Doctor as Teacher: Part II
Earlier this year I wrote an article for Practitioner’s Corner entitled Doctor as Teacher. The basic idea was that we need to open up dialogue with patients/clients and be able to educate them on what’s going on in their bodies. And by doing so, not only do they, as a side effect, give us valuable respect because they believe that we know our stuff, but more importantly, they begin to take interest in their own bodies and health. I still stand by everything that I said in that article. But, after another almost year of learning, observing, and most importantly, practicing with patients, I feel the need to add something to this idea.
Not only do we need to educate our patients so that they understand what’s going on with them and how we’re going to treat them, but we also need to start giving them the tools to take care of themselves at home and become their own doctor/coach/therapist.
The new paradigm of medicine is to not only treat the symptoms, but to also treat the underlying cause of the symptoms. For many of us that means working up and down the kinetic chain, exploring lifestyle causes, and possibly even working on the mind and its relationship to pain/dysfunction. But what if, throughout this process of healing, we were to take things a step further? Ideally we would begin to impart our knowledge to the patient and start to train them to be their own doctor. Kelly Starrett, whose work I am a huge fan of, has a mission statement of sorts that goes as follows:
This is what I’m talking about. It’s a beautiful idea and one that could drastically change the lives of human beings all over the world. But how are people going to learn to “perform basic maintenance on themselves”? I think that as practitioners, we have the ability to jumpstart this process for people. We are able to begin to teach patients why they’re having the issues that they are, but then also begin to impart our understanding of how to assess for and treat issues for oneself.
I joke around with friends and family that the only reason I became a doctor was to heal myself as nobody else had been able to help my chronic and nagging low back pain. While I’m mostly kidding, there’s no doubt that I’ve become a junkie for learning to take care of my own body and mind, and it’s been for the better. I’m not suggesting that everyone spends the better part of a decade in school and amasses the cost-of-a-house-worth of student loan debt to figure these things out, but everyone should have a basic understanding of how their body works and what it takes to stay injury free. And I think it’s part of our job to teach them.
My chiropractic colleagues catch a lot of flack, and rightfully so, because many of them simply adjust patients’ bones from stuck, abnormal positions, back into positions of correct alignment and mobility and then send them on their way. Doesn’t sound bad right? Patients feel better and their joint issues are “fixed”.
But what happens when those patients come back the next day, 4 days, a week later with the same complaint and the same stuck joints? We adjust them again and send them on their way. We repeat this over and over again, and the patients don’t know why they keep having the issues, all they know is that they get short-term relief with an adjustment but then it comes back. Many times, the doctor doesn’t even know why the joints continue to have issues. Rarely does anything ever actually get fixed.
And don’t think that chiropractors are alone in this. Orthopedists give out pain pills, anti-inflammatory injections, and surgeries in the same exact manner that the chiropractor delivers the adjustment. The pain pills do more harm than good, due both to the negative side effects and the masking of pain that’s there to signal the brain that something is very wrong and needs to be addressed.
Surgery rarely takes into account the kinetic chain, and even though we “fix” the problem in the particular area, the global biomechanical issues are still present, if not more pronounced, due to additional compensatory patterns and scar tissue from the surgery. The result usually leads to the return of pain and more band-aid treatments.
Ok, I’m taking a couple of deep breaths, stepping off of my soapbox, and I promise to be done with the rants. The point is, there’s a better way.
Chiropractors aren’t the problem, and neither are MDs, or DOs, or PTs. In each of these professions there are vast numbers of awesome practitioners. But as a whole medical community, we could use a shift in the way that we approach what we do. We need to not only step up our games as practitioners to help patients get better, but we also have a great opportunity to then educate our patients on what they need to do to maintain themselves and what they can do in the future if the same thing occurs.
The best practice would be one in which we help someone get better as quickly as possible, teach them how to maintain and prevent it from happening again, and then send them on their way. The patient has not only come to our clinic for treatment, but they’ve also graduated from our “school” with a higher level of insight and knowledge in taking care of their own body. That’s how we create Thomas Edison’s coveted “patient of the future”. You know the quote:
And we can’t worry about losing patients and “maintenance care” and all of that. I would personally rather equip my patients with the skills and knowledge to be able to do their own maintenance care at home and have them send me referrals because they feel that I did right by them, than keep patients in a perpetual reliance on me and have a stagnant patient base.
Let’s go back to Kelly Starrett. His site MobilityWOD is a prime example of a tool that can be used to help people become their very own sports medicine specialist. He posts awesome videos every single day that teach people how to do many of the things that I would do for them in the clinic, but by themselves either at home or at the gym.
And Kelly’s not the only one putting this information out there. There are a growing number of awesome people all over the world who are finding fantastic ways to care for one’s own body in order to reduce injury and increase performance. Hell, come up with your own ways of doing things on yourself. Identify ways that you could do what you do for your patients, without you. Regardless of how we choose to come up with the practices, we need to start teaching them, and the importance of doing them, to our patients. We need to become the doctors and teachers that we can be.
Now of course part of that teaching is getting our patient’s to understand when they have aches and pains that they can deal with on their own, and when they do need to come in for extra care and evaluation. But the fact remains that many tweaks and minor injuries can be dealt with by the athlete if they know what they’re doing.
The future will belong to the people who can jump aboard this train. The healthcare model is shifting to a “cheaper is better” model anyways, with active care and home care being favored over passive care, so we really don’t have much of a choice long-term. Whether we have a capitalist-based, or government-run healthcare system in the future, we will be forced to make Edison’s dream a reality simply because it’s cheaper to do so. And I don’t think that’s such a bad thing. We might as well start now and do it the right way.
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