Preceptorship Week 8 of 8

I finished up on the last week of August. What a crazy week. There were 4 out of town patients, and at the end of a week, a doctor came up to train (2 of the patients were his from Texas). It was madness with the schedule and local patients on top of that.

I was so burned out by the end of the preceptorship that I was so glad to be done and to get back to PA to relax. I was able to get some good work on Steve, per post radiographs. I also sat in the scoliosis traction chair for 5 minute sessions a few times to pull on my right side dorsal-upper-dorsal angle. It made my ribs and upper thoracics feel so much better!

I learned a lot during my 8 weeks preceptoring. I saw some interesting cases, and got a better understanding of the flow for rehab and scoliosis correction. I learned how I would do things differently in regard to staff communication and leadership. I learned how to deal with difficult patients, or the difficult parents of patients, and I learned how to better analyze radiographs. I also realized that I most definitely don't want to work that many clinic hours per week. I just don't want to burn both ends of the wick...I'd rather work 20-30 hours a week and be totally focused and energized with my patients during those hours than to give them only 60% of my energy, and have even less left over in the evenings for my family.

Preceptorship Week 7 of 8

Last week we worked with a couple of out of country, intensive care scoliosis patients. Having new patients here for intensive treatment is a lot of work.

Monday: history and exam, full-spine x-rays and analysis, report of findings, demonstrating and teaching patient exercises, 2 rounds of treatment with warm-up (MIX), adjustments (FIX), and rehabilitation (SET) which usually lasts 2-2.5 hours.

Usually, I don't have to start taking photos of the patients until the 2nd day, but that wasn't the case this week. I added it up and taking photos of the patients x-rays, the patients warming up, getting adjusted, and doing rehab adds up to close to 120 photos per patient. So, on average, I take about 240 photos per week, edit & crop photos, and create a 38-40 page personalized report for the patients.

On top of everything going on with that, we were short 1 staff member last week because she was on vacation. Then, on Tuesday afternoon, the other staff member who works with patient rehab wasn't able to come in due to a family emergency. That left 1 person, the intern, ME, doing EVERYTHING: muscle stim on regular patients, setting up 4 scoliosis patients on all the mix and set rehab equipment. Additionally, the doctor was giving me even more stuff to do like review home exercises with a patient. There's only so much 1 person can do in an afternoon to get everyone done by closing time!

I was so thankful for the weekend!!

Preceptorship Weeks 5 & 6 of 8

Last week, I was able to visit a local clinic that's only been open less than 2 years. Dr. Keith gave me lots of awesome pointers on where to find office supplies and clinic equipment for an inexpensive price. Seeing his practice also gave me confidence to know that I can start out from scractch with bare-bones for adjusting equipment, and still make it!

This week, we have several out of town patients here for a week of intensive treatment. I've been busy with exams, report of findings, teaching patients' their home exercise and rehab protocols, running the scoliosis center, and helping out with front desk operations. Also, a doctor from Mississippi is in town training for a week; she's here with a CA and her husband. I've been able to pick her brain and learn about running a high volume practice that includes scoliosis treatment while also being a mom. She's given me a lot of tips and pointers, including adjusting patients much larger than me and still achieving results (thank goodness for Thompson drop tables!). Together, we've been analyzing x-rays and determining the best method for treatment for the respective patients.

The more clinics I visit, the clearer picture I develop on how I want my future practice to look and to run. However, I'm still undecided on whether or not I'll work with insurance plans . . . or at least whether or not I'll work with Medicare. I still don't know how I'll eventually balance being a mom AND a doctor, because I never want my practice to come before my family. I never want my kids to grow up and say that their mom wasn't around enough for them. Somehow, Steve and I will balance raising a family, running a practice, and cultivating our marriage for a lifetime.

Maybe it's for the best that I don't know yet where I'll practice, where we'll plant our roots, and what we're doing after the next 6-8 months. For now, we're focusing on having a baby, meeting our immediate budget needs, and being open to what plans God has for us in the future!

Preceptorship Week 5 of 8

Less than 1 month left . . . and past the half-way mark of preceptorship! This past week, I did exams on an out-of-town teenage scoliosis patient and her mom. Both improved considerably with 5 days of treatment, and both felt tremendously better after only 5 days of treatment. Focusing on cervical curve restoration and addressing the upper cervical subluxations helped them to feel "lighter and clear-minded" and it reduced a lot of headache pain and nausea related to the strain they were both feeling on their spinal cords.

Additionally, I did an exam on a non-scoliosis patient who complained of a foot drop and low back pain due to nerves severed from an injury in the military. The orthopedic tests and motor and sensory tests we learn in school definitely come into play for a case like that!

On another interesting note, I learned more about the genetic disease, Turner's syndrome. In Turner's syndrome, females have only 1 X chromosome (X,O) instead of X,X. Some Turner's syndrome females manifest with X,Y.

In school and for national boards, we learn about the common characteristics which manifest itself in an adult, but we never learn about what that presentation looks like in a child. There is a young patient who is undergoing genetic testing for this disease. Although the results haven't yet been provided, some research provided more insight into the presentation . . . and this patient presents with very classic findings:

• short stature for her age
• congenital heart defect
• scoliosis
• drooping eyes, down-slanted eyes
  

Other related affects with Turner's are kidney defects and premature ovarian eggs which typically means that someone with this disease cannot get pregnant nor have children. Although a young girl who isn't yet interested in boys may not think this is a big deal, one day it may be a hard concept for her to embrace. I would think it would be even more difficult for her parents to endure. You can read more about Turner's syndrome here.

Chiropractic and Schuermann's Disease

A week ago, I did a re-exam on a 15 y.o. male who had been diagnosed with Scheurmann's disease. When he first came to the clinic in January, he had a 67 degree kyphosis in his thoracic spine. Normal is 40 degrees.

After 6 months of treatment, rehabilitation, and home exercises, a post-film revealed a significant improvement. His kyphosis decreased to 49 degrees. Re-exam findings also indicated improvement in proprioceptive balance with Hautant's test and increased lung capacity (spirometry testing).

To see those findings in a young man when we're taught in school that chiropractic pretty much can't help Scheuermann's disease.

Preceptorship Week 1 of 8, Part II

Independence Day felt like a Saturday in the middle of the week. I liked the break, but it made me want even more time off! Thursday was pretty slow in the clinic. I was left to do a report, and I had plenty of down time to work on a school project.

Friday was another story . . .

Dr. Dennis had me adjust anterior dorsals on several patients. I barely felt anything move on anyone, and I couldn't figure out why. Later that day, a chiropractor was the patient and he gave me some pretty good feedback. Plus, he was the first patient where I actually felt the joints move when I adjusted him. He emphasized using an inferior-superior line of drive. Thus far that day, I had been hit or miss with that aspect, and I had been thrusting more anterior-posterior.

A couple of the staff members also asked me to work on them later that day. They'd never seen me adjust anyone nor had I ever adjusted them. So, in spite of not knowing about how forceful or in fact decent I am at adjusting, they at least felt comfortable enough working with me in the clinic to ask me to work on their spines. Since it was near closing time, I only had time to adjust 1 person. The only catch was that I had to dictate the SOAP notes into a recorder, something I've never done before. Thankfully, there was at least somewhat of a pattern to her SOAP notes. Since the diagnosis hadn't changed, and I was using Pettibon adjusting procedures, I could at least reference similar things that had been recorded in previous adjustment SOAPs. The best part about it was that the patient was easy to adjust, and her legs balanced with a neurological leg check so that I didn't even have to address the upper or lower angles of the atlas.

Also, she gave me feedback that helped me with all the self-doubt I'd accumulated adjusting numerous other patients' thoracics that day. She said she felt her thoracics move in at least 3 places when I adjusted her. I, however, didn't feel ANYTHING move. So, it's possible that I had adjusted some patients throughout the day, but I hadn't felt anything, just like when I adjusted a staff member at the end of the day.

Dictation notes are definitely the way to go. The electronic push-button forms are great, but they don't help much if they don't cover all the stuff that you actually do when you work with a patient. Presently, there aren't any electronic note forms that are compatible with structural correction. Also, dictation is always patient-specific and relevant. Much less likelihood to get in trouble with a malpractice suit for poor note-taking when you have dictation notes. However, I'm a novice at it, and I need practice. I also need to learn the codeword shortforms for standard phrases. I hear Dr. Dennis say "Macro 7" or something similar.

I'll probably develop my own form of code notespeak for the typist once I get settled into my own practice. Once I get that down, I'll be much faster at treating patients for each respective visit.

Preceptorship Week 1 of 8

I had a really relaxed first day. I thought I'd be running around like mad trying to keep up, but it wasn't that way at all. Since this is a holiday week, and the clinic is closed for 2 days, there aren't any new patients. In fact, yesterday, we were able to leave by 5pm instead of 6pm since the last scheduled patient was finished early. The staff said that early close time NEVER happens. They were super excited about it.

My first day was relaxing due to the fact that I got to experience the Young Living Raindrop Technique . . . which is a treatment that combines essential oils, trigger point therapy, and massage. Dr. Dennis mentioned that he uses this for his out-of-state patients who get the intensive scoliosis treatment, and that the therapy helps them relax before getting chiropractic treatment and rehab. He asked if I wanted to try it out . . . who am I to refuse a treatment that my prospective patients will endure, especially if it has essential oils and massage! It was great, and Dorie avoided using any oils that were potentially harmful to a pregnant woman and developing baby, so I only got a truncated version of the therapy. Wow was it cool . . . and it smelled great!

Day 1, I also adjusted 1 patient's thoracics, applied a few therapeutic modalities on patients, read some current research and chiropractic-related reading material, and I got the run-down on the front desk operations. I only had to analyze a few sets of films. I got the first set correct, but I forgot a couple of things on the lateral cervicals for the last 2 sets. I'll never forget those body base lines again. Since I was thrown into analyzing an S-curve lateral cervical with a very short time limit, I messed up the math on the loss of curvature. However, once Dr. Dennis pointed out what the value SHOULD be, I was able to see where I made the error, and I know I'll never mess it up again (hopefully). It finally makes sense to me.

Day 2, the clinic isn't officially open, but a few emergency patients and a couple of out-of-state patients are receiving treatment. Tuesdays are when I get a weekly 1-on-1 meeting time with Dr. Dennis to ask questions. Today, my questions mostly focused on employing staff, firing staff, wages and bonuses for staff, office policies, worker's compensation, & accounting and billing. There's only 1 more patient scheduled for this afternoon, and I'll also get treated later on today, YAY!

Next week, we're expecting 2 out-of-state patients for intensive treatment. They are daughters of chiropractors. So, their dad's will be observing and learning in the clinic, too. It should be a busy and fun week.