with a DC who made house calls. When I asked why, she was quick to explain she learns much more about her patients when she sees them at home than she could ever observe in the office.
Treating LBP in Golfers: Beyond Basic Assessment
The drive to master the most efficient swing demands a tremendous amount from the lower back. Maintaining stability in a flexed posture, supporting torso rotation and repetitively supporting the golf swing all put the lower back in a vulnerable position.
Learning the Transformative Language of the Channel System: The Sinew Channels
The Chinese medical classics describe the energetic terrain of the body in much detail. The acupuncture channel systems, as presented in the Ling Shu illustrate the various expressions our qi energy can take.
Teaching Qi Gong to Children
Many of us have come to embrace Qi Gong or Tai Chi practice as a regular part of our lives. Qi Gong has been a stabilizing factor in my life for the last twenty years.
Making Public Health a Chiropractic Priority
As highlighted in this edition's News in Brief, Rand Baird, DC, MPH, FICA, FICC, editor and occasional author of our long-running column, "Chiropractic in the American Public Health Association", was recognized by the organization recently for 40 years of membership.
June, 2008, Vol. 08, Issue 06
The Essence of Palpation: How Do You Feel?
By Leon Chaitow, ND, DO
Palpation lies at the heart of much that we do in manual medicine and bodywork in general, and massage in particular. But how accurate and reliable is it?
What we do therapeutically commonly is determined by prior palpation and the meaning we give to what has been palpated.In other words, we assess and decide what treatment is needed and then apply techniques in order to achieve those ends. If, however, our palpation skills are limited or our interpretation of what it is we are feeling is inaccurate, then the treatment we choose to apply based on such misinformation is likely to fail.
Famous osteopathic physician Viola Fryman said: "Palpation cannot be learned by reading or listening; it can only be learned by palpation."1 Palpation represents a two-way communication between the examiner and the patient. Decisions as to what to do therapeutically often will be based on a variety of palpation and assessment methods, together with the symptoms and the patient's responses to these manual (and sometimes observational) evaluation procedures.
In other instances - I am thinking of methods such as neuromuscular technique or many massage techniques - palpation and treatment are synchronous with decisions over how we should respond by varying the degree, duration and directions of forces. These decisions are determined by what is being assessed/felt by the contact hand(s), and how this is interpreted in real time, moment by moment. What is being done therapeutically in such a setting is directly related to what is being palpated and assessed at that moment, rather than having been planned ahead.
For experienced practitioners and therapists, much of the instant decision-making that results in modifications of application of forces (compression/stretch, etc.) happens without due deliberation. The hands do the thinking - intuitively, so to speak. - in much the same way a tightrope walker makes instant, non-cognitive decisions based on the processing of multiple pieces of information.
In other circumstances, active deliberation and thought are required as to what to do next. How accurate such decision-making is will be based on a combination of experience and learned information, as well as being present in the moment and truly in touch with tissues that offer information requiring interpretation.
So, at the heart of palpation is what I termed palpatory literacy many years ago. Do we know how to read the signs and signals the body and its tissues offer us? Nowadays, with the clamour for "evidence-based" methods, a great deal of effort goes into evaluating how reliable and valid (accurate) palpation and assessment-methods are. These can be looked at in several ways. The most common are studies that try to see how reliable an examiner's findings (and therefore the methods used) are. This is measurement of intra-examiner reliability. The other major focus is on how repeatable findings are when different examiners are involved. This is measuring inter-examiner reliability.
The difference between these is that one (intra-) looks at how competent you are in making judgements about what you palpate, and whether the same findings are repeatable when you apply them to other people or other tissues that display similar characteristics. Do your current findings commonly agree with your previous findings? In this case, there is good intra-examiner reliability.
Inter-examiner evaluation looks at how much agreement there is when others palpate the same tissues. Do they come to the same conclusions you did? In that case, there is good inter-examiner reliability.
It's worth reminding ourselves that such reliability does not necessarily mean accuracy has been achieved. The interpretation of methods of palpation that can reliably be duplicated and which agree with the palpation findings of someone else, does not in and of itself mean the conclusions deriving from the palpation exercise are accurate. You may both be wrong, depending on the basis for your interpretation of similar palpation findings. For example, you could reliably aim and hit a dartboard every time you threw a dart, and this would reflect your throwing reliability. However, only if you consistently or frequently hit the bull's-eye would the dart-throwing be categorised as accurate.
So, how can we ensure better intra- and inter-examiner reliability and accuracy? I've explored ways to do this in my book Palpation and Assessment Skills, which attempts to lead the reader through multiple graduated exercises that should result in enhanced skills. Assessment and palpation methods need to be standardized, well-taught and regularly assessed for both reliability and validity (accuracy). The acronym STAR is used in osteopathic medicine to describe characteristics that commonly are present and assessable when dysfunction exists:
Some of these elements are measurable and some not. In other words, some are subjective (tissue texture, for example) and some are objective (range of motion, for example). One thing is certain: The more you practice palpation methods, the more sensitive and reliable your methods should become. What your palpation and assessment means depends on the degree of knowledge you have acquired and your particular belief system. For example, when palpating the radial pulse, your belief system might cause you to interpret findings as relating to heart rate, whereas someone else who appears to be performing precisely the same palpation might be evaluating qi levels in different meridian systems. I will return to the vast topic of palpation in a future issue.
Click here for more information about Leon Chaitow, ND, DO.
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