October 18, 2007 | Leave a Comment
On the same shift I saw two very sick patients, both of whom were under the care of chiropractors before they decided to pay us a visit in the Emergency Department. The first was an old woman with a one week history of dyspnea, chest pain, and a cough. Her chiropractor had diagnosed her with a “displaced rib,” and had been dilligently popping it back into place every day for the previous week. After a simple setÂ of vital signs revealing low blood pressure, a slow heart rate, and a slightly low temperature, not to mention a chest x-ray which showed a huge unilateral pleural effusion, it was not hard to come up with the diagnosis of pneumonia with sepsis.
“He [the chiropractor] said she didn’t have a fever and she wasn’t coughing anything up,” said the sister.
A little knowledge is a dangerous thing. I’m sure chiropractors study a little bit about infectious diseases somewhere in their four years of training but that’s not the same thing as recognizing a constellation of symptoms and responding appropriately.
The second patient was a 70-year-old man who finally came in after a week of ineffectual adjustments for “muscle aches” and general malaise which had evolved, by the time we saw him, into a vague intermittant chest pain related to exertion but which the chiropractor insisted, apparently, was some kind of subluxation. The EKG told the true story, an evolving myocardial infarction. My patient would have probably died if his son hadn’t raised the alarm and insisted his father see some real doctors.
Is this kind of dangerous ignorance typical of all chiropractors? Probably, although some are probably quicker to push the panic button than others. Sending a patient to the Emergency Department costs them nothing after all, and you can always get the patient back if he lives. I note with interest that some people consider chiropractors to be primary care and that many chiropractors would like this recognition for themselves. The problem is that, their laughable primary treatment modality aside, chiropractors are not qualified to be primary care physicians because they know nothing about it. There are, of course, incompetent medical doctors but they tend to stand out. Incompetence seems to be the norm among chiropractors, at least from my perspective and from some of the patients I see.
Look, it’s not rocket science. Chiropracty is based on treating imaginary defects of the spine, called subluxations, by manipulation. These so-called defects, which are also common in people who are not sick, are believed by chiropractors to cause disease and dysfunction of organs. Again, this is an example of a little knowledge being dangerous.Â Chiropracty was invented at a time when physicians were just beginning to understand the role of nerves and particularly those of the autonomic nervous system. The metaphor proposed by David Palmer, the father of chiropracty, to explain disease might have sounded credible 100 years ago but it no longer fits with objective reality. It is only a dogged faith among its practitioners and the credulity of its patients that allows it to survive. And survive it does like an old painted whore, displaying a new wig and a few new trinkets, but still an old painted whore.
Now, as to whether a visit to a chiropractor makes you feel better, I don’t care. Lots of things make people feel better including having their back cracked. When I was a young Marine on the island of Okinawa, the local barbers provided a vigorous back and neck cracking after a haircut. Did it make me feel good? You betcha.’ A medical specialty?Â No way. I understand you can get the same thing nowadays with a happy ending but I don’t believe it requires a medical degree. The point being that not everything that feels good or makes us happy is medicine. Endorphins, those magical happy chemicals that along with placebos and quantum mechanics are the last refuge of qauckery, are over-rated. Feeling good is not the same thing as being well, an important concept that gets obscured in the expanding dust cloud from the stampede to well-being.
Sounds Like a Personal Problem
Strictly speaking, your well-being is not a medical problem except for the part of it that is effected by your real medical problems; a difficult concept for many in the Complementary and Alternative Health community to grasp. Improving your health improves your well-being but not the other way around. To believe it does would be to say that vigorously wagging a vicious dog’s tail will improve its disposition. You might feel good about it but he’ll still sink his teeth into your ass.
The tail does not wag the dog which is why most of Complementary and Alternative Medicine, as it focuses on well-being, is so ridiculous. Medicine is by necessity reactive. We treat objective medical problems, either early in their course as is the case with primary care, or late in the game in the more overtly reactive medical specialties like interventional cardiology and Emergency Medicine. Your well-being, as it is dependent on hundreds of factors most of which are decidely non-medical is your own business, more of a personal problem really, and not something that needs to be or even can be addressed by your doctor. This is why the largest consumers of Complementary and Alternative Medicine are people who are not really sick but only playing at it. They have a vague disquietude about the course of their increasingly materialistic and spiritually bankrupt lives which manifests as nebulous symptoms, eagerly interpreted and accepted as perturbations in their qi or an unbalanced chakra, and then healed by some combination of cheap Eastern mysticism and dime-store science. Complemenatary and Alternative Medicine provides them with an alibi, not therapy, in much the same way that recycling and shopping in trendy organic coops gives the same patients an alibi for their increasingly materialistic lifestyles.
Imagine trying to throw some Ayurvedic therapy at the typical census of patients in the Emergency Department. It just won’t work with sick patients who have subjective complaints resulting from objective medical problems. All the chanting in the world is not going to cure a yeast infection or diagnose meningitis unless if helps steady the hand holding the spinal needle. (Because it does feel kind of creepy sticking a long needle into somebody’s back the first twenty times you do it). Your well-being, your opinion of your disease, your spirituality, and your ability to laugh and spread happiness and sunshine are completely useless in the face of a real disease. This is why there are no Complementary and Alternative Medicine emergency departments. That is, because their patients self-select for credulity. To open up your CAM practice to random patients with real complaints would put the lie to most of what you do, not to mention opening you up to all kinds of legal jeopardy for practicing fake medicine.
A Reader Writes: “Hey, Panda, I notice you’re not posting as much. Are you losing interest in your blog?”
Well, no. But I have a real job now and I don’t have the time I once had. While it’s true that I don’t work as many hours now as I used to during my two intern years (new readers will have to do a little digging in the archives for an explanation), when I am at work I am really working and I no longer have the odd hour or two here or there that I managed to squeeze in while I was working longer hours but not technically working all the time. I mean, call was usually pretty busy when I was doing it but I still managed, by sacrificing a little sleep (which would have been interuptted anyways and not worth much), to knock out what I hope were interesting articles that you folks enjoyed reading.
As an aside, my pet peeve are people who send me private emails saying that this or that particular article was not as interesting as previous articles. Hey, I’ve got close to 200 articles on this blog (search the newly catagorized archives) and if you think it’s easy filling every paragraph with completely new and mind-numbingly original ideas than you need to get yer’ own blog and have at it. I do what I can.
But I digress. The point is that while I work fewer hours now and fewer total days per month, my schedule is kind of screwy and as I find myself frequently out of sync with my family’s schedule, it’s hard to find time to write. I enjoy it, of course, and as I feel almost obligated to keep churning out what some of my kinder critics refer to as the usual crap I will keep writing and I beg your indulgence, oh my faithful readers, as well as your patience. And if you have any questions about the whole medical career shooting match go ahead and email them to me.
In the meantime, you may as well peruse the selection of blogs on the right sidebar. I don’t just put anybody on that list. Every blog listed there has some quality that makes it stand out, in my mind, from the crowd and they are all, in their own way, a little subversive.
I include Kevin, MD on theÂ left sidebar because he is an institution as is the Student Doctor Network. Over!My!Med!Body! is well written, informative, and a good way to keep up with what The Man is teaching medical students. It’s sort of the anti-Medschoolhell.
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