The end of average care

I pretty much loathe facebook.

I used it quite a bit for a few years, then found my self pretty much addicted to checking it.

Still, that’s dopamine for you.

Then I got into an argument with another Chiropractor over something we disagreed on.

I know of him through a Chiropractic organisation and have talked on the phone once (never met him in person).

And there I was getting into an argument about something random with a guy I’m not friends with and don’t care about.

It was the end of Facebook for me.

The only reason I have any dealings with it these days is to promote the Academy of Chiropractic Nutrition.

Annoyingly this morning I went on to post some information and caught a glimpse of a post by an academic at one of the Chiropractic colleges about MRI & x-rays for back pain.

Headline read:

MRI and X-Ray Often Worse than Useless for Back Pain

Medical guidelines “strongly” discourage the use of MRI and X-ray in diagnosing low back pain, because they produce so many false alarms.

I stupidly took the bait and read the article.

In reality, it’s about medics in America and the overuse of MRI’s to diagnose the cause of pain.

But this really has nothing to do with our practice.

Though there were plenty of DC’s commenting/projecting their insecure

little egos all over the post.

(I think that’s what 99% of Facebook/Instagram is, projection of mental health issues?)

From the content, the vast majority hadn’t even actually read the article.

But the thing that caught my attention was the definitive use of a headline to create a black & white/binary scenario in clinic (non-clinicans do that a lot)

On AVERAGE x-rays and MRI don’t help to diagnose the cause of pain.

So my take is this: Who wants average care?

How may average patient’s do you see in clinic?

None. It’s a statistical midpoint.

Chiropractic has always been personalised care.

I mainly x-ray to help rule out pathology, plus some bio-mechanical info in some patients (when appropriate).

If you have ever diagnosed pathological or post-traumatic fractures previously missed by A&E you will know the “what if’s” thoughts running through your mind.

It’s scary stuff.

I do not want or need an online sceptic or academic, non-clinician posting from their ivory research tower, about a non-existent, black and white world where you treat by averages.

If you want to be a master clinician to you need to learn to live on the edge of clinical uncertainty.

We care for individuals with totally unique issues, that may follow certain patterns that respond to similar care, but each visit should be bespoke to some degree.

Test, treat, re-test, repeat.

Nowhere can the folly of averages be seen better than blood test results.

Take a group of “healthy” people (healthy is a relative term, they mean asymptomatic) and the 95% in the middle are “normal”.

The 2.5% either side are low/high respectively & thus are abnormal.

But I don’t want to wait until my patients are so ill they are finally diagnosed with a blood test.

To me, that is unethical (plus some never get so low they actually get treatment).

I want to catch them as they are headed down/up & optimise them and give them their life back.

Vitamin B12 is a perfect example of this.

According to the NHS if you are over 160 pmol/L you are fine (kind of).

(They do actually say if neurological symptoms are present but results are normal they should treat with B12 injections, but I’ve only seen this happen once in 18 years.)

But in reality, optimal probably is in excess of 800 pmol/L and maybe much higher in certain patients.

Without B12 you can’t make myelin.

Think about that for a second.

MYELIN

Good luck improving the neuromechanical system and symptoms with slowly disappearing myelin due to a “normal” B12 level.

So keep doing what you know is right, never treat averages, always bespoke the care you deliver & ignore non-clinicians telling you how to practice.

Action to take today: 

Take a break from Facebook, you’ll feel better for it.

Check some B12 levels, if they have persistent pain and are in the 160-500 pmol/L levels try some sublingual B12.

And as always don’t waste those valuable adjustments,