Mr. Rollinger, a dear old friend of my uncle, called him unexpectedly. He needed advice. His problem was the chiropractor he was faithfully seeing. The doctor was very professional, and he was generally pleased with his treatment. He had been going for some months now for his back pain. But he had to admit he wasn't getting better. Sometimes he was worse.
On two occasions Mr. Rollinger had spoken about this to his doctor. Each time he was told that the reason he wasn't feeling better was because his "muscles and ligaments had to adapt to their new positions." Improvement would take time and treatment. Now he was wondering ...
Mr. Rollinger was a mature man, of a high class. He was accustomed to having authority, and he respected authority. He respected his doctor's expertise and authority so much that he hesitated to get a second opinion. My uncle referred his friend to a chiropractic doctor across the country, a professor at a chiropractic college.
My uncle sadly recounted his friend's ensuing phone call to the professor and the medical referral. The diagnosis was end-stage prostate cancer, and this diagnosis had been delayed for crucial months. My uncle was mourning his friend's death. No legal action had been taken.
Perhaps Mr. Rollinger and his family were angry with the treating doctor for the delay in diagnosis that might have cost him his life, but they decided they were in too much crisis to pursue a legal action. Instead, the family simply did not communicate with the doctor's office.
The treating doctor could have never realized he did something wrong. All the treating doctor might know is that this particular patient had dropped out of treatment.
My response to my uncle was to extend sympathies about his friend. I tried to save face for our profession by not mentioning that probable cause for legal action existed in this situation.
How could this tragedy have happened? Possibly the treating doctor was also trying to save face for himself and our profession. Maybe he was so involved in trying to make his treatment work, he couldn't admit defeat. He couldn't admit that the complex, exacting analysis and treatment he was undertaking with this patient was irrelevant to the patient's real problem.
Maybe the treating doctor really believed that "muscles and ligaments need time to adapt to the new position." Many doctors say "muscles and ligaments need time to adapt," and continue on their pre-determined treatment course. Although it is true that muscles and ligaments need time to adapt, it is not true that the patient should not experience improvement in subjective symptomology and objective signs while this is happening.
I've heard about too many situations where the chiropractic treatments weren't working, and this explanation was used to leverage acquiescence to more treatment visits. I wish "muscles and ligaments need time to adapt" could be removed from the lexicon of things we say to patients when the results aren't good.
Another reason why this tragedy may have happened is the treating doctor wasn't paying attention. Perhaps the doctor overlooked some important signals.
This patient could have been one of many people who are very tight lipped about their health problems. When treating one patient after another, it's easy to fail to suspect trouble in someone who's not accustomed to describing their complaint and is unexpressive of their distress.
We need to constantly remind ourselves people are trusting their lives in our hands. Since our treatments are generally so benign, we need office procedures that help us keep our index of suspicion high for unusual, but dangerous conditions.
Train yourself to look at the treatment record. Keep track of the point at which it's been two weeks since you found out whether the patient is really improving. Disease develops.
In patients who don't improve, take seriously our obligation to investigate. Make sure the patient is accessing the expertise of other doctors. Your biweekly short re-exam form should make this clear.
Heads up, doctors! Watch out!
Linda S. Elyad, DC
