How does your doctor look at you? A patient visited our office the other day who fell out of a chair in an optometrist’s office and hurt her hands. A month later, she developed weakness in her left hand and was dropping things. She visited her primary care provider, who referred her to a neurologist who did an MRI of her neck and then to therapy for her arms and hands. Nothing improved. She later on visited an orthopedic hand specialist, who also sent her to a therapist who worked with her for over three weeks with no relief. A neurologist then did a nerve study where they used needles and suggested she has carpal tunnel syndrome and some arthritis in her neck. Since August, she has spent thousands of dollars on tests that should have been done last, not first. Doctors and facilities have wasted thousands on tests that were less helpful than a good history and exam of the musculoskeletal system. The system incentivises tests over performing a thorough history and evaluation, and then incentivises management by specialists who run more tests and do more procedures, yet the patient has arrived in our office months later, more chronic and less functional. The problems begin with primary care and incentives. When we have a problem, we visit a primary care doctor who keeps us out of the system by evaluating our internal systems. They would take a history and speak with the patient about their past and family histories, too. This is impossible to do when the incentive is to spend less time evaluating due to reimbursements, and the way the larger systems have developed monopolies of care in regions of the country. The incentive is to do more testing, more high-tech things that often are useless in musculoskeletal conditions. Traditional primary care has never had musculoskeletal system issues as a strength, partly because they have never been required to learn how to do so during continuing education, something all medical professionals, including chiropractors, are required to do. When doctors don’t know, they test. This dinosaur behavior is costing patients thousands, and the algorithms of care do not work, as we are all different. This yields high costs and poor results. The failure to refer to chiropractors, especially those certified in sports injuries who are taught neurology, orthopedics, and even basic internal medicine, has led to huge costs, patients becoming chronic, and poor results. Medical providers in large systems refer within those systems mostly, as they are incentivised to do so. Chiropractic primary care models streamline all of this by doing a thorough history, a functional evaluation of the patient based on the history, and performing functional care, usually on the first visit. Most patients improve quickly and do not need thousands of dollars in procedures and tests that do nothing to improve the patient. The patient should have been referred to a chiropractor first after the initial primary care evaluation. While this is not malpractice, it is bad practice. If needed, the chiropractor would have referred the patient to the specialist they needed. The good news is, they rarely do because patients improve with chiropractic care. The chiropractor can order these and other tests if needed. Often, they aren’t. Using the chiropractic model also reduces unneeded procedures that have more risk and limited value in many cases. Why not just visit a chiropractor first? Patients are taught early on to rely on their primary medical care provider for most problems. Rarely do they ever refer to a chiropractor. What if we changed the incentives from doing more to having all doctors be primary care, with specialists, and those who get results faster and at a lower cost would be reimbursed accordingly? What if the incentives to do a proper history and exam were increased, making it more profitable for the doctor? What if it were more profitable to be a primary care doctor than a specialist? Would that increase the number of doctors who switch into primary care? Would doctors who were incentivised to refer to chiropractors first change their referral patterns if the chiropractor got great results at a lower cost? Without overthinking this, why not see a chiropractor who practices primary care of the musculoskeletal system first? In the patient above, a more detailed history was performed in our chiropractic office, which revealed the patient had chronic back problems, a left knee problem, lower leg swelling, right heel pain, and she had problems with stability when standing from a seated position, and long-term standing caused her to lean to one side, which was noticeable when looking at the patient. The flat feet were obvious just watching the patient stand, and her shoes were a full size small. The evaluation revealed a single problem causing all of her current symptoms: her feet. Did her primary medical doctor purposefully miss this, or was their training and time available inadequate? The patient’s first treatment showed improvement in her balance, ability to squat, move, and even grip in her left hand after I performed spinal and extremity manipulation, and performed myofascial release to the affected parts of her lower body. An X-ray of the pelvis showed hip involvement from years of improper walking. An off-the-shelf foot orthotic I gave her reduced her knee pain and improved how she walked. Who you visit first will determine your cost, risk, and results. Chiropractic primary care is desperately needed to be further integrated into daily medical practice. We can simply no longer afford care that rewards the wrong things and does not get results, but instead makes you chronic while managing pain rather than improving function. The patient mentioned above is typical of what we see in our office. You do not need 3-4 specialists. You need a chiropractor who performs primary care. I am a certified sports physician with additional training in extremity and traumatic on-field injuries. We have further training in orthopedics, pediatrics, and neurology. On the field, we have to do it all. In our office, we do it all. Chiropractic sports physicians are one-stop shops for what aches. Simpler is better and often seems like the old model of primary care, where the patient was kept out of the system unless necessary, vs. the current model, which is a revolving door to specialists who see your symptoms, rather than the patient in front of them. Keep it simple. Think chiropractic first. Need help today? Book online or call either of our offices today.