Introductory Post

Welcome to my new blog documenting experiences from my internship at the National Naval Medical Center (NNMC) in Bethesda, MD. The purpose of this blog is to provide insight for chiropractic students, professors and administrators into the experiences I have had during my six months at the NNMC. As chiropractic continues to become more integrated into multidisciplinary health care settings, the demand for chiropractors who can operate professionally and effectively in this environment will increase. Therefore, it is my goal to help chiropractic students become excited to participate in similar internships to prepare for this challenge. This blog will consist of reflections on the administrative challenges present in a large hospital setting, presentations of interesting cases, discussions of various radiologic studies, and so on. Without further delay, I would like to give you a quick summary of my first two months.
For those of you who do not know, the NNMC treats active servicemen and women, as well as their dependent family members, and retirees. Going into this position I thought I was prepared to step into a completely different world of a military setting as well as a large hospital. However, the NNMC is not only a military hospital, but also a military base. In addition to the hospital, there are buildings specifically for housing active duty servicemen and women, a child development center for the children, and even the navy’s version of a Walmart. I quickly realized I had a lot to learn about the military culture if I was going to have a comprehensive understanding of my patients.
My first week was spent walking between various departments and buildings getting various ID tags, clearances, sensitive document training, and other administrative headaches. Although these protocols are necessary to ensure the safety of those on the base, due to the enormity of the grounds and the endless number of medical departments in the hospital, it is easy for these measures to become laborious. After working my way through the initial administrative check-in process, I spent a couple days shadowing the intern from Davenport and before I knew it I was treating patients.
I have been treating patients on Monday, Wednesday and Friday while on Tuesday and Thursday I have been doing rounds with various groups in the hospital. These rounds are determined by Dr. Morgan’s advice and my interests. My first rotation was with the in-patient physical therapists. We worked with blast victims who were just coming out of amputation surgery, sniper victims with traumatic brain injuries, as well as patients who had total joint replacements within the last 36 hours. Working with the physical therapists was extremely educational. I realized I did not fully understand what physical therapy consisted of and the scope of their practice. I appreciated talking with Dr. Morgan after this experience because he told me these rotations are not only intended to increase my clinical skills but also to establish relationships with other professions and learn about what my patients go through in the various stages of healthcare.
Most recently I have been working in radiology reading musculoskeletal x-rays, CT-Scans, and MRIs. Sitting for eight hours a day in a dark room reading imaging studies can be a bit monotonous, but my ability to read MRI studies to my patients and explain what they are seeing is well worth the effort. Interestingly, most patients that I treat who have had an imaging study have never seen their films and nobody has ever explained what the results mean. I think this presents an opportunity for chiropractors to develop excellent relationships and gain confidence of patients by taking a little extra time to explain to them the anatomy seen on their film and what the results entail for their future.
The most enjoyable part of my experience at the NNMC so far has been the patients. The military patients are different from civilian patients in many ways, but the most noticeable include excellent compliance (for the most part) and a strong commitment to physical fitness. I have had the opportunity to examine patients with complex cases including IED blast victims, multiple disc herniations, healing sternal fractures and I am happy to inform you that chiropractic care is bringing amazing benefits to these servicemen and women. Also, Dr. Morgan is an excellent mentor because he is receptive to questions concerning treatment plans and adjusting techniques, but more importantly, he encourages me to be confident in my abilities and the effects of chiropractic care. This confidence is not only built on the improvement seen clinically in my patients, but also supported by current research which Dr. Morgan encourages me to study. This brings up a significant difference I have noticed about working in a hospital setting; being knowledgeable about current research is not only helpful to the patients and provider, but expected by colleagues throughout the hospital. Although this experience has been challenging, time consuming, and financially stressful on my family, I could not have imagined a better environment to improve as a clinician as well as member of the general healthcare community.
If you are interested in this internship, working in a hospital, or VA, I strongly suggest a day at the hospital to learn more about working in this setting. You can contact me at kyle.alexander@med.navy.mil.