Inside Scoop: Justin M. Goehl, DC, MS
In our staff profile series highlighting the roles of individuals and their departments across the organization, D-H Today visits with chiropractor Justin M. Goehl, DC, MS, who joined Dartmouth-Hitchcock (D-H) in January 2017 as a primary spine care provider within the Department of Community and Family Medicine at Dartmouth-Hitchcock Medical Center’s (DHMC) Heater Road facility. He is also a clinical assistant professor of Community and Family Medicine at the Geisel School of Medicine at Dartmouth and an adjunct clinical assistant professor at Southern California University of Health Sciences (SCU). Goehl earned a doctor of chiropractic degree and a master of sports science and rehabilitation from Logan University College of Chiropractic in Chesterfield, Missouri. This was followed by a residency with the VA (Veterans Affairs) Greater Los Angeles Healthcare System, and then a six-month fellowship in primary spine care at SCU. At DHMC, Goehl has created the Primary Spine Care program within The Center for Integrative Medicine. This program offers an innovative approach to treating and triaging spine-related disorders with a focus on cost-effective, evidence-based, patient-centered outcomes. Medical acupuncture appointments with Dr. Louis A. Kazal, Jr., MD, are also available as part of D-H’s integration of complementary and alternative medicine in Primary Care.
Why did you choose to come to D-H?
My role as a primary spine care provider affords me the opportunity to work in an integrated primary care setting. This unique and innovative structure allows patients with spine complaints to receive streamlined care under the management of a single provider. At Heater Road, I have the pleasure of co-managing many of these complex cases alongside an incredible team of providers. In addition to providing patients with conservative care for musculoskeletal complaints, I also serve as a referral option for my colleagues’ patients who suffer from spine related disorders, including neck and back pain.
What made you want to specialize in chiropractic medicine and what are your areas of expertise?
Growing up, I was an active child. I enjoyed watching and playing sports, including baseball, basketball and soccer. A career where I could work with people and help them to live more active and fulfilling lives was something with which I naturally connected.
Initially, I was drawn to chiropractic and to physical therapy as they would build upon my education in human performance (my undergraduate degree is in exercise science) and allow me to help patients achieve a healthier lifestyle. Both fields incorporate multiple visits, which helps to develop a therapeutic relationship between provider and patient. I believe these relationships, based in trust, are an essential component of patient care. Ultimately, I connected more with the hands-on approach of chiropractic care.
I had the opportunity to complete a residency through the VA healthcare system, which is the first national accredited program of its kind for chiropractic. During my training, I was exposed to the most challenging cases of my career all while working within the country’s largest VA hospital. I worked with and learned alongside residents from physical medicine and rehabilitation, as well as pain medicine fellows. After completing my residency, I spent additional time training in the primary spine care model at Southern California University of Health Sciences in Whittier, CA. Later this year, I will be part of the first cohort pursuing my certification in primary spine care through the University of Pittsburgh.
What types of patients and conditions/ailments are good candidates for chiropractic care?
Part of my current role as a primary spine provider is to determine those patients who are not suitable for chiropractic care and determine the appropriate alternative avenue for those individuals. As I tell all of my patients, my goal is to get you to the right provider in the quickest manner possible, regardless of whether that includes care with me.
Overall, the majority of the patients I see in clinic have some form of spine related pain or interference of their daily function. I treat a wide range of patients: young and old, acute and chronic pain, patients with and without radiating symptoms, those in severe pain and others with less pain but an ailment that is restricting some aspect of their life.
What do you want prospective patients to know about chiropractic care that you think they may not know or understand?
I think that when people think of chiropractic care they automatically think of the adjustment or manipulation. While mobilization/manipulation is often the most common method of treatment, it is only one of the tools that I use to address spine pain. I regularly employ techniques to lessen a patient’s pain without having to use mobilization/manipulation of the spine. There any many different levels of treatment and the patient’s comfort is always taken into account.
I also hear from patients that they were reluctant to visit a chiropractor because they had heard it often involves a high number of treatments or a long-term care plan. While there are complex cases that require additional visits, the average number of visits to my office for a particular episode range from four to six treatments.
What brings you joy in your work?
My greatest joy is when I see a patient who had been in pain return to what makes them enjoy life. For some, it may be getting back to their favorite outdoor activity, and for others it may be something as simple as putting on their shoes without back pain. The ability to have a positive impact on people’s everyday lives is why I do what I do.
Moreover, it is fulfilling when a patient tells me they have been given the tools to manage their symptoms on their own and that they no longer need my care. My goal with every patient is not to see them in the office but rather to see them out in the community, living and enjoying life with less pain.
What is the greatest frustration in your work?
The inconsistency in spine care can be a frustrating aspect of my day-to-day job. There are so many different specialties that one can seek out and receive a different diagnosis, recommendations and treatment. Even within the same field, there can be a large disparity in the course of treatment for similar conditions. Spine pain, in general, tends to be a gray area where there is not a simple indicator, such as a blood test for diabetes with clearly defined normal limits. Various problems or diagnoses may have an overlap of symptoms and may not be clearly delineated, as well as being subjective in nature. While this can be discouraging to both the patient and the provider, it can also be exciting when a patient responds to a certain type of care, which supports the differential diagnosis.
What's your favorite non-work activity?
My wife and I love to take short day or weekend trips to explore new areas, shops and restaurants. This is our first time living in New England and we are really looking forward to seeing the beautiful East Coast and to taking advantage of the close proximity of so many great towns and cities.
What about you would surprise most people?
I am the proud five-time winner of my fantasy football league comprised of my friends from elementary school through college, which we started in 2003.
What is the best piece of advice you have been given?
One of my mentors in California advised that you should take a moment prior to entering the room with each patient to make sure that you are completely focused on that interaction and to leave any other patient concerns or distractions outside of the room. It sounds simple but, as one becomes busy in practice and life, it is sometimes easy to get caught up in the everyday hustle and bustle and not give your absolute undivided attention to the patient in front of you. I use the time during the short walk from my team room to my treatment room to gather and focus my thoughts.
How do you strive to make a difference in the lives of our patients and your colleagues?
I hope my presence here at D-H as part of an integrated service is offering patients and providers a beneficial resource and referral. By being completely entrenched in a large, academic health system, I am able to communicate with patients through the myD-H portal, interact with other providers both in person and through electronic health records, and access patients’ complete medical history to avoid repeat or unnecessary testing, imaging or referrals. The ultimate goal is to provide a streamlined service that allows individuals to have an advocate in care and in navigating the multitude of options for musculoskeletal relief. If I do not feel that chiropractic is the best avenue of care for a patient, I work with them to help make the necessary recommendation or referral to allow them to receive the care they need.