Look for these ways to increase the services that you as a practitioner can provide
THE CONCEPT OF INTEGRATING DISCIPLINES is not limited to the concept of joining or participating with another health care entity. Without discounting those opportunities, there are other choices DCs can consider that are arguably far more rewarding and satisfying.
One choice is to integrate into their current practice vital procedures that literally save lives. DCs are already well-equipped and trained, but many have not integrated these simple procedures into their practice.
Basic vitals
If you have visited your medical provider lately, you might have noticed a significant change in the routine application of certain procedures. Although nearly all medical professionals have been required to take and record a patient’s vital signs since the commencement of the Affordable Care Act, I have recently noticed that every single time I visit an allopathic provider, they take my vitals. Yes, for every appointment regardless of the amount of time between visits. These “vital” measurements are…vital!
Technically speaking, “vitals” are the measurements of the basic functions of the body and include body temperature, pulse rate and respiration rate. However, the “vitals” are usually accompanied by blood pressure results, pulse rhythm and strength.
Vital services saving lives
After graduating from Western States Chiropractic College in 1991, I discovered early on how important vitals are.
While performing an exam on a driver of a commercial motor vehicle, I discovered that the driver had Stage 3 hypertension which is a blood pressure of 180/110mmHG or higher. His was the highest blood pressure I had ever recorded.
According to the Department of Transportation, the appropriate action is to direct the driver to seek “immediate” medical intervention, which is what I did. Of course, this is not what the driver wanted to hear. He related that he felt perfectly fine and was unbelievably reluctant to heed my advice. For 20 minutes I persisted to emphasize the seriousness of his condition and he finally promised to go directly to either the hospital or his medical provider.
The driver returned three weeks later to thank me. He hadn’t recognized how tired he had been feeling due to the high blood pressure and reported that he was given immediate treatment and feeling better than he had in a long time. He was a walking time bomb. One life saved. Imagine how many of your current patients have undiagnosed hypertension. If it is potentially life-threatening, do you really want to be adjusting that person’s cervical spine?
Physicals and irregularities
Do you perform school sports physicals? Unfortunately, we hear of athletes suffering Sudden Cardiac Death (SCD) all too often, the most common cause being hypertrophic cardiomyopathy (HCM).
The good news is that you don’t have to be a cardiologist to detect this undiagnosed heart condition. The Littman Eko digital stethoscope can detect murmurs, which are often a sign of this condition. Prior to the Littman Eko becoming available, I was able to identify heart murmurs using a similar device, the Zargas/Littmann Cardioscan program with my Littman 3200 stethoscope.
I remember an occasion when I was auscultating the heart during the exam of a driver. I could not hear any irregularity, but the program recommended a cardiologist referral. The driver was livid! However, Walmart would not let him continue to drive without having my signature on his medical certificate. I disqualified the driver, and he obtained an appointment with a cardiologist. The cardiologist told him that it was lucky he came in and estimated that he would have had a heart attack within two weeks. After emergency heart surgery, the driver returned to my office a couple of weeks later to thank me.
At a recent live training conference in Dallas, Texas, I was teaching DCs, MDs, DOs, NPs and PAs how to perform physical exams for commercial drivers. One question I asked those in attendance was, “If a normal adult heart rate ranges from 60-100 beats per minute (bpm), at what bpm would they require the driver to seek medical attention?”
After a brief discussion, we concluded that 120 bpm merited a referral. The point is that regardless of your medical background, if you don’t use it, you lose it. Checking your patient’s pulse should be part of your routine. The good news here is that if you’ve “lost it,” it seems much easier to access that knowledge than when you learned it for the first time.
Integration rewards
I know hundreds of DCs who didn’t stop at performing exams for truck drivers but have contracted with the driver’s employer to also provide the company with drug and alcohol testing, random drug testing programs and many other services.
Different forms of integration offer different types of rewards. I became involved with the National Registry of Certified Medical Examiners because I recognized the opportunity to bring more understanding and acceptance between DCs and their allopathic counterparts because the process of driver medical certification required working together.
If you are looking for integration, look for ways to increase the services that you as a practitioner can provide. Look for those opportunities you have a love for. Perhaps it is choosing postgraduate training, certification or a diplomat program. The most prevalent DC postgraduate program at this time is composed of over 4,000 DC National Registry of Certified Medical Examiners. Or perhaps you wish to practice in a multidiscipline practice. And then again, maybe you just want to save lives.
MICHAEL MEGEHEE, DC, was appointed by the Federal Motor Carrier Safety Administration in 2005 as a subject matter expert for the National Registry Survey Working Integrated Product Team and the National Registry Education Team that developed the core curriculum for the certified medical examiner training. He is a nationally published author and radio show guest and has traveled the U.S. training physicians regarding the DOT physical exam. He was the first doctor of chiropractic to be designated as a Walmart distribution center medical examiner. He founded the TeamCME® National Network of DOT Examiners in 2010. As past president of the nation’s largest provider network of national registry certified medical examiners he is the medical examiner expert resource to 800 TeamCME member clinics. TeamCME is an Accredited National Registry Training Organization. Learn more at TeamCME.com.
