Patient Jane Doe, age 42, entered the practice as an established patient who had not been seen for nine months.
Her new presentation of neck pain and headaches represented a different condition than her previously encountered low-back pain.
She was seen for approximately three visits involving spinal adjustments and electrical muscle stimulation, including some deep-tissue techniques. She had some minor, temporary relief, but the condition was still significantly present on that third visit when she expressed some discontent on the continuation of her symptomatology and moderate pain with headaches.
She indicated her desire to seek medical attention and clearly was telegraphing that she was going to go to another provider along the medical route.
She stated her husband was pushing her to go to their family medical doctor. Although I explained cervicogenic headaches and the loss of range of motion, as well as the tight musculature and joint fixation found on the basic examination from her first visit the week prior, she seemed reluctant to continue with care even though it had only been three visits.
I’ve always been a successful communicator and the majority of times patients follow my recommendations, especially at this stage of care.
A need for diagnostics
I suggested to Jane that we obtain further diagnostics to determine the exact alignment in both the upper cervical spine and the mid-cervical region, as her posture demonstrated forward head carriage. Since we had not taken prior X-rays of her cervical spine, it would help us get an accurate assessment to determine the exact involvement of her spine with her condition.
She said she didn’t have time, but when I explained that the entire process would take only five minutes, she agreed.
Because she sits at her desk much of the day working at a computer and had a notable loss of extension ROM, we obtained a five-view cervical series that included flexion and extension views. We used our digital X-ray system and obtained all the images in a few minutes.
The findings demonstrated a moderate reversed cervical curve, with degenerative changes at the C5-C6 level with anterior osteophytes, and significant disc degeneration at the C5-C6 level. In addition, the APOM view showed her C2 vertebra was rotated significantly to the right side and counter-rotation on the C1 to the left, causing biomechanical alterations and cervicogenic headache involvement. In addition, significant loss of extension was evident.
Some of these findings were previously unknown by examination. Using annotations on the digital X-rays, we were able to illustrate for Jane a direct comparison between what her X-rays revealed in contrast to a normal cervical spine.
That day was significant for Jane. It changed her life by giving her a direct and immediate understanding of her condition.
Visible evidence
The digital X-rays, complete with those annotations, empowered her in a way my explanations could not. She could literally see her condition, and after sharing the annotated digital X-rays with her husband, committing to the recommended care plan was a no-brainer.
Over her next 14 visits, more specific adjustments were provided to Jane. Specific corrective exercises were also provided with home instruction. The headaches that had been ongoing the past several months had now abated 100 percent.
And Jane better understood the need for future care after seeing the X-rays. Tellingly, preventative care was something Jane requested (before I even had the chance to suggest it), making reference several times to the digital X-ray findings.
Conclusions
The result after five weeks of care: Jane’s husband, who was the person wanting Jane to go elsewhere, became a new patient to the clinic for his back complaints. The positive experience from both the husband and wife resulted in two other patient referrals over the next six months. And from a practice profitability standpoint, the net effect was $4,300 in total care revenue from Jane, her husband, and the two other referrals.
All of this because of two critical factors: The digital X-rays and annotated line measurements gave Jane a perspective she would not otherwise have had—one that empowered her to make the right decision and complete her recommended care. Plus, the X-rays altered the approach to care from me as the provider, guiding me toward a more specific approach that gave us a better outcome for Jane and her future.
Why is this critical for DCs to understand? Because the vast majority of the population —especially the cohort that grew up with a screen in their hands—are visual learners. And one of the biggest problems we face as chiropractors is getting patients to fully commit to our recommended care plans. And in this regard, digital X-ray technology, together with annotations, does more than make an image; it makes an impact.
Steven J. Kraus, DC, FIACN, DIBCN, FASA, FICC, is the founder of Biokinemetrics, a provider of chiropractic digital X-ray and software systems. He is an acknowledged expert in health IT, electronic health records, and HIPAA issues. Kraus serves on national committees involving EHR and clinical quality guidelines. He can be contacted through biokinemetrics.com.
