Do you work as part of a team?

Yes and no. For the most part we operate as a regular chiropractic clinic, albeit with increased communication with the patient's other providers. In complex cases, I try to meet with the other providers to coordinate care. For inpatients the team approach is the standard.

Is collaboration with the medical doctors there going smoothly?

There are certain physicians I have formed strong alliances with: spine surgeons, PMR [physical medicine and rehabilitation] physicians, neuroradiology, internal medicine and neurologists. I try to maximize outcomes by coordinating care and seeking counsel from these various specialties. For example, when a patient is referred to chiropractic for treatment of symptoms attributed to a stroke, I usually call the patient's neurologist and make sure that he or she is onboard with my proposed chiropractic treatment program.

Collaboration is focused, patient-centered care and for the most part it works wonderfully. When we pool our thoughts and resources we are able to get results that aren't possible without the team.

So that our readers can get a sense of what's it's like for you practicing on a day-to-day basis at Bethesda Naval Hospital, can you tell us about a patient that you've seen recently, maybe an injured soldier, sailor or Marine, who was helped by chiropractic care?

I have a very good relationship with the doctors here and receive referrals from most of the other specialties here at the hospital. There are certain cases that are complex. We get Marines from the war, of course, and some have multiple spinal fractures and are referred down here from neurosurgery. Most chiropractors aren't seeing patients who are healing from cervical [neck] and thoracic [upper and middle back] spinal fractures. Such complex cases require lots of communication with other members of the treatment team. It's a trust thing, where doctors must trust me to provide appropriate care and I must trust them not to send me patients that would be inappropriate. Also, based on this trust they will listen to me if I determine that a particular patient is inappropriate for chiropractic care, if I feel it would be too dangerous or that I don't have anything to offer them.

What has the response been from the patients you've seen, some of whom, I assume, had not had chiropractic care before?

The ones that get better all love it! [Laughter]

I guess no profession gets everyone well.

No.

Are there any other specific cases you'd like the mention, any interesting examples? Are most of the patients sent to you for back pain and neck pain? Are there other conditions?

Mostly, I treat neuromusculoskeletal conditions. However, I had one woman come in who had abdominal pain for years. She had been worked up and had I don't know how many thousands of dollars worth of previous diagnosis and treatment. This is actually a case I'd like to write up. Her problem turned out a thoracic disc derangement. She responded almost immediately. Three chiropractic visits and the pain was gone and hasn't come back. I say pain, but it was pain, dysfunction, abdominal bloating and indigestion. These were visceral [internal organ] symptoms from a vertebral lesion [imbalance].

I also see a lot of patients with extremity [arm and leg] disorders, headaches, and disc derangements as well.

In what ways do you find serving in a government-run health facility different from individual or group private practice, which is where most chiropractic is currently delivered?