Chiropractic + Naturopathic Doctor

Keys to Your Practice: July-August 2013

Angelo Santin   

Features Business Management

Part 1 of this article (June 2013) focused on details of Dr. Carter’s exam methods. For the second part, I was able to interview two well-known and experienced leaders in the chiropractic profession

Part 1 of this article (June 2013) focused on details of Dr. Carter’s exam methods. For the second part, I was able to interview two well-known and experienced leaders in the chiropractic profession – Dr. Dennis Mizel (DM) and Dr. James Carter (JC). They both graciously agreed to share some of their thoughts on the questions I posed below.   

In your opinion, what is the purpose of the examination besides coming up with an accurate diagnosis?


JC: The purpose of the examination is to objectively find the degree of functional loss as indicated by the positive (abnormal) findings. Correcting these specific, measurable, abnormal findings becomes the measurement of progress – the milestones of care. The outcome of examination will be that the findings collectively will indicate the kind and nature of the problem (diagnosis, analysis). The type of care, duration and frequency will be largely determined by the patient’s ongoing, objectively measured level of function as determined by prescheduled progress exams and comparative examinations.

DM: In addition to coming up with an accurate diagnosis, the examination is a useful tool to help the patient understand how their disorder/dysfunction interferes with how their body is working. The examination will illustrate a loss of function in strength, flexibility, balance, co-ordination and endurance. An examination has the potential to educate the patient on how the nervous system controls, co-ordinates and regulates the body.

What are the biggest mistakes chiropractors make when examining new patients?

JC: Approaching the examination too casually, without enough respect for its importance.

DM: I would say that they do not demonstrate to the patient the loss of function they are having in various areas of their body. By educating the patient so they understand how they develop functional losses in their health/body, you are providing them with more choice and a larger goal with their chiropractic care.  

Where can chiropractors improve the most when it comes to delivering an exam?

JC: Almost every chiropractor I have observed could benefit from dramatically raising their level of intensity, professionalism, certainty, precision and artistry in the examination. Most chiropractors examine at the same level of arousal that they have on a Sunday morning stroll. I believe this is because many chiropractors have not sufficiently studied the neurology behind the examination. We are dealing with major health issues in the examination: issues that are very important to the patient in front of us. We know that as spinal myelopathy advances, it causes severe debilitating and crippling illnesses. Just look at the research. We must keep this in mind when examining every patient and execute the examination with the expertise, respect, diligence, sensitivity, seriousness and artistry that the patient deserves.

DM: Examine the area of chief complaint first. Find the problem first and find it fast.  The exam should be carried out at a brisk pace, keeping in mind the comfort of your patient. Be sure when you find their problem that the patient also can feel that you found it and if possible can see what you are seeing.

Most chiropractors don’t begin their examination with palpation. Why is it so important to start the patient face down and locate the subluxation first?

DM: The patient who has right-sided neck pain wants to know what is causing their problem. If you palpate their low back first, the patient may inquire as to why you are doing that as their problem is in their neck. The patient has probably been to other practitioners who have not located their problem. Finding the problem first and finding it fast will illustrate your clinical expertise to the patient.

Why is it so important to make the patient aware of the loss of function?

JC: We generally are not aware that we are not functioning to capacity. If our goal is to increase the level of function to live in a more healthy state in our environment, we need to point out the loss of function that will mitigate this and agree to work together to correct it. Chiropractic can achieve more than alleviating pain and disability. By focusing on removing the interference to optimize function, patients can benefit much more from chiropractic care.

DM: When they understand that subluxations interfere with the nervous system’s ability to control, co-ordinate and regulate every organ, system and cell in the body, they will have the knowledge to be able to make an informed choice regarding their health care.

What other advice or comments can you give to chiropractors when it comes to their examination procedures?

JC: Become a true professional; study the neurology, get a coach and practise incessantly to increase your expertise. By becoming a true master in the examination, you will find more problems you can help, the patient will benefit more, and their health and well-being will improve in ways that will surprise you.

DM: Demonstrate impairments in a way that the patient can confirm, for themselves, they have an impairment. The patient should be in a position that they can see or feel any loss they may have.

I hope the pearls these two have shared will give you the drive to improve your exam and to inspire more people to be under chiropractic care. I challenge you and a colleague to review your exam procedure together and then look for ways to improve your methods.

Remember, when it comes to your practice, work from the inside out.

ANGELO SANTIN, DC, operates a busy subluxation-based family practice in Thunder Bay, Ont., and is president of the Thunder Bay Chiropractic Society. Dr. Santin is also a Carter Universal proficiency-rated chiropractic coach. He can be reached at or 807-344-4606.

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