By Douglas R. Briggs, DC, Dipl. Ac. (IAMA), DAAPM, EMT
As practitioners, we value communication with our patients. We work hard to establish open and honest lines of communication. We should listen without judgment and be able to offer a non-biased, clinically based opinion.
We do this because it establishes a bond of trust between us and our patients. They have entrusted the care of their bodies to us, and they trust we will treat them in an honest and medically responsible manner.
What happens when well-intentioned friends and relatives offer their advice to our patients? If the information is conflicting, this can cause the patient to doubt whether their trust in us is justified. How do we then re-establish that bond of trust? Again, it goes back to communication.
We live in an information era - between the published resources, myriad of pamphlets and fliers, TV and the Internet, you can find almost any information to support your claim or view, no matter how extreme. It can become very difficult to give a rational answer to patients' questions when they already have an opinion based on someone else's statements.1 We have all had patients ask about the new product that melts away pain or the mystical fruit extract that cures everything from baldness to cancer.2,3 The marketing ploys are endless, but as health care providers, we are responsible for giving good, sound advice and providing the best care possible. Misinformation is one of the obstacles we face every day.
A recent example involves a patient, Allie, who suffered a back sprain from a fall at work. She had been through several courses of therapy and had been out of work for months. With a combination of chiropractic and acupuncture, we were able to get her pain down and return her to work. Although she still had some discomfort, her functional capacity was measurably improved. We continued care at a decreased frequency because although she was better, she still benefited from care.
She recently came back sobbing. She told her sister about her persistent back pain. (Her sister is a PA so she must know everything.) Her sister had Allie stand back against a wall and raise her arms. She then told her, "See how your one shoulder blade sticks out against the wall more? That means you have scapular winging. You probably have permanent nerve damage." Allie was devastated. Despite all the progress we had made, she was now convinced she had a horrible nerve injury that was never going to get better. She was convinced she was going to be permanently disabled - all because of one comment from one person, based on one screening test.
The good news is we were able to calm her down and get her flare-up under control pretty quickly. But she still has a lingering fear that "something else" might be horribly wrong. She is now trying to get approved for an EMG of her middle back to rule out her sister's passing diagnosis of nerve damage. With all the good we had done, it only took one comment to shake the foundations of her faith in the care we provided.
People often are very gullible. If you give them the information in a way they want to hear it, you can sell almost anything. That is not always best. While it's important to clearly explain your findings and the rationale for your plan of care, realize that you usually are talking to someone in pain. Don't abuse that leverage to force unnecessary care or products down someone's throat.
Another example that has been an issue in my state in the past involves selling multi-level products. There was a case a few years ago in which a local medical doctor had a big following with his vitamin products. After all, they were prescribed by the doctor, they were good for you, and they were conveniently shipped right to your doorstep every month. Woo-hoo, sign me up! Then it came out the doctor was only selling one brand of a multi-level product company. He was signing up his patients to his downline. That can be very good for business, but the big question raised was whether he was prescribing vitamins for the patients' benefit or solely for the secondary gain. Ouch! That is not a good place from which to try to defend your patient care. The issue made a big splash in several papers, and the articles targeted how he abused his position as a physician to sell products for secondary gain.
It all comes back to communication. Take the time to talk to your patients. If you are too busy to spend time to adequately explain your care, then you are too busy. I have talked to patients about why I think they should pursue conservative care instead of surgery for carpal tunnel.4 I had to take the time to explain how the median nerve can be irritated at other places besides the carpal tunnel and why I don't think surgery will help them. Yes, I do sell vitamins and products in my office, but I take the time to explain why I believe it will help a patient at that time.
So, what have we learned? As practitioners, we strive to be compassionate listeners to our patients. They have real questions and concerns, and they often look to us for answers. They get a lot of other information fed to them from sources that, right or wrong, don't agree with what we tell them. Recognize this up front, confront the other opinion and explain why you don't agree. Cover your bases. There is no single modality that will meet the needs of every patient. Given your personal experiences, you may or may not like this or that technique. You may not wish to pursue some specialized therapy. Make sure you are open-minded enough to recognize when a patient may not be responding to your plan of care and when you should be referring for co-management with a competent para-practitioner.
Next, patients are different, and their individual needs are different. So every patient should be evaluated and treated on the grounds of what is best for them. Finally, you should recommend what you feel to be the most appropriate care plan, regardless of what insurance covers. If your care is limited by a plan contract or by a patient's choice to only receive services covered by their plan, you still are obligated to share with them your recommendations and document why those treatments are not being pursued.
Make sure you know why you do the procedures you do. Make sure your patients know you're working to meet their needs. Be known for offering the highest level of patient care - don't settle for anything less.
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