Saturday, 13 February 2016

What does a Chiropractor do … on a Tuesday?

Because I work on Saturdays and have Mondays off, Tuesdays start early at 7:30 and begin with an assault on the in-tray: two days’ post, messages, following up patients, phone calls and making sure the social media for the week is planned and posted (thanks goodness for Hootsuite and ‘autoschedule’).

It’s important that the decks are cleared before patients start, because Tuesdays are invariably fully booked … and often overbooked, as was this particular Tuesday, which kicked off fifteen minutes early with an emergency patient, who had cricked their neck sleeping awkwardly the previous day and was nervous about seeing another chiropractor.

The morning consisted of a typical mix of patients: There were twelve cases of low back pain (including one new patient), one hip pain, one ankle injury (tennis), a couple more cases of cervicalgia, and a couple of headache, a child with poor gait, a cartilage injury in the knee, a rotator cuff tendinitis and a lady with temporomandibular disorder … and one no-show, which is always incredibly frustrating when you’re not only full but have people on the waiting list, desperate for appointments.  Fortunately, everyone was getting better and staying better apart from one of the headache patients, who was referred to our next specialist Headache Clinic so the dental and stress components that were preventing the condition from settling could be addressed.

Although I always try to run to time, the last couple of patients proved slightly more complicated than expected and that made lunchtime a bot of a scramble – Tuesday’s morning session is at Yeovil and the afternoon session is at Crewkerne … which gives me the opportunity to stop at home en route and quickly eat a rather belated lunch.

As ever, when time is tight, the traffic on East Street is backed up to Mount Pleasant (someone build a bypass for Crewkerne PLEASE!!) and clinic starts seven minutes late!  This, of course is the immediate cue for patients to be complicated, refactory, or to present with unexpected new conditions.

The first patient was typical of this, a lady with a recovering sacroiliac joint causing buttock pain who had been feeling so much better that she decided to move some furniture and now had raging sciatica and all the signs of a prolapsed lumbar disc.  The next three patients also all had sacroiliac joint problems; however, these were all recovering as per prognosis – improved after three treatments, better after six and two of the patients were ready to start some gentle home-based exercises to stretch out tight, fibrotic muscles and rebuild core stability.

The next case is a tough one – a whiplash injury that has been referred via a solicitor having previously failed to recover.  The delays involved in processing the claim has allowed the injury to become chronic and it’s not just neck pain, like a lot of whiplash there is also a jaw problem (which is preventing the neck from settling), back pain and a shoulder injury … all made worse by the stress of dealing with solicitors and the whole compensation process. Today, at last, there is some sign of improvement: everything is moving better and hurting less – but with so many areas to treat, there is no chance of catching up and now I’m running almost quarter of an hour late.There is, however, no point in worrying about that … most patients understand that sometimes you need to spend longer with a patient – next time, it could be them! 

Fortunately, the next lady in is a new patient: at last a chance to sit down for a few minutes and to take a case history. Fortunately too, her case is relatively straightforward: a long history of migraines, which sound like they’re coming from the neck with no evidence of anything sinister or untoward going on – the physical examination confirms the diagnosis and there’s time to start a course of treatment which turns out to solve fifteen years of weekly misery in just  couple of weeks!

The rest of the evening is full of complicated patients: a knee riddled with osteoarthritis that would probably do better with surgery but the lady’s determined to avoid the kind at all costs; neck pain in an eighty-four-year old lady with osteoporosis who needs particularly careful handling; another case of low back pain following not one but two car accidents (the neck and jaw had already responded to treatment); a lady with back hip and knee pain; a cervical disc injury causing arm pain and, to finish the day, a disc problem which is stubbornly refusing to respond to treatment and needs referral for magnetic resonance imaging in Bridgwater, where we have a special arrangement … all of which means that clinic finishes fifteen minutes late – which is still quarter of an hour earlier than the rest of the week (for historical reasons, Tuesday’s Crewkerne clinic ends at 6:30 rather than 7).

Home at 7pm having left at 7am. Although there is stuff to be done (when isn’t there?), the lure of an early night proves irresistible: tomorrow is going to be another early start with budgets, cashflow forecasts and marketing analysis all to do before another 36-patient day and a fresh brain will be required.