logic of Chiropractic which may be epitomized with the terse command,
“Adjust the _cause_,” and considers his practice as requiring him to
dabble in every suggested or discovered method of treating _effects_,
so, too frequently, the young Chiropractor is prone to consider that
his practice consists solely of the adjustment of vertebrae, that he
practices a mechanic art rather than a profession; too frequently
he overlooks the thousand details which lead to and surround the
adjustment and are essential to its success.
The practice of Chiropractic involves more than correct technic. It
includes the use of a vast fund of knowledge; the constant study of
diseases and of patients; the art of controlling and directing others
sometimes in their very trivial acts. Successful practice requires a
proper setting, proper business methods, and a knowledge of psychology.
Anyone entering upon a profession assumes a great moral responsibility
and the greatest responsibility of all falls upon the doctor, of
whatever school. He enters the stricken home at a time when all members
of the household are off guard, as it were, at a time when all turn
to him as to one of higher knowledge and of greater power for their
guidance and often for their strength in affliction; he becomes the
repository of their most sacred confidences. He who is unable to meet
this responsibility, to realize his influence and his power and to
prepare himself with care and conscientious training to acquit himself
well, has mistaken his calling. He is unfit for his ministry.
The thorough student wrestles not alone with the technic and the
text-book branches necessary in practice but also studies his
profession from every possible standpoint, broadening his field of
usefulness wherever possible.
This section does not by any means contain all the information not
found elsewhere in this book but necessary to the Chiropractor in his
practice. It is intended merely to suggest some of the many sides and
phases of our work and to open the way for a life study of humanity and
of professional life as a Chiropractor.
OFFICE EQUIPMENT
Value of First Appearance
The patient, upon first entering an office, consciously or
unconsciously forms an estimate of the personality and standing in his
profession of the occupant of that office. This impression is gathered
from the kind and arrangement of the furniture and visible equipment,
from the neatness or disorder of the room, from countless little things
which play each their part in making up the whole appearance. This
first estimate is sometimes the only one, for an unfavorable first
impression may lead to the loss of a prospective patient. In any case
it will play a part in all subsequent judgments which the patient may
form concerning the Chiropractor and his work.
Many patients entering our offices have no previous knowledge of our
profession; their minds are open and curious, alert for new impressions
of some sort. We may impress them as we choose. Every good business
or professional man realizes the value of the first impression and
strives for a good one. Therefore, upon entering practice, choose for
yourself every article which shall have a place in your office. Your
surroundings will then truly reflect your personality and will attract
those upon whom that personality can work in harmony and understanding.
It is of no avail to attract the type of patients you cannot hold, to
draw through the borrowed judgment or taste of another surroundings
alien to yourself and thus to attract people who will at once sense the
incongruity and be repelled by it.
Yet one may aspire. And if you are able to perceive and appreciate
truly professional surroundings you may hope to school yourself by
association and study to harmonize with them.
Choice of Articles
In choosing the contents of your office keep in mind good taste,
utility, and the psychological effect upon all visitors. Remember
that you expect to spend many hours each day in the company of your
furniture, and select such things as will contribute to a proper
professional state of mind in yourself. A Chiropractor’s profession is
in many ways like, yet in many ways unlike, any other. Therefore his
office equipment, while following in general the equipment of other
professional offices, must be selected with an eye to the special and
particular needs of the Chiropractor and his patients. Too little
attention has been paid thus far by the profession to the selection of
office equipment.
Furniture in General
The furnishing of an office depends upon the amount and disposition
of the room at your command. One must have at least a waiting room
and a private office even if a single rented room must be cheaply
partitioned to make the division. A larger suite is a better investment
when possible. In the waiting-room should be found easy chairs, library
table, hall-rack, mirror, and an easy divan or couch. The floor should
be covered with a good rug or carpet and the walls properly and cleanly
decorated and hung with restful, pleasant pictures. A book-case filled
with carefully selected books is a good addition.
On entering your private office the patient should see your diploma,
which hangs in full view of the entrance and which bespeaks with no
weak voice your fitness to practice, your professional ability. The
importance of this point cannot be overestimated. The intelligent
visitor expects you to have had careful training and to possess
thorough knowledge of your work. If he notes the diploma as evidence of
it and of your pride in your college he is assured.
If only two rooms are at your command the second must be at once
consulting room, adjusting room, dressing room. As such it should
contain your desk, desk chair, chairs for the patient or patients,
adjusting table or tables, towel cabinet, lavatory, and a curtained
recess for a dressing-table, chair, and hooks for hanging clothing.
On the wall hang those charts from which it is at times necessary to
explain a part of the human mechanism to the inquirer.
This room should convey a two-fold impression--business and
professional. It should contain the special paraphenalia of your
profession and some of the suggestive contents of the ordinary business
office, such as desk, card-index file, typewriter, etc.
Let us consider these points more in detail.
Waiting Room
In your waiting room new patients wait and form their estimate of you
before your appearance. They are tired patients, worn perhaps with
years of disease, and their comfort must be considered. Some time
is theirs for use in some way and the use of their minds during the
waiting interval must be studied.
For these reasons first of all the waiting room should be furnished
quietly, in perfect taste, but _well furnished_. A good dark rug
for the floor rather than matting or linoleum with their suggestion
of bareness, a tinted or papered wall done in a soothing shade,
upholstered furniture pleasing to the eye and comfortable for tired,
weak bodies, and a library table with proper literature for the
occupation of the mind--these are the proper furnishings for a waiting
room.
Let the table contain chiefly Chiropractic literature and select that
literature with care. Be sure that it reflects the view-point toward
your profession with which you wish your patients to be impressed. It
must be scientific, well written, not sensational, not dealing coarsely
or vulgarly with the revolting diseases or features of disease, but
quietly convincing. Your literature must impress with the greatness
of Chiropractic without setting forth extravagant claims which your
patients will expect you to vindicate. Your selection of books for the
book-case must convince all observers of your proper literary taste or
the book-case had better be omitted. Likewise the pictures on the walls
must suggest pleasant things, restful things, good to contemplate.
When possible secure a high-ceilinged room with good ventilation,
plenty of fresh air without drafts. And then let all the articles in
the room _harmonize_. One jarring note in form or color may mar the
entire effect, which should be that of comfortable simplicity.
Private Office
Even more important than the contents of the waiting room is the
equipment of your private office. It is in this room that your work is
done. There your patients confide to you their weaknesses; there they
determine finally whether to trust themselves to your knowledge and
skill; in that room they form their judgment as to your cleanliness,
your use of system; _there they meet you_.
Arrangement of Furniture
Every bit of furniture for the private office having been carefully
selected its _arrangement_ should be studied.
When the patient first enters the private office he should be able
to see your diploma. He should also sit where he can notice it as
he consults you and every other object within his vision during the
consultation should be picked so as to avoid attracting his attention
to anything foreign to his visit and its purpose.
Two chairs are placed near the desk, one an easy chair for
yourself, a revolving chair being preferable, and a straight-backed
leather-upholstered chair for the patient. In placing these chairs be
careful of two things: let the strongest light shine over your own
shoulder and bring the face of the patient out in clear detail; and let
your own chair be _higher_ than the patient’s so that he looks slightly
upward to meet your direct gaze. For the last mentioned point there
is a sound psychological reason; to control any dialogue with another
person place yourself on a higher level than he and unconsciously he
will obey the suggestion and lift his thought to meet yours, offering
it rather than commanding with it. The light is arranged for its value
in observing, as a matter of diagnosis, every indication in expression,
gesture, and skin coloring.
Hanging back of the desk where it may be easily reached but where its
gruesome suggestion will not obtrude itself upon the nerves of the
sensitive without your deliberate intention, have a vertebral column
for demonstration purposes. There are many times when it is necessary
to show a subluxation as it would occur.
Beside the desk and within easy reach of your hand should be placed at
least a single book-case section containing those reference works which
you frequently consult. The contents of this section will be considered
later; suffice now to say that they should be well bound and should
be so placed that if a doubtful point arise they can be consulted at
once without your rising. I am not of the opinion that a pretension of
unlimited knowledge is a valuable professional asset. It seems better
frankly to seek authoritative information, even in the presence of
the patient, than to allow an error to creep into your work, and your
more intelligent patients will appreciate your care. Furthermore, this
placing of your books is convenient when you are alone and considering
the cases which have passed before you during the day. It tempts to
study.
The desk should hold a typewriter, significant of business methods,
and a card file for case records. Incidentally, you should have neat
bill-heads and printed stationery for all correspondence, though blank
white paper is better than over-ornate design or profuse coloring.
On the wall hang a few good anatomical and physiological charts upon
which may be pointed out certain facts for the instruction of patients.
It may be suggested that these hang on racks so that the surface charts
may be easily changeable and that those ordinarily exposed to view be
such as will avoid unpleasant suggestion of any kind. For instance, an
X-Ray chart of the body showing the skeleton is but one degree less
repugnant to the average person than the bones themselves. Though your
college training has robbed the subject of all emotion, for _you_, take
thought for the feelings of your visitors.
Adjusting Tables
For all purposes the best type of bench now on the market is probably
that composed of two sections, one fixed and the other--the rear
one--sliding on a track. Both sections should be adjustable at various
angles to the plane of the base and some of the best tables are made so
as to permit changes in the distance from the floor to the entire top
or to any part of the top, a great advantage in that the table height
may thus be made to suit the height of the adjuster.
An abdominal support is now indispensable but must be so elastic as not
to interfere with the adjustment. Leather upholstery is more sanitary
than plush and has come into general use.
An opening in the front section such that the face may look downward
through it and straighten the cervical and upper dorsal spine for
palpation and adjustment has been proven a disadvantage instead of a
help and will be entirely unnecessary to one who follows the technic
laid down in this book.
The Roll
A desirable addition to this table is an upholstered roll of quite
solid material and about eight inches in diameter. This can be placed
under the patient’s thighs on the rear section, thus elevating the
thighs and straightening the Lumbar region so as to separate the
spinous processes. The roll is especially useful for the adjustment of
posterior Lumbar subluxations, being inadvisable with rotation.
With a patient lying on the bifid bench in the ordinary adjusting
position the Lumbar spinous processes are crowded together and the
bodies separated. In rotation, since the adjustment works by using
a short power arm against a long weight arm (distance from contact
point to center of rotation against distance from center of rotation
to anterior margin of body), and since the heaviest portion of the
vertebra--the body--is to be moved most, this position of suspension
secures the easiest adjustment. But if the vertebra be posterior and a
spinous process contact is used the best adjustment can be secured over
the roll or with a table adjustable to an angle equal to that which
would be secured with the roll.
Cleanliness
Everything in the office should be kept scrupulously clean. A lavatory
with towel racks well filled with clean towels is an absolute
necessity. If no lavatory is inbuilt in the office a portable one may
be secured which will answer every purpose. It will be well if the
patient observes that you carefully cleanse your hands before giving an
adjustment.
The office should contain a towel cabinet with a stack of clean towels
and a compartment for used towels. Or tissue towels may be used to
save laundry bills. Before each adjustment a clean towel should be
unfolded and placed upon the front section of the bench so that the
patient rests head and face upon a perfectly clean surface. When the
adjustment is completed toss the towel into the used-towel compartment.
This use of towels minimizes the risk of contagion or infection from
a germ-infested upholstery, suggests care and cleanliness to your
patient, and gives the patient greater trust in you.
Dressing-room
A curtained recess separated by a screen from the remainder of the room
will serve if no separate room is available for a dressing-room. It is
better, if possible, to have a separate dressing-room and better still
to have separate dressing-rooms for men and women. If extra rooms are
not at your command and you use a curtained recess be sure that it
contains good light, a dressing-table with mirror, a small chair, and
hooks for clothing. Provide also a few dressing-sacks for women though
most of them will prefer to furnish their own.
The Rest Room
It is a known fact that the patient who can be kept in a quiet,
restful, and relaxed state for some time following the adjustment
derives the greatest benefit therefrom. Having loosened subluxated
vertebrae by adjustment their tendency is to settle in their old
abnormal position and every movement of the patient for a time aids
this tendency. Quiet permits adaptation of surrounding tissues to the
changed position of the vertebra; action facilitates the re-adaptation
of the vertebra to the state of surrounding tissues.
If possible a special room should be provided in which patients may lie
down in comfort for twenty or thirty minutes following an adjustment.
If more than one patient at a time is to rest, separate rooms should be
provided for men and women. The rest rooms should have high ceilings
and excellent ventilation without drafts. The floors should be carpeted
so as to soften footfalls and suggest quiet and rest. Potted plants
adorn such a room very well and always afford a pleasant suggestion.
The patients lie on cots, foldable for convenience when not in use, and
should lie on their backs as quietly as possible. Some prefer solid
cots on rollers so that the cot may be noiselessly rolled beside the
adjusting table after the adjustment, the patient may by one turn move
himself upon it, and it may then be gently rolled into the rest room.
This is a more finished, if more expensive, handling of the problem.
It may be well to furnish some occupation for the mind and to this
end, since reading in such a position is injurious to the eyes, a good
phonograph is a valuable addition. Equip it with a soft parlor needle
and select only soothing, restful music. Just as you would avoid doing
the walls of the rest room in striking or garish colors, exciting to
a diseased mind, so avoid exciting or harsh music. The object of this
room is _rest_ for mind and body. Let every thought be directed to that
end. With some patients the use of the phonograph or other amusement
must be avoided. Study your cases with care.
The trip to the Chiropractor’s office is too often regarded in the
light of an unpleasant necessity. If proper care be used in equipping
an office and if such means as have been suggested for the rest room
be employed, these in addition to the pleasing personality of the
Chiropractor may make of the visit a pleasant thing, a part of the day
to be anticipated with eagerness.
A Complete Suite
The number of rooms in a perfectly convenient suite depends upon the
approximate number of cases to be handled daily. If it is needful to
economize the practitioner’s time a greater number of rooms will be
required than would be desirable with a small practice.
A waiting room, a consulting room, two or more adjusting rooms, and
two rest rooms make probably the best number and employment of rooms.
It is desirable if possible that the adjusting room be used for that
purpose only and that there be separate rooms for men and women. Each
adjusting room can then have its own dressing room or recess. Or in
addition to the other rooms named above there may be many small rooms
each containing an adjusting table and a rest cot and each serving as
the rest room after the adjustment. If a sufficient number be provided
as many patients can be handled in this way as time permits, the
practitioner need lose no time at all, and each patient may have a room
entirely to himself throughout his visit.
Reference Library
This should consist of those standard works to which you will
necessarily refer most often. Gray, Morris, or other standard
anatomical authority, Brubaker’s or Haliburton’s physiology, Butler or
Osier on diagnosis, Delafield and Prudden on pathology, Morat on the
physiology of the nervous system, Bing on regional diagnosis of nerve
lesions, one or two good works on psychology, gynecology, histology,
etc., a good medical dictionary, and any books on Chiropractic in which
you have confidence make up an excellent list. Any standard works
will suffice and this list is merely suggested for those who may be
uncertain as to their own tastes. Always examine a book before buying
it, even those named above. Next to works on Chiropractic no single
book is as necessary or useful as a good medical dictionary, preferably
a large and complete one.
Door Sign
Your door should bear a sign in gold or black, setting forth your name
and business and perhaps your office hours. It may read, “W. R. Jones,
Chiropractor,” or, “Jones & Jones, Chiropractors,” with office hours
appended. Avoid repetitions such as “Dr. W. R. Jones, Chiropractor,” or
“W. R. Jones, D. C., Chiropractor.”
Advertising
The word of a satisfied patient to his friend is the best
advertisement. Beyond this, considerable diversity of opinion exists as
to what constitutes proper, ethical, and wise advertising. I shall make
no attempt to settle this question but shall simply suggest that while
it is undoubtedly necessary often to explain to the public through
various avenues what Chiropractic is and what it can do it is wise to
be as reserved and dignified as possible and to avoid offense to any.
Thus it is clearly unwise to advertise that your competitor is a fraud,
much wiser to convince your readers by the logic and strength of your
statements that _you_ are not. Consider good taste and avoid unpleasant
references to loathsome or vulgar diseases. Such advertising is
associated in the public mind with quackery, with patent medicines and
medical institutes, and no matter how sincere and right your motives
may be it will be misinterpreted by those you wish to reach.
Consider also the legal side of advertising. Study the laws of your
state and avoid any statement which will conflict with the law. In some
states it is illegal to advertise with the term “Dr.” unless you hold a
medical license. In others to advertise to “treat,” “cure,” or “heal”
disease is to practice medicine technically. Such statements miss the
truth, in any case, because the Chiropractor administers an adjustment
and not a treatment and because Nature alone can cure or heal.
Collection Cards
Different communities respond to different collection methods. With
one class of patients it may be better never to mention fees except to
answer inquiry and simply to submit monthly statements of account to
all patients. With another it is necessary to charge in advance. More
Chiropractors use this method than any other and many use cards for the
purpose.
These cards are best printed with name, address, telephone number,
etc., on one side and on the other six or twelve spaces ruled off at
one end for punching to indicate adjustments given, and the words,
“Good for six (or twelve) Chiropractic adjustments at (office)
(residence) when properly countersigned.” A line should be left below
for your signature and at the bottom the price of the card should be
printed plainly. If desired a space may be left for the patient’s name
so that the card may be made non-transferable.
The card is issued at the beginning of a course of adjustments and
a duplicate is kept on file. Each time the patient is adjusted he
presents his card before leaving and one space is punched out. By this
system both the patient and the adjuster may know exactly the number of
adjustments given and accounts may be easily kept. Without it, a book
entry of some sort must be made for every adjustment.
The best thing about this system is that it reminds the patient that
you expect to be paid in advance without the necessity of your saying
so, since the words “in advance” follow the statement of price on
the card. At the time of payment you give him, as a receipt, a card
entitling him to a certain amount of your service at a stipulated place.
Schedule of Examination
This method of procedure for the investigation of new cases is
offered as a suggestion to be followed as far as the education of
the Chiropractor will permit. If every practitioner adopts some such
method of making his own diagnoses he will advance in ability much
more rapidly than by accepting the diagnoses given his patients by
physicians or others. We should remember, though without arrogance,
that our special ability to discover subluxations and our knowledge
of their significance as the primary causes of disease renders us
better prepared for correct diagnosis than our medical friends, other
education being equal.