Chiropractic + Naturopathic Doctor

Responsible Interdisciplinary Practice

By Maria DiDanieli   

Features Business Management

“Each of us has the responsibility to ourselves and to our country to do our part in decreasing our country’s high expenditures on health care, and decreasing the burden on the system, by promoting . . . well-being.”1

“Each of us has the responsibility to ourselves and to our country to do our part in decreasing our country’s high expenditures on health care, and decreasing the burden on the system, by promoting . . . well-being.”1


This quote by Osborn, Jones, et al., is reflected in the vision and daily operations at the Oshawa Health Centre in south-central Ontario. The clinic’s founder, Dr. Adrian Pettyan, is a chiropractor whose previous years of experience in practice brought home, for him, the importance of delivering health care that actually addresses the goal of achieving better health, rather than being centred on the management of isolated symptom patterns.


Dr. Pettyan’s vision is rooted in a sense of responsibility to the individual patient as well as to the community and the health-care system. As a chiropractor, that may begin with delivering an adjustment, but then must include educating patients toward better overall health. Furthermore, he feels that this can best be done while working within an integrative collaborative team, with full transparency and fluidity among practitioners who are focused on delivering patient-centred wellness care. Finally, Dr. Pettyan finds that practising responsible and prudent use of technology, and other expensive health-care services, could serve to demonstrate to patients and clinicians alike which options are necessary and which might be considered superfluous or costly – but without added benefit, thus, adding to the burden on the health care system.

Some years ago, armed with this vision, Dr. Pettyan partnered with Dr. Hamilton Jeyaraj, a family physician who trained in England and the United States, and whose practice philosophy was perfectly aligned with the clinic’s intent. From there, a formidable multidisciplinary team was built – and continues to grow. Today, housed in a four-storey building owned by Pettyan, the clinic enjoys an ongoing expansion of services aimed at offering high-quality, integrated health and wellness support for the Oshawa community.

When Canadian Chiropractor visited the Oshawa Health Centre, its multidisciplinary team consisted of seven family physicians, two chiropractors, three councilors, one dietician, two registered massage therapists, one nurse practitioner, three occupational therapists, a team of medical assistants and a cohort of administrative specialists filling a variety of front-desk and behind-the-scenes positions. Dental and pharmacy services, though contractually distinct, are available within the building as well. Within the team, practitioners are considered independent consultants and not employees of the clinic.

Monthly rounds are held where case presentations geared toward optimizing each patient’s wellness are brought before the care team. The idea is to focus less on the disease or condition with which the patient presented to the clinic –this will be handled by their primary care giver – and more on how the team members can use their respective skills and resources to guide that patient toward achieving optimal health and quality of life.

(That said, the patient is not considered peripheral to the team’s efforts. In fact, both Drs. Pettyan and Jeyaraj feel that patient-centred care must include allowing each patient to take an active role in choosing caregivers, and in planning and executing his/her care plan. This will not only increase the patient’s accountability, but will promote a sense of ownership, thus increasing his/her commitment and, ultimately, compliance to the care plan.)

Finally, team presentations might also include in-services held by the different subspecialties. The goal of these is to educate the rest of the team on the skill sets and utility that each discipline brings to the clinic.

These two terms are, more or less, the “a” words in health care. Laudable in their intent, their implementation presents special challenges. Within the Oshawa Health Centre model, however, these words lose some of their edge – Drs. Pettyan and Jeyaraj believe this is because of the underlying fundamental vision behind the clinic’s development, which includes access to and fluidity between a team of professionals without the onus being on billing issues.

The rule is that no patient is ever turned away based on the fact that they may have trouble with providing payment for the services rendered to them.

“We find ways to assist patients who have trouble paying for their health care,” says Dr. Pettyan. “We can work out payment options for those with difficulties.”

“Regardless, we always try to ask for a fee, no matter how nominal,” he adds. “It gives the patient a sense that a fair trade is being conducted – this lends them the dignity of being able to pay for what they take from you and also gives them a sense of ownership for, and commitment toward, their care. Finally, without putting the focus on how much money you make, it lends a value to the service that you provide.”

As for accessibility, the level of respect and collaboration among the clinic’s team ensures that patients who come for care receive holistic and wellness-oriented attention that is driven by their best interests and not the silos or affiliations that can sometimes motivate health-care organizations.

“If a patient comes with musculoskeletal complaints,” says Dr. Pettyan, “but also seems to have other issues, I will not hesitate to educate that patient on his/her need for further care, and will proceed to make that happen as seamlessly as I can. The other practitioners in the clinic will do the same for their patients, so that no one who comes to us is denied the overall care they need to reach a higher level of wellness.”

Pettyan feels strongly that integrative practice involves integrating with the community as well. The clinic offers programs geared to teaching patients about chronic lifestyle conditions and/or prevention of these. Its newest venture, a metabolic program, provides diabetes education on a one-on-one basis to patients and their families. Each patient is educated through an individualized program that includes a plan customized for his/her needs and lifestyle. This has been highly successful, as individualized regimens translate into increased ownership and thus better compliance.

The clinic’s practitioners are also involved in corporate wellness ventures that have met with considerable success. They partner with corporations to promote fundamental health and safety strategies that ensure employees stay healthy and are able to work. This, clearly, is a win-win for all involved.

Dr. Pettyan, himself a DC for more than 30 years, sees chiropractic as having a vital role in integrative care.

“We have a great service to provide,” he says, “to keep people functional and to help make them healthier.”

He feels that chiropractors can best serve this role by remaining open and willing to learn about other practitioners’ services and to articulate the utility of chiropractic in practical and clear terms. He also cautions DCs not to shy away from improving their business acumen and approaching the development of a team – or involvement with one – as a business venture as well as a vocation. In fact, Pettyan feels that the more familiarized a practitioner is with the business aspects of providing care, the more sustainable and effective the treatment environment that he/she establishes will be.

“Going about improving health care means more than talking/writing about it,” says Dr. Pettyan. “Doing it is a must!” You have to deal with a patient, deal with their finances, work within business models, and so forth, to arrive at a model that improves health and is not just about disease management. You have to focus on what you’re trying to do – which is improving health care – and not focus on seeing the numbers.

“We can build an affordable, sustainable patient-centred, caring health system that works in a way that is accessible for all patients across the country,” concludes Pettyan. “This [indicating his clinic] is the kind of model, a team model, that can actually get better results by working together, responsibly, in a truly interdisciplinary fashion for success.

“I want people to live better and I want to do that the right way.”

1. Osborn, S., Jones, H., with Hoffman, B. and Deitch, J. Discover Wellness – How staying healthy can make your life rich (Canadian Edition). Center Path Publishing, St. Paul, Minn. 2010, pg. 10.

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