One DC's View of Overutilization

Today I read another article regarding the atrocities of overutilization of chiropractic adjustments, just like the dozens that I've read over the past two or three years about chiropractors destroying ourselves for the sake of a few bucks.

The article stated that chiropractors are going to soon be removed from the insurance system because a few chiropractors are abusing the system by overtreating patients. The article stated that insurance companies are getting fed up with these abuses and are soon going to do something about it, such as stop paying chiropractic claims.

I've been in practice for about seven years; I'm going to be vain enough to assume that when I examine a patient I have a good idea of whether or not that patient needs to be adjusted. I'm also going to assume that virtually every DC who reads this has much the same diagnostic or analytical skills that I have. I would further assume that virtually every DC reading this has a good idea whether or not a patient needs to be adjusted.

I am convinced that overutilization does exist, but not the way many of these articles say that it does. This afternoon I spoke to a patient who told me a true and frightening story about overutilization; I think that most readers will identify with the story.

The patient is a high official with the police department in my area. He's well-educated, intelligent, and one of the policymakers in the police department. He's been a chiropractic patient for many years. He began seeing me on a periodic basis for a low back injury in June 1989. In January 1990 he discontinued treatment because the police department insurance administrator told him he was getting too many chiropractic treatments and should see one of the police department's "real doctors."

The patient's low back condition originated from a minor injury, but the intensity of the injury was so severe that the patient developed a "tic" in his upper back and neck, and was diagnosed as suffering from "anxiety" by the police department's "real doctors." The patient told me that he was discontinuing medical treatment because he felt "okay," not well, but "okay." He stated that due to the "politics" at work, that he didn't want to make waves. Remember, this man is one of the highest ranking officers in the department and is part of the policymaking body. This is not your average "cop on a beat."

When I saw him for the first time in almost a year for an exacerbation of his low back problem, he informed me that he has seen no fewer than 5 psychiatrists for his "anxiety," has been treated with numerous depressant drugs, and has been hospitalized for drug addiction from the anti-anxiety drugs that he was prescribed. He has missed numerous work days and has spent his life's savings on these ineffective and damaging treatments.

Today he told me that he has not had anxiety-related physical symptoms since his initial adjustment with me three days ago, and has been trying to tell the "real doctors" that this anxiety problem began during the acute and severe pain stage of his low back injury a year and one-half ago. Of course, all of these so-called experts shrugged off this possibility because everyone knows that a spinal problem could not possibly cause a peripheral nervous disorder.

Now, let me ask you a question. How many "overutilized" chiropractic adjustments would have to be administered to how many different patients to equal the overutilization that this one man experienced in the past year from the "expert" medical doctors who got him addicted to drugs and ruined him financially? Is there any evidence that any chiropractor has ever caused a patient to go through this? If there is, please feel free to send me the information.

What is overutilization anyway? Isn't overutilization actually the supplying of a service that is unnecessary? Is it even possible to overutilize a treatment that is effective. No! You cannot overutilize an effective and necessary treatment. Is an internist accused of overutilization when he puts a diabetic patient on insulin injections for the rest of the patient's life. No! Is a cardiologist accused of overutilization when he puts a patient on nitroglycerin tablets for life? No! Is a dentist accused of overutilization when he recommends that a patient return every six months for cleaning and examination of his teeth for life? No! Is an optometrist accused of overutilization when he recommends that a patient wear glasses every day for the rest of his life? No! Then why is it that chiropractors are accused of overutilization when they see a patient for more than two or three months? If it is true that the average chiropractor knows when a patient should and should not be adjusted, why are we accused of overutilization when we recommend that a patient be checked again tomorrow or next week or next month and adjusted, if necessary, at that time?

Why is this? I believe that chiropractors are easy targets. Organized medicine has known for years that if their illegal boycott couldn't destroy us, we would eventually destroy ourselves. Organized medicine knows that by pointing their fingers at us, and because we try so hard to please everyone else, we will eventually underutilize ourselves right out of existence.

I personally believe that it is time to stop fighting and pointing fingers at each other and start telling the truth. Chiropractic adjustments should be given any time that a vertebra is fixated or subluxated, and the truth is that some people require lifetime care. It is not possible to overutilize a necessary procedure; and if an adjustment is needed, we are the only doctors trained to supply it.

If you disagree, I invite your reply.

Kenneth D. Pace, D.C.
Metairie, Louisiana