Podcast Episode: What Do Athletic Trainers and Physical Therapists Think About Chiropractors?

 

Timothy Mirtz, DC PhD from the University of South Dakota chatted with me about what athletic trainers and physical therapists think about chiropractors and what can be done to change the interprofessional relationships.

Find it on iTunes by searching for OnTheOtherHand or go here.

This is our first episode with our new sponsor. It’s very cool that a great business sees the value in our podcasts and wants to help us continue to make them.  I would appreciate if you would check out coldlasertherapy.us I’ve used them for years to buy all of my cold laser equipment. They have really fair prices and excellent customer service.  Complete cold laser setup with two pairs of safety goggles for under $1600.  For real!  Plus, listeners to the podcast get $50 off their order by using coupon code: PODCAST

Deformed Consent: It Was a Million to One Shot, Doc!

Informed consent in healthcare is the process by which the provider informs the patient about the options for the diagnosis and treatment of the patient’s condition. In addition, the risks and benefits are described to the patient so that the patient can make a rational decision regarding what he or she wants to be done.

Informed consent is a good aspect of healthcare. Giving patients the information to make decisions about their health preserves their right to autonomy. Many people mistakenly believe that informed consent is simply getting a patient to sign a written form. It is more than that. It is a process of communication between the patient and provider that results in the patient’s authorization or agreement to undergo a specific intervention. Patients should always have the opportunity to ask questions to elicit a better understanding of treatments or procedures. Patients should always be able to make an informed decision to proceed or to refuse a particular intervention. All medical encounters should conclude with the patient agreeing that all his questions have been exhausted. And patients should be adequately advised patients prior to any procedure in order to exercise the patient’s right to choose which side of the risk/benefit table he would like to place his chips.

So how do we fully inform a patient? In order to be as fully informed as his doctor, must the patient be sent to medical school? Actually, yes. By committing even minor omissions, doctors fail to deliver a fully informed consent. After all, patients who do not have the same medical knowledge as their provider can never truly comprehend all of the risks of a given intervention in the same way their doctor does. And what of minor, but likely possibilities? Should we be required to tell a patient that he may get a papercut by handling an informed consent form? What if the patient refuses treatment, and in his haste to exit, gets a static electricity shock from the doorknob. No big deal, right? Not worth metioning, right? What if that shock shorted out his pacemaker? Ahh…bigger deal. Should we have provided the warning to this possible, but foreseeable event? Can you picture the huge disclaimer poster required to be put in medical waiting rooms informing potential patients of all risks and benefits of opening the door to the office hallway? And another poster in the hallway denoting all of the risks of entering the treatment room. I don’t even want to imagine the one in the restroom.

We would most certainly have to stop offering coffee and tea in the waiting area. I mean, right now, the cups come pre-printed with: CAUTION – CONTENTS MAY BE HOT. I am not sure there would be room on the cup for: CAUTION – CONTENTS MAY BE HOT, WET, CAFFEINATED, DECAFFEINATED or SWEETENED. MAY STING EYES, CAUSE DIABETES, CANCER, ANXIETY, HYPERTENSION or DROWNING. DO NOT INVERT OVER EYES, EARS OR PRIVATE PARTS. DO NOT INSERT RECTALLY. WARNING IS CONTINUED ON NEXT CUP. NO, NOT THAT ONE, THE BROWN ONE. And of course all written warnings need to be in 6800 languages in case someone who understands only Luxembourgish wants a cup of joe.

Informed consent is an excellent idea and one that healthcare should embrace…within reason. Patients have a right to the explanation of procedural or invasive risks in advance. Exclusive of emergency procedures in life threatening situations, informed consent should be made available whenever possible for significant risks with a high estimated likelihood of occurrence and tempered with the potential benefits and alternatives. Minor risks would take too long to explain, and would cloud even the most simple of procedures: “I’m going to draw blood from you now, Mrs. Smith. By inserting this needle in your arm, I am exposing you to the following 40,000 infinitesimally small risks which I shall explain in detail one at a time….” The delivery of informed consent would take hundreds of times longer than any actual procedure!

As for chiropractic, there are, of course, some common risks. These risks are usually temporary and minor, involving things like post treatment soreness. There are also a few major risks which, in terms of likelihood of occurrence, are more akin to choking on an aspirin tablet. To date, there is no warning on bottles of Bayer aspirin telling the user he may choke and die on the tablet. It certainly is a real risk with such a low likelihood of occurrence, it hardly warrants mentioning. If a patient asks if there is a chance of dying by choking on an aspirin, his doctor should address the concerns honestly and directly. I am not implying that doctors should skirt around any patient questions but a proactive stance for remote risks does neither the patient, the doctor, nor the entire field of healthcare any good.

In communicating with our patients, we should make sure they understand that which is likely and that which is serious. The operative action here is to communicate. If we strive to improve the doctor/patient relationship, and provide honest, open communication, we would do much to reduce the reasons informed consent has exploded into ridiculousness in the first place.

Brett Kinsler is an informed and consenting chiropractor in Rochester. NY

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What’d Ya Say? Divided By a Common Language.

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The importance of using common language when communicating about back pain has been well documented in the medical literature. There are three main areas that lead to difficulties in communication about back pain:

  • patients seeking information from health care professionals can experience difficulties understanding them and the medical literature
  • misunderstandings among health professionals concerning terminology can arise
  • lack of standardized definitions for back pain terms can make comparison of research studies problematic

A study just published in the BMC Musculoskeletal Disorders aimed to explore the meanings and issues surrounding the use of existing medical terms for back pain from the perspective of health care professionals and lay people. Focus groups were used to explore participants’ understanding and samples included general practitioners, chiropractors, osteopaths, physiotherapists, and lay people.

Lay participants understood the majority of the terms explored in the group differently than the health professionals. Some terms were not understood, some misconstrued and some had inadvertent negative connotations or implications. (For example “wear and tear” instead of the harsher term “degeneration” gave implications of wearing away or rotting).   The commonness of misunderstandings, unintended meanings and negative emotional responses to terms used in this study have a number of implications.

Firstly, it must encourage providers to ensure their patients understand what has been explained to them including the contextual and emotional implications. Secondly, patients and providers should have an ongoing dialogue to promote understanding of terms and comminality of language.  Third, this study should be used as a lesson to chiropractors who cling to old, antiquated terminology that we know has differing meanings both intra- and interprofessionally. If other chiropractors cannot agree on a term’s meaning, and other professions cannot agree on that term’s meaning, you can sure as heck bet that your patients have no idea what you are taking about either.

I was recently told that we should take antiquated terms and reframe them so we can continue using them in a different context. To me, this study implies that is not a wise course of action.

 

Brett L. Kinsler, DC is a chiropractor in Rochester, NY who avoids using antiquated terms when he blogs at www.RochesterChiro.wordpress.com

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Health Insurance Crisis? Solved.

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Don’t panic.  I may have done it.  Yes, your friendly chiroblogger may have accidently solved the national healthcare crisis.  I found an existing health insurance company that provides comprehensive health coverage for under $40 per month.  And this isn’t just some catastophic Roadrunner gets smushed by a falling safe and winds up in traction kind of coverage.  This is really good.  Really, really good.  Just look at these benefits:

Illness – Covered
Injuries & accidents – Covered
Hospitalization – Covered
Surgery – Covered
Hereditary conditions – Covered
Diagnostics – Covered
Prescription medications – Covered
Vaccinations – Covered
Annual Exams – Covered   
Dental Scaling/Polishing  – Covered
 
Wow!  Prescriptions?  Dental cleanings?  They even include some elective surgical procedures.  For forty bucks a month?  There aren’t even any copayments!  I’m awaiting the phone call from Obama any second now.
 
This just may be the ticket the country is waiting for. 
 
Now, there are a couple of exclusions.  There’s always fine print, right?  Okay, the following are not covered: parvo, distemper, kennel cough, heartworms and feline leukemia.  And grooming, bathing and dipping are out too.  Other than that, PurinaCare seems to provide a pretty darn good health insurance for a really reasonable price. 
 
Crazy, right? Dogs and cats get high quality health insurance while their owners are left to be ill.  What’s in it for we, the people?  A lot, according to the North American Pet Health Insurance Association (NAPHIA). 
 
According to recent studies, the NAPHIA figure the health benefits of  pet ownership  include:
  • Reduced risk of cardiovascular disease
  • Higher survival rates from heart attacks
  • Significantly lower use of general practitioner services
  • Reduced risk of asthma and allergic rhinitis in children exposed to pet allergens during the first year of their life
  • Better physical and psychological well-being for seniors
  • Interesting.  These are pretty tangible preventative health benefits.  I may have solved the health insurance situation after all.  I mean, obviously the pet insurance companies won’t cover people.  But if the benefits of pet ownership are so great for health, I might just start instructing my uninsured patients to take two kittens and call me in the morning.  Problem solved.

    Next?

     

    Dr. Brett Kinsler is a chiropractor in Rochester, NY.  He is insured but his cat (favorite hobby = peeing in corners) has no coverage.

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