The treatment plan.
It’s a crucial part to recovery from any injury in a managed care setting. Some insurance plans will not provide any reimbursement without having one written and on file. So, why are we devoting an entire blog post to the potential perils of the “traditional chiropractic treatment plan?”
Well, like so many things, it is a practice that began with good intentions that has far too often become twisted into something almost exactly the opposite.
A treatment plan is something your chiropractor, physical therapist, or any other clinician who provides ongoing therapy should sit down with you and discuss. It’s intent is to
1)Identify your problem
2)Lay out the steps to recovery
3)Establish goals to hold the clinician accountable to providing results in a timely manner.
However, when I hear horror stories of my patients with previous providers, usually chiropractors, the focus gets shifted all into #1 and 2 and completely ignoring the most important part, #3. How so? By over emphasizing a trivial problem and using scare tactics to drive a long treatment plan with no end in sight or penalties for leaving early.
Now, don’t get us wrong. Chiropractic adjustments are one of many useful tools for recovery from numerous musculoskeletal injuries. But it’s not the cure for all the world’s ails. And it isn't a cure for degenerative disc disease - DDD is simply a sign of aging, and stating you will progress to terrible pain without adjustments is unethical, to put things kindly.
And it doesn’t have to go on forever as some chiropractors would tell you. In fact, any clinician, whether a chiropractor, a physical therapist, or a surgeon, who tells you the ONLY way for you to get better is with THEIR specific modality of treatment, is probably trying harder to sell you something than to help you.
So here are some things you should be wary of when a clinician is proposing a treatment plan, specifically one related to non traumatic spinal or joint injuries:
1) Scans or tests offered before you even set foot in an office. Often times x-rays or full spinal scans are offered for "free" in order to entice you into an office so a long term treatment plan can be pitched and sold. An ethical clinician doesn't know if you need imaging or a test before they sit down to discuss your problems.
2) Excessive treatment. It’s normal to come in a couple times in a week at first. Maybe even 3 times a week if the case is severe and acute. But everyday treatment isn’t necessary. And at this interval, change should occur within 4-8 visits. If you’re coming in for visit number 10, 11, 12, and don’t feel any different, something isn’t right.
3) Upfront payment or contracts. You don't pay your doctor or dentist, or plumber or painter for that matter, before they provide their service. And having a patient sign a contract is essentially admitting that they should feel better before the treatment plan is finished and trying to trap them on a hook to pay for more than they need.
4) Heavy reliance on passive therapies you can only utilize in a clinic. If the majority of your treatment modalities are done TO you, and not things you do yourself, you'll only become reliant on a doctor, a table, or a machine to get better. And that leads to increased costs and usually poorer outcomes.
So, now that we know a few things to avoid, what should we strive for? A good treatment plan will have several characteristics, but here are a few of the most important:
1)SMART goals (Specific, measurable, attainable, Relevant, Time dependent)
2)Regular treatment intervals, that are fluid to change based on stages of recovery
3)Progresses away from passive therapies dependent on the clinician and towards active, independent self care (such as the McKenzie Method or functional rehab) over time.
4)End date to re-assess outcomes. At which point you are either dismissed, given new treatments, or referred out if recovery is unlikely.