Pain vs. pathology in your report of finding (part 1 of 3)

As a doctor the ‘extent’ to which you promote treatment of a patient’s “pathology” (and the “fear” engendered with it) is inherently up to you. The interaction is almost always behind closed doors. The FDA however place severe limits on manufacturers (of FDA cleared devices) regarding what they claim the machine and procedure actually treat e.g. the “pain associated with disc or joint pathology”, not the pathology per se. The FDA recognizes that connecting “pathology” (e.g. MRI/x-ray findings etc) to pain is dubious at best. Reliability and validity regarding tests & MR findings are still inherently non-existent.

We as doctors have much looser restraints as to how we can “sell” our treatments to the public (though each state board does set standards).

Given your own unique Chiropractic perspective (which, within rational limits you’re rightly entitled to) you can readily suggest in your ROF that in your professional opinion not getting the treatments may well create ominous future health trouble e.g. the “pathology” that is causing the trouble may/will inevitably worsen. Many Chiropractors have used the “pain vs. pathology” in their ROF for generations (e.g. the “silent subluxation”; “without adjustments your spine will decay” etc).

The basic reason we may be restrained (by state laws and insurance regulations) is inherent in the Latin expression: Credat Emptor (“buyer have faith”). We are health care professionals/doctors and the public fairly assumes we won’t lie to them or exaggerate their condition for our own economic ends. However since “standards” of care are so widely divergent (there are over 100 “techniques”, some suggesting 1-3 treatments, others daily care for years) it isn’t unfair to say Chiropractic’s “standard of care” is wrapped up in the “convictions” held by the individual Chiropractor.

(Continued in Blog 28)