Eliminating Our "Never Events"

We have all heard the stories about surgeries gone wrong. Typically these include the wrong leg being amputated, removing the appendix or other body part from the wrong patient, or leaving a scalpel, gauze or other medical "material" inside a patient after sewing them up.

These stories are based on surgical "never events" that actually happen far too often. According to a recent study,¹ they occur at least 4,000 times a year. As this number comes from malpractice suits against individuals, the authors speculate that the actual number is probably higher.

Needless to say, these stories (based on actual occurrences) have tainted our view and ultimately the public's trust of surgeons, even though this is a very small percentage (.008 percent, in fact) of the total number of surgeries performed each year – about 48 million in the U.S.

The point is that carelessness on the part of a few health care providers can impact the public's perception of an entire profession in ways that all the advertising in the world can't erase. Surgeons will never live these "never events" down. As we consider the public's opinion of chiropractic, we might be able to recognize some issues that stem from "never events" in chiropractic. Most of the negative opinions about chiropractic seem to fall into two camps: "adjustments are dangerous" and "they keep you coming back."

Like it or not, every couple of years the media runs a story about some study, usually by a group of neurosurgeons. It is typically a survey that tries to show a correlation between chiropractic and arterial dissection. The papers (and subsequent articles) often fail to compute an ultimate risk percentage (probably close to the risk of a surgical never event).

These stories (the most recent back in April 2012) have a negative impact on our reputation. To ignore them and never address them is not dealing with reality.

There are a number of available studies suggesting that people with a dissection or stroke in progress have neck pain or headaches that cause them to naturally seek a doctor of chiropractic for care.^2-3 One important study you may be familiar with reported "no evidence of excess risk of VBA (vertebrobasilar artery) stroke associated chiropractic care compared to primary care."⁴ This means a person having a stroke is just as likely to have recently seen a DC as they are to have recently seen an MD.

The issue of multiple visits being a negative comes from the mistaken belief that the patient's ailment should be resolved in a single intervention (pill). This negative stems from patients leaving chiropractic offices without a clear understanding of the progressive nature of disease and the philosophy supporting how chiropractic care addresses disease. Too many DCs have never communicated well enough to educate their patients about why multiple visits are both necessary and preferred.

In both cases, the negative opinions about chiropractic stem from a lack of information. The fear of injury can be addressed with available research. The concern about multiple visits can be addressed by communicating our philosophy.

The chiropractic "never event" is not life-threatening, but it does carry the potential to damage our reputation. Our "never event" is letting your patients leave your office without being certain that they understand the importance of multiple visits (as needed) and know the truth about the risks of care.

By diligently communicating these truths with our patients, we will arm them with the necessary responses to negative comments they will likely receive when they talk about their last visit to your office. Properly educated, every patient can speak knowledgeably about chiropractic and ultimately refer new patients who had the wrong opinion based on ignorance.

References

1. Mehtsun WT, Ibrahim AM, Diener-West M, Pronovost PJ, Makary MA. Surgical never events in the United States. Surgery, Dec. 18, 2012; e-pub ahead of print.
2. Haldeman S, Kohlbeck FJ, McGregor M. Unpredictability of cerebrovascular ischemia associated with cervical spine manipulation therapy: a review of sixty-four cases after cervical spine manipulation. Spine, Jan. 1, 2002;27(1):49-55.
3. Haldeman S, Kohlbeck FJ, McGregor M. Stroke, cerebral artery dissection, and cervical spine manipulation therapy. J Neurol, August 2002;249(8):1098-104.
4. Cassidy JD, Boyle E, Côté P, He Y, Hogg-Johnson S, Silver FL, Bondy SJ. Risk of vertebrobasilar stroke and chiropractic care. Eur Spine J, April 2008;17(Suppl 1):176–183.

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