Blurred Lines of Health Care

Multiple x-ray.jpg

I felt the need to share the case of a patient I had recently.  The issue is not with the patient themselves but with the care they received from another practitioner.  

The mature gentleman in question had presented to me with a long history of knee pain. Due to that long history he had also developed some compensatory pain in the hip and low back as his overall function had diminished. Some treatment helped with the presenting complaint but the knee was still pretty bad. A quick consultation with the GP and it was agreed a specialist referral would be necessary. Turns out the knee was severely degenerated and he was a strong candidate for  knee replacement surgery.

The patient was not keen on surgery, which is fair enough. The recommendation is always to hold out for replacement surgery as long as possible and I support that wherever possible. He decided to get a second opinion from another manual therapist, a Chiropractor, that had been strongly recommended by a friend of his. This opinion was meant to see if any more could be done to prevent surgery. I would always encourage a client to seek further advice if they have any doubts at all.

A COUPLE OF WEEKS LATER....

The patient returned to my practice a couple of weeks later with a full spinal X-ray series - from head to bum basically. They wanted my opinion on this series of X-rays that the Chiropractor had ordered. The patient was particularly interested in my opinion of their neck X-ray. There was a little bit going on in the neck but nothing too sinister at all. I asked whether they currently had neck pain. The answer was a resounding "No". Turns out they hadn't had any neck pain at the time of the X-rays either. However the Chiropractor had pointed out a lot of areas of 'concern' that would need to be addressed in a series of treatments over the next YEAR! 

I'm sorry, but there was no pain and no clinical indication to X-ray anything above the knee in the first place. The Chiropractor may have valid reasoning in their own mind for pursuing a course of treatment on an asymptomatic neck but it's not good health care. 

THE BUSINESS OF HEALTH CARE

A big problem with private practice health care is that it is about the practitioner's livelihood. There are mortgages, living costs and often large educational debts to pay for, as well as their own health care needs, and the list goes on. Many get into health care professions with the most noble of intentions only to find it is not that easy to make a living - not as easy or lucrative as many would think. There are numerous health care business coaches out there who wax lyrical about the money that can be made in private practice. Unfortunately, it is completely driven by increasing treatment for patients and this means they aren't always selling good health care in order to build those numbers. They are selling over treatment and dis-empowerment of the patient and that's not an equation we like too much.

A multitude of practitioners sign people onto treatments they don't need.  In fact Four Corners did an hour long expose of the billions wasted in unnecessary investigations and treatments within the medical system.  

http://www.abc.net.au/4corners/stories/2015/09/28/4318883.htm

Instead of the public purse paying for treatments it is the patient's personal income that pays for unnecessary treatments and for what end?

Practitioners may unknowingly prescribe snake oil.  They have invested a lot in their careers and they may be dissatisfied with their earning potential or they may have chosen to ignore the evidence to everyone's peril.

HCF PROFILE

HCF is a private health fund that sends us the data comparing the number of treatments we provide to their members compared to other Osteopaths in the area.  Providers at Fairfield Osteopathic Clinic provide 30% less treatment per person. I don't think it's limited to clients who are members of HCF!

And don't get me wrong, I don't think it's because we're more talented. I think it's because we take time to explain the complexities of pain, encourage clients to be insightful about their condition, and encourage an active care approach and more than anything empower our patients with the confidence and knowledge to help themselves on a daily basis.

Another thing we do is to ask what your goal is?  Most of the time it's simple things; to get a better sleep, to be able to run with no pain, etc. Not many people are aiming for one hundred percent.  There is no finish line or silver bullet.  Reducing pain and improving function is maddeningly provisional and a lot of the time we are just there to give you a better chance of doing it better the next day.

This is not something that works for every patient. Some people benefit hugely from therapeutic touch for lots of different reasons and they seek hands-on treatment much more often than others. As long as patient and practitioner have a clear understanding of the care plan going forward then that is entirely appropriate.

OUTCOMES NOT OUTPUTS

All practitioners at Fairfield Osteopathic Clinic look at the outcomes for our patients, not at the outputs on the books.  It's a terrible business model of course.  So please, unless it's an exercise program, don't sign on for anything that's going to take twelve months.

* For interest of privacy many details have been changed.

 

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