Quack, Quack

Growing up I remember my older brother referring to the local chiropractor as the "Town Quack".  The term quack can be defined as someone who fraudulently pretends to have a medical skill.  This has often been used to describe chiropractors.  Chiropractors did not pretend to be medical doctors or possess the same skills as a medical doctor, rather we have developed our own particular skill set.  Chiropractors were seen as being unscientific and the chiropractic approach was labelled unorthodox.  Even though countless people were helped with chiropractic care, chiropractic was ridiculed and chiropractors labelled as quacks.

There has been a significant shift in attitudes in the past two decades as science has caught up to what chiropractors have observed clinically for a long time.  Independent researchers and policy makers are acknowledging the benefits of the unique chiropractic approach.  For the great majority of patients with both acute and chronic low back pain, neck pain, and cervicogenic headaches spinal manipulation (chiropractic adjustments) is recommended by authoritative groups who establish treatment guidelines in both Europe and North America.  These include the UK Evidence Report (2010), Joint Clinical Practice Guidelines from the American College of Physicians and the American Pain Society (2007), European Back Pain Guidelines (2004), Bone and Joint Decade Neck Pain Task Force (2006), and Evidence-Based Practice Center at Duke University (2001).  As recently as May of this year the British Medical Journal was arguing that primary care for patients with back pain and musculoskeletal problems should be transferred from general practitioners to chiropractors, osteopaths, and physiotherapists.

The reason for the wide acceptance of the chiropractic approach is that there is now a great abundance of research showing that chiropractic adjustments are amongst the most effective treatments available for neck pain, back pain, cervicogenic headaches, and other musculoskeletal conditions.  More of what we do as chiropractors is validated every year.   More of what we do still needs to proven.  But just because something is not scientifically validated doesn't mean it should be discontinued.

Even as chiropractic struggles to prove itself, much of what we consider to be scientifically accepted medical procedures actually remain unproven.  The Office of Technology Assessment, a branch of the United States Congress, with the help of an advisory board of eminent university faculty, has published a report with the conclusion that, " . . . only 10 to 20 percent of all procedures currently used in medical practice have been shown to be efficacious by controlled trial."  The British Medical Journal puts give the figure 15%. Therefore, 80% to 90% of medical procedures routinely performed are unproven.  Should all these procedures be discontinued until they are scientifically validated?  Probably not and neither should chiropractic procedures.  The very nature of scientific analysis and the vagaries of the human body may mean some very effective procedures may never be scientifically validated.

Only rabid sensationalist continue to call chiropractors quacks.  The term still doesn't apply because we are not medical doctors and we don't pretend to do medical procedures.  We practice chiropractic; a scientifically validated branch of the healing arts.

Financial Crisis

Every day lately, the news reminds us of the sad financial state many of the western world's countries are in.  Thankfully Canada's financial situation is still looking solid.  That's not something that's guaranteed to continue should our neighbours to the south and across the pond succumb to the weight of their debts.

As an individual looking at the massive amounts of money countries owe, including our own, I find the numbers incomprehensible.  I simply cannot even begin to visualize what those amounts of money really look like.  How big a stack of looney's is one hundred billion?  How many greenbacks in ten trillion?  And then I have to consider that these debts are debts of the people of the country.  The governments cannot be separated from the people.  The politicians may have done the spending, but they have been spending the money of the people.  So if it is our money as citizens we must assume some responsibility for this debt.  As I see  it we must do two things.  One is to hold governments responsible for how they spend OUR money and secondly is to be responsible ourselves in how we utilize government resources.  It's this second point on which I want to focus.  The sense of entitlement I see in news articles about the protesters to austerity programs in Europe saddens me.  The populous is bleeding the countries dry.  Governments cannot give support if they have nothing to give anymore that I as a individual can give support to others if I have nothing to give.

We are going to have to expect our governments to give us less if there is going to be financial stability.  The biggest single expenditure item in the budgets of Canadian governing bodies, and most western countries, is health care.  This is an area that we as individual citizens can have a significant impact.  How can you or I as individuals make a difference to the financial health of our country?

The first step is to take responsibility for our own health.  It's not up the the government or their paid helpers to keep us healthy.   The lifestyle choices we make should be ones that promote health not hinder it.  Do we choose nutritious food or junk food?  Do we choose to smoke or not?  Do we exercise or become couch potatoes?  The list of choices we face goes on.  Many of our lifestyle decisions will determine how big a burden we will be on the health care system.

The second thing is to choose cost effective health care options.  Nutritional supplements may look expensive as we pull out our wallets and pay for them.  Drugs are not cheap either.  The big cost savings with supplements is that they build the body up rather than tear it down.  Drugs on the other hand cause many side effects which often require the need for more drugs and more intervention which escalates the costs.  Whenever possible low tech, low cost diagnostics should be used.  Save the expensive procedures for serious, complicated situations.  Not every headache requires an MRI scan.  Chiropractic care is extremely low cost compared to medical care.  A patient can receive many years of chiropractic care for the cost of a low back surgery.  Every prevented surgery saves the health care system and the economy tens of thousands of dollars.

Certainly there may be times when we will need to have expensive interventions for the sake of our health.  But if we have made wise choices those occasions will be minimized.  If used judiciously by everyone the health care system will be healthy enough to meet our needs in times of crisis.  It is like we have put money into savings over time and can withdraw it in our time of need.  As individuals we can help our country's finances and improve the health care system by taking responsibility for our own health.  This is the kind of financial situation I can wrap my head around.  

FIRED ... Again

I was fired again today.  Got my pink slip.  Think I'd be use to it after all these years.  Patient's fire me when I don't meet their expectations, when I fail to give them value for their money, or when I simply can't help them to their satisfaction.  I don't blame them when they fire me.  You see the patient is the boss and I'm their employee.  That's the way it should be.  The patient pays me and in return I provide a service to them.

Unfortunately, in many areas of our health care system the patient is no longer the boss.  They cannot fire the provider even if their expectations are not met, or they do not get the results they desire.  The problem arises from the fact that there is no accountability to the patient because the provider is not paid directly by the patient.  The "value for the money" part of the equation is missing. The provider has no incentive to be accountable to the patient.  As a result the patient has lost the ability to fire the doctor.

You can fire your dentist, you can fire your psychologist, you can fire your optometrist, and yes you can fire your  chiropractor, but if you want to continuing getting medical care you will have a difficult time firing your medical doctor.  That's because your MD is not accountable to you.  He/she is only accountable to the "system".  The system doesn't fire someone for as small a thing as not satisfying the patient.  Patient satisfaction often seems to be a low priority.

Even though I've been fired many, many times,I don't like it any more today than I did when I was first in practice.  But each time I get fired it causes me to evaluate the care I'm providing.  I need to provide service that my patients value and what patients want is constantly evolving.  I know full well that I will not be able to give every person what they desire, but I strive to meet the needs of as many people as I can.  If I can't do it, then I should be fired so the patient can connect with someone who will satisfactorily meet their needs.

The Back Bone's Connected to ... Everything

Perhaps one of the most dangerous developments in modern health care is to look at parts of the body or individual body systems without the context of the whole body.  Too often when a patient has a symptom it is viewed as an isolated element.  The reality of the matter is that the body was created as a single whole unit.  No part can function effectively without the other parts functioning.  The implication is also true that when one part is not functioning the whole cannot function either.

A headache is a good example of this.  A pill may reduce the pain, but it won't fix the cause.  Does a headache mean there is a problem in the head?  It can, but it can also mean there are problems elsewhere in the body or even outside the body.  Food allergies produce headaches.  So if the digestive system is ignored the real cause of the headache won't be determined.  As far removed from the head as the feet are, chronic foot pronation can cause headaches.  Altered gait produces a chain of events during walking that causes abnormal muscle pull on the head and headaches.  Vertebral subluxations in the neck and upper back have been shown to frequently cause headaches.  It is common knowledge that stress, allergens, and sleep disturbances can also cause headaches.  These things are all originate outside the body and if the focus is limited to the head, the cause of the headache will never be determined.  Consequently, there can be no prevention or proper management of the headache.

Headaches provide a ready example of how the body functions as a unit, but the same is true for every symptom.  Stomach aches are not necessarily the result of a sick stomach.  They are simply a sign that the body is not working properly.  A cold indicates that a virus is stressing the body, but why isn't the body strong enough to fight that virus?  Pain in the hip can be the caused by a vertebral subluxation in the back.  These examples are just a smattering of the many possibilities.

When a person has symptoms, it is simply a case of the body not functioning properly.  The body must be looked at as a whole to determine the root problem.  One part cannot be separated from the other parts if the body is to be truly healthy. That's why chiropractors look at the body as a whole unit.   Everything's connected to everything else.  This is particularly true of the spine.  Nerves exiting the spine go directly to every part of the body.  A healthy spine is a key component to a healthy body.

Health Care Reform

There is an ongoing debate in Canada and Alberta about how to reform our publicly funding health care system.  The governments at both levels have commissioned numerous studies which have recommended a myriad of changes.  Always the studies have found that our current approach is unsustainable and some type of user pay must be introduced into the system to prevent collapse.  Yet over the 20 years I've been following this process, there has been no significant progress in reforming our health care system.  This lack of progress has baffled me.

A recent article in Macleans by Andrew Coyne entitled "The biggest hurdle to reform: unions" gave me some real insights into why after all these years and all the studies we continue to have a health care system that is unsustainable.  Our public sector and health care unions are so committed to maintaining the status quo that they are hobbling the legislators.  The result is that we are stuck with a system that is increasingly inefficient and unresponsive.  It is a health care system that, although once the envy of the world, has rapidly fallen to become one of the least effective.  Our population is suffering all because we can't let go of the flawed premise that health care must be totally free for everyone.


One thing ignored in our system of free health care is a basic of human nature.  We value what we pay for.  When health care is free it becomes a right instead of a priviledge.  Over time we value it less and less.  The system has become abused by both users and providers as they have lost sight of need for the checks and balances that financial input provides.  Chiropractors have noticed all along that patients value our services when they pay for them.  Those who pay their bills actually seems to respond better to care than those who don't.  They value what they pay for.  And we as providers need to be responsive to the needs of the patient or they will withdraw their financial support for what we do.  The transfer of money is beneficial for both patient and doctor.

I'm not suggesting that Canada abandon universal health care.  What I am suggesting is that we implement some of the changes recommended in study after study to introduce a form of user pay.  Either we make changes or our the system will collapse completely.  How long can we allow the public sector and health care unions to force the maintenance of an unsustainable health care system?  The patient is dying but can be saved if the treatment is changed. 
 

TV vs Computer

We got our first TV when I was a child.  It was a black and white behemoth.  We got one channel with sporadic reception.  But it took a commanding place in our household.  It was front and center in the living room.  It was also front and center in our minds.  It was television!  It demanded our attention.  We had to do things on it's terms.  If we wanted to see a particular show, we arranged our schedule around it.  Skipping commercials was not an option.  (They were often part of the show itself.)  TV hasn't changed much.  It still demands that the viewer do things on it's terms and it's schedule; even as hard as VCRs, DVRs & PVRs have tried to change that.

Computers, as an entertainment source, on the other hand allow the user to come and go as they please.   We decide what we want to view, when we want to view it.  The advertising is there, but again we choose whether to view it.  The user is in control.  (As I say this I also realize that while I technically control my computer, sometimes it seems the computer is doing it's own thing ;) 

There is an important analogy here for health care.  In the past the doctor told the patient what to do and when to do it.  Today the patient has the opportunity to take charge of their own health.  With adequate information patients can effectively evaluate available options and make the best decision for themselves and their families.  For who can make a better decision than the individual themselves.  The doctor becomes an adviser; part of their team, rather than someone who dictates what must be done. 

For many years now, I have tried to educate patients and give them the option to chose the care they feel is best and respect the choice they make.  All I can do is make recommendations.  I know that in my own health decisions I want to be in control, not controlled.  I want to be on the computer, not in front of the TV.  How about you?

Potholes

As I was driving to the office the other day, I realized that pothole season has begun in Medicine Hat.  Given the large crop that has sprung up already, it looks like we will have a bumper crop of potholes this year.  Driving my wife's Smart is like trying to navigate a battlefield.  During the warmer parts of the day, the city is attempting to patch some of the bigger craters.  I fear they are fighting a loosing battle until spring arrives.  A few freeze/thaw cycles and the holes will be back; only bigger than before.  The only way to really fix the road is to resurface it completely.

This reminds me very much of what I see happening in the lives of many of my patients.  They have a health issue and work very hard initially to get rid of the symptoms.  They have their spines adjusted, they exercise, they take nutritional supplements, they get massages and laser therapy.  Behold they feel better!  Just like the patched road, life seams to be smooth.  But like the patched road, their body's are not strong.  A few stresses and their symptoms are back again.  Like the pothole, it's often worse when it returns.

Just like resurfacing the road is a better long term solution, continuing doing things that will heal and strengthen the body is the best thing for us humans.  It means changing one's focus from symptoms to health.  It means taking a long term view.  Although the cost may be higher initially, the long term benefits of an improved life actually reduces future expenditures.  It means focusing on the body, even when it isn't screaming with symptoms.  Everything we do every day affects us positively or negatively.  Become aware of how the body is affected and make choices for long term benefit.  

May your roads be smooth.

Eyes of a Chiropractor

The way we look at the world is a product of our experiences and training.  As I made my way through my chiropractic education, I realized that my view of the world was changing.  That's a good thing.  Education is pointless if all it does is give us knowledge.  Education should enable us to process information in a continually more mature fashion.  As a result we think differently; we see things differently.  This was certainly the case during my education at chiropractic college.

My view of the world became less status quo.  I questioned the conventional theories of health care and embraced the concept of the body being a self healing organism designed by an all knowing Creator.  A healthy body is one that functions as it was designed to.  All its parts work together in harmony.  When the harmony ceases, the body becomes unhealthy or diseased.  Once harmony is lost, it can only be restored by improving the body as a whole, not just individual parts.

The chiropractic concept that health comes from above down and inside out became real to me.  The ability to heal is God given and within us.  That I could heal anything is incomprehensible!  All I or any doctor can do is to turn on the body's healing abilities.  I am just an instrument.  A humbling and freeing realization.