Have You Been Scared By A Doctor?
Chiropractor in Amarillo TX discusses it
I want to begin by saying there are two kinds of 'scares' in the healthcare industry. There are the good kind of scares and there are the bad kind of scares. Let me explain further.
Let us begin with the good kind of healthcare scares. I believe everyone can admit there have been times in their lives that they needed a wake-up call. For example, there are people that have missed 'gym day' for 20 years or more and somehow forgot to watch their Weight Watchers points. At all. What was once a comfortable waistline has now ballooned up to a very uncomfortable daily struggle.
It's not like these people don't realize there could be a developing issue. They know. But sometimes, in order to snap someone out of it, a healthcare practitioner may choose to spook the patient a bit. For example, a doctor may say something like, "It is not a matter of IF you develop diabetes. It is a matter of WHEN you develop diabetes. And when you do develop diabetes, here is exactly what your life is going to look like and you're not going to be happy about any of it."
Most can understand that this sort of communication is going to be much more effective than something like, "You know.....I know you enjoy your cake and your hamburgers, and I know you enjoy your couch that has formed to the shape of your butt.....but it sure would help your health if you get up and move a little more often."
That sort of communication is literally going nowhere. Right?
The same goes for a cardiac patient. Sometimes they need to be scared into stopping eating fried foods every day or to get out and go for a walk to strengthen their heart. Sometimes, they are an immovable object and they need to be smacked with some honest talk.
Sometimes, a more drastic level of communication needs to happen to guide someone closer to taking better care of themselves so that they are acting preventatively rather than waiting to develop a more severe disease process later on andthen being forced to treat it reactively.
This is a GOOD SCARE! It can be loving, it can be helpful, and it can save someone's life.
'Bad Scares', in my opinion, come down to clinic-centered communication. Also known as doctor-centered communication with patients. Let me explain; there are times services are recommended for patients that are not very well-backed in the research literature (if at all) and have little hope in actually helping the patient. Yet they are recommended mostly for the purpose of making money for the doctor and the clinic rather than healing the patient that is sitting in their office. That is the very definition of 'doctor centered'.
Not only are the services unethically recommended, but they scare the patients into performing the services. This is the worst kind of scare and it happens in all walks of healthcare. A recent research paper suggests that there are 56 million back pain sufferers in America and out of those 56 million, only about 5% actually need any surgery. There is also more recent research showing that the most popular musculoskeletal surgeries have little to zero research proving their benefit and have never been compared in a research study to not having the surgery at all. In fact, out of all of the research, they could find on the most common procedures, only 64 of the more than 6,735 studies actually compared surgery vs. not having surgery at all. And of those 64 that actually compared the two, only 9 of those were even favorable to having the surgery.
I've had patients tell me the craziest things that have come from surgeons' mouths with regard to their future. Again, 'It's not a question of IF you're having surgery on this. It's a question of WHEN you're having surgery." I think they teach them that line in school if I'm guessing.
Let me add to the discussion that the American College of Physicians now recommends the following as first-line therapy for low back pain of any duration:
- Spinal manipulative therapy (chiropractic)
- Exercise (evidence-based chiropractors make this a big part of their practice)
- Massage (many chiropractors employ massage therapist or do soft tissue work themselves)
- Acupuncture (many chiropractors employ acupuncturists or do soft tissue work themselves)
- Heat (basically all chiropractors have moist heat)
- Low-level laser (many chiropractors offer laser)
- Cognitive-behavioral therapy
- Tai Chi
ALL of these should be tried and failed before progressing to medication, then to shots, then to surgery.
Either the medical field is yet to be aware of these new guides coming from their largest organizations, or they are willfully ignoring them.
Turning focus away from the medical field, what about the chiropractic profession? Do chiropractors scare their patients as well in order to get them to do what they want them to do? The answer is a big, "Yes indeed."
I'll give you some examples. But first I want to share some thoughts on current guides with regard to communication and treatment. We know a lot more about communication than we knew even 5 years ago. We are learning that our words matter and that communicating properly can make a big big difference as to whether a patient eventually resolves. We need to communicate hopefully and optimistically. We need to communicate in a way that gives the patient confidence in their future and in their ability to get out of pain and move forward with their lives.
Not only that, but we are also recommended to teach the patient at-home, self-management strategies rather than creating a feeling of dependence in the mind of the patient on a clinic or a doctor. When a patient is empowered and given the confidence to self-treat like that, it makes a huge difference down the road.
Now, to the examples I mentioned. I have had patients relay to me the most disturbing things told to them by other chiropractors. One of the most common is some variation of this statement while reviewing x-rays with the patient, "You might only be 32 but looking at these x-rays, it looks like you have the back of a 70 year old. I'm real concerned about this and we're going to need to see you every other week for the rest of your life to keep this from getting any worse."
First of all, no 30-something has the back of a 40, 50, or 60 year old. They just don't. Secondly, that type of communication puts doubt and fosters a lack of confidence in the patient to recover. It also creates dependency on the doctor and the clinic. Every other week for the rest of their lives. Third, this type of clinic typically does not offer at-home, self-management strategies because they are clinic-centered and want the patient visiting regularly. Patients don't attend regular appointments when they're taught to self-manage their conditions at home.
Another common strategy is to tell patients that the curve in their neck is reduced and that the only way to ensure health long-term is to fix that curve. I'll be honest here; is it more ideal to have a great curve in your neck? Of course it is! I'll also be honest with you when I tell you that current research, including longitudinal studies, show that a lack of normal curvature in your neck is.....well....pretty normal and is probably not all that problematic long-term. Still, we commonly hear of chiropractors recommending 50, 70, and even 100 or more visits over the course of just a year or so in order to try to improve the curvature. We have seen bills for this type of treatment up around the $5,000-$10,000 mark.
This is usually accompanied by a lot of unnecessary x-rays, a lot of dependency on the clinic, and a lot of adjustments. Plus, the patient thinks they're not normal on some level. They may think they are fragile on some level instead of young, strong, and vibrant. They think something is really wrong with them when, in fact, they are really pretty normal. In addition to the wrong messages being sent, a lot of adjustments like this have the potential to actually compound any issues that may have been going on. The more and more segments of the spine are moved, especially 70-100 times in a year, the more and more those segments begin to loosen up. To be clear, the spine likes stiffness, strength, and being 'tight'. If the bones in the spine are loosened too much and too often, there is a potential to create more movement and instability in the region. That has the potential to create more discomfort and, eventually, possible chronic and longer lasting pain. So, these practitioners may actually be creating what they are claiming to treat.
That doesn't mean people should be scared of going to the chiropractor. Not at all! In fact, I really believe EVERY person should go to a good, evidence-based, patient-centered chiropractor when they have a musculoskeletal issue. There is also research proving the benefits of preventative visits through the year to keep from developing issues down the road. I'm simply saying that 50-100 visits in a year and creating dependency on a clinic or doctor in the mind of the patient is probably overkill and likely unnecessary for many, if not most.
The last issue is one of claims of immunity by some chiropractors. The claim being that if a patient and their family will visit their chiropractor every two weeks for life, they do not need to ever be vaccinated because these regular adjustments will boost the immune system and they'll never get sick.
Now, there has been some research I have heard of that suggests a slight immune boost from an adjustment but the guess by some experts is that a punch in the face would provide a similar result as well. Is it likely that visiting a chiropractor regularly throughout the months and years provides immunity to viruses? The experts in the field have said repeatedly that it is very unlikely and the vast body of the research literature fails to support the notion at all.
When we look at the claim critically, again, from a communications aspect, this sort of thing sets up dependency on a doctor or a clinic. Dependency for life. Good for the doctor and the clinic's finances; bad for the patient. Especially when we, once again, consider frequent adjustments and the potential for creating spinal instability as a result.
Not all irresponsible communication is unethical, immoral, or meant to be harmful. Sometimes practitioners simply haven't updated their full understanding of the vast biopsychosocial spectrum of pain and the resolution of pain. Good scares help patients snap out of it and get their lives together in a positive direction. When a little good scare causes a patient to take better care of themselves to avoid pitfalls later in life, nothing negative can come out of it.
On the other hand, bad scares can take advantage of patients emotionally and financially, can cause long term issues for the patient, and scar patients physically, emotionally, and mentally for a lifetime.
Make sure your medical or chiropractic practitioner is communicating responsibly, optimistically, and in an evidence-based, patient-centered way. When that is the case, the patient is almost always the winner.
Dr. Jeff Williams, DC, FIANM is a Fellowship-trained Neuromusculoskeletal specialist and chiropractor in Amarillo, TX. As an Amarillo chiropractor, Dr. Williams treats chronic pain, disc pain, low back pain, neck pain, whiplash injuries, and more. Dr. Williams is also the host of The Chiropractic Forward Podcast (https://www.chiropracticforward.com). Through the podcast, Dr. Williams teaches fellow chiropractors and advocates weekly for evidence-based, patient-centered practice through current and relevant research. If you have any questions for Dr. Williams, feel free to email at [email protected] Learn more about Dr. Williams and his practice at https://www.amarillochiropractor.com.
Dr. Williams was voted Best Chiropractor In Amarillo in the Best of Amarillo 2020. Dr. Williams's full-time Amarillo chiropractic practice is Creek Stone Integrated Care at 3501 SW 45th St., Ste. T, Amarillo, TX 79109. If you are searching for a chiropractor near me, Dr. Williams is your Amarillo Chiropractor.