Don't Always Trust Your Musculoskeletal Diagnosis

On the cusp of changes in our health care delivery system from Obamacare, things are going to be changing, ways to save money and produce a well rounded and cost effective treatments will be paramount. Practitioners that have a great satisfaction and positive outcome with their patients should be rewarded. Practitioners that also see the most of a certain condition or case and are experienced in that effective treatment should see those patients the most, that's not happening in our current system. Most cases of musculoskeletal pain are presented to general practitioners (M.D.) who have very little education and training at properly diagnosing and treating these conditions, besides treating a pain symptom which is usually ineffective.  Recent studies have concluded that medication for lumbar back pain is almost completely ineffective and some surgeries have as high as a 75% failure rate even though the number of certain surgeries have doubled from 2002 to 2008. According to John Birkmeyer, director of the Center for Health care Outcomes & Policy at the University of Michigan indicated that U.S. health care costs rose 6 percent last year to $2.47 trillion. Unnecessary surgeries cost at least $150 billion a year. It’s amazing how much evidence there is that (spinal) fusions don’t work, yet surgeons do them anyway,” said Sohail Mirza, a spine surgeon who chairs the Department of Orthopaedics at Dartmouth Medical School in Hanover, New Hampshire. “The only one who isn’t benefiting from the equation is the patient.”

The general practitioner (M.D.) lacks education and experience treating musculoskeletal conditions compared to the chiropractor, it's not medical doctors' fault, they just aren't taught that realm in medical school.  The chiropractor is more effective at treating these condition as shown in recent research and also have better patient satisfaction scores as shown in consumer report of 2009. In that report out of 14,000 patients, chiropractors were rated as highest satisfactory at 59% percent compare to 34% for general practitioners. Obviously, I'm bias in what I do, but it's in the research and numbers don't lie. The reason I write this article is bases on personal experience, about a week ago a patient came to our office seeking help for pain in her neck. She reports that she suffered the injury when she was diving into a pool and hit her head. She presented with laceration on the head and positive orthopedic test in her neck. We referred her that day to the emergency room to be evaluated for a closed head injury.  The next day the patient called to our office again and stated she needed help that the medical doctor at the emergency room just felt her neck, gave her muscle relaxers, and told her she would be OK. Well we were all surprised at the office, no evaluation at the hospital, we told her we would do radiographs of her neck when she returns. The radiographs came back that she had a broken neck, anterior fracture of C4, we were surprised that a doctor was unable to diagnosis a cervical fracture from a textbook history that causes cervical fractures.