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An Inside View of a Chiropractic Office

The author of this article, whose identity is

known to Dr. Barrett, wishes to remain anonymous

 

During 1995, I worked in a chiropractic office for about four months. Initially, I had applied for a position as a receptionist/office manager. I had done temporary work in office settings and had worked briefly in a medical environment.

The hiring process consisted mainly of self-administered "IQ" and personality tests, which I apparently passed. After a short interview with the chiropractor who ran the clinic (whom I will call Dr. Smith), I was hired as a "chiropractic assistant." My pay would be $8 an hour, plus a bonus (usually 25¢) for each treatment I administered.

I never worked at the reception desk or managed the office. Instead, after some four hours of training, I began administering treatments. The most common treatment was "trigger point" massage, a sort of free-form acupressure using a small, T-shaped bar with a rubber tip. I was instructed about a few acupressure points, but was told to feel for "knots" in the muscles, and to apply pressure to them as well, using the bar and the weight of my body. I doubt that this felt good. I was clumsy and inexperienced, but the doctors didn't seem to care about this. Each "trigger point" massage was to last ten minutes (or less, if we could get away with it). My bonus was not based on patient satisfaction with my work.

I also applied "EMS" (electrical muscle stimulation) to patients. This involved applying sticky electrodes to specific areas on the patient, and operating a machine that supplied a gentle electrical current. I underwent this procedure my "training." The treatment feels like insects crawling over one's skin. I was told this would increase blood flow to affected muscles. We used the same electrodes over and over again, until they lost their adhesiveness, cleaning them with a foaming spray (an Amway product) that was ostensibly germicidal. It was also used to clean tables, desks, and other office furniture.

I also administered hot and cold packs. (These were my favorite, as I simply had to place the pack on the patient to receive my 25¢). Later, towards the end of my time in the office, I administered a "Vax-D therapy" which I describe below. Because this took half an hour, my bonus for these was $1.

The office hours were conducive to patients coming during their lunch hour and after work. The day started at 11:00 AM or so, and Dr. Jones (again, a pseudonym), an employee of Dr. Smith, would work from 12:00 noon to 1:00 PM and from 4:00 PM to 7:00 PM. During "off hours," I transcribed patient notes and letters to insurance companies (justifying treatments). I also designed coupons.

As part of its marketing strategy, the office placed boxes at local business establishments, advertising a "contest" for a free massage and spinal exam -- a "$150 value." In return, the businesses would receive books containing coupon ads for themselves and other participating businesses. I assembled these books, using an archaic equipment and a primitive software program. The resulting quality of these "coupon books" reflected this. Each participating business would get about five "books" with my cheesy designs. I once asked about the poor quality of the books, and was told: "what do they expect? It's free." Questions I asked about chiropractic itself were usually met with indifference, as if I were too stupid to understand.

The chiropractors employed a full-time person who did nothing but visit various businesses to sell this "book for box" concept to them. They also employed a young woman, part time, who telephoned people and told them they had won the contest. Actually, everyone who entered "won." Those who came to the office had a brief trigger-point massage, a spinal x-ray, and a brief consultation with either Dr. Smith or Dr. Jones.

As far as I could tell, everyone who came through the door was advised to have chiropractic treatment. For the doctors, life appeared to a constant struggle to convince masses of people that they needed spinal adjustments. One day they tried to get me to go home early because it was a slow day. They said: "You need to get your friends to come in and get adjusted." They didn't know any of my friends, or whether any of them were suffering from anything they might be able to help with. I should just round 'em up and bring 'em in.

The doctors kept "stats" on everything. Each day we would begin work with brief meeting during which we would all read off our "stats." Mine were simply the number of treatments performed. Although this obviously depended on the number of patients who were scheduled for treatment, an increase was "rewarded" as a "win" with a round of applause. Dr. Smith would then give a brief lecture. Sometimes this would be a reading from the staff manual, a huge looseleaf binder filled with procedures, outtakes from Scientology books, and flowcharts. Sometimes he would read patient testimonials. (A sheet was kept at the front desk for patients to write down their experiences. Negative ones were discarded.)

At other times, the chiropractors would discuss patients, or ask us about them. I can remember, on more than one occasion, a patient who wasn't responding to treatment was branded as "difficult" with additional comments like: "He doesn't want to get better," "She is lazy," or "He wants to keep collecting disability." Occasionally, a patient would be dropped. Not referred elsewhere, not told that maybe there was a medical problem. Simply dismissed.

The busiest period of the day was from 4:00 PM to 6:30 PM. It was like an assembly line. Patients would come in, and would be given their chart. They would rate their own symptoms, and lie down on one of six tables for treatment. Treatments were administered by Dr. Jones, using the "Activator" technique. The activator is a miniature spring-loaded hammer used to tap along the spine, a procedure he referred to as an "adjustment." (Unlike most other chiropractors I have heard about, the doctors didn't use their hands to manipulate the spine.) Some patients were also advised to do isometric-type exercises as a form of "preventative maintenance."

During our busy times, Dr. Smith and another man I'll name "Bob" met individually with patients. Bob was not a chiropractor. During these sessions, they would discuss diagnosis and treatment recommendations and would display the x-ray films, which the senior chiropractic assistant had marked with a protractor. They would also discuss treatment costs.

Also during this time, the senior chiropractic assistant would administer tests that were supposed to measure flexibility, sensation, and so forth. One of these used a small, hand-held set of electrodes and a computer. It produced charts with large arrows (the larger the arrows, the bigger the alleged problem). I was supposed to be trained to use this equipment, but didn't get very far. I practiced once on Bob. His results were lousy. He said: "well, I haven't been doing my exercises'.

After their chiropractic adjustment, patients would come back to the "treatment' area" where I would administer the treatments described above. I also developed x-rays. Everyone who came to the office had at least one full-spine x-ray done. I had one done on myself. Patients who were given the exercises had a full set of range-of-motion type x-rays. These were marked by the senior assistant, who appeared to be measuring differences in shoulder height, and angle of the hips. It seemed to me that the markings reflected the position the patient was standing in when the x-ray was taken.

The patients would then turn their cards in at the front desk. I have often heard that one of the reasons for the success of "alternative" medicines is that the practitioner-patient relationship is supposed to be closer. However, the procedures in this office discouraged any form of closeness. Patients had consultations when they began treatment or were prescribed exercises. Or when they began to run out of money. Other than that, the process was designed to get as many people through the door as possible. Doctor Jones might say hello, and let the patients know whether their legs tested "even" when they were lying on the table. They might be told, for example, "quarter inch short today." Jones would give a few "adjustments" with the Activator and that was that.

Because the doctor could "stack" and adjust patients in rapid succession, there was usually a backlog in the treatment room. I rarely said anything to the patients because I was busy. We were forbidden to speak to the doctors during treatment times. We had to write them notes. I never figured the reason for this policy, and it was never explained.

The practice employed three women as collectors. They would try to get money from the patients' insurance companies. Patients with no insurance, or whose insurance company had paid its limit, were encouraged to get credit, to pay as they went, or, in some cases, to make installment payments. I am unsure of the exact details of these plans, as I never dealt with them directly.

After a month, I was eligible for free chiropractic treatment. I had a full-spine x-ray taken, and was asked if I had any symptoms. I had been suffering from insomnia, probably caused by my irregular hours. I noticed that when I began keeping a regular bedtime, I slept much better. I also had headaches, probably related to stress caused by lack of sleep. My x-ray was marked up, and I was told that my spine was too straight.

The adjustments I had done felt strange. The Activator felt like a heavy tap, and I would feel a "pressing" sensation in my hips, buttocks, and lower back (the main areas adjusted) for a moment or two afterwards. Once or twice, the activator was used on my neck. I must say that seemed to help the headaches, but it was like taking an aspirin. The headache would go, but it would always come back later. It could be argued that I didn't allow enough time (or have enough treatments) for it to truly work. I certainly can't refute that argument, and I won't try. The treatment had no permanent effect on either my insomnia (cured by regulating my sleeping habits, a long time after my last adjustment) or my headaches (which went away after I began sleeping better, and a few stressful events in my life had passed).

After about two months, I learned how to put patients on the Vax-D table, a sort of large, hydraulically powered "rack." Patients were strapped onto the table with a large, canvas harness (basically a big belt), and held handgrips thast enabled them to regulate the stretching by letting go. This was supposed to decompress the spine. The equipment was supposed to have been designed by a medical doctor, and this was played up in the promotion of the treatment. It was supposed to eliminate the need for back surgery, and was reserved for "severe cases." It cost $125 a session, which were prescribed in ten-session blocks.

It was the Vax-D machine that got me fired, I guess. A patient came in, and was strapped to the table. The belt which strapped him in began to slip, so I stopped the treatment. He became upset that I had stopped the table, and insisted that I continue. I told him it wouldn't be safe (if the belt slipped, it would probably cause some nasty chafing as it snapped free of his body). He became belligerent, swore, unhooked himself, gave me the finger, and stormed out of the office. I was shaken by the man's aggressiveness, but neither Smith nor Jones said anything about the incident until the next day, when I was fired. I was told I had cost the practice a lot of money.

I eventually found work in an unrelated field. I am quite happy, and doing well.

I feel a small amount of guilt for having worked in such a place, and a larger amount of guilt for participating in the "coupons for boxes" side of things. Part of me may resent being fired; but all of the incidents and events related above are true, to the best of my recollection. I do not know what caused the Vax-D patient to get so upset. It was never discussed.

Looking back, the most important question for me is one I cannot answer: Did the doctors feel they were helping people, or were they cynical charlatans? They certainly defended chiropractic in general, and their practices specifically, but I only ever saw this done in the context of defending themselves from a denied insurance claim. I have seen and heard of the notion of a patient "not wanting" to get better used in other contexts, but never as often as I did there. My major problem with what I obsrved was the notion that everyone, whether they know it or not, needs chiropractic adjustments.

I do not claim that these experiences are typical of chiropractic. They do, however, illustrate how one office was run. From what I have seen, the aggressive marketing and the "free exam" ploy are common.

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