Maintenance care and Corrective Care, by Dr. Ogi Ressel
January 17 2010, 12:00 am
Warm hellos to everyone!
I've had these two greatly misunderstood topics on my mind for some time and I've talked
about one of these in the past. So let's rip into this:
Let's talk about the issue of "Maintenance care" and "Corrective care."
What are they exactly?
The vast majority of chiropractors across the globe schedule their patients (adults & kids) for
their once-a-month "maintenance" adjustment (visit). And patients are sold on the idea that
this monthly maintenance visit will then help prevent and allay many problems a patient would
be saddled with if they did not buy into this preventative measure.
And patients look joyously to the end of their "corrective" care and the start of their "maintenance
care."
They have graduated. They have paid their dues. Their subluxations are corrected. They are no
more!
Hurray!
Now life begins!
So patients are seen on a monthly basis because it's good for them - that is our mantra. And
most chiros are adamant about their patients following this protocol. It makes total sense not
only for the benefit of the patient, but also for the benefit of the doctor.
Right?
Of course!
I mean, there is a financial benefit for the doctor in that he/she can count on and be certain of
a steady income stream from "maintenance" patients.
There are also other benefits to the doctor: we all like to see our patients return and happy to
see us. It is like a party! The ego boost is amazing! The office is busy, there is energy,
excitement, the sun is shining, the skies are blue, and everything is wonderful!
Fabulous!
What about the benefit to the patient?
Well........that is a little more difficult to quantify, isn't it? I mean, they are getting great care
from you, aren't they? Well.....aren't they?
And you are preventing all these future "nasties" from rearing up their ugly heads, aren't you?
Well.......aren't you?
Hmmmmm......all of a sudden, your certainty has dropped a few notches, hasn't it? And you
are feeling a bit uncomfortable, aren't you"?
Alright.......let me ask you this: Are you really delivering what you promised?
Are you really able to prevent/allay a patient's future health problems with your monthly
maintenance program?
Are you?
Not so certain anymore?
I totally understand.
Listen.....I want you to absolutely know that I am not against maintenance care - although
from the tone of this THOT you probably felt that I was. Absolutely not so.
But.......here is the reality of "maintenance" care that most DCs place their patients on, from
my perspective:
Most of us recommend to our patients that our monthly maintenance program is of great
benefit and that it will then prevent this and that from happening to them in the future
(when I graduated from college, I also did this).
Ok....this is very difficult for me to come right out and state openly, but I am very
committed to the growth of our profession and so I must confront you with this reality:
In essence, when most chiropractors place a patient on a monthly maintenance schedule,
they are simply maintaining their problem - their problem is still very much there but their
symptoms are gone! The patient thinks their problem is all gone because they feel so much
better! You are thrilled!
That is the reality.
Ok, Ok....I've just pushed a gazillion buttons. However, any way you slice and dice this, that is
the reality.
Here is my reasoning:
•1. First of all, research done by Tapio Vidman, a number of years ago, tells us that a
Subluxation, once formed, will cause an inescapable degenerative progression if it is allowed to
remain for any longer than 2 weeks. Did you get that? 2 weeks! This means that a monthly
maintenance visit to your office will absolutely ensure your patient will get worse over time.
And they will. And the problem is that they will confront you at some point in the future and
ask you point blank why you have allowed them to get worse when they have paid you all their
money over the last few years to prevent this problem and keep them healthy.
.........And you begin to blabber something about the Principle of Limitation of Matter - just
what your patient wants to hear.
I can smell a lawsuit already!
•2. Most doctors do not see their patients on an appropriate schedule of care in order to be
able to really correct their Subluxations.
Period.
A Subluxation, once formed becomes a habit - it is a neurological pattern. It is a neurological
habit the body becomes accustomed to. And it most often starts in children.
(If you'd like more info on this, you are very welcome to write to me)
"..........In the child, neuromuscular and functional adaptive reflex
development represents a critical period of time when the young
developing nervous system assimilates, differentiates, and
adapts to external and internal stimuli. By means of these processes,
the nervous system learns proprioceptive patterns and
acquires future habits and reactions by responding to repetitive stimuli.
However, such a developing nervous system is not always able to
distinguish between proper and improper stimuli; thereforeit responds
to both. This is the conundrum - the response in neither "good" nor "bad",
but rather adaptive to the presenting stimulus.
These adaptive responses are remembered and patterned and thus the
young nervous system is conditioned for future response.
This process of neurological "learning" or "programming"of the central
nervous system with respect to locomotion, posture, proprioception, and
body kinetics begins within a few short months after birth........"
*Ressel, O,, Rudy R, Vertebral Subluxation Correlated with Somatic, Visceral and
Immune Complaints: An Analysis of 650 Children Under Chiropractic Care, J. Vertebral
Subluxation Res. - JVSR.Com, October 18, 2004 19
Most doctors see a patient on a schedule which they feel a patient will accept. One that is
"reasonable" - whatever that means. And often the patient's wallet is x-rayed and carefully
examined - Now I am really getting in your face. Relax....you know I am very blunt.
This translates into a patient being placed on monthly maintenance once their symptoms are
relieved - nothing more - although they are told otherwise.
I can't tell you how many patients I've had in my office over my practice lifetime who were on a
monthly maintenance schedule with their former doctor, when their examination revealed many
problems they thought they no longer had. This is not good for their health and your reputation.
So....instead of some nebulous and poorly understood "maintenance" program, I recommend
you see your patients on "Wellness" care - every two weeks at the very maximum, especially
children. The correction of their Subluxation patterning and habit is most important.
To me, there is no such thing as "maintenance." And tell your patients the truth. This is what
you are doing, and here is why. They will totally be with you. And money will not be an issue.
Now, get out there and be the doctor you were meant to be.
Warmest wishes,
Dr. Ogi Ressel
