quickly, taking a position of watchful waiting is prudent. We cannot be in a position or cannot be expected to be in a position that everybody that gets dizzy after an adjustment winds up going to an emergency room getting an MRA. It's not simply possible. It is not good healthcare. There will be more complications from the MRA test than there would be from the dizziness to begin with at that point, but it is incumbent upon you and I, to consider the area adjusted, to consider the type of adjustment given, and to consider if an alternative approach to the care would be in order. Because we practice a given technique approach doesn't mean that we can fail to move away from that if it's in the best interest of the patient to move away from that. Most importantly, when you've got that patient that had a little bit of a bleep, following or associated with an adjustment, things have resolved and calmed down, my advice and counsel to you, is do not adjust that patient again at that time. I always tend to hear stories from chiropractors that they had a patient in the office, they adjusted them and then the patients does that spin deal, where they want to see if their head can now go 360°, even though they couldn't move it two inches one way prior to that adjustment. Now when this happens, the doctor will respond to the patient because the patient may say, "Well doc, that was much, much better but I still feel a little bit stuck down here. Can you help?" All too often the doctor readjust that patient. My experience is that's when the doctor gets into trouble because they did more than they should have on that one visit. Practice management 101, if you think that they need another adjustment, let what you did settle down and then have them come back the next day. Re-evaluate and see if there's something either that you missed or something else that has now shown up and you'll be so much better off for not doing it on that same visit, especially if that patient had a negative response to your adjustment, you certainly do not want to go back in and readjust on that visit. When a patient begins to show neurological signs, when a patient begins to move in the direction of being neurologically compromised, stop your cervical spine adjusting. I would say at that point, the other adjusting becomes relatively less important as well, until that patient stabilizes and normalizes. I would not adjust that patient that day again. If the symptoms do not resolve you want to monitor the patient, stay with the patient and again, no matter how stacked up your waiting room is, no matter who is out there, you want to monitor this patient, stay with the patient. You want to watch for the development of additional symptoms. You want to note any change in the mental status. You want to note any degree of confusion, if any, that arises. Generally, you want to be extremely attentive to what's going on with this patient. I'll restate my advice to you again, do not adjust that patient at that time. Let me take a sidestep here and reaffirm something to you. I am pro-adjustment chiropractor. When I was a 12 year old kid adjustments changed my life. I got my eye sight back as a result of chiropractic care. I have a daughter who is 28 years old
Dr. Stu Hoffman:
Dr. Gerry Clum:
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