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From Practice to Policy

Dr. Shawn Thistle is a chiropractor, educator, international speaker, knowledge-transfer leader, evidence-based healthcare advocate and medicolegal consultant. He practiced for 14 years in a busy, interdisciplinary clinic in downtown Toronto, Canada and now sees private patients. He is familiar to most for his weekly Research Reviews, which he has been publishing for chiropractors since 2006. His goals are to enhance our cultural authority and promote rational integration of current evidence into chiropractic care, so we can continue to improve patient outcomes and healthcare efficiency.

Dr. Thistle graciously provided our TechTalk listeners a personalized discount code! You can save 25% on Dr. Thistle’s Research Reviews (available individually, or access to all via subscription) and E-Learning options by entering code TECHTALK25 on checkout (expires Dec 31, 2024). Thank you, Dr. Thistle!

In this of TechTalk Podcast, Brad Cost, Dr. Jay Greenstein, and Dr. Shawn Thistle sit down to discuss:

  • The Canadian healthcare system vs the American healthcare system.

  • Data roadblocks & the distribution/publication delay on research.

  • Dr. Thistle’s programs, available now at



3:16 – “In first year at CMCC in 2000, you could prove competence in some of the bigger courses. I did and had about 10 free hours a week of no class time while my classmates had to go. I decided to make use of that time by going to the library to read journals, so I would pick up a physical issue of JMPT or Spine or European Spine Journal or whatever to flip through the pages. I started realizing there was a lot of the research in those journals that wasn't being covered in the curriculum. This isn't a knock on CMCC, it happens everywhere. I started writing little summaries of these papers and emailing them to my classmates. Fast forward to graduation, I had almost every student in the school on my email list, including faculty members and people that were being referred to me. I decided to formalize it into a subscription-based service about two years into my practice in 2006. At that time, I had a full-time practice that was in a busy part of downtown Toronto. I started developing the subscription service on the side. I called it Research Review Service, where I was summarizing research papers for chiropractors. I started getting invited to speak at conferences like provincial association meetings or local societies and realized I was a good speaker. I started adding online continuing education options maybe in 2011 or so. I started getting associations subscribing for their entire membership like the Canadian Chiro Association, the British Chiro Association, the Swiss Chiro Association. My practice was great, but my hands weren't scalable. Next thing I knew, my side hustle was out earning my front hustle. I decided to back off my practice to focus on the company a little more. My company has since been folded into my personal website at”

12:54 – Healthcare system issues. “It's easy to point a finger at a profession, like medicine or orthopedic surgery, and say they are doing things wrong. They are, to some degree, but I think to your point, the constraints of the system in which a profession works has to be taken into consideration when you consider the output that they're able to achieve with their patients. The orthopedic surgeon isn’t happy about it, but the province mandates that he sees 200 people in three hours. Many of whom had questions, many of whom had just had a major limb in their body cut open, had metal pieces in it and were hurting. There's nothing he's really allowed to do about it. That's not a knock on the profession. That's a knock on the system. One area of synergy we have is we want to see a better working system and how information and data can inform how healthcare works. That's not a chiropractic issue – it’s an issue for the entire healthcare system at this point.”

19:01 - The Canadian versus American healthcare systems. “In most of Canada now, governments don't pay for chiropractic services. Although based on emerging evidence and trends in musculoskeletal health, a lot of those governments are starting to come back to us with some interest in adding chiropractic back to the slate of services that are offered. Whenever I speak to an American friend or colleague about what you guys have to go through with medical insurance coding… I remember one of my friends from Nevada said, well, when you see a patient, you put your claim in through Medicaid or Medicare, and then about 30-40% of them, you don't even get paid. That is not how it works in Canada, so I think there's that difference that's still quite prominent. As both of you know, there are some historic things in some of the Medicare, Medicaid billing procedures in the US that are still kind of boat anchors for us in terms of advancing our profession in diagnostics or requirements for imaging. The practice environments from a billing perspective are quite different and they're evolving.”

23:03 - Game changing factor. “The full day seminar program that I’m working on and presenting in Canada over the next few months is called Chiropractic Research Game Changers: From Practice to Policy. That's going to highlight our journey as a profession from documenting what we do in practice to being able to influence policy via the results from our research. In the US, these databases are giving us huge advantages in the literature because time and time again, it's coming out positively for chiropractic in terms of reducing healthcare escalation, improving patient outcomes, saving costs depending on the condition. In Canada, Pierre Côté and some of his colleagues are just starting to get access to similar data in some of the provinces. I think the publication lag between the Americans and Canadians in that regard will tighten soon and hopefully the results will be just as positive. That sort of research is not perfect, but when the answer is the same over and over and over again, and now we're dealing with database sizes of 6 million patients, 11 million patients, it's hard to deny the impact. That is a game changing factor in our evidence that we just simply didn't have five years ago, so one of the biggest game changers we have now is our access to big data now.”

24:37 – The speed behind publications. “There’s that paper published ages ago that says it takes 17 years for published evidence to get into clinical practice, so I’m trying to get practicing clinicians up to speed on what's happening in the literature and how that can influence their patient care. I also get asked to go with a provincial association or a national association in Canada when they speak to insurance companies, and it always shocks me how behind they are on what the evidence says about anything. I would argue, based on my more minimal experience with government, that they're even further behind. The similarities in the US and Canada might be that it takes a long time to change a well-entrenched system, but we're at a critical juncture in our profession now where we can come into a meeting and bludgeon them with evidence. You can't deny the results at this point. The narrative is shifting.”

33:00 – Data roadblocks. “It's transitioning our colleagues into a mindset of being okay with what the data says. Sometimes our profession sets our own bar too high. If you ask an average practitioner if they would be willing to share their EHR data on their patient outcomes, how many visits, what kind of conditions you see, some of them default to no. Every chiropractor has a pretty good batting average, but nobody's perfect. It's that small percentage where we're not perfect that's been holding us back from giving our data. We have to realize that the bar isn't that high because you can't fix everybody. We just have to get over our confidence problem because there's nothing wrong with batting 875, right? It's more important to show cost, patient outcomes, and patient safety. As Brad mentioned, that’s a generational mind shift of getting our practitioners to the point where we're comfortable putting our data out there insofar as the data is even identified to your specific practice anyway. You're just dumping it into the pool.”

41:45 - Research “drug dealer.” “I've been posting a research review every week since 2006, so I've reviewed about 1,100+ papers at this point. The goal with that service is if you want to read or listen to one or two, you can buy them for $5 and check it out. If you want the whole access, which is the way most people go, it's $120 a year and that goes on discounted. Most practicing chiropractors don't have time to stay current on evidence and it's becoming a challenge for me, yet I do it full-time! All this available data that we've been talking about is skyrocketing, but it's like drinking from a fire hose sometimes, you know? My job for a clinician is to help give you a weekly taste of what's happening in the literature, how it can be applied to your practice, what it means for your patients and what you do with them on Monday morning. I also do full day in-person seminars. They're all in Canada at this point, but I can talk about game-changing chiropractic research all day and that's what I'm doing at my upcoming events in the next three months.”

44:29 Dr. Thistle’s newest eSeminars. “The other format I've been doing the last couple of years are video-based eSeminars, so it's like being at a three- or four-hour event with me, but in video sections. There are quizzes to help us meet the requirements for continuing education across the globe. I did a recent one with my colleague and friend from CMCC, Dr. Simon Wang. We did a five-hour e-seminar going through all the research on the mechanisms of action of spinal manipulation. It's full geek out on neurophysiology, immunology, biomechanics. We were aiming to answer: when you adjust somebody, what happens? That's called the Science of the Chiropractic Adjustment: Have we cracked the code, and that's available on my site now. We also have a second one that is a follow-up to a 10-hour program that I produced a couple of years ago with my friend and colleague, Dr. Demetry Assimakopoulos. He did a program for me a few years ago called All Aboard the Pain Train, A Chiropractor's Guide to Chronic Pain, where he goes through the different phenotypes of chronic pain and how that can change management strategies. He and I wanted to do a follow-up about the biopsychosocial model, so we got together with two PhD chiropractors in that area, Dr. Peter Stilwell and Dr. Kent Stuber, to make a four-hour program. It’s called Mastering the Biopsychosocial Approach, a Contemporary Lens for Chiropractors, and it is also available on my website. Those are the two newest programs I have, and I'm really proud of them.”

47:07 – The biopsychosocial approach. “To put it simply, it's a realization that there's a person attached to the medical condition or the musculoskeletal condition that they have. In the literature, specifically in the last 10 years, a lot of data is showing us that it's not necessarily all the medical details that matter most. It's how you interact with a patient. It's how they view their patient experience. It's if they value and perceive a good therapeutic alliance with their chiropractor, their physio, their medical doctor. All these qualitative factors have a huge impact on patient outcomes and patient satisfaction. We're just starting to be able to capture this properly in databases and I think that will only get better over time. It's something we need to harness, but our goal for that program was to operationalize and show you examples of what being a biopsychosocial chiropractor means in terms of how you say things to patients can really matter. We have some patient interaction demos within that course as well. My goal in the next few years is to bring the best from the research world into my courses to present and help practitioners understand the science directly from the scientists, along with my clinical spin and ability to put it in the context of the general state of the literature in our profession.”




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