The other night, whilst I was playing cricket, one of our bowlers twisted his ankle when he unfortunately stepped on the ball, whilst attempting to field it off his own bowling. Fortunately, within 30 seconds he was able to return to bowling with little ill effect.
Standing at the other end, behind the stumps it was clear that the bowler had suffered a minor over extension to the lateral collateral ligament of his ankle.
After the game the bowler, who had been a patient of mine in the passed with a successful resolution of the condition that he had presented to me, made a bee-line to the GP for advice. Not surprisingly, due to his minimal musculoskeletal undergraduate training the GP stated that if he could weight bear, then everything was okay.
The interesting outcome of that experience was that the GP knew the limitations of his musculoskeletal training, and he also should have known the extent of my musculoskeletal training and suggested that the bowler have a chat with the chiropractor. Similarly, the patient should have considered asking the chiropractor the question.
This raises a number of issues on a number of levels.
1) The Arrogance of the GP.
2) The Ignorance of the Patient
All patients know that if they have a toothache they do not consult a GP but refer themselves to a dentist. Why is this? In part it is because, associated to dentistry, is a multi-million pound industry, that promotes dentists and dental care generically. Thus, although many dental practices are no larger than many chiropractic practices, the fact that a multi-million pound industry promotes their work, without any cost to the individual dental practice, via television advertising and many other promotional platforms, informs the public as to who to see and thus provides income for the dentist.
In chiropractic there is no such generic multi-million pound industry generically promoting the manual treatment of musculoskeletal conditions. In fact, quite the reverse: 20% of the income of a pharmaceutical company is from the medication sold that purports to treat musculoskeletal conditions. Thus, no such multi-million pound industry is going to support chiropractic care when to do so would wipe 20% off their annual turnover.
3) Lack of GP Knowledge and Training
The second most common complaint that presents to a GP in his daily practice is a musculoskeletal condition. Approximately 27% of the patients that present to a GP practice have a musculoskeletal complaint. Yet, in their 5 year undergraduate training the medical student spends less than 3 weeks learning about musculoskeletal problems. Conversely a chiropractor spends all his 5 years of undergraduate training focusing on the numerous musculoskeletal conditions that present and the way in which to treat them.
A few weeks ago I was sat chatting to a GP at a social event, who had been in practice for over 30 years. In that time he must have seen thousands of patients with a condition that would have benefitted from manual therapy. At one point he asked me what was the difference between an osteopath and a chiropractor. That’s a bit like asking what the difference is between a neurologist and a cardiologist. Not knowing what an osteopath and a chiropractor do is like a GP not knowing which medication one would prescribe for a respiratory complaint as opposed to a cardiovascular complaint. The bottom line is that it is clinically negligent on the part of the GP not to know the skill set of the professions that would most assist to treat 27% of his patient base.
The moral from this is to never fall foul of the white coat syndrome. Never, ever, when talking to a GP, presume that he or she knows what they are talking about. If what they are saying does not seem to sit well with you as the patient, question them until they prove that their comments are not superficial and that they do have a true knowledge of how to help you.
10th August 2019