Subluxation Discussion with MD

#4 MD Meetings- Primary Care

#22 Subluxation Script

This one is a bit longer in duration and is designed to be more of a conversation rather than a sound bite.  Aside from our lack of written communication to the medical community the term Subluxation is the biggest barrier to you getting more new patients referrals.  It actually means different things to medical professionals than it does to chiropractors.  We are THE ONLY ONES that use the non-medical definition, which is not a bad thing, but it can cause confusion and avoidance by medical doctors.  That word is the #1 reason that MDs report that they have to “re-educate” patients on erroneous clinical and diagnostic information provided to them by chiropractors.  (Survey of North American Orthopedic Surgeons – Spine Journal 2010)

Here is the basic verbiage to use when talking with MDs, physician assistants, nurse practitioners or other medical providers. This is NOT designed to be a philosophical conversation about subluxation, its effects or how to reduce it.  This is to help you to communicate what you do to the medical community to generate referrals.  At the beginning I want you to avoid using the term altogether and focus on these substitutions.  Once you have a relationship with the MD, then you can talk more about subluxation and its theories.  There is always a place for those discussions, however it is NOT at the beginning of the relationship when it is fragile and one misunderstanding can ruin a potential long term partnership.  This outline below is from an actual conversation I had with an orthopedic surgeon’s PA.  This will help you to be able to explain subluxation in biomechanical terms.

C = Chiropractor

M = MD

C = Have you ever had a patient come in and tell you that they are seeing a chiropractor and the chiropractor told the patient that they have a subluxation in the neck?

M = Yes, I had a patient the other day come in and say they were treated by their chiropractor and the chiropractor said they have subluxations at C4-5, C5-6 and C6-7. 

C = What did you do?

M = I started to freak out a little and immediately rushed the patient down to our x-ray and did flexion/extension radiographs.

C = What did you find?

M = Nothing!

C = That is what I thought – What the patient was talking about was the Chiropractic version of the subluxation which is a biomechanical lesion characterized by joint adhesion, inflammation and muscle spasm.  That is why spinal manipulation is the modality of choice.  The medical definition is characterized by ligamentous failure and joint hypermobility.  Spinal manipulation is NOT indicated in a hypermobile joint.   That is why you didn’t find anything because you were looking for joint instability!

M = No ^%$%!  I really thought the chiropractor was an idiot!!!

The best way to TEACH the MD is to have a two way conversation and to allow him/her to be part of the process by using an example in the real world.  Start using this in your conversations and if you are using Subluxation codes in your ICD-9 diagnosis and are not prepared to explain what they mean in that section of your reporting then STOP using them. If you can insert some language into your EMR and really want to use Subluxation diagnosis codes, be sure that the MD is not interpreting them as unstable.

I personally do NOT use subluxation codes in my reporting or billing.  That is a personal preference.  

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