I have the utmost sympathy for anyone suffering with musculoskeletal pain, not just because it’s undoubtedly a very unpleasant experience, but trying to figure out who is the correct person to help you is a seriously difficult decision, and when you do find someone that you’re comfortable with, how do you even know if you’re receiving good quality care?
I’ve put together a checklist for those of you unsure about what constitutes good quality care for musculoskeletal conditions. As a chiropractor, I can only really advise on my own profession, although some of my advice will be transferrable to physiotherapists and osteopaths.
The first thing that you should be asking when contacting a clinic for treatment is how long are the sessions?
My initial consultations are 1 hour long and my treatments are up to 30 minutes.
I’ve been a chiropractor for 10 years and I find it impossible to see how a therapist can take a full case history – really diving into the patients problem – conduct an examination, explain the issue and the treatment plan to the patient, and then treat them in under 1 hour. There are of course exceptions to this rule – most notably teenagers who say about 12 words in total over the entire appointment! Treatment sessions at my clinic are 30 minutes long, but anything as short as 15 minutes can be acceptable depending on the circumstances. For instance, if your chiropractor is sending you follow up e-mails with rehab and educational videos, then a session can be shorter
and still be effective.
If a treatment is less than 15 minutes long, then I would have serious concerns as to the quality of the treatment being administered and what the justification is for making an appointment so short.
The second question on my checklist that I recommend asking is Are they suggesting that I should commit to a long term plan from the outset? There are many chiropractic clinics that will suggest treatment plans of even as much as 20-30 treatments for “normal, routine” back pain, i.e the type of back pain that 91% of sufferers experience. You will likely also be offered the chance to pay upfront or by direct debit for the treatment plan. I will say now that this type of practice is allowed under the General Chiropractic Council’s guidelines, but the science backing up this sort of plan would be very questionable – if it even exists at all.
I only book one session at a time because I simply don’t know how a patient is progressing until I see them, therefore booking a plan that could be 16 weeks long simply doesn’t make sense. If a patient is doing well then we’ll start to space their treatments out, if they’re struggling for improvement then they might need more sessions before reducing the frequency of visits. There are of course exceptions to this. I have seen good chiropractors offer pre-paid plans to their patients, but these pre-paid plans centre around rehab sessions in the gym and are not simply based on a patient having more and more treatments.
You also need to be asking what else is my chiropractor doing apart from treating me?
As I’ve said many times over the years, multi-factorial problems (like back pain) require a multi-factorial approach. If you’re chiropractor is simply doing treatment after treatment, without any consideration for physical rehab or your general exercise levels, your work, stress levels, quality/quantity of sleep and diet (to name a few), then it’s unlikely that you’re receiving the best standard of care.
Having multiple treatments, all of the same format, is acceptable under our professional guidelines, but it’s not the gold standard of care. Treatment packages need to involve advice on other areas of your lifestyle as well.
The final question that I would recommend considering is do I feel like I am being rushed? Fostering a relaxed environment where patient’s feel empowered to not only say what they need to say, but get the opportunity to say everything is essential to an effective working relationship. That working relationship is also known as the Therapeutic Alliance (some of you may remember this from an earlier column of mine).
At our clinic we never rush patients. Ultimately, the patient is the one holding the information that we need to effectively diagnose the problem and draw up a treatment plan. Not getting all of that information will lead to an ineffective plan and therefore reduce the patient’s chance of recovery.
I would also make a strong argument that if a patient feels rushed and uncomfortable during an appointment, then any treatment that the patient receives in that session will be far less effective than a treatment received in a relaxed, calming environment that puts the patients needs first.
When trying to figure out if you’re chiropractor is any good, a patient needs to decide if they feel the above questions have all been answered adequately and decide if they trust their chiropractor to help them – even non-science backed, low quality treatment can sometimes help patients, if the patient is happy! It simply comes down to if you’re satisfied with the clinician and if they can justify how they have put together your package of care.
To read Rob Bailey’s latest column in the Diss Express please click here.
