Decisions, decisions. decisions

by Alain Michelotti

It has been said that ‘life is just one decision after another’*. Some of these decisions or choices are ready-made for us because of changing circumstances; others involve a lot of soul-searching. The stakes can’t be much higher than when our health is concerned.

It used to be simple; decisions were made solely by the expert professional. They would ask questions, perform an examination and we would be told what we had to do to get better. Patient and practitioner, knew their places and the responsibility was clearly established. As a result of improvements in education and increases in awareness through the media, this model has gradually changed and we are now able, even actively encouraged, to take a more active part in decisions involving our health.

This change of dynamic between patients and practitioner has not been an easy one. Patient’s must actively participate in an often difficult decision making process. The practitioner is required to impart technical information and guidance to the patient which can be time-consuming. Part of this procedure includes detailing a range of alternative treatment options available. This culminates with what is called the ‘informed consent process’ which should take place before the start of any treatment. The main objective throughout is to enable the patient to make an informed decision about whether the benefits of the treatment offered outweigh the risks.

As chiropractors we must not assume that because the patient has made the decision to consult us, we can avoid talking about the range of alternative options available. For the majority of ordinary acute episodes of neck or low back pain, I will usually tell my patients that these conditions are invariably self-healing, that our intervention will simply speed up their recovery and that the alternative to manipulative treatment usually involves pain killers or non steroidal anti-inflammatory drugs have side-effects and can irritate the lining of the stomach. Having made my diagnosis and before starting treatment, I explain the benefits and risks of the techniques I plan to use. I make sure the patient has taken on board my explanations, ask the patient to sign the consent form and let them know that the consent may be withdrawn at any stage during the treatment.

Chronic neck or back pain is more difficult to treat and we regularly explain the principle of the ‘ladder response’. The rungs of the ladder start with medical drug based treatments, stepping up to physiotherapists and osteopaths whose objective is to create a virtuous circle by restoring joint mobility and diminishing pain, allowing the return of normal function. If this fails, the next step is a referral to the GP and possibly a referral from the GP to a consultant. At the top of the ladder the response is surgery, fortunately only necessary in extremely few cases.

It is important for us all to ensure that we understand our options on every rung of the ladder and be prepared to participate in decisions about our health and wellbeing. And you must never be afraid don’t be afraid to ask questions until you’re sure you’ve fully understood everything.

* Jonah Lehrer 2010

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