You may have seen the episode on “Four Corners” this week on the billions of dollars of waste in our health care system, through unnecessary investigations and/or surgical intervention.
Here is a link to the episode in full.
Here are five take home points to think about from the program.
Don’t forget your Doctor, but be questioning
A problem, that I have personally felt pervades our healthcare system, is blind trust in healthcare practitioners. Medical practitioners are highly trained individuals but that doesn’t make them infallible. It is possible that they may not be up to date on current research. Sometimes they can misread what you desire to get from your appointment, and are working to address your specific wish. The answer is to always ask questions and be clear about what you want. In the case of imaging the best question to ask is “Is getting that imaging likely to change the management of my condition?”
Imaging will sometimes still be appropriate
We covered the very issue of imaging in back pain in a blog recently by Rob Erickson https://www.capitalclinicphysio.com.au/low-back-pain-should-i-get-a-scan/
Imaging will sometimes be necessary, so do not think you will not ever need it. It is highly useful for ruling out sinister pathology. If you are being told you’re “out of alignment” or “subluxed” on the basis of an x-ray or other imaging, then you are 100% being given the wrong information. We have known this for a long, long time.
In regards to knees, just like backs, the instance of unrelated findings on MRI is very high. The relevance of these findings needs to be questioned. More and more evidence is becoming available that shows physiotherapy to be equal in outcomes to arthroscopy, and in many cases better.
Surgery will sometimes be needed
There are still lots of cases of appropriate surgery. If being offered a surgical solution, the best question to ask is “What are my other options?” As I have just mentioned, the case is continually mounting for conservative physiotherapy management of knee pain, even including ACL injury. Conservative management of back pain is certainly shown to be superior in most cases than surgical intervention. Most of the time (except for some acute, traumatic injuries) there will be no harm in trialling a period of conservative management.
Treatment (in this program) is referring to medical intervention only
Treatment or imaging being referred to as futile or unnecessary was mentioned several times throughout the program. Treatment is this context was referring to medical intervention, particularly surgery. For example there is excellent research supporting the role of physiotherapy and exercise based interventions in the management of knee pain, including arthritic knee pain
Physiotherapists are musculoskeletal experts
Physiotherapists are highly trained in the assessment and treatment of the musculoskeletal system (all your bones, joints, ligaments and muscle). There is evidence to support diagnosis by a good physiotherapist being equal or superior to most other health professionals.
You don’t need a referral to see a physiotherapist. Physiotherapists are regarded as “first-contact” practitioners meaning you can attend them as your first port of call. Getting a second opinion will never hurt!
The moral of the story is to constantly question and explore your options so YOU can make an informed decision.