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Building Healthy Relationships

Integrative healthcare offers patients something that used to be unheard of—one place that offers access to a variety of healthcare practitioners. These providers often work as a team, to determine the most appropriate practitioner or practitioners to best address a patient’s needs.

As the multidisciplinary healthcare field has grown, so has the level of participation in it by chiropractors. At the same time, chiropractors are increasingly valued by other providers for the conservative, cost-effective, non-invasive and drug-free healthcare option they provide.

Each of the Palmer alumni profiled in this article have made inroads into multidisciplinary care. Their work is benefitting patients the way only chiropractic care can. It’s also giving them and other healthcare professionals an appreciation for what they can accomplish when they work together.
CASE BY CASE: Entire clinic meets regularly to review each patient’s care

PRACTICE 

James Spina II, D.C., Davenport '81
Dolson Medical Plaza, Middletown, N.Y.
Years ago, Dr. James Spina, left, recruited like-minded healthcare practitioners who could work together to “provide the highest-quality and most-comprehensive care in the area.”
Dr. Spina II looking at computer with two healthcare practitioners

After years of running a successful practice, Dr. James Spina II found himself drawn to integrative healthcare.

“Seeing the way patients were handled by other practitioners or therapists, I knew I could do a much better job,” he recalls. “So instead of referring them out and the patients not being satisfied, I decided to provide the same care all in one place and now it’s working well for everyone involved. Patients love it.”

At Dolson Medical Plaza, Dr. Spina practices alongside other chiropractors as well as massage therapists, acupuncturists, physiatrists, nurse practitioners and physician assistants.

“We all work as a team and review all patient charts twice a week,” he says. “We review any tests that have been ordered such as MRIs, CAT scans, EMGs, special X-rays or any test the medical practitioners or chiropractors may have ordered. This way everyone who touches the patient knows their condition as well as their progress and test results.”

The group also discusses the best treatment for their patients, whether it be chiropractic care, physical therapy, medical care or a combination of all three. While this environment can increase one’s referral base, Dr. Spina says that the main reason to pursue a multidisciplinary care career should be out of a need to create change.

“I think B.J. Palmer said it best,” he adds. “‘Your right hand is your service hand and your left hand is your money hand. If you do a good job with your right hand, you never have to worry about your left hand.’”

Sports chiropractors on the roster at integrative clinic

PRACTICE 

Taylor Rabbetz, D.C., West ’00
Chiro-Medical Group, San Francisco
Four of the providers at Chiro-Medical Group are West Campus alumni. From left, Michael Lord, D.C., ’10, Daniel Lord, D.C., ’08, Hal Rosenberg, D.C., ’01, and Taylor Rabbetz, D.C, ’00.
four chiropractors standing together

When Dr. Taylor Rabbetz began working at Chiro-Medical Group (CMG), a multidisciplinary practice in San Francisco, he thought most of his time would be spent developing the practice. Nearly 12 years later, he divides his time equally between running CMG and caring for his patients.

“Although I essentially maintain two fulltime jobs,” says Dr. Rabbetz, “I love what I do: being a chiropractor and helping patients achieve optimal health.”

With 17 patient-care rooms and a fullyequipped rehabilitation center, CMG specializes in helping patients manage sports-related injuries. Its sports chiropractic staff includes Dr. Rabbetz, who played on the Palmer Pride ice hockey team, and three other West Campus graduates, (above). Additional providers include exercise rehabilitation specialists, physical therapists, M.D.s and a nurse practitioner.

“In the acute stage for injuries, medicine has a great role in decreasing pain,” notes Dr. Rabbetz, referring to the scope of care provided at CMG. “However, for long-term success, patients want more. They want to know what types of stabilization exercises they can do; and what stretches they can do in order to help reduce the risk of suffering the same injury again. We fill this need with an ‘all-in-one’ facility.”

Healthcare with childcare

PRACTICE 

Tom Young D.C., Florida ’06, CCSP
Florida Campus Alumni Office Representative and Instructor
“I left school ready to communicate with others how chiropractic care can integrate into current models,” says Dr. Tom Young, who found the perfect outlet at an integrative practice in Raleigh, N.C.
Dr. Tom Young

Before joining the Florida Campus faculty in 2010, Dr. Tom Young was part of the American Institute for Healthcare & Fitness (AIHF) in Raleigh, N.C. Set up like a shopping mall, AIHF is filled with healthcare practitioners instead of stores. Those providers include chiropractors, acupuncturists, massage therapists, family practitioners, orthopedists, mental health professionals and imaging specialists.

“Many of us collaborated on patient cases, marketing and community service,” says Dr. Young. “The lines of communication were always open. The providers would meet regularly to educate each other about the types of patients we were best suited to treat.”

According to Dr. Young, the close proximity of AIHF’s providers allows for faster-than-normal lab and imaging results, and more timely referrals—saving patients time and the need for return trips. The facility also offers families the conveniences of a fitness center, pharmacy, café and childcare center.

“Getting to know practitioners and collaborating on cases not only increased referrals to each other,” he says, “but was a great learning experience as I was exposed to cases that I may not have seen in a stand-alone family practice.”

Dr. Young recalls two patients in particular who benefitted from AIHF’s multidisciplinary setting. The first had ankylosing spondylitis, and another dealt with debilitating headaches and low back pain. “I was able to consult with several providers regarding appropriate and available treatment and co-manage their care, so that they got the pain relief they needed as they progressed,” says Dr. Young.

Pain management for patients undergoing cancer treatment

HOSPITAL 

Jeffrey Sklar, D.C., Davenport ’97
Eastern Regional Medical Center, Philadelphia
Dr. Jeffrey Sklar, right, discusses pain management care with a patient, left, and naturopath Dr. Sheba Roy, at the CTCA hospital in Philadelphia.
Dr. Jeffrey Sklar sits across from patient with Dr. Sheba Roy standing in background

What would a chiropractor be doing at the Cancer Treatment Centers of America (CTCA) hospital in Philadelphia? Plenty. Dr. Jeffrey Sklar doesn’t treat or diagnose cancer at CTCA, but provides chiropractic care to patients receiving cancer treatment. Sometimes, he’s asked to adjust patients the day before they have surgery.

“My focus is to find and remove vertebral subluxations and help patients with common side effects to treatment such as chemo-induced neuropathy or tissue fibrosis, which can often occur with radiation treatment,” he says. “Additionally, I assist in pain reduction, with the intention of reducing the need for pain medication.”

Recently, Dr. Sklar had a patient with a chemo-induced headache that kept her from sleeping through the night. After an adjustment, her headache went away and she slept normally again.

Like all CTCA facilities, the Philadelphia hospital assigns a multidisciplinary care team to each patient. It also has the “Mother Standard,” whereby each patient and caregiver is treated “like one would treat a member of their own family.” The mission has special meaning to Dr. Sklar, as three of his immediate family members have had cancer.

“The patients here are truly amazing people,” he says. “They bring an undaunted spirit to the hospital, a spirit I have never experienced before in my life. And, on top of it all, they thank us for being here.”

Some D.C.s make house calls. Dr. Doug Briggs makes hospital calls.

HOSPITAL 

Doug Briggs, D.C., Davenport ’95
Beebe Medical Center, Lewes, Del.
At Beebe Medical Center, Dr. Briggs says he’s noticing increased referrals from orthopedic spine surgeons for pre- and post-surgical pain, and also as an option to try and avoid surgery.
Dr. Doug Briggs adjusts patient

“I am listed as ‘on call,’” says Dr. Briggs, referring to his working relationship with Beebe Medical Center in Lewes, Del. “And if any attending doc or hospitalist requests my care, I can see the patient in their room or in my office upon dismissal.”

Dr. Briggs says having hospital privileges has given him a range of patients with conditions that he might not otherwise get to treat. He cites one man with spinal fusion pain who, under chiropractic care, was able to stop taking narcotics and resume his regular workload.

“Patients in hospitals need chiropractic care, too,” he points out. “But if we aren’t there to participate, how are they going to know what we can do?”

Dr. Briggs stresses that he’s developed good working relationships with other providers at the hospital, which has, in turn, resulted in mutual respect for everyone involved.

“Working in a hospital, or with medical doctors, does not dilute the value, philosophy or ideals of chiropractic,” he says. “We have different care options to offer. Isolating ourselves from mainstream health care serves no benefit.”

Alaska Native gives back to her community

HOSPITAL 

Angela Michaud D.C., Davenport ’08
Alaska Native Medical Center, Anchorage
Dr. Michaud has found her training at Palmer on terminology, timely treatment, examinations, differential diagnoses and documentation to be very helpful.
Dr. Angela Michaud standing next to clinic

Dr. Angela Michaud is a fourth-generation Tlingit Alaska Native working her dream job: as a chiropractor for Southcentral Foundation in the Primary Care Center at the Alaska Native Medical Center (ANMC) in Anchorage. Her patients are Native American/Alaska Native descendants or employees of ANMC.

“I love working in this setting because I am giving back to my Native community,” she says. “A lot of the patients I see would not be able to see an outside chiropractor due to financial situations.”

Dr. Michaud is very appreciative of her education at Palmer because the hospital receives patients with all types of diagnoses that accompany their musculoskeletal conditions. Her own patients are referred to her by primary care physicians with whom she stays in contact regarding patient findings, care and progress. “We also will contact them if we find useful information for their treatment plan or if we need to have further studies ordered, such as MRIs or blood work,” she says.

Dr. Michaud encourages any chiropractors who are Native American or Alaska Native to contact a new organization, the American Indian Alaska Native Doctors of Chiropractic (www.AIANDC.org) to help provide more chiropractic care to Native communities.

New grad takes integrative initiative

HOSPITAL 

Mike Olson, D.C., Davenport ’11
Bigfork Valley Hospital, Bigfork, Minn.
Dr. Mike Olson was one of two class salutatorians at the Feb. 25 Davenport Campus graduation.
Dr. Mike Olson in graduation garb

Within days of walking across the stage at his graduation, Mike Olson, D.C., walked into the hospital in Bigfork, Minn., and became its first chiropractor. Dr. Olson had initially interviewed at an integrative orthopedic clinic in Grand Rapids, Minn. While they didn’t have any openings, they referred him to Bigfork Valley Hospital, where he now works.

“The clinic I initially applied at was not currently hiring, nor was the hospital,” he says. “However, by taking the initiative and sending them my résumé, much progress was made.”

His contract with Bigfork Valley provided him with two adjusting rooms at the hospital and another two at the hospital’s clinic 15 miles away, where he provides care once a week. “They’ve given me the wonderful opportunity of developing a great system for the hospital,” says Dr. Olson. “They are very open to all of my opinions, questions, concerns and the way I envision myself practicing.”

“Chiropractic needs to be involved in multidisciplinary health care,” he says. “We have so much to offer our patients, and by becoming involved in a multidisciplinary setting, we not only can educate our patients, but we can also educate other healthcare professionals as to what we do.”

Free care that has great value

CLINIC 

Steve Agocs, D.C., Davenport ’00
Volunteer at Kansas City Free Health Clinic
Dr. Steve Agocs with a patient, who comes in regularly to see him for adjustments as part of her overall care, at Kansas City Free Health Clinic.
Dr. Steve Agocs next to patient

Dr. Steve Agocs first worked in an integrative healthcare setting while precepting. Today, he provides care part-time at the Kansas City Free Health Clinic (KCFHC), one of the largest of its kind. On average, Dr. Agocs sees 30 to 45 patients during the eight hours he donates each week.

“My work at KCFHC has become the highlight of my week, and it is very rewarding in a professional sense,” he says. “I get to see cases like none I ever had in private practice, and the satisfaction of being able to use my talents to help people who would otherwise not have access to chiropractic care is just incredibly rewarding in every way.”

Dr. Agocs regularly sees patients with multiple complaints, including a man who has lived with a heroin addiction and diabetes for 10 years. Chiropractic pain management has proven to be critical for patients like him because it doesn’t interact with drugs and can prevent the need for additional medications.

“There is an enormous market for chiropractors in the medical system that is almost entirely untapped,” he says. “But a little bit at a time, all of us who work in a multidisciplinary setting are showing other professionals how valuable chiropractic is to patients and, frankly, their bottom line.”

Where med students do chiropractic rotations

PRACTICE 

Donna Frederick, D.C., Davenport ’06
Frederick Family Chiropractic, LLC, Muncie, Ind.
Seen adjusting one of her younger patients, Dr. Donna Frederick volunteers to host students from a local hospital to observe her work.
Dr. Donna Frederick adjusts young patient

Some medical school students must observe the care of hospital patients under the guidance of an attending physician. In Muncie, Ind., some med students also do a rotation at the chiropractic clinic of Dr. Donna Frederick.

Each rotation involves a student in residency at Indiana University Health Ball Memorial Hospital observing Dr. Frederick during one four-hour visit as she performs patient exams, gives reports of finding and interacts with and adjusts patients. In some cases, the two will discuss how each would address a particular patient’s case before weighing the pros and cons of both actions. As an added bonus, students are free to interact with the patients.

“They talk to the patients to find out how chiropractic has helped them,” says Dr. Frederick, who believes the visits provide a win-win opportunity for both parties.

“We don’t want the M.D.s to be closed-minded about what we do, and we shouldn’t be closed-minded to what they do,” she says. “It’s a learning experience.”

“I enjoy getting an opportunity to teach the residents things that they may not otherwise learn or be exposed to,” she adds. “Plus, it’s always fun if they want an adjustment after their round with me!”

Creating a hospital’s first chiropractic department

HOSPITAL 

Steve Barnett, D.C., Davenport ’79
Director of Chiropractic Relations, DeKalb Medical Center, Decatur and Conyers, Ga.

When Steve Barnett, D.C., retired from his successful, 30-year practice in Stone Mountain, Ga., a few years ago, he never envisioned himself as a pioneer in enhancing collaboration between D.C.s and M.D.s. “I was bored,” he says, “so I started a management company to facilitate chiropractic referrals to a hospital setting for outpatient care, specialty consultation and diagnostic imaging services.”

After presenting his idea to the administrators of DeKalb Medical Center, with nearly 600 acute care beds and campuses in several Atlanta suburbs, the hospital administration asked him to work for them and create a chiropractic department. Dr. Barnett became the director of chiropractic relations for DeKalb Medical Center (DMC) in Decatur and Conyers, Ga. He quickly began developing a network of Atlanta-area chiropractors in the fall of 2009, which is now more than 175 members strong.

“From the beginning, the hospital staff was very impressed with the level of knowledge of the chiropractic practitioners,” Dr. Barnett says. “The hospital’s imaging department has received most of the referrals, but nearly all specialties have received chiropractic referrals and the hospital is reciprocating.”

The chiropractors are listed as non-staff physicians and invited to come to the hospital at any time, he adds. “I’ve learned how the hospital works and they are learning a great deal about us, our education and the quality of care we provide.”

The role of the chiropractors at DMC was expanded dramatically beginning in November 2010 with the start of an emergency room chiropractic referral program. Through this program, all low-level motor vehicle accident (MVA) patients coming into the DMC emergency room will be referred to the network of chiropractic providers for DMC. These are ambulatory patients without cuts or broken bones, but who are experiencing back or neck pain. They are stabilized in the ER and then referred to one of the chiropractors in the DMC network.

Dr. Barnett credits the “tremendous, tireless support of the chiropractors” in the referral group with the success of both the original referral program and the new program for low-level MVA patients. “It is estimated that this new program could introduce 300 patients per month to chiropractic care,” he says. “For those in our profession who are worried that chiropractic will go the way of osteopathy, make no mistake—our program is one of integration, not assimilation. It’s a wonderful concept that puts the patient first.”

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