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Good Doctoring is Certainty

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Every month I teach a chiropractic re-licensing seminar on sports injuries, and every class I say,

Listen, it’s so important, doctors, that you believe in what you are doing–to the degree that the patient believes you–because if either of you are uncertain, it’ll be much harder for healing to take place.  Both the doctor AND the patient must believe in the treatment, and if only one believes, then it must be the doctor!

Reminds me of an experience my mother-in-law had regarding a wound that was having difficulty healing.  She was seeing a doctor in her home town who recommended a skin graft, but get this, he said, “It is probably not going to work, but it might.”

When I had heard what he said, I asked my wife why her mother was following through with it.  She said her mother wanted to give it a try; she wanted to believe.  Did it work?  No.  Three grafts, three failures.  At the time, I was peeved that the doctor would approach things in that way.  Why would he even go through the procedure if he thought it wouldn’t work?

After the third try failed, to his credit, he did recommend that she check out the NYU Wound Healing Center.  I decided to do some research on the Center, and what did I find right on their website homepage:

Under our innovative, comprehensive, and compassionate care system, healing is not just an outcome, it’s the expectation. This philosophy that every wound can heal is the focus of care at every level – from our wound clinic to the operating room to our research laboratories.

Duh!  I mean what the heck?  If the doctor doesn’t believe the treatment will work, why would the patient?  Here, we’re going to staple your eyelids shut and we’ll check your hemorrhoids in a week…but it’s probably not going to work.  Cha-ching!

The beliefs of both parties in the health care team are an important part of the healing process.  That is exactly why all healing-arts help some people some of the time, yet none helps all people, no matter how effective it is.  There is no such thing as 100% success rate in health care.

But the caveat is that doctors don’t know which people they are going to help and which they are not.  So….it is imperative that doctors approach ALL patients as the ones they are going to help.  If you truly think you are not going to help any one person–and doctors, we have all had patients enter our practices that we knew we couldn’t help–tell them so and refer them out!  How a doctor handles that patient, the one they know they can’t help, is what really counts in the end.  Good doctoring is certainty.

My mother-in-law went to NYU and guess what?  Her wound healed.  Go figure.

Today’s True Believers are Tomorrow’s Litigants

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Are you a firm believer in medical care? Do you think medicine is the best bet at getting you healthy and keeping you that way? Do you think, for the most part, when done right, medical care is pretty darn badass—doctors can tell you what’s wrong with your body, and get you better fast? If you’ve answered yes unequivocally to any one of these questions, then you are likely a future plaintiff in a malpractice suit.

Oh yes, you heard me right—if you champion western medicine to the degree that you think it’s nearly infallible, you will probably one day consider a malpractice lawsuit against the doctor(s) or hospital that doesn’t live up to your fantasy. Don’t feel bad—you are definitely not alone. In fact, you belong to one of the largest groups in the country: The Disillusioned Medical Victim. (Read this article: 9 in 10 doctors blame lawsuit fears for overtesting)

You know who you are. You worship medicine. You think Dr. Oz is the smartest guy on T.V. (and quite the looker, too). You wouldn’t think of taking a lesser health care practitioner’s opinion on your serious health issues. Oh no, if it ain’t Harvard magna cum laude, you ain’t buying it. But if the doctor is a specialist, then, well…she may as well walk on water.

Except it’s all an illusion. Doctors are people like you and me (OK I’m a doctor; I mean like you and your sister).  They have some extra knowledge and training, but guess what? They don’t know as much as you think they do. And they eff up like we all do. And when you have an experience in which your almighty doctor fails to miraculously fix you, guess what you are going to do? You are going to blame him/her/them.


It’s their fault, right? Yes, their fault you have cancer, are de-conditioned and ripe for disk herniation, or have complications with your routine surgery. They failed to find the problem, test well enough, or prescribe the proper treatment. Right?

Yes that’s how it happens. And it’s why medical malpractice is through the roof. It’s why doctors order an inordinate amount of tests, whether you really need them or not—to protect their arses!  It’s why medical costs are astronomical (if you are still living by the illusion that medical costs are out of control because people don’t have federally funded health insurance, then there may be no hope for you…ever) and will continue to grow until something changes.

Sure we could push for tort reform and hope that the problem goes away. OR…how about you just a) take better care of yourself, b) stop living by the illusion that medical care is for anything other than crisis care, and that you are at risk every time you use it (doesn’t mean don’t use it—just know the risks), and c) YOU ARE RESPONSIBLE FOR YOUR OWN HEALTH! Nobody’s to blame but you if you put all your eggs into one health basket. So don’t go crying to your malpractice attorney when the doctors don’t live up to your illusion.

Thinking Outside of the Box

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Hung out today at the Los Angeles Times Festival of Books held on the UCLA campus. What a great event! Got to listen to Holly Robinson and Rodney Peete talk about their autistic son, RJ. What a treat!

This post is not about autism, or the Peetes; it’s about something they said that stirred some thought in me. As they discussed RJ’s growth and battle through autism, they said they were able to, “check off all the things the doctor had said he’d never be able to do.”

Now that got me to thinking about how so many doctors tend to absorb themselves in the diagnosis—got to call it something, give it a label. Then all these preset parameters come along with the diagnosis, and the one being diagnosed becomes exactly that, the diagnosis itself. That has never been my method in my Beverly Hills chiropractic practice, although I do get a handful of people insisting on having a diagnosis (conditioning, I guess). For these people, I play the game, but I always tell them I prefer not to get caught up in labels. There’s a real danger there; people start to identify too heavily with their labels. They start to become their condition (illness, disease, disorder, etc). I am very pleased the Peetes didn’t follow this path.

Medical diagnosis serves a purpose: it’s a way of organizing information common among a group of people experiencing a particular set of symptoms. But I think doctors would be wise to see the bigger picture–the possibilities that exist in treatment and healing. I know, I know…sometimes all they have is a hammer…but there is more than what medical science pushes. It takes a healer to know the difference. Not all doctors are healers; many, if not most, are technicians. The doctor that gave the Peetes RJ’s diagnosis was likely a technician. Safe in his diagnosis, covering all bases to avoid liability. Bravo! Well done; a perfect display of modern medicine—think science and law all wrapped into one. But healing? Not by my definition.

Perhaps it’s peoples’ responsibility to take charge of their own health? That’s certainly the message I promote, since health comes from within. But doctors are facilitators—they assist in the healing process, and as such, I think giving the patient a dose of hope helps the prognosis. No doctor knows whether any one individual will be just another statistic in a particular condition. Doesn’t every person deserve to be considered one of the odds beaters until proven otherwise?

Anyway, I went up and talked to Rodney Peete during the book signing (Not My Boy!), and commended his and his wife’s decision to “think outside of the box.” I’ll let you read the book on your own to find out how the Peetes did this. He was gracious toward my praise and said that it is “amazing how things open up for you,” when you think outside of the box. I asked him what his thoughts were on receiving the diagnosis and daunting checklist of things his son would never be able to do. He said that some doctors are all too willing to nail that type of diagnosis without even blinking an eye.

Yes, I know—not thinking outside the box. Bless the Peetes for finding another way.

I’d also like to plug Holly Robinson Peete’s book, My Brother Charlie, written with her daughter Ryan Elizabeth (who read the book onstage today—very well done!)

Bye, Bye Doctors

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OK people–say goodbye to doctors, and hello to nurses, physician’s assistants and disease educators, because that’s what you’ll be getting under the new health care system. That’s right, primary care physicians are on their way out—in droves. But you’re not surprised, right? I told you just that in this here blog, remember? And for my fellow chiropractors, I made that very clear in my Dynamic Chiropractic article, Chiropractic Suited for Primary Care?, last year.

Awright, good, you knew…just wanted to give a heads up, because new estimates have 40,000 primary care physicians leaving practice within the next decade. That’s how money is saved in a nationalized health system. Reminds me of the time my wife’s esthetician told me that she was a doctor in Russia. “Awesome!” I said. “Not really,” she replied. “Being a doctor there is not like over here, it doesn’t pay much and the hours are long; very few people want to do it.” And now she’s giving facials in Beverly Hills. Nice.

Only 30% of all doctors practice in primary care. If you don’t know, these are the docs that see you first. Don’t know why you’re gassy all day? Primary care physician. Don’t know why your baby toe tingles? Primary care physician. Pissing fire? You get it.

Interestingly, 65 million people currently live in areas designated as having a shortage of primary care physicians, according to the government. But never fear, the new health plan will offer to pay doctors 10% more to serve in those areas. Wow! So if I were to serve in those areas, they’d pay me an additional $3.10 (Medicare pays $31.00 for chiropractic; trust me, it’s my humanitarian gift to society to treat the elderly). Love the government–they sure know how to value a service.

Not only are primary care physicians leaving practice, but when the new health care system takes off in 2014, both the newly insured and existing patients will make a mad rush to doctors’ offices, putting a strain on an already buckling specialty.

No worries, less educated physicians assistants will pick up the slack. They’ll have their government manuals telling them how to handle each condition. Who needs doctors? Differential diagnosis is soooo overated.

I just hope I never see my PCP, Dr. Weiner giving haircuts at the local Fantastic Sams—that’d be awfully embarrassing.

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