Practice Article January 2009

Since I have started teaching a 6th trimester class at a chiropractic college, I am once
again faced with the realization that the board examinations still insist upon asking
questions about Gonstead, Meric, and Upper Cervical - “LISTINGS.”
Everyone knows that a motion unit functions as rotations around the X, Y, and Z axes.
Adjusting, changes the motion dysfunction around these axes and re activates the
dysafferentation from the hypo mobile joints back to the CNS. Trying to improve a listing
by adjusting in the mirror opposite direction only begins to restore normal joint function.
Some motion units need to be adjusted for “PR” and “PL” because the motion unit can
not rotate from posterior to anterior, bilaterally. Another situation is that the motion unit
on the x-ray from which the listing is taken, can actually be quite mobile and not
dysfunctional. It doesn’t really need to be adjusted even though it rates a listing.
Listings lead the user away from actually working with the whole, closed kinematic,
locomotor system. Board exams like to regionalize technique and treatment, similar to
how insurance companies only like you to treat the painful, inflammatory component of
a patients’ condition. For example, a patient complaining of headaches may have very
dysfunctional sacroiliac joints that are causing a symptom producing, upper cervical
dysfunction. Restoring function to the S/I joints for the first few visits are not seen as
“medically necessary” by the insurance companies. They think like most others that
headaches come from the neck therefore only the neck should be treated.
Those of us in the functional model realize we are always treating the closed kinematic,
locomotor system. A dysfunction anywhere in the system will cause an adaptation by all
the other joints in the system. The adaptation is via the muscular system. Joints are
compelled to be rotated and tilted as part of the adaptation response. By trial and
observation we must find the single or multiple major dysfunctions to which the rest of
the system is adapting. These so called “Major” fixations and dysfunctions are treated
by a series of treatments, in order to get the specific changes to our treatments’
imposed demand….better known as the S.A.I.D. Principle.
For our soap notes we state the range of motion that is lost in a motion unit. For
example: C-5, C-6 lateral flexion and flexion. If I adjust that motion unit and get an
audible release I draw a small circle and place a check mark through it. If I don’t get an
audible release I place an “x” in the circle. Remember for best insurance
reimbursement, note what the patient reports at each visit, what your new assessment
is after testing for reflexes, springing pain, SLR, active ROM etc., all followed by
recording what you did and finally the next appointment and any home care instructions.
The old fashioned, so-called “travel card” is useless for recording proper soap notes.
When I did a little insurance work to see first hand why chiropractors had so much

trouble getting insurance payments, I was embarrassed by the abundance of absent or
ridiculously skimpy notes in patients’ files. If you show necessity and record what you
did on about 4 lines, your collection problems will be solved before they occur. The
comprehensive notes can be copied and mailed in as your report. Occasionally they will
request a full narrative report but not often. They move on past your patients’ case and
“attack” a poorly, substantiated case.
I write these notes in the case history file during the time I am with the patient. Don’t
leave them to do at the end of the day. It only takes a minute or two during the visit. All
needing attention at the end of the day takes an hour, if you had a busy day.
I like to change the order of SOAP. I like to say to a patient, “Sit on the palpation stool
and lets see what we need to do today” This is where I do most of my “objective” signs
such as motion palpation. I finish the tests that require a supine or prone posture and
then write in my findings and assessment of their status regarding the healing response.
Now if they haven’t already told me, I ask them how their specific symptoms are doing
and record by paraphrasing their comments. I then treat them and record what I did for
them.
Lastly I check off the treatment, diagnosis etc. on the 3 part super bill…one part for
them, one copy for them to send into the insurance company and one copy for our
business files. I hand them the three part form and ask them to give it to the front desk
so they can “settle up.” This form has the next visit day/date written in so that the front
desk person can book the next appointment.
Practice can be hassle free seeing 3 patients per half hour with three treatment rooms.
Super efficient doctors can give quality care seeing 3 patients every 20 minutes using 3
treatment rooms. My treatment rooms are 8’ x 12’ and have the modalities in each
room. My rehab is low tech and I get patients to purchase a gym ball for the core
exercise follow-up to the treatments that restored joint function and the reversal of the
inflammatory component of their condition. They all purchase a copy of “Goodbye Back
Pain” as their manual to a full recovery including core conditioning at the first visit.
“Goodbye Back Pain”, 2008 is available on Amazon.com (by Leonard J. Faye DC) .

Don't forget to visit us at: http://www.chiropracticmentor.com