I moved to Sun Valley in late 1999. I joined another spine surgeon in a small spine practice. I had been practicing spine surgery in downtown Seattle for 13 years.
It was a challenging transition. A significant aspect of major spine surgery is having a large hospital with an ICU. I still did spine surgery, but on a much smaller scale. I was at the peak of my skills in regards to my ability to perform large cases. I also did not have all of the non-operative resources at my disposal. I had to learn to be innovative to bring as many resources into my practice as possible. I eventually felt good about the level of spine care I brought to the valley. I was able to send the large cases to Boise and follow them post-operatively in Sun Valley. It was in this scenario that the DOCC Project began.
I was a tertiary referral surgeon who ended up seeing primary low back pain. I had a lot of prior experience with physiatrists in supervising non-operative care. I had access to excellent physical therapists. I also had access to physicians who could perform excellent cervical and lumbar blocks when needed. I had already been working on helping patients sleep, and I knew which patients were under a lot of stress and at high risk for becoming disabled. Because I’d had a lot of personal success with using David Burn’s “Feeling Good,” I started to have my patients use the book to deal with the stress of chronic pain.
As a surgeon, we become used to triaging our patients. We are trained to look for problems that we can solve surgically. If surgery is not a promising solution, we will do the best we can do provide some non-operative treatments. As it is not our primary training and interest, we generally don’t tackle it that aggressively. In Sun Valley, my situation was a lot different than in downtown Seattle. Over 90% of my practice was non-surgical, which isn’t ideal for a surgeon. However, I was the main resource, so I just put my head down and went to work without expectations. I did have a strong non-operative background, but what was different in this situation was that I applied my surgical mind set to non-operative care. I also had some training as an internist and understood that the mind-set of a physician often has to be “managing” rather than “curing.” It was about two years into my small spine practice setting when the “rhythm” of the DOCC program began to develop.