Transcription

CHEC 1(A).ps2/6/099:13 AMPage 1I S S U E # 3 : F E B R U A RY 2 4 , 2 0 0 9The Magazine Dedicated to Practice Growth and Prosperity Since 1954 www.ChiroEco.comThe powerof positiveinfluenceICSOMROCHI PRA55IC ECONCTthSER ARYNIV4 - 2009N5A 19PAGE 15Profit from“pay per click”advertisingPAGE 27Brand yourselffor successPAGE 36Tax tips fortrade showsPAGE 62PLUSMarketingResourceGuidePAGE 50Target yourMarketingfor today’s economyPAGE 32

CHEC 2.ps2/5/0911:03 AMPage 2

CHEC 3.ps2/5/0911:05 AMPage 3CIRCLE 135 FREE INFORMATION

CHEC 4.ps2/6/0910:37 AMPage 4contentsC H I R O P R A C T I C E C O N O M I C S VO L U M E 5 5 , I S S U E 3wellnessIN EVERY ISSUEBest practices and the power of positive influence . . . . . . . . 15By Dan Cruoglio, DCclinical researchEvidence-based practice and chiropractic . . . . . . . . . . . . . . . . 21By Christopher Kent, DC, Esq.EDITOR’S MESSAGE . . . . . . . . . . . . . 8NEWS . . . . . . . . . . . . . . . . . . . . . . . . 10INFORMATION FOR READERS . . . . 58DATEBOOK . . . . . . . . . . . . . . . . . . . 64PRODUCTS . . . . . . . . . . . . . . . . . . . . 68MARKETPLACE . . . . . . . . . . . . . . . . 70CLASSIFIEDS . . . . . . . . . . . . . . . . . . 72MARKETING DIRECTORY . . . . . . 50ChiropracticE CO NO M I C SmarketingClick Cha-ching! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27By Michael Beck, DCMarketing for today’s economy . . . . . . . . . . . . . . . . . . . . . . . . 32What is your brand? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36B y Ly n n e S u l l i v a n , D Cpractice managementEmployee termination starts before the hire . . . . . . . . . . . . . 41By Laurie MosierPractical Documentation:Activities of daily living deficits . . . . . . . . . . . . . . . . . . . . . . . . 44By Kathy Mills ChangSuccess File: Position your practice for success . . . . . . . . . . . . 46By Bob LevoyChiro Biz Quiz:Marketing on the Internet: Web site basics . . . . . . . . . . . . . . 48B y M a r c H . S e n c e r, M DfinancesFinance & Taxes: Attending shows and selling you . . . . . . . 62Chiropractic Economics (ISSN 10871985) (USPS 019-178) is published 20times a year, once every three weeks, byChiropractic Economics, Inc., 5150 PalmValley Road, Suite 103, Ponte VedraBeach,FL 32082,Phone: 904285-6020, Fax: 904-285-9944, Webcontact: www.chiroeco.com (A FloridaCorporation).POSTMASTER: Please send form#3579 to Chiropractic Economics, POBox 3521, Northbrook, IL 60065-9955.Periodicals class postage paid at PonteVedra, Florida and at additional mailingoffices. GST #131868416.SubscriptionRates:U.S.andpossessions, 39.95 one year, Canadiansubscribers add 35 per year shippingand handling; overseas subscribers add 60 per year shipping and handling.Students, 19.95, Single copy, 4.Statement: While encouraging the freeexpression of opinion by contributors tothis publication, Chiropractic Economicsand members of its staff do notnecessarily agree with/or endorse thestatements made in the advertisementsor contributed articles. ChiropracticEconomics is owned by ChiropracticEconomics, Inc. a Florida Corporation,Joseph D. Doyle, President and fphotographs and/or illustrations is theresponsibility of the author(s). Allmaterials submitted for publicationshall remain the property of thismagazine until published.By Mark E. BattersbystudentDC.comTips for passing board examinations . . . . . . . . . . . . . . . . . . . . 66B y K . J e f f r e y M i l l e r, D C , D A B C O4CHIROPRACTIC ECONOMICSW W W. C H I R O E C O . C O MChange of Address: Six to eight weeks priorto moving, please clip the mailing label fromthe most recent issue and send it along withyour new address (including zip code)to the CHIROPRACTIC ECONOMICSCIRCULATION DEPARTMENT, PO Box3521, Northbrook, IL 60065-9955. For a fasterchange, go to www.ChiroEco.com and click on“Customer Service.”VOL 55: ISSUE 3 FEBRUARY 24, 2009

CHEC 5.ps2/5/0911:07 AMPage 5CIRCLE 151 FREE INFORMATION

CHEC 6.ps2/5/0911:08 AMPage 6NOW ONLINEHOME PAGE FOR THE SUCCESSFUL DOCTOR OF CHIROPRACTICThe Leading Chiropractic Web SiteMagazineHomeProducts and ces for you at ChiroEco.comDaily NewsUpdatesThe latest news in theworld of chiropractic, plus industry andhealth news, now updated daily atwww.ChiroEco.com.First Tuesday @ 2Webinar SeriesMore from this issueChiropractic Economics hosts a freeWebinar series on the first Tuesday ofeach month at 2 p.m. Sign up for ournext Webinar or view our archive atAfter you read Kathy Mills Chang’s“The Fortune Wheel ofDocumentation,” learn more aboutSteve Yeomans’ OATs program rstTuesdayResource CentersActiv e Carewww.ChiroEco.com/wave R.I.C.E. and sportsrehab Keeping a healthy spine:Rules to live byDiagnostic Toolswww.chiroeco.com/myovision Institute releases iPhone compatiblediagnostic tool sEMG used to find cause ofChildhood Flexible FlatfootChiropractic Tableswww.chiroeco.com/hill Technology and aging populationdrives growth in medical devicesmarket Top 10 ways to develop a pregnancynicheJob BoardVisit www.ChiroEco.com/jobboard foremployment opportunity listings for: Associates Billing ChiropracticAssistants Doctors ofChiropractic Faculty Front Office/Reception/Scheduling Independent Contractors Marketing Massage Therapists Multidisciplinary PracticeOpportunities Office Management Temporary Positions OtherNew Resource forCanadian DCsA new section of our Web site forCanadian DCs features the latestnews from schools, organizations, andseminars. The site also includesCanada-specific coding and billinginformation as well as blogs byCanadian chiropractic experts. Checkit out at www.ChiroEco.com/Canada.Online PollDo think the stimulus packagewill achieve its goals withelectronic health records?To enter your response andview the results of our lastpoll, visit www.ChiroEco.com.Expert InsightsBlogs by Jean Murray, Perry Nickelston, Michelle Geller-Vino, Kelly Robbins, Kathy Mills Chang, Jasper Sidhu, Paul Varnas,and the Chiropractic Economics editorial staff. We have chosen these bloggers from different niches: Practice startup,reimbursement, strategies from the ‘real world’ of chiropractic, and the chiropractic press. We do this to make sure youget the big picture about chiropractic success.The ChiropracticMarketing ConnectionHolistic marketing andvalues go hand-in-handBy Kelly Robbinswww.ChiroEco.com/robbins6CHIROPRACTIC ECONOMICSDon’t Practice onyour PracticeWith a little luck, this willtransform your practiceBy Paul Varnaswww.ChiroEco.com/varnasW W W. C H I R O E C O . C O MThe Marketing MentorNew patients, newpatients.where are you?By Michelle Geller-Vinowww.ChiroEco.com/geller-vinoVOL 55: ISSUE 3 FEBRUARY 24, 2009

CHEC 7.ps2/6/0910:38 AMPage 7CIRCLE 157 FREE INFORMATION

CHEC 8.ps2/6/099:37 AMPage 855CHIROOMICSONeditor’s messageACTIC ECPRthANNIVERS1954 - 20 AR09 YMaking a name for yourselfChiropracticE CO NO M I C SDEDICATED TO PRACTICE GROWTH AND PROSPERITY SINCE 1954Volume 55, Number 3American artist Andy Warhol believed that everyonein the future will have 15 minutes of fame.The elusive 15 minutes of fame refers to how people focus on one thing, andthen pass to some new object as soon as their attention spans are exhausted.Not especially good for a chiropractic practice or abusiness, is it?While having your 15 minutes of fame can be a goodthing, how do you sustain for the long run? Making aname for yourself and have a lasting impression onpeople — who could become patients — would makemore sense.This issue of Chiropractic Economics is full of ways toLet me know what’smarket your practice and make a name for yourself.on your mind:“Click Cha-ching!” (page 27) explores the benefits904-567-1539Fax: 904-285-9944and possibilities behind Internet “pay per click”[email protected] and how to make it work for you. Thefeature story on page 32, “Marketing for today’s economy,” showcases industry“marketing masters” and their marketing tips for dealing with today’s economy.The story on page 36 asks, “What is your brand?” and then answers with waysyou can create a successful brand for your practice. The Chiro Biz Quiz onpage 48 discusses marketing on the Internet and some Web site basics youneed to know — then, as always, quizzes you on what you read.Some people bask in the glory of their 15 minutes of fame, while othersseem to forever search and search.Would you rather be famous for 15 minutes or famous to your patients for alifetime?Wishing you success,Editorial DirectorStanford [email protected] [email protected] EditorRyan [email protected] AssistantMelissa [email protected] DirectorChristine [email protected] SpecialistNancy [email protected] President, Web Operations/Audience DevelopmentManuel [email protected] DeveloperJuan [email protected] [email protected]eco.comNational Account ExecutivesJeff Pruitt, [email protected] Ruddiman Long, [email protected] Morris, [email protected] Zittin, [email protected] Bautista, EditorAdvertising CoordinatorHustin Wildman, [email protected]’S TIMELINEAs part of our celebrating 55 years in the profession, Chiropractic Economicswill feature a section of the chiropractic historical timeline in each issue leadingup to 2009.Classifieds Account ExecutiveSidney Duncan III, [email protected] B.J. Palmer, son of the founder of chiropractic and founder of theInternational Chiropractic Association (ICA), passes away.President/CEOJoseph D. [email protected] Palmer College of Chiropractic begins teaching liberal arts courses.1963 Chiropractic becomes legal in New York State.1963 Today’s National Board of Chiropractic Examiners (NBCE) is chartered.It will give its fist exams in 1965.1964 The American Chiropractic Association’s (ACA) director of educationwarns Chiropractic Economics readers about the American MedicalAssociation’s (AMA) intent to eliminate chiropractic.1965 Medicare is established, providing hospital and medical benefits topeople more than 65 years old and financed through Social Security.8CHIROPRACTIC ECONOMICSW W W. C H I R O E C O . C O MVice President, Business DevelopmentKevin [email protected] & Editorial Offices5150 Palm Valley Rd., Ste. 103Ponte Vedra Beach, FL 32082Phone: 904-285-6020, Fax: 904-285-9944www.chiroeco.comFounded 1954William L. Luckey and Helen C. LuckeyVOL 55: ISSUE 3 FEBRUARY 24, 2009

CHEC 9.ps2/5/0911:11 AMPage 9CIRCLE 145 FREE INFORMATION

CHEC 10.ps2/5/0911:12 AMPage 10news flashTOP NEWSGIVING BACKHouse-passed stimuluspackage will impactchiropracticThe 800 billion economic stimulus bill making its waythrough Congress may positively impact chiropractic byproviding increased funding for such issues as healthinformation technology and clinical effectivenessresearch, as well as give a boost to health prevention andwellness programs.As the House-passed bill currently stands, it wouldprovide 20 billion to implement computerized healthrecord systems for public insurance programs, such asMedicare and Medicaid, and would pay private physiciansto do the same. Individual physicians would receive up to 65,000 for establishing an electronic record system.Physicians not using electronic health records by 2016may face reduced Medicare payments.According to American Chiropractic Association(ACA) staff members, the bill defines “physician” usingSocial Security Act Sec. 1861 (r), which is also theMedicare definition. This would allow for DC-inclusionin the aforementioned electronic health record incentiveprogram. The details of program funding and parametersare still forthcoming and much of the money for theincentive program will not be appropriated until 2010.Source: American Chiropractic Association, www.amerchiro.orgICD-10 sees delay for two yearsDoctors are getting a two-year reprieve before they’llhave to use the coding system known as ICD-10 — a newset that will allow for more specificity and precision in theway doctors and hospitals bill insurers for tests,procedures, and other types of care.To see the Centers for Medicare and MedicaidServices’ (CMS) fact sheet on the ICD-10, go towww.ChiroEco.com/factsheet.After receiving more than 3,000 comments on itsearlier ICD-10 proposal, the Centers for Medicare andMedicaid Services (CMS) now says medical providers willhave until Oct. 1, 2013, before they have to use ICD-10,rather than a prior proposal of Oct. 1, 2011. Manycomments requested more time to comply, citing costsand the need for training and testing, according to CMS.ICD-10 has 155,000 codes, a nearly tenfold increaseover the current system. The idea is to allow for more10CHIROPRACTIC ECONOMICS 1 Million to Parker Collegeof ChiropracticStandard Process Inc., manufacturer of nutritionalwhole food supplements, has given Parker College ofChiropractic a one million dollar gift.Standard Process Inc. and its president, Mr. CharlieDuBois, presented Parker College of Chiropractic’sPresident, Fabrizio Mancini, DC, with the one milliondollar check at Parker’s 2009 Las Vegas Parker Seminar,Jan. 15–17.For the past 80 years, chiropractors have beendevoted supporters of Standard Process. In an effort togive back to the chiropractic profession that has given somuch to Standard Process, the company has offered itsongoing support to the chiropractic profession and thecolleges that will educate future chiropractors byworking with Parker and other chiropractic colleges.At the seminar, DuBois also received the covetedphilanthropy award in recognition of years of service, time,effort, support, and funding to the chiropractic profession.Source: Standard Process, www.standardprocess.comdetail on patients’ medical records, and to keep up withthe many ways medical care evolves each year.Source: The Wall Street Journal, Health Blog, http://blogs.wsj.com2009 Las Vegas Parker Seminarshines againLeading experts in the fields of chiropractic, health,and wellness converged at the 2009 Las Vegas ParkerSeminars, providing more than 3,000 attendees withvaluable insight and information that will take theirpractices and daily lives to the next level.Joining the 2009 Las Vegas Parker Seminar wasSuzanne Somers, actress, author, and wellness enthusiast;W W W. C H I R O E C O . C O MVOL 55: ISSUE 3 FEBRUARY 24, 2009

CHEC 11.ps2/5/0911:12 AMPage 11CIRCLE 120 FREE INFORMATION

CHEC 12.ps2/5/0911:14 AMPage 12news flashJack Canfield, best-selling author of the Chicken Soup forthe Souls series; and relationship expert and best-sellingauthor of Men are From Mars; Women are From VenusJohn Gray — all showing their support for the professionwith their presentations.Receiving awards for 2009 DC of the Year were GeneOrlowsky, DC; Patrick Bodnar, DC; James Chestnut, DC;Ali Jafari, DC; and Thomas Rigel, DC. The 2009 CA ofthe Year awards went to Ms. Marie Larsson and Ms.Tammy Ducharme.The First Annual Parker Gala, hosted by ParkerCollege of Chiropractic and benefiting chiropracticresearch and the advancement of the profession, was ahighlight of the weekend — bringing together some ofthe biggest names in chiropractic for an elegant eveningdedicated to honoring those who work tirelessly tovalidate the already-known truths about chiropractic.The Drugless Research Hall of Fame also made itsdebut at the Parker Gala, honoring Dr. Ron Rupert, deanof the Parker Research Institute, as the first inductee.Source: Parker College of Chiropractic, www.parkercc.eduINDUSTRY NEWSNew organization brings‘wellness to the world’A new organization, Journey to Solidarity, has beencreated to aid people all over the world by bringingchiropractic and basic living necessities to areas in need.Jay Breitlow, DC, director and president of Journey toSolidarity, anticipates that for each doctor the organizationsends, free or reduced-cost services will be provided tomore than 15,000 people each year. The launch mission ofJourney to Solidarity is to Madagascar where a licensedchiropractor began providing care in the country Feb. 2.While there are many nonprofit organizations thatprovide free or reduced cost healthcare for people whocan otherwise not afford it, none provide long-termchiropractic care for people in rural developing countries.The vision of Journey to Solidarity is to share a natural,safe, and effective form of healthcare with the world.Source: Journey to Solidarity, www.journeytosolidarity.orgCOLLEGE NEWSSCU faculty member publishesbiochemistry textbookSouthern California University of Health Sciences(SCU) faculty member Garrett Thompson, PhD, haspublished a new textbook titled Biochemistry in a Nutshell.The textbook is a National Board of ChiropracticExaminers (NBCE) Part I examination review. The textcontains a concise summary of facts pertaining tobiochemistry, with 18 easy to follow figures, 25 summarytables, and 260 practice questions.Source: Southern California University of Health Sciences,www.scuhs.eduNorthwestern Health SciencesUniversity offers new scholarshipsNorthwestern Health Sciences University is offering fourfull-tuition diversity scholarships, boosting its commitmentto create an institutional culture that cultivates diversity.Each winter term, one student enrolling in theMinnesota College of Acupuncture and OrientalMedicine, one student enrolling in the School of MassageTherapy, and two students enrolling in the College ofChiropractic will receive the scholarship award.To be eligible for this award, the applicant must be aminority student who is underrepresented in their futureprofessional field, and/or a student who has shown strongparticipation and commitment to minority communities.They also must demonstrate a financial need; show highacademic achievement; provide an application essay, letterof recommendation, and complete a personal interviewwith the Diversity Commission Scholarship Committee.Source: Northwestern Health Sciences t us at.BIOFREEZE.COMPain reliefthat works12CHIROPRACTIC ECONOMICS W W W. C H I R O E C O . C O MVOL 55: ISSUE 3 FEBRUARY 24, 2009

CHEC 13.ps2/5/0911:14 AMPage 13CIRCLE 147 FREE INFORMATIONCIRCLE 294 FREE INFORMATION

CHEC 14.ps2/5/0911:15 AMPage 14CIRCLE 209 FREE INFORMATION

CHEC 15.ps2/5/0911:16 AMPage 15wellnessBest practicesand the powerof positiveinfluenceBy Dan Cruoglio, DCEvery new patiententering your officebrings a unique setof expectations.Some patients are interested in aquick fix with pain-relief being theirhighest priority. Others focus ontheir need to return to work or desireto improve in an activity or sportthey enjoy. Still others hope tomaximize their overall health and wellness.Discovering your patient’s expectations and ensuringthey are in alignment with your expectations is anessential step in establishing a successful doctor-patientrelationship.Are you often frustrated when patients do not followyour recommendations or discontinue care before theyreach the goals you established for them? If so, you may bemissing a crucial step in patient management.Reaching a point of shared expectations for the greaterbenefit of the patient may require you to master the skillof positive influence. Positive influence means swayinganother person’s opinion in a nonmanipulative way fortheir own benefit.Influence begins with a certainty that you are doingwhat is right for your patients. Only when you are certainabout your expectations can you communicate themeffectively.Two communication methodsTwo methods of communication include hard powerand soft power. Hard-power communication is anVOL 55: ISSUE 3 FEBRUARY 24, 2009authoritative, domineering way of exerting influence.When you engage in hard-power communication, you runyour practice without tolerance for variation in individualpersonalities or behavioral styles.You refuse to accept diversions from your policies andmake an assertive attempt to bully your patients intofollowing your recommendations: No missedappointments, no cancellations, no exceptions. It’s a “myway or the highway” approach.While this communication technique can occasionallybe effective, more often than not its short-lived resultsend in frustration for the patient and you.Soft-power communication is a more effective way toinfluence behavior over the long term.It requires you to empathize with your patients’ uniqueset of fears, desires, hopes, and needs. It lends anemotional component, touches the heart, and cultivatesloyalty.Most people draw upon their emotions to support thelogical decisions they make. When you empathize withyour patients, you connect on an emotional level andbecome better able to inspire trust and confidence.W W W. C H I R O E C O . C O MCHIROPRACTIC ECONOMICS15

CHEC 16.ps2/5/0911:17 AMPage 16wellnessPractice the positive influenceacronym: C.A.R.E.S.S.You’ll be more effective at exerting positiveinfluence when you consistently practice thefollowing techniques:Concentrate on the patient and make them thefocus of your attention.Acknowledge what the patient has to say andshow interest in the topic of discussion.Research and respond. Gather research by askingthe patient about their values and needs; findout why they are there. After you discover theirmotivation for the visit and expectations forcare, respond in a manner that resonates withthose values the patient places highest.Exercise emotional control when dealing withhighly charged messages. Before you jump inwith a response, remind yourself that yourpatient may be in pain or feel anxious about theloss of control of their health. Wait until theyhave communicated all there is to know.Sense is a medium for receiving nonverbalmessages. More than 55 percent ofcommunication is through body language. Lookfor nonverbal cues that make you aware of apatient’s needs, expectations, and sensitivity toparticular subjects.Structure is a way to organize information asyou receive it in order to develop the nextquestion you are going to ask.Build rapportYou can connect with your patients on an emotionallevel by developing rapport. Rapport is the perceivedaffinity between two or more people. You can fosterrapport by focusing on those things that you share incommon with your patient.For example: When someone comes in referred byanother patient, you can create an instant connection byasking questions about the one thing you are sure youhave in common — the referring person.People prefer to associate with others like themselves.When you acknowledge your connection to the personwho referred them, the patient subconsciously associatesyou with that person, making them feel more at ease andprepared to accept your recommendations.You can further develop rapport with your patient bypracticing active listening. Active listeners listen twice asmuch as they speak. When you actively listen to what16CHIROPRACTIC ECONOMICSW W W. C H I R O E C O . C O MVOL 55: ISSUE 3 FEBRUARY 24, 2009

CHEC 17.ps2/5/0911:17 AMPage 17CIRCLE 108 FREE INFORMATION

CHEC 18.ps2/5/0911:19 AMPage 18wellnessyour patient is saying, you portrayprofessionalism and thoughtfulness.You will never learn your patient’sexpectations for care until theycommunicate them to you. Only thencan you evaluate and offer a plan ofcare that serves their best interests.Lay the positiveinfluence foundationDuring your initial consultation,ask the patient questions. Theanswers will lay the foundation fordelivering your recommendations.During this question-and-answersession, engage the patient’semotions and give them enoughinformation to draw their ownconclusion and provide you withuseful feedback.Even with the best preparation,you occasionally will run intoobjections after a patient receivesyour recommendations. Master thetechnique of asking positiveinfluence questions that lead patientstoward a positive outcome.Practice the tools of positiveinfluence on a daily basis.As a doctor, your leadership role inyour practice gives you a considerableadvantage when communicating to apatient.You are a leader in thechiropractic profession, socommunicate in a way that positivelyinfluences your patients and providesthem with compelling reasons tofollow your advice.Dan Cruoglio, DC, is a seniorcoach with BreakthroughCoaching. He can be reachedat 800-723-8423,[email protected], or throughwww.mybreakthrough.com.Examples of positive inflencequestions can be found atwww.ChiroEco.com/positiveinfluence.CIRCLE 130 FREE INFORMATION18CHIROPRACTIC ECONOMICSW W W. C H I R O E C O . C O MVOL 55: ISSUE 3 FEBRUARY 24, 2009

CHEC 19.ps2/6/093:27 PMPage 19A D V E RT I S E M E N TCIRCLE 104 FREE INFORMATION

CHEC 20.ps2/6/0910:40 AMPage 20CIRCLE 211 FREE INFORMATION

CHEC 21.ps2/5/0911:21 AMPage 21clinical researchEvidence-basedpractice andchiropracticBy Christopher Kent, DC, Esq.Evidence-based practice (EBP) is aterm gaining prominence inchiropractic publications andseminars.A growing number of policymakers and third-partypayers are viewing EBP as a way to control runawayhealthcare expenses. What this means to you, and allproviders, is that you can anticipate greater scrutiny of yourprocedures. If a procedure is not supported by adequatescientific evidence, reimbursement is likely to be declined.The fundamental concept of EBP is simple, and as old asthe healing arts. Sackett defines EBP as “The conscientious,explicit, and judicious use of the current best evidence inmaking decisions about the care of individual patients.(it)is not restricted to randomized trials and meta-analyses. Itinvolves tracking down the best external evidence withwhich to answer our clinical questions.” 1What’s wrong with that? Absolutely nothing. It iscertainly not a revolutionary idea. As Baltzan wrote,“What’s new about that? Certainly that is what I learnedfrom my instructors when I went to medical school nearly50 years ago and what my father told me he learned inmedical school 80 years ago. In fact, Hippocratesunderstood the concept.” 2The problem is not, as Sackett proposed, “integratingindividual clinical expertise and the best externalevidence.” 3 Every doctor does that.The challenge is defining the nature of the evidencethat renders a procedure reimbursable, while retaining theability of the doctor to exercise clinical judgment,VOL 55: ISSUE 3 FEBRUARY 24, 2009customize the care to the needs of the individual, andinclude patient preferences in the decision-makingprocess.The risk of EBP is the cavalier dismissal of evidencethat doesn’t fit into a rigid hierarchy, and thecompartmentalizing of the profession into two classes: An oligarchy of researchers, and Doctors who are reduced to mere techniciansfollowing the flowcharts and algorithms promulgated bythe elite.There is grave danger that the heart and soul of thehealing encounter — the doctor patient relationship —may be a casualty of the more extreme application of thismechanistic approach.There are other problems associated with theapplication of EBP. Healy warns that “the autonomy andauthority of the doctor, and the subsequent variability incare, are the problems that evidence-based medicine(EBM) wants to cure.” 4But does quality equal homogeneity? Are all patientswith the same ICDA code going to respond uniformly tothe same treatment? Can all potential confounding factors— including age, gender, co-morbidities, history, preexisting conditions, lifestyle habits, environmentaldynamics — be codified and their impact on an individualbe determined prospectively?The single most damning aspect of EBP is the lack ofscientific evidence that it improves clinical outcomes.According to Haneline, “It should be noted that theprocess of EBP itself has not been rigorously tested, so wedo not know for sure if it actually results in improvedhealth.W W W. C H I R O E C O . C O MCHIROPRACTIC ECONOMICS21

CHEC 22.ps2/5/0911:21 AMPage 22clinical researchevidence applies to the individualpatient at all and, if so, how it shouldbe integrated into a clinical decision.“Similarly, any external guideline Council on Chiropractic Practice: Vertebral Subluxation in Chiropracticmust be integrated with individualPractice, www.ccp-guidelines.org/guideline-2008.pdfclinical expertise in deciding Practicing Chiropractors Committee on Radiology Protocols,whether and how it matches thewww.pccrp.orgpatient’s clinical state, predicament, International Chiropractors Association: Recommended ClinicalProtocols and Guidelines for the Practice of Chiropractic,and preferences, and thereby whetherwww.chiropractic.org/index.php?p guidelines/mainit should be applied.” 1 Council on Chiropractic Guidelines and Practice Parameters,So what does this mean to you? Bewww.ccgpp.orgwary of the misuse of EBM by National Guideline Clearinghouse, www.ngc.govindividuals and organizations thatstand to profit by denying“No randomized controlled trials (RCTs) that havereimbursement for care. A practical clinical strategycompared EBP with standard methods or practice havebegins with the use of reliable and valid patientbeen carried out in any of the healthcare professionsassessment tools.because of the methodological difficulties and exorbitantlyThese tools permit the clinician to objectivelyhigh costs that would be associated with attempting todetermine if a given regimen of care is associated withexecute such studies.” 5favorable changes in function and quality of life in aAs Sackett wrote, “External clinical evidence canspecific, individual patient.inform, but can never replace, individual clinical expertise,Such tools as surface EMG, skin temperatureand it is this expertise that decides whether the externalinstrumentation, algometry, inclinometry, and heart rateOnline resources f

will feature a section of the chiropractic historical timeline in each issue leading up to 2009. 1961 B.J. Palmer, son of the founder of chiropractic and founder of the International Chiropractic Association (ICA), passes away. 1962 Palmer College of Chiropractic begins teaching liberal arts courses. 1963