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#5 MD Meetings- Medical Specialist 

#20 Lead with diagnosis NEVER treatment 

One of the biggest mistakes that chiropractors make when meeting with the medical profession is to talk TREATMENT.  This is going to lead into the next consultation “Chiropractic is a profession NOT a modality”.Medical doctors do not define themselves by treatments, they define themselves by diagnostic expertise.There are many examples that I could give you but lets take a look at a primary care physician that has a patient with diabetes.  The patient is 60 years old and has struggled to control their condition and the primary care doctor has cared for them for 40 years.The diabetes is getting more difficult to control and the primary care physician needs to consult with someone that has more specific training in metabolic disorders.  In comes the endocrinologist.So the question becomes, what can the endocrinologist give the patient that is different from the primary care physician?  Not much, BUT the endocrinologist can give a more accurate and detailed diagnosis to determine insulin resistance, metabolic syndrome, weight gain from thyroid etc .  The primary care physician relies on the endocrinologist to help better DIAGNOSIS the patient.In medicine, the expertise is defined by board certification.They know and understand this because the primary care physician has been exposed to endocrinology consultations during their training.So remember it is the DIAGNOSIS not the TREATMENT that the Primary Care Physician is looking for from the endocrine doctor.During my Royal College Training, we had split into small groups and I had in my group an emergency room psychiatrist, an interventional radiologist [who does mostly vascular studies] and a primary care MD. Our case study was a 80 year old female that fainted while getting out of bed in the morning. She had loss of memory, a reduced ejection fraction in her heart and a host of other EKG results listed. The facilitator handed the page to the ER psychiatrist and he immediately looked at me and the primary care MD (we are both in the family medicine department) and said, you guys are family medicine, this is ALL YOU!  That is when it hit me the hardest…it is OK to stay within your expertise – you are not impressing MDs by winging it!!! Lets contrast the above example with chiropractic and medicine. Firstly, medical doctors have no exposure to chiropractic in their training (this is changing but only recently). This results in them not understanding where our expertise is and how to “use” us for consultation. Top that off with the fact that when an MD does talk with a chiropractor, the first thing out of the chiropractors mouth is “I do spinal decompression” or “I provide wellness services”.  We always talk treatment, contrast this with “I specialize in the diagnosis and management of mechanical spine pain”. What I then stay to the MD is, “I specialize in the diagnosis and management of mechanical spine pain and if the patient needs continued medical management I have a network of specialists that I work with”.  The idea is “One we determine an accurate diagnosis, then we can decide TOGETHER what is the best course of treatment”…THAT is what the MD wants to hear.  When you lead with treatment what that says is, “I don’t diagnosis, I don’t do and examination I am just a technician that provides [insert treatment/modality here].”  It also means that the MD has to figure out which types of patients need your “modality”, they are generally a little stand offish since most of the patients that they see come back to them because certain modalities didn’t work for them.  So now they see you as someone who offers a specific treatment NOT the diagnostic expertise they are looking for, that is why they send to the surgeon first!  We know that the surgeons HATE that but that is a different consultation.  

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