Five Tenants of Choosing Your Care-provider Wisely

As active leaders in both the chiropractic and wider medical industries, we take pride in being first in line to educate patients, the public, and anyone who will listen about the importance of providing supportive, conservative care to patients in need. While we do our best to go above and beyond for all of our patients, that doesn’t always mean providing more care than we need. To us, conservative care means finding the right treatment for an individual’s specific needs and nothing more.

Choosing Wisely

This concept is closely aligned with the American Board of Internal Medicine‘s (ABIM) Choosing Wisely initiative. Their most well known initiative, Choosing Wisely was built to address “waste” in healthcare. While no moment spent with a patient is wasted, it is often found that patients may receive more care or treatment than they actually need. Their official mission is “to promote conversations between clinicians and patients by helping patients choose care that is:

• Supported by evidence
• Not duplicative of other tests or procedures already received
• Free from harm
• Truly necessary”

While it is your choice to choose what type of practitioner to seek, it’s our duty as leader in the chiropractic industry to discuss the fives ways you can be assured that you are “Choosing Wisely” when choosing your chiropractor based on the ABIM’s recommendations for chiropractic care:

1. Do not obtain spinal imaging for patients with acute low-back pain during the six (6) weeks after onset in the absence of red flags.

Chiropractors who closely follow best practices will look for red flags before recommending spinal imaging. Because imaging tests often incur additional cost of care, it is in the best interest of the patient to refrain from imaging unless there are extenuating circumstances that lead the doctor to believe it is absolutely necessary. Red flags can include history of cancer, a possible fracture, progressive neurologic symptoms and infection, as well as conditions that potentially preclude a dynamic thrust to the spine.
If your chiropractor requests x-rays when you are not experiencing chronic low-back pain or suspect a possible fracture, you may want to ask additional questions or seek another practitioner.

2. Do not perform repeat imaging to monitor patients’ progress.

Again, unnecessary imaging incurs unnecessary cost. Unless you are being seen for a severe, ongoing problem such as scoliosis, there is no need to leverage additional x-rays to track outcomes. At Tuck Clinic, we choose to track our outcomes by reviewing a combination of the custom care plan we provide to the patient as well as their perception of their treatments and the relief resulting from such treatments.

3. Avoid protracted use of passive or palliative physical therapeutic modalities for low-back pain disorders unless they support the goal(s) of an active treatment plan.

That sounds like a lot of chiropractor jargon, don’t you think? We’ll break this one down for you. Often times, chiropractors administer passive techniques such as heating and cooling, electrical stimulation, or ultrasound therapy to supplement chiropractic adjustments. These, alone, are not the solution to fixing the overall wellness of your body after an injury or even during maintenance visits. It is highly suggested that these treatments are paired with a therapeutic exercise program that empowers the patient to continue their wellness efforts outside of the office walls. After all, the ultimate goal is to get our patients feeling better and living better overall.

4. Do not provide long-term pain management without a psychosocial screening or assessment.

There are many common causes to long-term pain. Sometimes, it’s a severe injury that has been ignored for years. But sometimes, it could be the unexpected side effects of depression or anxiety. It is the duty of a chiropractor to do their due diligence to get to the root cause of pain, even if it includes a psychological issue.

5. Do not prescribe lumbar supports or braces for the long-term treatment or prevention of low-back pain.

As noted in our recent examination of low back pain and lumbar support devices, these are great tools for temporary support but should never be considered a long term fix for an issue. Providing passive support for the lower back with these devices have been shown to reduce strength in the back, leaving it even more vulnerable to pain and injury. If your doctor has prescribed one of these devices as a quick fix, you may want to seek an alternative opinion.