Gaaaagggghhhh, what the pfwwwth. That’s it, I’ve had it up to here with this.
I’ve just had a patient come in who’s got a raging sacroiliac joint and low-lumbar posterior facet syndrome (see this earlier post: http://chiropractor.blog.co.uk/2009/08/21/posterior-facet-syndrome-what-is-it-and-can-chiropractic-help-6775867/)
He had to go and see his GP so that his BUPA cover could be validated (that alone makes me spit, see why later). The patient said, in an equally exasperated tone as this blog, that the GP failed to look at any of his notes from his previous GP, who, incidentally, agreed with his chiro’s diagnosis. He then told the patient that the diagnosis and treatment we’d been advocating was wrong and that he should start stretching and get some exercise – on a sprained joint with some PFS to boot – so a bit like me telling you to stretch a sprained ankle. He then added that the only practitioners the patient should see should be osteopaths and then only those with a medical background (such as the one his wife was seeing). Good God, so the Masters level training is not enough to cover musculoskeletal issues such as this. Tellingly the patient, a wise man, said “I wanted to hit him and was thinking ‘I do not like you now’” and, God bless him, got up and walked out.
Well this was irritating enough but add to it this gem of resent research and I’m still gritting my teeth. There have been two bits of work done recently in the really solid journal Spine:
1. Buchbinder R, Staples M, Jolley D. Doctors with a special interest in back pain have poorer knowledge about how to treat back pain. Spine 2009; 34(11): 1218-1226.
2. Orthopaedists’ and family practitioners’ knowledge of simple low back pain management. Spine 2009; 34(15): 1600-1603.
The background is that low-back pain (LBP) patients usually first consult with their GP (and then perhaps a specialist). In fact, back pain is the most common musculoskeletal reason for consulting a family doctor. So you’d think it would be good if these GPs had a high level of competence in managing these patients. However these studies show that, taken together, those who are consulted first (in most cases) for LBP are not managing this condition in an evidence-based manner.
The authors state: “Taken together, these results provide strong evidence that poorer beliefs about management of back pain is driven by a special interest in LBP. These findings raise serious concerns about how back pain is currently being managed among general practitioners with a special interest in LBP.” There is a great quotation in the review where it says : that there is a “disappointing picture of medical management of simple LBP.”
More details are available at:
http://chiropractor.blog.co.uk/
And you wonder why we rage at idiots like this GP.
And breathe
I have been dealing with lower back pain from a herniated disk for years now. I have been undergoing chiropractic therapy, physical therapy, and epidural shots…as well as pain medication. I don’t think I would ever consider back surgery unless it was to a point where i couldn’t walk.