September 6, 2006

Have you ever been sued for malpractice? I have. The suit was spawned after an ignorant statement from an ER physician. He eagerly told my patient that a DC should not have been treating a herniated disc. Once the seed of malpractice was planted, the patient found the possibility of a large cash award too irresistible and filed suit. The case was dropped. but the issue illustrated the need for our profession to educate other medical professionals and the public at large about the literature and evidence-based benefits of chiropractic management of herniated discs. By the way, the patient consulted the ER only because he had no insurance and found that trading services with my office (he cleaned my carpets) was unrealistic. He consulted the ER since they were obligated to treat him regardless of coverage. 

I considered suing the ER physician, but decided to educate him instead. I also attempted to understand him. In his 1997 North American Spine Society Presidential address, Dr. Saul stated: "...physicians often prescribe treatment for their patients based upon their most recent success or failure. We skim our journals for articles that appeal to us and sort out information that does not support our frame of reference. Even learned people will tend to gather and synthesize information preferentially as it supports and relates to their own opinions and objectives."  "Sort out the information".......I wonder how many of us are guilty of that level of creative rationalization? Bottom line: despite the uncanny ability for us humans to selectively consider evidence, including literature, we must educate the masses. 

Recognition of this tendency has let our group, CCGPP, to develop a useable means of sifting through the literature, and it is important to understand the how Best Practice will benefit you and your practice. 

Please consider the short list of BP benefits:

1. Education of medical providers: This document can be used to educate medical professionals of all types (MDs, DOs, PTs, optometrists, podiatrists, dentists, athletic trainers, nurses, surgeons, personal trainers, massage therapists) in your geographical area about the benefits of DC treatment, especially spinal manipulation and active care, which received the highest rating for the most common conditions treated by DCs. Those who educate win!!

2. Stimulate Referrals:  When the medical field has confidence in the literature, and they have a relationship developed through various forms of communication (email, letters, research summaries, DVDs, websites, etc.) they will readily refer in an effort to help their own patients. This document provides you the resources and confidence you need to begin a consistent program of communication.  

3. Education of third party payors, benefit managers, and employers to potentially expanded benefits:  We have a better chance to preserve or enhance benefits related to the services provided by DCs given the high rating related to the core of a chiropractic practice:  manipulation and active care. This document provides us the tools/information we need to educate decision-makers in order to influence benefits in a positive manner. 

4. Fight bad consultants.  This document can and will be used to illuminate the illogical profit-driven opinions of income-dependant, predictably negative consultants. This document clearly supports chiropractic management for chronic pain, a hot button area of consistent denial by bad consultants who seem oblivious to the literature supporting chiropractic treatment of the chronic pain patient. If you want to shoot back, you need ammunition!

5. Allows greater discretion for physician decision-making. Probably the greatest benefit of this document is the shift away from consultant denials based on traditional guidelines and literature only, and support for the reality that medically necessary care is based upon the combination of:  (a) literature, (b) clinical experience and a consideration of risk factors/stratification that affects the natural history of a condition, and (c) patient preferences. Gone forever should be the consultant denial language of "there is no literature".  Why? Support for care depends more upon the documentation and response to care, versus the literature alone.  Literature provides a foundation for care, but should not tyrannize care.  This document honors that fact that each patient is unique.

6. More good news:  This document clearly identifies the fact that the average chiropractic practice is on an equal, if not superior, scientific foundation compared to most other forms of medical treatment. 

7. Patient information:  Patients today are Internet savvy, intelligent, and have an emerging knowledge of "Best Practice".  This document and process, along with the other information technologies including interactive websites, DVDs, patient focused publications, etc., will be utilized by those looking for an evidence-based, best practice DC.  Patients will seek you out if you become BP certified.

What if we do nothing?  If we do nothing in the area of evidence-based practice we risk being tyrannized by those who will do it for us, without chiropractic input.  It's been happening for years.  We've all felt the negative effects of ODG, ACOEM, Milliman and Robertson, and other guidelines that consultants and third party payors have used inappropriately to limit your care.  We need to move in a different direction.  The Best Practice movement is a concept long overdue.  Either we gather and rate the evidence or it will be handed to us on someone else's financially motivated platter.  The future is bright for chiropractic IF we accept that times are a chang'in.  Remember, "Life is Change.  Growth is Optional."  Let's grow together!