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Chiropractor: Mark J. Blessley, NTS., DC

Cathy Sivak, Contributing Writer

The Actual Work

Describe a typical day of work for you.

I treat around 18 to 20 patients a day. I greet them in the waiting room, I watch them move, how they get up from their seating position and how they walk. That’s a big advantage to me over a doctor who might come in when they are already in the examining room. I do a bit of an exam every time, measure certain points and tenderness or muscle spasms. Then I do adjusting. I use a percusser, which is an impact tool, it percusses rather than vibrates; it puts a wave directly into the tissue that directly reaches the tissue; it doesn’t oscillate, it’s like a piston coming in and out that loosens the tissues. Then I do chiropractic adjusting depending on what they person needs. For an older person, I do it gently, while for a young athlete or a vibrant person, I might use a more assertive touch. Sometimes I use an ortheostem, a device that creates an impulse of 12 times a second into the nervous system. It helps to balance the muscles in the area, turns off the pain receptors and increases the feedback from receptors that cause pain to go down. I talk patients about stretching and nutrition. Then I’ll check to see how they are doing, watch them walk. Treatments usually last between 10 and 15 minutes. It takes much longer with a new patient or an acute patient.

Each visit, I try to do something a little bit different the patient. One time I might check feet and knees, another time their shoulders. I want to check their whole movement system, but I can’t do it all in one visit. If was to do everything I could do, it would last hours. So I have to break it into different aspects each time. I have a medical assistant who works with me for checking blood pressure and conducting range of motion tests. It’s beneficial to work with other professionals that can do some of the work, that way you can plan your patient encounter by knowing what other person can assist you with future patient care plans.

On a basic level, what skills does your career demand?

It demands empathy for people. It demands having an ability to recognize patterns; you need to have the ability to palpate, assist tissues changes and different motions of joints. There are many different ways we assess joints – sometimes the end feel when you move a joint will be squishy, sometimes it will be hard, sometimes it comes to the end point slowly, but appropriately, and sometimes it comes too quickly and you can’t move a joint. You need the ability to analyze different kinds of movement.

Is “squishy” the technical term?

The actually terms we use can be kind of funny. There’s a term “boggy”; swelling makes tissue feel boggy, like pushing down on a swampy area of ground. It’s funny how we use different terms; we can use squishy. I try to make my feedback to the patient appropriate to whatever level they can understand. I’ve worked with nurses and people who have had anatomical training, and I’ll go right in to naming muscles and talking about origins and range of motions. Other people don’t have training, and they might not understand. You can explain it and it is going right over their heads, but they may still nod as if they understand. Terms like squishy work for everyone.

What do you enjoy most about your patient encounters?

What I like is when they get up and say “Wow, that doesn’t hurt any more” or “I can feel my headache going away” or “The veil has been lifted, and my consciousness is upgraded” or “I feel so much better now.” I could almost do my work without getting paid. I like helping people, and I like it that I get that feedback every day. That’s what keeps me going.

What unique challenges and rewards come from being on the chiropractic and natural therapeutic side of a multidisciplinary healthcare facility?

There are challenges in explaining what you are doing and how it is helping, especially when a person has a chronic problem that has existed for years. It’s like the difference in working with concrete. If a person waits and doesn’t come in until the illness or disability has settled in, it’s like working with solid concrete, its very difficult to work with. If the person comes in with a new injury, or something that has just started up, its more like working with liquid concrete, you can still smooth and form it. One of the challenges is how to explain why it might take months to get better than they are now, and that they should get little changes for the better, but that at some points they might feel like they are getting worse. People have ups and downs. I try to relate treatment programs and progress in common terms. So that’s a challenge, but its fun to do that and to find new ways to express things.

How can the reality of being a practicing chiropractor and natural therapeutic provider differ from typical expectations?

Since I was doing patient care already, it was pretty much as I imagine it. I can remember when I was first hired by Dr. Christenson; we were in a meeting discussing patients and I asked about red flags for disc problems. He looked at me and smiled, and said “We treat those people every day.” I was being over-cautious because I was new.

There are times you have to refer for a neurological consult; a student has a lower threshold for determining if it’s a case you can treat or if you need to refer. What people don’t know is that chiropractic students treat the student population for a year. The last year you are in chiropractic college, you treat the general public. At Western State, students work at the free clinic in downtown Portland. By the time you are done with school, you develop pretty good confidence.

How has the popularity of the Internet affected your profession?

The Internet is becoming a larger and larger impact; we have all of our pre-treatment forms on the Internet. People are checking out doctors before they go see them. And of course, there’s a degree of marketing that the Internet makes available.

Best patient care tip for a novice?

Look them in the eyes, watch their movements and find out what their primary complaint is. And always address the primary presenting complaint first. They could have a foot problem that is causing a lower back problem, but if they complain of back pain, don’t go for the foot first. Check the lower back first, and then let them know the treatment will explore other potential causes.

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