Caregivers
This is an area that needs to be stripped down to its core. Here’s why, the general public’s belief in one stop shopping for their general health care is what is used against them in the area of whiplash. Don’t believe me, read on.
Basically, the majority of time, if something affects you enough to seek out a healthcare practitioner it will typically be because of a pathological disease (virus or bacteria) or an injury to your skeleton (called Neuromusculoskeletal). When we’re talking about the vast majority of whiplash cases they fall exclusively under the neuromusculoskeletal umbrella.
When it comes to training, please understand that both fields, pathology and neuromusculoskeletal, take years to study. The field of medicine is primarily schooled in pathology, while chiropractic’s main field of study is injuries to the skeleton, with a major emphasis on the spine (again, neuromusculoskeletal).
The status quo medical profession has, in one form or another, been around for about 400 years. They have gone through all sorts of changes and evolved into the carte blanche primary caregivers in the field of disease (pathology). Because of a number of factors they have, in the field of healthcare, what is called ‘Cultural Authority’ which is to say that just by being a member of that group/organization its members are given the benefit of the doubt that when they comment on/involved with a subject they are accorded a measure of authority whether they are qualified to or not. It is here that, in the field of whiplash, that the general public’s blind belief in medical physician’s training is all too often used against them.
It was once expressed to me that a medical doctor’s training, in the field of whiplash, is about as deep as it is in dentistry. As much as it may come across as ‘doctor bashing’ I don’t think it was meant as such. Again, the issue here is how one’s basic belief in the cultural authority of the medical physician is all too often used against you by those with a vested interest in minimizing your whiplash claim/injury(s).
“Injuries and diseases of the musculoskeletal system account for more than 20% of patient visits to primary care (family medical doctors) and emergency medical practitioners. However less than 3% (emphasis mine) of the preclinical medical school curriculum is devoted to teaching all aspects of musculoskeletal disease and only 12% of medical schools require mandatory training in musculoskeletal medicine during the clinical years of undergraduate medical education in Canada.”
In Canada, our Canadian Health Act (a federal document), forbids medical physicians from charging their patients user fees for a visit. Note, everything from a simple note referring the patient to a chiropractor, etc. (usually scribbled in about 13 seconds) can be billed directly to you the patient. Up until recently such simple tasks were considered a part of the patient’s visit, not anymore. In order for medical doctors to increase their incomes they are now billing patients for writing everything from a simple referral note to filling out a form for one’s employment. Having gotten my hands on one medical doctors price list I was astonished to see patients are charges $35.00 for a simple handwritten note. It would be interesting to see if such a practice would continue if other healthcare professions (naturopaths, chiropractors, etc.) were also 100% funded by the government.
I point that out because a large reason for whiplash patients attending their family doctors, post-collision, is because it is a ‘free’ visit. Any imaging they may order (i.e. X-rays, CT Scans, MRI’s, etc.) are also ‘free’.
Still not enough, not too long ago there was a paper published (The Adequacy of Medical Education in Musculoskeletal Medicine., published in the Americal Journal of Bone and Joint Surgery). The University of Pennsylvania medical school gave the newly minted medical school graduates a surprise test, on their 1st day of residency. As the paper stated about the test’s topics “…with which all physicians should be familiar.” Here’s the results that were shocking, with a passing grade of only 73.1%, 88% “failed to demonstrate basic competency in musculoskeletal medicine.”
It gets better, the same test was administered, under the same conditions at the Flinders School of Medicine, in South Australia. They had to reword 3 of the questions. Hey, it’s Aussie, they do talk a little differently down there. After having lived there for 3 years I can attest to it, but only in a nice way. Here the test was pre-examined by 31 orthopedic surgeons. It was again administered to 66 interns this time. The passing grade was again set at 73.1% and low and behold only 68% passed. Now here’s where it gets really interesting and ties into what was outlined above, the same test was mailed out to 100 medical doctors in the field, only 47 passed. You read that right, only 47 passed. Now relate that to having your family medical doctor as the primary caregiver in a whiplash injury and you can see the problem. Their formal training is in diseases and whiplash isn’t a disease. In other words they are primarily schooled in horses and you’re injury makes you a Zebra.
Because chiropractic care’s main armament is spinal adjusting said care achieves results that are pretty much unrivalled when it comes to whiplash injuries. Briefly, one of the main injuries, to the neck, in both acute and chronic whiplash is to what is called the facet joints. They are the small areas at the back of the spine’s bones (called vertebrae) and their job is glide over each other thereby directing motion. When the vehicle you are riding in is struck from behind the normal gliding motion, of one bone over the other, is replaced by one of the bones (C5) literally pivoting downwards thereby its bottom facets literally smashing into the top facets of the bone (C6) directly below it. Suffice to say the only known mechanism of this type of injury is that of a whiplash, courtesy of the Instantaneous Axis of Motion being elevated from C6 to C5.
Here’s what the experts have to say. Dr. Bogdan Radanov, (University of Berne, Switzerland) concluded “Cervical facet joints play a crucial role for about 45% of those who suffer from long-term pain after whiplash.” His findings coincide with those of Dr. Nickoli Bogduk (University of Newcastle, Australia) “Double blind studies...have shown that facet joint pain is the single most common basis for chronic neck pain after whiplash.”
The rubber hits the road when different discipline’s care are compared. In what is probably the largest metanalysis (comparative review) to date only chiropractic spinal adjusting combined with exercise was classified as ‘Strong Evidence’. The article was published in the Journal of Rheumatology, 2007. It was titled Conservative Overview Group, Conservative Management of Mechanical Neck Disorders: a systematic review. It was an update of 11 systematic reviews, encompassing 88 randomly controlled trials. They studied/compared a myriad of treatments including medication and chiropractic spinal adjusting.
Levels of evidence were broken down to strong, moderate, limited and none. As stated above only chiropractic adjusting, combined with exercise, made it to the top. Said results were across the board for different symptoms; mechanical neck disorders, neck disorders with headaches, neck disorder and radiculopathy.
Compounding the problem is what has been the age old premise of just how medical physicians are trained. The basis for all medical training is the ‘Acute Medical Model’: Complaint -> take a history and perform a physical examination -> determine a treatment -> apply the treatment ->cured. As dismal as it is for medical physicians attempting to deal with acute whiplash it totally breaks down in the case of chronic whiplash. That’s because all too often the pathophysiology (how the disease/condition happens) is unknown, any tests that are ordered are typically negative and when they aren’t normal they don’t know what to do because whiplash is not a disease.
Another side bar that should be discussed is the idea that a non-chiropractor (typically medical physicians and physiotherapists) can learn to adjust spines by taking weekend seminar(s). Here’s a way of looking at this topic. Let’s say I took $5000 and spent 3 days under the wing of a dermatologist learning how to administer Botox cosmetically. Thereafter I return to my chiropractic practice and I am now a Cosmetic Chiropractor. In other words I offer to inject (for a sizable fee) Botox into your face, would you let me? I can hear the howls from here of “Are you crazy?” Well that scenario is now playing out with the dentists of British Columbia. Our province has been the first in Canada to cover dentists wishing to expand their practices into the field of the cosmetic application of Botox.
Dr. Alister Carruthers and his wife were recognized as the first to administer Botox cosmetically. As of the writing of this section of the web site, he is teaching at the University of British Columbia. Here is what he had to say upon learing about the province’s dentists now scope of practice “...it’s nothing more than a cash grab by the dentists.”
When you recognize that it takes literally years to learn how to correctly deliver spinal manipulation. It verges on asinine to think you can compress such knowledge into some weekend seminars and call yourself a ‘manipulative’ medical doctor or therapist. In other words if your going to have it done GET IT DONE RIGHT.
With the above discussion in hand you can now see how those with a vested interest in minimizing/discounting your injury(s) use cultural authority against you. Most people trust, and so they should, their family doctor. Because a medical physician can be consulted for quite literally anything (including a toothache), the visit is ‘free’ (along with any tests they may order), medical doctors often believe their own professional organizations propaganda that they are the ‘real’ doctors in the area of back/neck injuries. In their defence they do the best they can, but no one can be all things to all patients. That includes chiropractors.
In closing this section a note about one’s lawyer should be made. All too often patients who have suffered a whiplash injury are directed to consult their medical doctors, or a therapist, by their lawyer. After reading this section you should now be armed with enough knowledge to ask why. There could be a perfectly good reason, but if there isn’t I would hope after reading this section you would ask some informed questions. It’s still common to have a patient being primarily treated by a chiropractor yet the lawyer will state ‘yes, I’m sure he/she is a good chiropractor, but let’s have you consult your family medical doctor as the insurance company puts more faith in their reports.’ If that last point sounds familiar you might send them to this section of my web site so they can get up to speed. Good luck.