Mel Siff (don't really know if he's Irish enough to be legitimately
referred to as McSiff) has brought up an interesting topic for
discussion and already (surely contrary to his expectations,
although he must be used to it now) we have people waiting in the
wings for the mudslinging to begin.
It's interesting, from my own perspective as a PT, to see how an
ample income can buttress a practitioner's feelings that what he or
she is doing is "validated" thereby as something important. The same
sort of financial success, however, can arouse suspicion if the
money is flowing into the pockets of someone else. The issue is
complicated enough that governments attempt to regulate practices in
health care, so obviously politicians and bureaucrats observing the
health care game from the sidelines are not comfortable with letting
free market forces run amok. This can surely generates great fodder
for a magazine with a title like Smart Money. I don't have access to
the article, but somehow the topic doesn't seem to be particularly
novel.
At the bottom of this mess is chonic pain, a very difficult problem
to deal with properly in a free market economy (not that I suggest
we suddenly switch over to authoritarian rule just to help people
suffering from chronic pain!). It may be easy for PTs to single out
chiropractors for taking advantage of a certain conditioning effect.
That is, a patient with chronic pain who has been inadequately
educated about the nature of chronic pain ends up repeatedly
seeking, as a result of conditioning, a particular treatment to find
short-term relief. Eventually this patient becomes a satisfied
"regular customer", who must indefinitely have his or her little
"fix" of treatment to through the day. Many of these people visit
chiropractors for an "adjustment" without which they would suffer
anxiety attacks. But a number of others depend on "PT" instead for
the same sort of gratification. Such patients are great sources of
"revenue", because their pain is genuine and they must keep
returning for more "treatment", which must be reimbursed in one
fashion or another.
If the preceding characterization is correct (this is NOT an
original formulation that has just now appeared in print for the
first time!), then shouldn't Mel's question be reduced to the ethics
of looking upon the sufferer of chronic pain as a source of periodic
revenue? I have heard of no legislation in any country (of ANY
political persuasion) that has been able to deal with this problem
head on. Yet there IS an ethically acceptable manner of dealing with
the patient suffering from chronic pain, one in which the patient
learns about gaining greater control of his or her life.
I thus submit that mudslinging between PTs and chiropractors misses
the point that Mel has brought forward. Can we discuss it rather in
terms of proper management of chronic pain?
Paul D. Andrew
Hiroshima, Japan
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