Do No Harm

Most people are familiar with the Hippocratic Oath that Doctors are supposed to live by:

“I will abstain from all intentional wrongdoing and harm.”

Or

“I will prescribe regimen for the good of my patients according to my ability and my judgment and never do harm to anyone.”

In today’s society we do not seem to hear these words echoed as often as they should be. It seems that we have two extremes that I like to call the “refer out doctor” or the “plug and chug doctor.”

The “Refer out doctor”

The “refer out doctor” does just that. The doctor has you show up at their clinic, you fill out paperwork wait in either the waiting room or a back room for an extended period of time to be spoken to by the doctor for 5 mins. At which time you are told that you are being referred to a specialist. Meanwhile, if you were to look into your chart notes that the “refer out doctor” has on you (which you can, and you do not have to wait an extended period of time to see your records, because they are YOUR RECORDS), you would most likely see your insurance was billed for an exam, that seemed to have happened during that time. I am not saying that there is no need for specialist, yet it seems to me that more and more people are ending up becoming tired of going through the “referral merry-go-round.” The cardiologist is concerned with the heart, the endocrinologist with the hormones, the gastroenterologist with the gastrointestinal tract. The person is lost in the mass of component parts, like the loose pieces of a jigsaw puzzle. It is at this point we must ask what is the purpose of this “doctor?”

For the most part this “refer out doctor” is doing no harm. They are actually not doing anything. The purpose of this “doctor” is to play the game that the insurance companies have decided to create to control the industry as best they see it. Specialist are just that, special, and since they are special they need a referral from someone whom the insurance company trust, hence the “refer out doctor.” This “doctor” is more concerned about following the proper procedure in order to cover “their butt” so they do not get sued for malpractice or removed from the network of the insurance providers they work for. Once the person is referred to a specialist then it is out of this “doctor’s” hands.

The idea that a person comes to you for help and the only thing they seem to get is a ride on the referral merry-go-round should be considered doing harm. The amount of stress that one goes through having to make new appointments with new doctors every month or so (because for some reason every specialist is always booked weeks or months out, even though when you arrive for your appointment they seem to be not that busy, ever) and then being told to try some new pill for a month in the hopes that it will work.

At no point during this ride through the referral system did any “doctor” look at the person as a whole. The idea that a human being is only the sum of a bunch of independently functioning parts is what drives people mad. Often it is the Doctor who looks at the person in their entirety that can find the reason for the ailment.

“The Plug and Chug doctor”

This is the “doctor” that knows all the tests. You see them and they run a test and the results of said test mean this one thing, and that alone. You are given a prescription based on that test of that single function of your body. What happens next depends on you how quickly your symptoms change. The reason I have used the phrase “plug and chug” is to bring you back to math, for example basic algebra. In this math you are given an equation A +B = C. If you know two of the factors then you can the third, and it is guaranteed to be only one thing (5 + B = 10, B = 5). All you have to do is plug in the numbers and out comes the answer. This “doctor” needs only to run a test to get some numbers to plug into an equation to get a diagnosis. Then prescribe away. The problem with this type of “doctoring” is when the test run out and the health problems still persist. More often than not, this “doctor” will dismiss the person as either making it up, having a mental issue, or that the person is just trying to get more drugs.

This usually leads the person to find a “refer out doctor” or a specialist, who will in turn simply be a more sophisticated “plug and chug doctor.” The main problem with this type of doctoring is the lack of keeping up on research, or the laziness to actually do any themselves. This “doctor” relies on labs and reports which already have the diagnosis on the report. If at any time these labs or reports comes back “normal” then there is nothing wrong with you, regardless of how you feel.

This unfortunate series of events has led to the rise in mental health diagnosis and subsequent prescriptions of mental health drugs. Yet, in order to get said prescriptions for mental health drugs, one needs to have a mental health diagnosis. This is an even bigger mess in the health care community than any physical ailment.

A recent paper published in the Journal of Psychiatry Research hits home the point that how diagnoses are made using the most recent criteria put forth in the Diagnostic and Statistical Manual of Mental Disorders: DSM-5 that there is no information about how to identify at what point someone has a ‘disordered’ response as opposed to one that is ‘normal.’ This paper goes on to conclude that this is a ‘disingenuous categorical system.’ Although diagnostic labels create the illusion of an explanation, they are scientifically meaningless and can create stigma and prejudice. We need to look beyond diagnoses and consider other explanations of mental distress, such as trauma. This study provides yet more evidence that the biomedical diagnostic approach is not working. The current diagnostic system in psychiatry wrongly assumes that all distress results from a disorder, and relies mostly on subjective judgments about what is normal and what is not.

I do understand that there is a difference in psychological disorders vs. physical disorders. But, the line seems to be blurry when both are being diagnosis by the same two types of “doctors” described above. Which brings us back to, Do No Harm.

If the Doctor can not get past their own ego, pride, or arrogance then they will only help those few who fall into their little boxes of care packages. All of those who do not fall nicely into predetermined care plans for the specific ‘diagnosis’ they have been labeled with are cast aside and sent to the mental ward to get their heads checked. How does this represent the Hippocratic Oath? The problem with ego and pride comes with the degree that instantly makes someone a Doctor. To quote the late Dr. Fred Barge: “Degree doth not the Doctor make...the field of practice graduates the real Doctor.” But how can one practice at their craft when they already believe they have all the answers, and if you the patient does not accept their answers then you are now sick in the head.

Yes, I am a Chiropractor, and this might seem like a long winded way of me speaking ill of the medical profession. The truth is, there are plenty of Chiropractors that fall into these two categories as well. I personally have strived to not fall into either of these roles. The number one thing that I try to do is check my ego daily.

Since I did bring up the fact that there are MD’s and DC’s who fall into both of these categories, what is an easy way to determine who is doing more harm and falling into the two categories more as a whole. I believe the simplest way is to look at the money. When you are a Primary Care Physician (both Medical Doctors and Chiropractors are), you should have malpractice insurance. This is the insurance a Doctor should have in case he makes a medical mistake and is sued for it. Just like having car insurance, the better driver you are the cheaper the insurance. Furthermore car insurance companies charge more for the 16 year old kid who has just received their license than the 40 year old adult who has been driving for decades with no tickets or accidents. Now, the 16 year old has no driving history, good or bad. Why would the insurance company charge more? Because statistics show that the average 16 year old driver will cause more damage than the 40 year old will. Malpractice insurance companies do the same. They look at the past numbers of accidents and deaths along with many other criteria to determine how much they are going to charge a health care professional for malpractice coverage.

With the above explanation in mind, let me give some numbers:

An American Medical Association (AMA) research report titled “Medical Professional Liability Insurance Premiums: An Overview of the Market from 2008 to 2017,” gave a list of the average cost of malpractice for Medical Doctors. The cost of Malpractice with respect to MD’s is dependent on area of specialty as well as location of Doctor, and a few other factors. The paper does give us a good range of what MD’s are paying.

  • Obstetrics/gynecology: $49,804 - $214,999

  • General Surgery: $41,775 - $190,829

  • Internal Medicine: $8,274 - $47,707

These numbers reflect the range in which this specialties pay every year for malpractice insurance coverage. They might seem rather high, and that is because the insurance companies use a wide range of data points to determine how risky it is for them to insure MDs based upon the profession past performance as a whole. Car insurance companies do the same thing when they tell you a 16 year old driver must pay more than a 40 year old driver with a clean record.

In a 1998 article published in the Journal of the American Medical Association they found that taking the correct drug for the correct diagnosis in the correct dose will kill around 106,000 Americans per year, making this the 4th most common cause of death in the U.S.

In a 2016 article published in the British Medical Journal found that medical error in hospitals kill anywhere from 251,000 to 440,000 Americans every year.

These numbers show why malpractice insurance companies are not willing to take a chance when providing insurance coverage for MDs. If the above studies are correct, then this would make the American Medical Model Health Care system the 3rd leading cause of death in the US.

What about the Chiropractor?

On average a Chiropractor pays under $2,000 a year in malpractice premiums. Why? For the exact same reasons that MDs pay what they pay; Malpractice Insurance Companies look at the risk involved in covering Chiropractors and how often they do harm that causes them to be sued.

This is one of the best ways to understand how safe it is to go to a Chiropractor.

I still hear from other types of health care providers from time to time that they know of multiple people a week being hurt by Chiropractors. This is simply not true, at all. The most common lie being spread about Chiropractors by other health care professionals as well as the media is that a Chiropractic adjustment of the cervical spine (neck) is extremely dangerous and causes a stroke. In 2008 the Journal Spine published research on the Risk of Vertebrobasliar Stroke and Chiropractic Care. The study investigated associations between visits to Chiropractors and stroke and compare this with Medical Doctor and stroke. This study looked at over 109 million person years of medical records and found no evidence of excess risk of stroke associated with Chiropractic Care. In fact it did show you are four times more likely to have a stroke while sitting in the waiting room of a Medical Doctor’s office than by being adjusted by a Chiropractor.

Chiropractic care is safe and effective. Every year more and more research is published that demonstrates the effectiveness of Chiropractic care on a continually expanding array of conditions. The evidence for Chiropractic care is overwhelmingly good, and the risk of harm is almost non-existent. Furthermore Chiropractic care is less expensive in most cases than traditional Medicine.

In conclusion, seeking Chiropractic care first in almost any health issue is a safer, less expensive form of Health care that could benefit almost anyone. The Chiropractor truly does live by the creed: Do No Harm.

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©2017 White Pine Chiropractic John K. Maltby II, D.C.