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Patient Values

Patient Values: Nothing matters more to the patient than: (1) is it the safest, (2) is it affordable, (3) its effectiveness to restore ADLs and RTP quickly, (4) does the doctor stand behind his/her craft. Western medicine is not exempt from providing customer satisfaction. Did you even ask the patient about their values?

Over the years, many explanations for low back pain (LBP) have been suggested throughout the research, with no consensus on the matter. Diagnosing LBP appears to be more of a challenge to define than to treat, since no-treatment self-resolves within 6-8 weeks in nearly 80% of cases. A modern-day diagnosis for a low back pain hardly exemplifies consummate medicine. Even modern LBP treatment strategies are unreliable. Surgical failures continue to offer unsatisfactory and unpredictable outcomes. Patient satisfaction and trust continue to decay.

Without getting into the obvious statistics of occurrence, prevalence, causes, or co-morbidities, let’s start conservatively by making this statement, “People suffer with back pain, and so the obvious thing to do, as clinicians, is to find the best way to treat it today at low cost.”

This article is a part of a larger work with the same title authored by me in 2016. It may be prudent to explain that much of my research to compile the data and knowledge is ‘recent research’ within the past 10 years, biased toward the more recent years. The inclusive citations inspire my arguments herein; more of an investment in the exploration into theoretical and critical thinking, than towards exactitude. However; as these citations age, the validity of my findings is not influenced, since the methods and treatment plan that I propose is useful in most non-traumatic low back pain cases seen in my office to date. I know why my treatment plan works since it is based in science; it works the same day, it is at low cost, and my patient satisfaction rate is 100%, with very low recurrence.

These articles intend to (1) re-evaluate the prevailing clinical practices thought to manage low back ‘pain’, (2) submit and debate novel low back ‘pain’ contributors and mechanisms, (3) meet patient expectations & satisfaction and clinically meaningful results, (4) recommend a conservative non-surgical course of care to over-ride ‘pain’ instantly, and (5) restore ADLs and patient confidence on the first visit at low cost. This article has a companion podcast. 

 “Is the glass ½ empty or ½ full?”
“Which works better, western medicine, or alternative medicine?”
“Should I offer the surgery, or not?”

Are we asking the right questions? These three examples are ‘either-or’ questions… however, there is a ‘third answer’, a non-binary answer… if you think critically. Critical thinking means that you make a highly educated examination of the data founded on all of the evidence supporting and rejecting every side of the argument. Critical thinking includes being able to understand a third possible answer… completely re-framed… that proves to support the best possible patient outcomes: (1) whether or not the case-managing doctor provides the service, (2) that is never based on clinical habits or automatic-pilot practices, (3) that is never based on prejudices for-or-against types of care, (4) when no other types of care offer higher patient satisfaction at 12 months. For example, epidural injection is commonly prescribed for LBP; however, do other types of care provide better patient outcomes? YES, all do, since patient satisfaction at 12 months is 0%. (Pinto, et al. 2012, Manchikanti, et al., 2016, Meueln et al., 2016) Yet epidural drugs are reflexively prescribed without regard to possible ‘third option’ critical thinking options for care, even when there is significant risk to the patient.

Start over, 

“Is the glass ½ empty or ½ full?”

A ‘third answer’ is: the glass is twice as big as it needs to be. This third answer addresses function, not ‘if I am a positive or negative person” since personal opinion and character framing are not involved in the scope of the question; rather implied. Clinical critical thinking should address real, not implied, medicine. Asking the right medical questions; making medical decisions requires critical thinking, not medical thinking.

“Which works better, western medicine, or alternative medicine?”

A ‘third answer’ is: choose a treatment plan that offers the highest rate of patient satisfaction at 12 months as reported by journal published RCT articles in the past 1-10 years regardless of its platform or provider. If you don’t know how to find or read these kinds of research, ask your doctor colleagues to help you out, or learn about it on YouTube, but never settle for less than robust research. If you are a medical doctor, please connect with an orthopedic/occupational chiropractic physician, like me, to build-out your success rates of patient satisfaction. If you are a conservative ‘alternative’ care doctor, please seek out alliances within the medical field since the two disciplines have little overlap. Patient values matter more than practicing territorial medicine.

“Should I offer the surgery, or not?”

A ‘third answer’ is to prioritize patient values: (1) is surgery the gold standard with least side effects (and you can prove it), (2) is there a lower cost treatment (always), (3) does the surgery return the patient back to ADLs and RTP faster than any other treatment, (4) are you offering a professional & personal money-back guarantee? This third answer is about respecting patient values over financial gain, ego, or treating from a ‘cookbook.’ Nothing matters more to the patient than: (1) is it the safest, (2) is it affordable, (3) its effectiveness to restore ADLs and RTP quickly, (4) does the doctor stand behind his/her craft. Western medicine is not exempt from providing customer satisfaction. Did you even ask the patient about their values? 

So, to be fair, let’s start on the right foot since these articles will continue to build concept on top of concept… ‘pain is not the only problem.’ Sometimes it is the clinician’s approach that is the problem; an approach based on long-time habits, personal biases, scope-of-practice limitations, re-imbursability, and ego. It is up to people like me, the author, and you, the clinician and researcher, to explore and expand into diverse and novel low back pain solutions. Remember, patients’ low back pain gets better 80% of the time without us! Let’s build on their successes!

LBP Blog General information

Series Description

These articles intend to (1) re-evaluate the prevailing clinical practices thought to manage low back ‘pain’, (2) submit and debate novel low back ‘pain’ contributors and mechanisms, (3) meet patient expectations & satisfaction and clinically meaningful results, (4) recommend a conservative non-surgical course of care to over-ride ‘pain’ instantly, and (5) restore ADLs and patient confidence on the first visit at low cost. This article has a companion podcast.

Dr. Dean Bio

Forester Dean is a chiropractic and physiotherapy sports medicine doctor practicing in Los Angeles, California. Dr. Dean is a lifetime athlete, and currently teaches tennis, track, boxing, yoga. The Core X System™ Campus flagship location was opened by Dr. Dean in 2020. www.preformancecxs.org

Copyright 2021 SpineSync, Forester Dean, DC
Duplication with permission only
spinesync@gmail.com

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