Mark's Musings - September 4

Below is an aggregation of the stories I posted on LinkedIn since my last edition. I curate them through the prism of an "intersection of chronic pain and appropriate treatment" and so they come attached with my opinion.

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Change to Chiropractic Window Period (543 views)

As #opioids are used less for #ChronicPain (and even acute pain) we must have individualized alternatives in place to help address the real pain. The change in North Dakota from a 6 visit to 10 visit cap on #chiropractic care is related to "pilot program analysis and provider feedback." Implied is this treatment modality should be used more frequently, which would be a good thing for individuals for whom chiropractic works. Not everything works for everybody. But unless we provide a larger toolbox from which providers can select that payers will reimburse, we won't effectively #CleanUpTheMess. I understand why some payers shy away from enabling chiropractic care. I saw firsthand where treatment was extended beyond curative care to copy-n-paste progress notes well beyond the scope of the work comp or auto claim. To some, "chiropractic" became a four-letter word. But as with many negative experiences, often positive outcomes aren't possible because of the negatives. I know firsthand that chiropractic care can be helpful (again, not everything works for everybody). It's obvious the North Dakota regulators believe that as well. Every patient's care needs to be individualized, which means the full toolbox needs to be made available.

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Science Explains What Happens To Someone's Brain From Complaining Every Day (919 views)

Are you a "Debbie Downer"? Do you know a "Debbie Downer"? Chronic complaining - ruminating - can actually pose health and attitude problems. "Harmful behaviors such as complaining, if allowed to loop within the brain continually, will inevitably alter thought processes. Altered thoughts lead to altered beliefs which leads to a change in behavior." So a simple (not easy) way to better manage life - and pain - is to find a way to be positive. Neuroplasticity, to get better or to get worse, is real. Use it to your advantage. Being in a negative echo chamber - either hearing yourself complain or being surrounded by negative complainers - makes everything more difficult. You may not just need to change your attitude but those around you. You are what you think. Whatever you have to change, rewire your brain to be positive.

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10 Things That Happen To Your Body If You Walk Every Day (459 views)

Figure out a way to free up 30 minutes each day to simply walk. I made a commitment six years ago to find ways to be constantly active. Here are the 10 positive things that happen by simply walking:

1. Brain changes for the better
2. Enhanced vision
3. Keeping the heart strong
4. Larger lungs
5. Improving the pancreas
6. Aiding in digestion
7. Leaner muscles
8. Firm joints and bones
9. Relieve back pain
10. Balanced mind

Worth it? You betcha!

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Conservative Care and Patient Education Lead to Better Outcomes for Low Back Pain (133 views)

What she said ... All of it ... Sounds very familiar ;) #CleanUpTheMess with #AllOfTheAbove using #BioPsychoSocialSpiritual Invest five minutes and read this article filled with lots of great stuff. As I have often said, educated consumers (patients, injured workers) make better choices.

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Take Back Your Health. Quit Smoking in 21 Days. Craving to Quit? (730 views)

I think everyone at this point knows the dangers of smoking cigarettes. Most everyone knows how this habit/addiction can lead to poorer clinical outcomes. But when continued use is so compelling how can someone stop? I've never smoked so I don't fully understand. Well, at a dinner meeting last week with three rockstar clinicians (who also happen to be my friends+mentors) they mentioned this approach - Craving to Quit?. It is a "21 day mindfulness-based wellness program" (there's that word again - #mindfulness - that fits with #BioPsychoSocialSpiritual). If you are a smoker - If you know someone that is a smoker - If you're a #WorkComp payer and want better clinical outcomes for an injured worker that is a smoker - check it out. When my rockstar clinician friends recommend something, I follow (and pass along) their advice. This is only one method to help stop. I know smoking, and stopping, very rarely is related to a work comp claim. But if stopping that destructive habit could increase the possibility of positive clinical outcomes - which often means positive financial outcomes - might it not be a good investment?

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Mindfulness-Oriented Recovery Enhancement (464 views)

Another recommendation from one of the rockstar clinicians with whom I had dinner last week - M.O.R.E. (Mindfulness-Oriented Recovery Enhancement). This mental training program is centered on three key therapeutic processes:

• Mindfulness ("this technique is also aimed at enhancing self-control over automatic behavioral habits elicited by addictive cues, stressors, and pain")
• Reappraisal ("potentiate cognitive reappraisal of maladaptive thoughts contributing to negative emotions and addictive behaviors")
• Savoring ("to mindfully focus attention on and savor naturally rewarding experiences (e.g., a enjoying a beautiful nature scene or the sense of connection with a loved one) while cultivating metacognitive awareness of their own positive emotional responses to such experiences")

When my rockstar clinician friends recommend something, I follow (and pass along) their advice. Clinician readers might want to consider this as a way to augment their toolbox.

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Should You Choose a Female Doctor? (624 views)

Interesting study from Florida (and others that essentially corroborate the findings). I found these points especially interesting:

• "Doctors who were women spent, on average, two extra minutes, or about 10 percent more time per visit, creating scheduling delays and putting them an hour or more behind their male colleagues by the end of the day."
• “Patients not only want you to take care of them in terms of making the right diagnosis, they also want to feel heard, and a big part of health care is the communication piece."
• "Female primary care physicians waited an average of three minutes before interrupting a patient. Male doctors waited an average of 47 seconds."

Obviously, not all women listen and not all men are dismissive. This post is not meant to feed stereotypes ("a widely held but fixed and oversimplified image or idea of a particular type of person or thing"). Instead it has two purposes:

1. "Empower patients to find doctors who listen"
2. For all clinicians (regardless of gender) ... LISTEN!

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Health Care: The Pain of Losing Employees (597 views)

"Education is everything" ... This article is especially appropriate given my presence in Frankfort to hear about progress on defining a #WorkComp drug formulary for Kentucky. If you're an employer or an employee in Kentucky, take 10 minutes to read this article - all the way to the bottom to "Where to Go for Help." Advice for (not just KY) employers - "With the majority of Kentuckians involved in this epidemic being of working age and often early in their career years, businesses are being advised to be proactive with workplace education."

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In addition, I published two blogposts:

• "Mark's Musings - August 27" on August 28
• "Kentuckiana Formulary" on August 31

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"It's Never the Wrong Time to do the Right Thing" - Martin Luther King, Jr.

#CleanUpTheMess