Should Some Doctors Watch What They Say?
Most in the healthcare field don't seem to know how detrimental their words and actions truly are
In this article, I'm going to discuss one of my greatest pet peeves and greatest disappointments happening in healthcare clinics. Not only traditionally, but also currently. Today. I'm also going to share personal stories from my patients to demonstrate my point.
We've all heard about providers with bad bedside manners. I see that as a provider that just doesn't seem to be good at communicating. They're a bit quiet, reserved, maybe egotistical, and aloof. They have zero interest in any relationship with the patient. While I personally believe that is the wrong way to go about being a caring provider, that is not what we will be talking about in the rest of this discussion.
What I am referring to today, for me, is abominable; bordering unforgivable.
It's proven time and time again in conversations with my patients that providers of all kinds have yet to get the message. The message is that harmful words and poor communication can absolutely hurt their patients and destroy their chances of climbing out of pain.
When helping a patient recover from pain, especially long-lasting pain, some of the primary concerns are addressing the warning signs. Warning signs can include:
- Being afraid to move
- Avoiding activities they love to do because they're afraid they'll pay for it with pain
- Being sedentary
- Anxiety and
- Having sleep disorders
More has been learned about pain in the last 10-20 years than has been known in the previous 1,000 years. Whereas vs. 10 years ago, we now know that these issues are some of the first things we need to address with our pain patients. But, how do these things develop and what do they mean?
Chronic pain doesn't happen overnight. It develops and it can be a bit like the World Trade Centers' collapse or as a string of dominos. One led to the next which led to the next. Here's the kicker though, the FIRST domino can be how the patient is treated by their provider.
Too many providers still look at pain as something that's caused by a simple malfunction. But the more recent way, according to research, is to approach pain through the biopsychosocial way of seeing it. It may have started with it but it's not just a body part that's messed up. Things like a person's feelings, thoughts, and beliefs play a part. That's the 'psycho' part of pain. Then there are other factors like a person's job, their income, their level of support at home, and their beliefs about healthcare providers. That's the 'social' part of it all.
All of the 'BIOPSYCHOSOCIAL' aspects of pain have to be addressed to get our patients where they want to go. We can be instrumental in changing their lives for the better. But we can also be instrumental in changing their lives for the worse and dooming them to a lifetime of chronic pain, inactivity, and poor health.
That may sound dramatic to some so I want to be more specific and break it down and explain exactly what I'm talking about. Here's how the process can play out.
- Some providers order x-rays when they are not necessarily needed. Sometimes it's because they aren't well-educated on guidelines for imaging. Sometimes, in less ethical instances, it is so they will have a tool to scare patients into lots and lots of visits or more serious surgical interventions and treatment.
- They don't communicate the findings of the imaging properly to the patient or they make terrible analogies that cause undo and inappropriate concern in the patient's mind. things like, "It's not a matter of IF you'll have surgery, but WHEN you'll have surgery,", "You have a spine like a dry twig.", "I'm really concerned about your future if we don't get this curve in your neck restored. We have to get to work today,", "You have the back of an 80-year-old."
- The patient begins to 'catastrophize' the findings and believes they are fragile, abnormal, and on the verge of serious injury.
- Because they believe they are fragile and on the brink of injury or danger, they begin to back away from activities they love because they're afraid of getting hurt. This is called Fear Avoidance.
- Some patients are afraid of any movement at all. My patient that was told her spine was like a dry twig from osteoporosis was afraid to walk across the room.
- When we stop moving, being active, and exercising, we become sedentary.
- In the middle of all of this storm and collapse, the patients tend to develop deeper, more entrenched pain.
- A sedentary lifestyle leads to depression, anxiety, and sleep issues.
- When you combine it all with more severe pain, you move even less
All are based on the handling of a patient from the very start. By one very ignorant provider. Ignorant of guidelines and recommendations. Ignorant of when to use imaging. Ignorant in the way they use words. Ignorant of the impact their actions can have on a patient when they leave their clinic and go through their lives in the coming months and years.
Let's compare communication and you keep score in your mind on which you would rather your child or parent experience if they were to go to a healthcare provider.
We have a 28-year-old patient with low back pain that's been hanging around for about 6 months. One provider does it wrong and one does it right.
The Provider That Does It Wrong
- Orders imaging immediately
- Tells the patient they're messed up because they have some degeneration, a disc bulge, and need to be seen 35 times to get over it
- Tells the patient if they don't do what the provider says, they could suffer forever
- Tells the patient to slow down, take it easy, don't overdo it, wear a back brace, and wait until they feel better to get active
- Writes the patient off of work for 2 weeks
The Provider That Does It Right
- Knows that national guidelines suggest, in the absence of anything overly concerning, the patient should be conservatively treated for 2-4 weeks before ever thinking about imaging. If there's no improvement, then get imaging.
- Assuming the patient has imaging, chooses not to allow the patient to think they're somehow broken and fragile. Instead, the provider tells the patient that almost 30% of 20-30-year-olds with no pain at all still have a touch of age-related findings on imaging and they have a little as well but nothing at all to worry about. This provider likely doesn't even mention a slightly bulged disc because it is usually of no consequence at all and is a part of normal findings.
- Instead of building a case for catastrophizing the patient's complaint, this provider tells them that they are young and strong and healthy. This provider tells them just a couple of weeks of focusing on treatment should get them well on their way to controlling this complaint on their own at home.
- This provider tells the patient to only wear a brace if they're doing something particularly strenuous or laborious and feel the need for some extra support temporarily only while being active.
- They tell the patient to get to the gym, go for a walk, movement is healing, motion is the lotion for our joints, and hurt almost never means harm. He reminds the patient that if those that have been hurting for a long time wait to start moving until they don't hurt someday....they're going to be in a lot of trouble.
- This provider, the one that does it right, keeps communication helpful, supportive, encouraging, and optimistic.
Now that I have laid out the differences, which would you rather yourself or your family be exposed to? The answer is clear to anyone with common sense but it is also clear in the research literature. Time and time again.
One story quickly before I wrap up.
A recent patient in her early 20's came to see me with back pain. Her previous chiropractor took x-rays outside of the guidelines. She didn't have any red flags indicating the need for x-rays. Yet, they were shot regardless. Then the predatory provider used the x-ray images as a tool to convince the patient that she was broken somehow and needed a lifetime of chiropractic care. The patient was told that her big issues were as follows:
- She has head forward posture
- She has scoliosis
- Degeneration in her neck
Now, this patient is convinced something very serious is wrong with her and is afraid to exercise or go to the gym because she's afraid of building muscle on top of the problems she already has. Do you see the problem here? A perfectly healthy 21-year-old is afraid to go to the gym because of how she was handled by this chiropractor.
Here's the thing; I checked her posture in her most comfortable position and if she had and head-forward movement, it was extremely minimal. If at all. I checked her for scoliosis, if she has any scoliosis at all, it is very minimal and not worth scaring anyone over. With regard to the degeneration finding, this is one of the more inappropriate things to point out and make an issue of to a 21-year-old. For some, it's normal to have a touch but it causes zero pain and zero limit in function. What would be the point of even sharing this with the patient if for no other reason than to freak them out and scare them into more and more treatment?
I can't describe how harmful this sort of communication and treatment is to a patient. And that harm can be lifelong harm. All in an effort to pad the bill and make an extra boat payment.
It's not just chiropractors. Trust me. I've heard some of the most insane things in my 24 years of practice from medical physicians themselves.
The point is, if you or your family member has been, or is being handled in this manner, I hope you will call us here at Creek Stone Integrated Medical. We want you to treat you right; we want to treat you like family. Because you are part of our family when you're one of our patients.
We'll get you on the right track and we'll do it the right way.
Dr. Jeff Williams, DC, FIANM, DABFP is double Board Certified as a Fellow in Neuromusculoskeletal Medicine and Orthopedics as well as a Diplomate of the American Board of Forensic Professionals, 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 & 2021. Dr. Williams's full-time Amarillo chiropractic practice is Creek Stone Integrated Medical 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.
As a service to our readers, Creek Stone Integrated Medical provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or another qualified clinician.