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Question and Answer with Dr. Sill

Why do you seem to have more than one focus in your specialization?

My focus is on my community of patients and is centered around their needs.  While I was earning my Doctor of Chiropractic I did not yet have a base of patients, but I have three sons who are active in sports and other activities.  I felt understanding their needs would later better serve my patients, so I earned a Masters in Exercise and Sport Science and became a Certified Chiropractic Sports Physician®.  This specialization allowed me to better understand trauma and acute injury.  After I opened my practice, I had a serious motor vehicle collision case and while I managed this case appropriately, I felt I could improve my knowledge about these complex cases.  I recognized that our office was becoming a trusted provider for people injured in traffic accidents.  I completed the Croft Advanced Level certification which provided the knowledge I needed to feel comfortable handling a patient’s injuries after a car accident.  I recognized many of my patients have disc injuries, concussions, etc… to which I sought out additional training in those areas.  My focus is the needs of my patient community.

My Medical Doctor says that I should not see a chiropractor.

There are MD’s who have not seen the latest studies supporting chiropractic care or do not understand the benefits of chiropractic.  We are seeing a shift in many medical doctors’ opinions of chiropractors for the better.  In the past, MD’s and DC’s have not gotten along and have had strong disagreements in care.  In recent years, MD’s have recognized the benefits of chiropractic care in the outcomes of their patients.  There has also been a split in chiropractic where many DC’s have moved away from procedures which are not shown to be effective in research, towards proven and validated procedures more closely aligning these modern chiropractors with medical providers.  Chiropractors undergo rigorous testing at both a state and national level and are governed by their state licensing board. The Oregon Board has strict guidelines regarding appropriate patient care.  These changes have made many healthcare providers see each other as partners in a holistic and team approach to patient care.  While stigma’s still exist within certain medical communities, the newer generation of Medical Doctors see chiropractors as musculoskeletal specialists and are valued members of the patient’s healthcare team.

Do I need a referral?

Probably no, possibly yes.  Chiropractors as ‘primary healthcare physicians’ are gateways into the healthcare system, therefore no referral is necessary.  On the other hand, some health plans require a referral from a MD, therefore a referral may be required.  Contact your insurance company to find out about the requirements of your plan.

What will my insurance cover?

When you come into our office we will do our best to provide accurate information about your coverage, however we STRONGLY recommend that you contact your insurance company.  We get our information from your insurance company and we have been given incorrect information about patients’ coverage.  Chiropractic coverage can be complex as insurance companies do not define chiropractors in the same way and can put procedures performed by a chiropractor under several categories: Chiropractic, Alternative Care, Primary Care, Specialists and Physical Therapists.  Insurance companies may offer many different plans with differing requirements.  Insurance companies change their plans and rules frequently.  If that is not enough complexity, for ‘alternative care’ many insurance companies will sub-contract with a 3rd party insurance company, adding another level of rule and communication problems.  Pacific West Chiropractic will not guarantee coverage.

Did my _____ move during the adjustment?

When adjusting, a chiropractor has 2 options:

1. Use the force or additional attempts needed to make an adjustment. 

2. Use only the force appropriate for the needs of the patient and not worry about ‘fixing’ everything in one visit. 

I disagree with number 1. I drive a stick-shift transmission; while I can force gears, I am simply causing damage to the transmission, on the other hand, if I slide it into gear I get a smooth gear change.  By accepting that not every joint is going to move every time, we can relax and not add additional trauma by forcing a joint which in not ready to release.  This results in less pain and increases trust.  As the patient builds trust in their physician, the patient can relax and not guard against the movement, making adjustments easier, more effective and more comfortable.  It follows the concept of ‘just because I can, it does not mean I should’.

Why did you not adjust my whole spine?

Many chiropractors believe that the entire spine should be manipulated with every treatment.  These traditionally trained chiropractors have compelling philosophy behind this decision.  I do not agree, unless there is clinical indication to address multiple areas.  Chiropractic care is proven to be a safe and effective treatment for many conditions; however, as with any medical procedure, there is risk with every manipulation, and even though the risk is small, subjecting a patient to this risk without direct clinical rational is not a practice that I agree with.  Adjusting more areas also means the provider can charge more, but this, in my opinion, is not justification for unnecessary procedures.

Why did you not perform a manipulation (adjustment) on me?

While adjusting is a primary tool for a chiropractor, it is but one tool.  In Oregon, Chiropractors are ‘primary healthcare providers’ which basically means they can be used as a gateway into the healthcare system.  Chiropractors are also ‘physicians’ which allows them to perform many of the abilities and procedures of what one would normally think would be the realm of a medical doctor with the exception of prescription medication.  Chiropractors, particularly those with sport physician specialization, perform many procedures a patient may receive from a physical therapist.  When a particular therapy is not the most effective available to treat a condition, it should not be used, and the patient should not be exposed to the cost and risk of unnecessary procedures.  Chiropractic manipulation is extremely effective for treating many muscular-skeletal conditions and even a few non- muscular skeletal conditions, but it is not always the most appropriate procedure.  I work with my patients to find the most appropriate treatment options for their particular needs, and this does not always include chiropractic manipulation.      

I already know what is wrong, can I just get an adjustment without an exam?

No.  Conditions change, similar pain can come from various conditions, and I as a doctor do not know you or your body.  To provide safe, effective care, I need to evaluate your condition and diagnose the causes and rule-out conditions in which treatments may cause harm.  Even if you saw another chiropractor yesterday, I need to perform an exam.  Another way of looking at it would be- if you wrecked your car in an accident and took it to a body shop for an evaluation, then took only the quote from the first shop to another, would the second shop give you a firm and binding quote off of the information provided by the first shop without ever seeing your car?  NO.  I cannot perform a procedure on a patient without an exam.

Are you going to order X-rays during my first visit?

This is one of the most common questions people ask our staff.  The standard of care before the turn of the century was to always order x-rays prior to treatment.  It was believed that we could see more and improve patient care with imaging during the exam.  This also, unfortunately, became a revenue source for many clinics, driving unnecessary imaging. 

The reality of the effectiveness turned out to be different than the traditional standard of care. Experienced Chiropractors who perform a thorough history and exam are very good at identifying the problem without the aid of x-ray. With this high-quality exam, it is rare for the x-ray to provide any significant information, which was not already identified, that would change the course of treatment. 

The standard of care has changed, and it is now considered inappropriate to order x-ray on every patient.  X-ray has risk and does add to annual radiation exposure.  I do order x-ray when:

1. Findings of the exam suggest the need for imaging

2. When patient history warrants this procedure

3. When mechanism of injury suggests the need for x-ray

4. When patient does not respond appropriately to conservative care. 

For patients who do not fall into one of these categories the added diagnostic information of x-ray does not overcome the risks and cost to patients.

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