Q&A with Dr. James Lehman, Director of Health Sciences Postgraduate Education
An estimated $500+ billion annual cost to American society. Unnecessary suffering. Enormous loss of human potential. Financial and personal debilitation. These are among the reasons behind the Samueli Institute’s sponsorship of the Chronic Pain Breakthrough Collaborative (CPBC) aimed at addressing pain – the number one reason patients seek health care in the United States – through a new multidisciplinary chronic pain care model. Supported by the U.S. Army Medical Research and Material Command, the collaborative unites ten experts across disciplines and the country. Their mandate is to achieve breakthrough improvement in person-centered, integrative care for the estimated 100 million in the U.S. alone suffering annually with chronic pain.
Among the CPBC experts is our own James J. Lehman, Director of Health Sciences Postgraduate Education at UB, Chairperson of the Chiropractic Research Committee, and a practicing chiropractor since 1972. A board-certified chiropractic orthopedist, Dr. Lehman earned his doctorate in chiropractic medicine long before the profession had a seat at such a prestigious and momentous initiative. In fact, he remembers when it was considered unethical for medical doctors to be in the same building as chiropractors, back in the 1970’s when the American Medical Association was trying to eliminate the chiropractic profession altogether.
UBecome recently sat down with Dr. Lehman to discuss the pressing need of addressing chronic pain, what it is like as a pioneer in the chiropractic profession then and now, and how the Chronic Pain Breakthrough Collaborative might impact our everyday lives and our society going forward.
Pain from an injury that isn’t properly managed can completely change a person’s life and lifestyle. If a person is suffering from pain more than three months, it’s considered chronic pain, and if they need to take off from work for more than six months, 99 percent won’t ever go back to work again. That’s debilitating not only for the patient, but for their family – and society as well because the ongoing cost of their health care impacts us all.
In addition, pain that does not go away becomes centralized, permanently affecting the brain. And for those who have a genetic disposition to addiction, a first prescription to an opioid for pain management could become a lifelong sentence to addiction. At the Community Health Center, Inc. (CHCI), we see patients with chronic lower back pain, neck pain, and headaches every day, and they are seeing us because no one diagnosed the cause of their pain. Many are already addicts by the time they walk through our door.
A typical example is this. A patient has their own business, jumps off the back of a pick-up truck, blows out a disc in his lower back, doesn’t get appropriate conservative care, and is prescribed opioid medication for the pain. He becomes addicted, loses his job, business, family – now he’s on welfare as an addict.
It’s a real fast decline once you get addicted, and it can happen to anyone.
I completely comprehend post-trauma pain as a patient. In high school, I was in a car accident that injured my lower back. I suffered with three years of pain, then went to a chiropractor and in two treatments and in two weeks, I was relieved of my pain.
At the time I was studying to become a horticulturalist, but my chiropractor, Dr. Raymond Walta, asked whether I would consider his profession. He just thought I would be a good chiropractor. I have no idea why he thought that, but when he took me for a tour of the Logan College of Chiropractic in St. Louis, I was overwhelmed with positive feelings. Dr. Walta not only saved me from chronic lower back pain, but he also put me on my life’s path.
“Patient-centered” means putting the patient IN the center of everything and taking the doctor OUT of the center. It’s that simple.
“Integrative Care” flows out of that model. Once you put the patient in the center, then you surround him or her with a holistic primary care team and system, depending on the injury or presenting symptoms. So a comprehensive, primary health care team would include not only doctors, but Advanced Practice Registered Nurses, orthopedic physicians, pharmacists, social workers, dentists, physician assistants, chiropractors, podiatrists, nutritionists, behavioral health professionals, and others.
I became a chiropractor in the 1970’s. Back then, it was considered unethical by the American Medical Association for medical doctors to be in the same building as chiropractors, so they certainly weren’t allowed to share information.
As a result of this discrimination, patients were not permitted to bring a radiographic study to a chiropractor. So, I would have to take the x-rays again, which would mean exposing my patient to radiation twice. One day, I had a patient ask me, “When will you doctors get together to benefit the patients?”
I’ve been on a mission to integrate since then. In 1991, I founded the first chiropractic services within the Lovelace Healthcare System in Albuquerque, New Mexico. A handful of years later, a 1999 Hospital Topics article, “Can Medicine and Chiropractic Practice Side-By-Side: Implications for the Future of Health Care,” demonstrated that 91% of the Lovelace primary care physicians were willing to refer their patients to a chiropractor.
Then in 2002, I served on an Integrative Medicine Advisory Committee to integrate chiropractic medicine rotations into the curriculum at the University of New Mexico School of Medicine, which still has an integrative medicine section with chiropractic care. As a result of initiating chiropractic medicine rotations, chiropractic medicine has been embraced by the medical school. Currently, there are three chiropractic physicians employed as faculty by the medical school.
The University of Bridgeport’s College of Chiropractic and the Community Health Center, Inc.’s partnership is my third venture with integration. And this one’s the most rewarding, because the 2010 Patient Protection and Affordable Care Act (now known as the Affordable Care Act) timing couldn’t be better. With the U.S. Department of Health and Human Services (HHS) mandate that we move from a sickness model of healthcare to a wellness and prevention model of healthcare, it’s now an imperative that chiropractic services have a seat at the table.
The National Prevention Strategy (NPS), an HHS white paper, is guiding the movement toward integrative healthcare, which in turn is how we are educating our students. By 2025, the NPS reports that 90-97 percent of healthcare providers will be practicing in coordinated care organizations. So in January 2012, I was asked by Dean Zolli and Vice-Provost Brady to work with the CHCI to put together a pilot program to determine whether the integration of chiropractic services would be well received by the patients. The pilot study outcomes were very positive, with 98% patient satisfaction and a statistically significant improvement in function. It became obvious that the primary care providers were comfortable with the integration of chiropractic services.
As the nation’s first university-based College of Chiropractic, the University of Bridgeport has been pioneering the education of the chiropractic profession since 1990. Today, as a leader in integrative medicine, the UBCC is the only school partnering with CHCI, offering students enhanced clinical training.
The CHCI is a world-class organization and one of only 11 statewide community health centers in the U.S., and we’re very fortunate to have this partnership with them. Not only do we have our fourth year chiropractic students doing clinical rotations, but also a three-year full-time resident training program within a community health care system, which has never been done before within the chiropractic profession.
For the past three years, our UB naturopathic and chiropractic students share patients and work together in teams during their clinical rotations, so they can better understand what other providers are looking for, what they’re offering as far as treatment. These “roundtable discussions” are the healthcare model of the future – and at the core of patient-centered, integrative care.
As another example of leadership, all residents at the CHCI are UBCC grads, and with the help of the CHCI and their grant-funded strategic plan, we’re looking to expand. We’re aiming to introduce chiropractic or orthopedic resident training programs from UB to 10-20 states across the country by 2016, with New Jersey and then Colorado as the next two. My personal goal is to expand from nine sites to 100 by the year 2025, the year I plan to retire.
The College of Chiropractic at the University of Bridgeport is the only chiropractic college in the collaborative. Hopefully, the Samueli Institute collaboration will focus on non-pharmacological treatment and improve the quality of care for both military and non-military patients suffering with chronic pain. Possible outcomes of the collaboration could be improved access to acupuncture services and naturopathic and chiropractic medicine, as well as enhanced career opportunities for our students.
6 When You Think Back At Your Patient Long Ago Who Asked When “You Doctors” Would Get Together For The Benefit Of The Patient, What Crosses Your Mind? Are We There Yet?
The Chronic Pain Breakthrough Collaborative is a magnificent effort by the Samueli Institute that’s extremely necessary if we’re truly going to integrate non-pharmaceutical treatment including chiropractic, naturopathic, and acupuncture into the healthcare delivery system. It’s huge for both the federal government and these reputable organizations to admit it’s time to welcome everyone into the same circle for interdisciplinary and holistic healthcare treatment, with the patient in the center. After 33 years in the profession, it is tremendously rewarding that I can finally assure my patients that YES, we’ve gotten ourselves – and “it” – together for their benefit!