Clinical Rounds
INTERVIEW
FEATURE
Interview with William Owens, DC
The American Chiropractor
Dr. Bill Owens is currently in private practice in Buffalo, New York and generates the majority of his new patient referrals directly from the primary care medical community. He is the Clinical Director of the Academy of Chiropractic's Fellowship in Spinal Biomechanics and Trauma and is an Associate Adjunct Professor at the State University of New York at Buffalo Jacobs School of Medicine and Biomedical Sciences, Adjunct Clinical Assistant Professor at the University of Bridgeport College of Chiropractic and an Adjunct Professor of Clinical Sciences at Texas Chiropractic College.
In an exclusive interview with The American Chiropractor Magazine, Dr. Owens shares the vision that made the Academy of Chiropractic commit to presenting clinical grand rounds on a weekly basis, and how you can participate.
TAC: Dr. Owens, I would like to thank you for taking the time to discuss your support of the chiropractic profession and embracing continuing education. I think this discussion is important to the profession and our ability to work at the highest clinical level possible.
Dr. Owens: Thank you, I appreciate you also taking the time to have this conversation. I believe it is critical to the advancement of our profession, particularly at this time with the opioid crisis, overutilization of surgical procedures and an overall epidemic of spine pain being treated by far less qualified providers based upon the literature (and my personal experience).
TAC: The Academy of Chiropractic, over the past decade, appears to be contributing significantly to advance the chiropractic profession by focusing on clinical diagnosis, interprofessional collaboration, sharing pro-chiropractic literature with the world and demonstrating the importance of the chi ropractic adjustment. So, this interview begs the question: What is the Academy up to now and why?
Dr. Owens: That is the question that I love to hear! It is something that my colleague, Dr. Studin, and I think about regularly, and the answer is always something new and exciting to advance the profession and each chiropractor’s office simultaneously. Chiropractic results and new literature breakthroughs keep us motivated to open doors for the chiropractic profession by bringing the “best of the best” in their fields to collaborate on coursework, but none of that is useful unless it can be put into practical use. That is why, in January 2019, the AcadWjiilm j. owins j emy of Chiropractic started Chiropractor the weekly Clinical Grand Rounds seminar series.
TAC: What exactly are Clinical Grand Rounds?
Dr. Owens: Grand rounds have historically been a methodology of medical education and inpatient care, consisting of presenting the medical problems and treatment of a particular patient to an audience consisting of attending doctors, residents, and medical students. It was first conceived by clinicians as a way for junior colleagues to “round” on patients to be exposed to challenging cases and expand the educational experience of the student. The patient was traditionally presented for the “round” and would answer questions; grand rounds have evolved with most sions rarely having a patient present and being more like lectures. These, however, are not medical grand rounds; these are chiropractic grand rounds! We are following a similar model of education, using real patient data, but with the focus being on the chiropractic diagnosis and management of the human body, with particular attention being placed on the trauma patient. We pick the traumatically injured patient since they tend to have the most complex issues and are not typically seen in our chiropractic academic “intern” experience.
"Chiropractic results and new literature breakthroughs keeps us motivated to open doors for the chiropractic profession."
TAC: Are these real cases or ones that the academy “makes up”?
Dr. Owens: These are real cases of real patients managed in chiropractic offices. These cases mostly come from doctors who are enrolled in the Academy of Chiropractic’s Fellowship in Spinal Biomechanics and Trauma program. However, we are always interested in unique and interesting cases that showcase a particular learning issue. The only requirement for a case to be presented is that they were properly worked up, diagnosed, and properly documented. When it comes to accurately presenting a case in Clinical Grand Rounds, everything needs to be explained and demonstratively documented. The documentation typically follows an academic standard because both Dr. Studin and I teach in both medical and chiropractic academia and realize that standard should be adhered to. That is the way it should also be in private clinical practice since doctors who have adopted poor documentation habits usually fare poorly in audits and are shunned by referrers because documentation projects your level of clinical excellence.
TAC: It seems to be pretty comprehensive, and I am understanding that clinical grand rounds are a regular part of the training in other healthcare professions.
Dr. Owens: Yes, as we had discussed, it is a central model in medical training, but it has been largely overlooked in chiropractic, particularly after graduation. The Academy of Chiropractic felt that it was time to bring the profession together through national weekly case studies. That is precisely why it is open to every doctor at every level of practice regardless of technique or philosophy, is free, and totally apolitical with no agenda other than clinical excellence of the individual provider. We are interested in case discussions with any doctor of chiropractic looking to learn, grow their practice, and help patients. It is about evolving and learning more about evidenced-based solutions when they are available.
TAC: Since Clinical Grand Rounds are the practical application to clinical knowledge and are designed to provide a review of interesting chiropractic cases, are they approved for CE credits for doctors of chiropractic?
Dr. Owens: Yes, these one-hour Clinical Grand Rounds are approved in 38 states through our relationships with the PACE-approved program for the Federation of Chiropractic Licensing Boards and approved at the postdoctoral chiropractic level through Cleveland Chiropractic University, Kansas City and the New York State Department of Education, Board for Chiropractic. Since our goal is to offer this at no-charge to the profession, there is only a nominal charge to manage the CE credits. However, even if you cannot apply the credits toward licensure renewal, you can use the entries on your curriculum vitae and enhance your career as a result. In addition, we feel strongly that it is time for the chiropractic profession to embrace the advancement of continuing education as medicine has done and have one national standard that is accepted by all states. We are hoping to see that for chiropractic in the near future, thereby removing our current system, which is antiquated. Chiropractic will struggle to grow in a system that prevents quality graduate-level education by having 50 states and 50 sets of rules.
TAC: What exactly is reviewed during the Clinical Grand Rounds presentation? Is it just physical examination and diagnosis or is there also a “big picture”?
Dr. Owens: That is a great question and one that the academy struggled with for some time. We had wanted to present a difficult or unique case in a way that was interesting and fun. The flow of the case presentations follows a common format, but the discussion is unique. The case starts with the “Clinical Pearls” section, which outlines the basic facts of the case; we then move into discussing compliant and thorough documentation, working through our diagnostic dilemmas while correlating clinical findings. Many cases involve collaborative management with medical specialists and most include the interpretation and review of plain-film radiographs and MRIs as well as the clinical interpretation of electrodiagnostic testing and other specialized tests. Remember, these are complex and difficult cases, so they tend to include a lot of clinical data. That is why they are such good teaching tools.
TAC: Who is presenting the cases, and forgive me for asking, are they truly qualified?
Dr. Owens: Dr. Studin and I are the lead presenters. Currently, we either hold academic positions or teach through the following chiropractic and medical institutions: University of Bridgeport, School of Chiropractic; Cleveland University-Kansas City, College of Chiropractic Health Sciences; Texas Chiropractic College; The State University of New York at Buffalo, Jacobs School of Medicine and the State University of New York at Stony Brook, School of Medicine, Department of Neuroradiology. Together we have over 60 years of clinical experience to direct the conversation, so Dr. Studin and I are leading the presentation. We also have our current graduates of the fellowship program as panelists; if we add the fellows to the list, we have over 200 years of experience, and it is all chiropractic-centered. The doctors who have completed their fellowship training followed a rigorous two-year course of didactic training in MRI spine interpretation, clinical spinal biomechanics, trauma triage, and vascular neurology to name a few, and have completed 12 clinical rotations with specialists in their own communities. They are highly trained and qualified to assist us in our presentations.
TAC: What are some common items that are demonstrated?
Dr. Owens: Each case presents unique information, which is the ultimate purpose of the Clinical Grand Rounds. We have had cases that demonstrated multilevel intervertebral disc herniation with spinal cord compression, ligament laxity in degenerative spinal joints post-trauma, acute spinal fracture and vertebral vascular insufficiency, to name a few. The presentation also brings into play the patient’s history, physical examination findings, imaging studies, electrodiagnostic studies, and interprofessional referral when indicated. They are quite comprehensive, but fun.
TAC: When looking at our readers and the profession as a whole, who would you say would benefit the most from these weekly presentations?
Dr. Owens: Every doctor of chiropractic and chiropractic student currently enrolled in our colleges could benefit since these presentations are discussions about chiropractic management. In fact, all are invited, and to reiterate, they are all free. I think in the end we all benefit from each other, so the more doctors involved, the better because “real-time” question and answers are part of the Clinical Grand Rounds. The real-time questions help drive the conversation to fill “educational gaps” that we often never realize when preparing the presentation. We have been very lucky to have this concept embraced at the level that it has been accepted because the Academy of Chiropractic has been presenting these Clinical Grand Rounds since the beginning of 2019.
TAC: How have these helped doctors in their practice?
Dr. Owens: We all agree that knowledge is power, and it is the power of your clinical excellence that builds a practice. As I mentioned earlier, we discuss not only what was wrong with the patient, but also how to communicate that information to the patient’s primary care provider, spinal surgeon, attorney, as well as the patient themselves, and with the focus on compliant documentation, we see a better format in communicating with the insurance carrier. It is this level of interprofessional communication that is building bridges in our individual communities, elevating chiropractic, and ultimately benefiting our patients. It also helps prevent audits by teaching doctors how to document compliantly, thoroughly, and demonstratively. It is just a fun way to be a chiropractor and to build a practice.
TAC: I know we are about out of time here, so I would again like to thank you for your time and the Academy of Chiropractic’s interest in promoting clinical excellence and interprofessional communication while staying true to chiropractic. In closing, how can a doctor get more information on these weekly Clinical Grand Rounds?
Dr. Owens: Thank you for wanting to have this discussion in the first place. I think it is a powerful way to advance our clinical knowledge and a way to build confidence in communicating interprofessionally with others. For more information, doctors can visit academyofchiropractic.com or email me directly at Dr.Owens@ AcademyOfChiropractic.com. It was a pleasure talking with you.
