Helping patients stay pain-free through an integrated approach – By Dr. Mikhail Burdman

There’s no denying we’re in the middle of a major opioid crisis today. In fact, the National Institute on Drug Abuse (NIDA) estimates more than 115 Americans die every day from opioid overdose.

For the most part, we can trace this issue back to the late 1990s, when physicians first started prescribing these pain medications. Unfortunately, most did not realize their addictive properties at that time.

And throughout the years, many physicians became increasingly reliant on pain medications as a go-to tool to quickly get patients out of pain and increase the number of patients leaving their offices [at least temporarily] satisfied.

We now know that prescribing opioids often does more harm than good. Patients can become hyper-sensitive to pain and in the long run, require more drugs to be pain-free. Further, pain medication is often a short-term solution leading to a long-term issue.

We know that chiropractic can help many of those suffering from chronic pain, but frankly, it’s not as simple as saying that’s the solution to the opioid crisis.

What about the patients who are already addicted to prescription medications?

When I graduated from Palmer College of Chiropractic West in 2012, I wasn’t sure where my path in practice would lead. But after returning home to Baltimore and working with other practitioners in the area, I saw a large need for a clinic that offered a safer path to pain management.

Patients shouldn’t have to choose sides between medical pain management and chiropractic – there are a number of patients interested in both, especially those who are already on pain medication. They need a clinic that helps them transition off high-dose medications and incorporates alternative therapies, like chiropractic and physical therapy, to help them begin to rebuild their strength and range of motion, and decrease aggravating factors.

Patients also deserve a clinic where all of this is done in one place, both for the convenience of making it to their appointments, but also, and more importantly, a place where their practitioners were all truly on the same team.

After realizing there was such a need for this unique, more integrated approach, I set out on building my practice, The Pain Doctors. We’re an interventional pain management clinic made up of medical doctors, chiropractors and physical therapists working together to get patients out of pain quickly, effectively, and most importantly, safely. We use the latest technology and medical advancements to provide patients with the best services to treat their pain.

Dr. Burdman in front of X-ray machine.

Dr. Burdman at his practice, The Pain Doctors, in Baltimore, Md.

It’s now been two years since we’ve opened our doors and we’re proud to say that we’ve been able to help an incredible number of patients in Baltimore become less dependent on their pain medications – something many of them didn’t think possible after consistent use for years!

It is my hope that more practitioners see the need for this integrated model in their own neighborhoods and we can all work together to help patients work to lead pain-free and drug-free lives in a safe manner.

If you’re interested in learning more about interventional pain management practices like mine, whether you’re a current student or have already graduated, I’d be happy to talk with you more about my journey and plans for the future. Feel free to contact me through my website at www.thepaindrs.com.

About Dr. Burdman: Mikhail Burdman, D.C., is the director of The Pain Doctors of Baltimore, Md. He works closely with his team of medical doctors, mental health counselors and therapists to provide patients with safe and effective treatment plans to reduce their pain and medical dependency.

Prior to his chiropractic career, Dr. Burdman was born in Moldova and came to the United States as a refugee in 1991. He graduated from the University of Maryland Baltimore County with a degree in biology. He completed an internship at the Naval Air Station in Lemoore, Calif., and went on to graduate from Palmer College of Chiropractic West in 2012. He currently resides in Baltimore, M.D., with his wife and enjoys staying active and spending time with his family and friends.

Dr. Charles Fulk – Reflections of a PCC Alumnus

Dr. Charles Fulk

Dr. Charles Fulk

As Palmer College of Chiropractic alumnus starting my 34th year in practice, I have often reflected on the years I spent at PCC and how they have prepared me for practice life. I graduated from PCC in December of 1982 and began practicing in January of 1983 in Kansas.

The education I received was very thorough, but at the time I wondered why it seemed so redundant. The classes seemed to march us through one body system to another, but I soon realized that the closure of each class laid the framework and understanding that I needed to more fully understand the next.

When I entered practice life in 1983, I realized that the education I had received during my time at PCC was the very foundation I needed to develop and grow my practice.

From anatomy and physiology, to manipulation technique classes, to understanding X-rays, they all seemed to knit together the knowledge, understanding and confidence I needed to test, correctly diagnose and then effectively care for people.

I spent my days exploring the mysteries of the human body and developed the competence and confidence that I needed to restore my patients’ health.

I went into the chiropractic field mission-focused and with a passion for helping people. I was thankful for the opportunity to care for others and felt honored to have the ability to diagnose and treat them.

The trust they put in me was inspiring. The close nature of the doctor-patient relationship that is formed in a matter of minutes during a consultation made me proud of the education I had received and the person I had become.

However, early in my career, I found it challenging to get my practice going, and it was even more difficult to learn how to manage my staff and patients it as it grew.

I soon discovered the challenges of the economic side of being a chiropractor. Financial tasks distanced me from the reasons I had chosen chiropractic in the first place. That’s the duality of being a chiropractor. There’s the fulfilling personal side and the difficult impersonal side.

I soon discovered that chiropractic is not a profession for the “thin skinned” individual or the “faint of heart.” I began to build around myself with experts in the fields of business management, marketing and accounting, and this soon freed me up to focus on what I love most, helping people.

Although the field of chiropractic may be challenging, it is an extremely rewarding profession that can bring an incredible sense of satisfaction and purpose. The education I received at PCC gave me the foundation of knowledge to build my practice and withstand the inevitable storms of practice life.

Chiropractic is an incredible product for the consumer and, when delivered with commitment and passion, will yield tremendous benefits. Thank you, PCC.

 

Charles Fulk, D.C. practices at Fulk Chiropractic in Olathe, KS.  Open seven days a week, Fulk’s 11 chiropractors offer chiropractic treatment to Kansas City-area patients when they need it most. 

Advice for new chiropractors

Each week, we’re asking our alumni to share their advice and experiences on the Alumni Voices blog. This week, P. Burdoc Nisson, D.C., shares his personal list of Do’s and Don’ts for new chiropractors.

If you would like to share your own practicing tips and more, follow @palmercollege on Twitter and like our Facebook page to see the weekly question on Wednesdays.

Dr. Burdoc Nisson

Dr. Burdoc Nisson and grandbaby

Do’s & Don’ts:

1. Make sure that you are in the best health that you can be (get adjusted, eat well, etc.).

2. Make sure that you have everything to help the patient that they are read for.

3. Don’t overwhelm the patient.

4. Do what the patient’s body wants done first, check if that worked and then find the next thing that patient’s body wants now.

5. If the patient’s body is not telling you what is next but is not “done,” try having them move, walk or rest.

6. If the patient comes back the next time feeling exactly the same, find out what you missed.

7. Get to know which local health practitioners do things differently than you do so that you can refer to each other.

8. Refer patients when they are not improving fast enough.

9. Use all of your senses to work with the whole patient (physical, emotional, causal, mental, spiritual).

10. Keep learning.

– Dr. P. Burdoc Nisson

What I’ve learned after 30 years in practice

I graduated from Palmer in Davenport in December 1982. After graduation, I associated in an established practice for 2 years and then struck off on my own. I began my practice with a typewriter and a copier.

Most of our bills were done by hand on paper. Mountains and mountains of paper. Faxes had not been invented yet. There was no email. The social media was called a telephone. Most people wouldn’t have modern “off-the-shelf” desktop computers for another 5 to 10 years or so. And when computers began to emerge for the public, their operating system (on “modern” TRS-80 computers from Radio Shack) used CMOS. Instead of colors and icons, you were greeted with a black screen and this: C:\.

Photo from hoolawhoop.blogspot.com

There were no clicking on icons or “copy and paste” shortcuts. There wasn’t even Solitaire or Mine-Sweeper. There were some naissant black and white T.V. video games (Pong and Tanks). Pac-man would soon arrive and add color! Video arcades were on the horizon. Bill Gates would start marketing Windows in late 1985, and I bought my first “real” computer in 1987. It was a little more powerful than a calculator today, with memory measured in kilobytes, not gigabytes.

Prior to then you made duplicates of things with carbon paper and typed on a manual typewriter. Word processing would come later. In that era, “white-out” was as close as it came to word processing. Billing was time consuming. Paper work was a chore that consumed most of your clinic time. It was a very different business environment. New graduates can probably not imagine a world without DVD or Blu-ray, but this was actually even before VHS! Family memories were preserved on super-8 cameras and usually without sound. Cars had cassette players or an 8-track player.

Palmer was also a different place. Lectures were illustrated by the professor writing on a rolling sheet of acetate while the overhead projector shone it’s weak light up on the wall.

My biggest clinical observation therefore is that the modern practice is as different in day-to-day operations in 2013, as airplanes have made the world since the horse and buggy days. Information is almost instantaneous. Phone books are arcane today. Even snail-mail is on its way out. Sending out the clinic billing now goes through a clearinghouse where it’s checked, corrected, sorted and instantly delivered via the Internet with a turn-around from billing to resolution of days, not months. Patient record keeping still usually involves some paperwork, but that also is being phased out for EHR and verbiage-generating software. (Not always a good thing, BTW.) We design our own forms on our own word processors. We print them on our own color printer. We fax records. Our phones are cordless. We digitize X-rays. We back up on carbonite. We email newsletters to all our patients with the click of a button, and we track our billing through the Internet. And sweetest of all, the computer re-paginates my typing automatically, letting me add, delete and spell check my work with a simple mouse click.

As with all invention-based revolutions, from gunpowder, to the steam engine, to the Wright brothers, to the repeating rifle, to the silicon chip, the world is not the same place that it was even just 30 years ago. Everything has changed. We can do twice as much in half as much time! Our modern world is amazing, and we can only presume that our grandchildren will look back on our “modern” era as quaint and archaic, as new inventions come along.

“Grandpa, you actually watched movies on a plain big-screen television instead of in the 3-D hologram portal chamber?” But the one thing that hasn’t changed, and hopefully will never change, is the need for ethics, morality, honesty, integrity and altruism that chiropractors must generate with their patients. No amount of technology can compensate for sham treatments, unethical care or short-cuts when it comes to patient care.

Patients are also more sophisticated now. They expect to know the “how” and the “why,” not just the “what” of the care you’re giving them. Sadly, with modernization has also come some short-cuts in patient care among some chiropractors. Junk science is sadly still too alive and well within our profession. Treatment plans that plan out a year in advance on the first visit are not ethical. Ignoring X-ray guidelines to generate a revenue stream into your clinic when films are not needed is dishonest and immoral.

We have been slow as a profession to modernize our thinking. We still fear guidelines and fight to find our own true identity as a profession. While we want to embrace the modern world, this does not mean we want to embrace a less ethical world. We cannot claim to be equal partners at the health care table when we still cling to outdated and implausible case-management habits. Differential diagnosis and critical thought has been slow in making a foundation for the chiropractic profession, which still relies on health models from the 1800s. We struggle to modernize ourselves, though we long ago accepted the modern world. We struggle with defining ourselves as a profession. We struggle with money, which risks compromises that can poison the chiropractic well for future generations.

To new graduates, I would urge you to be cautious on accepting every scam wind that blows through the chiropractic profession. If you want to be successful, above all else, be grounded in ethics, science and evidence-based care. The best way to make the most money is to make yourself the best doctor you can be. The rest will follow when the core is abundantly constructed. Practice gurus, bogus techniques and eternal treatment plans are also inventions of this modern world. But though we embrace shortcuts in our time-requirements, we need to also be wise enough to reject any shortcuts in our ethics. Ethics have never changed. Loving your patients more than yourself has never changed. And hopefully, they never will.

– Garth Aamodt D.C.

PCC-12/82

www.aamodtchiro.com