This post was inspired by the following top 5 list from a physical therapy blog http://blog.myphysicaltherapyspace.com/2011/07/the-top-5.html and it appears the idea originating from an article published in the Archives of Internal Medicine (Vol. 171 No. 15, Aug 8/22, 2011) http://archinte.ama-assn.org/cgi/content/short/archinternmed.2011.231
As we think about various professions there are certain common negative aspects that come to mind. I know that when we think of lawyers, car salesman, police officers, chiropractors, and many others there are certain images or negative stereotypes that come to mind. Despite those aspects, we know that the majority of the people in these professions are talented, dedicated, and ethical people. For those reading this, I challenge you to come up with the list of 5 things you would like to see changed about your profession. Here are 5 things I would love to see change within mine (in no particular order):
1. Do not rely too heavily on imaging (x-rays/MRIs) to justify treatment and do not use ‘common’ findings as scare tactics or reasons to justify ‘restorative’ care. There is little evidence this truly matters. Imaging should be used to find ominous pathology, fractures, and instability. Not finding these pathologies should be reassuring and framed in a positive light for the patient. (See prior imaging findings discussion)
2. Do not schedule several months of care in advance or have people prepay for months of care. We need to understand and respect individuality. There should be an appreciation that methods of treatment, results, outcomes, and patients needs/goals vary. There is no cookie cutter solution.
3. Avoid putting someone on ‘maintenance’ or ‘wellness’ care when their issue is not yet solved. It’s unfair to the patient… see # 4&5 for what else to do. All patient issues and concerns should be addressed to the greatest possible extent.
4. Get your patients more help when they need it. Refer within (& outside) the profession when necessary. We are fairly good at referring outside the profession to other specialties, but often forget to refer to other chiropractors who have specializations (neuro, pediatric, rehab, nutrition, …) that may help our patients. Be confident in your expertise, but be sure to recognize others as well. So many patients can benefit from appropriate referral and/or comanagement.
5. Limited or no instruction in active care. Also, carelessly chosen corrective exercise. Research is numerous showing need for active interventions, I don’t understand why we continue to fail at this? (This problem goes beyond the chiropractic profession to physicians who prescribe medication with no form of active care or self-management and extends into physical therapy as well where at times active is utilized haphazardly with poorly chosen exercises or stretches.) Patients should be encouraged to be responsible for their health, exercise (appropriately), manage stress, and strive for a healthier lifestyle.
These are just my thoughts, feel free to post your comments or additions to this list.