Chiropractors and x-rays were a hot topic on NextDoor.com recently, and that’s a topic where I have strong opinions.
First, the comment that caught my attention:
This is well-intentioned, but there are two things wrong with these statements.
1. Treating all patients the same
Should you have full x-rays done on your spine before being treated by a chiropractor?
The answer is “yes, no, and maybe,” depending on the specifics. In medicine, you can’t always apply a hard and fast rule. You have to weigh the risks vs benefits before deciding to x-ray.
There are two issues with x-rays: first, radiation is dangerous, so you don’t want unnecessary exposure. Second, any price is too much to pay for an unnecessary test.
Your provider should tailor their diagnostic assessment and treatment plan to you. If your doctor suspects a treatable condition and needs an x-ray to confirm it, then it’s possibly justified.
But no competent doctor will ever routinely perform or insist on a test without a justifiable reason specific to the patient’s circumstances.
For instance, if you’ve recently had a spinal x-ray and there are no red flags in your history such as trauma, neurological damage, cancer of the spine, etc., you simply may not need another x-ray. Just bring the recent x-ray with you.
If you’ve already been exposed to significant radiation during cancer treatments, if you’re trying to get pregnant, or if the patient is an infant, superfluous “just in case” x-ray procedures can be harmful too.
2. Substituting x-rays for actually listening
I’ve found that patients generally are the best source of knowledge about what’s going on in their bodies. Sometimes they just know it’s muscular in nature. An experienced chiropractor with neuromusculoskeletal expertise should be able to double-check your self-diagnosis, and can often tell quickly whether the problem is neurological, muscular, skeletal, or something else.
Keep in mind that research into overtreatment has found that a number of “standard” medical tests are often unnecessary. Overtesting leads to overtreatment, like surgery for a problem that likely would have healed on its own.
Testing should never be a substitute for listening. NOTHING can substitute for actually sitting down with a patient and getting to know their problem first-hand.
How thorough is thorough enough?
Wow. ALWAYS doing a full exam, WITH x-rays. No matter why you’re seeing her. This is like taking your car to a mechanic for an oil change — but he always does a bumper-to-bumper overhaul first. It’s as if your family doctor ran every lab test in the book just because you went in with the flu.
Your provider should tailor the amount and kind of care (and their bill!) to the size of your problem. I can only imagine how much extra cost all these full exams and x-rays add up to.
If either your chiropractor or MD always does the same tests no matter why you’re seeing them, ask what they’re expecting to see and what they’re going to do with the results.
1. A full exam with x-rays…
Full exam can mean an exam of the whole body or a full spine exam. Some chiropractors feel it’s necessary to address the whole “kinetic chain” which is a fancy way of saying they want to assess all of the joints and their interconnections, like ligaments and so on.
In principle, I understand that view. An alignment issue in one part of the body can definitely cause problems in another area. But not every patient wants “the works.” Many just want to fix the most obvious issue — to get back to normal as quickly as possible, without excessive cost, and with little effort or disruption to their daily routine.
If you do want a comprehensive approach, then you certainly want to have a full spinal exam and/or x-rays. This way a comprehensive plan can be created to address all of your imbalances.
You still should expect a brief, focused, and thorough exam of the painful area that’s your most immediate issue. This is the everyday pain relief care so many people want, but can’t get from providers who only want patients that are willing to sign up for long-term treatment plans.
Again, it’s all about individualization.
2. Those x-rays aren’t free!
…Even if your insurance pays 100% of the cost. It is a painful fact that in the U.S., patients and doctors have overutilized x-rays and MRI’s because insurance would pay for it. And that has contributed to higher healthcare costs in the form of higher premiums, higher co-pays and deductibles, or fewer covered procedures.
And as I said earlier, excessive or unnecessary x-rays expose patients to pointless radiation risk.
3. Testing can end up as “fishing expeditions”
The Internet is full of examples of people who went to a doc for a routine physical and went home with thousands in charges for diagnostics that had nothing to do with the reason for their visit.
It’s a serious enough problem that the AARP has launched an awareness campaign to help its members decide if they’re being charged for tests they don’t need.
Also, a significant portion of well-intentioned doctors try to cast the widest possible diagnostic net in order to not miss anything. In principle, that’s a worthy goal. Yet many will also acknowledge that when a patient has a particular set of symptoms and a matching health complaint, they’re virtually certain of the diagnosis.
Ethical chiropractors and MDs will never insist on a test in the hopes of finding something they can treat. They use x-rays and other tests as they’re intended: to confirm tentative diagnoses.
Patients deserve reasons and explanations
Which brings me to the next comment. This time, I mostly agree with the poster.
As I mentioned above, x-rays are not necessary for all new patients. That’s too wide a net to cast and it doesn’t always tell you anything you can’t find out by asking.
BUT when you need an x-ray, the point about sitting down and discussing it with patients is dead-on. Many chiropractors and doctors don’t do this.
I believe the first thing a patient should hear from his chiropractor is a definitive reason for getting the x-ray in the first place. Then what the doc expects to learn from it, what he’ll do with the information, explaining the results of the x-rays taken, and what treatment is recommended.
I’ve seen providers call patients and say “I got the X-ray report, and you have arthritis, and don’t worry, it’s part of getting old.” That’s it. They don’t explain what the x-rays actually showed. And they just write it off to age, as if that means nothing can be done to help their pain.
My view: it’s not up to the doctor or chiropractor by themselves to decide your pain doesn’t need treatment. Your treatment should be a collaborative decision, between you and them. Either way, you certainly have the right to understand what your x-rays or other tests show.
Chiros in my office and many others start communicating with our patients way before the x-ray. They go over everything in a patient’s diagnosis and treatment plan, and respect the patient’s fundamental right to respectful care.
Sometimes you just need to be patient…
For example, studies show that most back pain gets better on its own in about 4 weeks, and x-rays are generally not useful unless it persists or is unusual in some way.
Pay attention to your body. If you’re experiencing acute, searing, burning, shooting, wake-you-up-out-of-a-dead-sleep pain, by all means contact a healthcare professional immediately.
But sometimes, we’re just sore after a day of yard work. Life’s not pain-free, many of the best treatments for minor aches and pains are pretty simple, and we all need to do our part to not over-test and over-treat. We need to give our body the opportunity to heal itself, and not get worked up thinking that a little discomfort is actually something horrible hiding under the bed.
…and in charge
In the end, your health is YOUR decision, and you have a right to be a participant; not a victim of overtesting, over- or mis-treatment, and doctor-knows-best thinking.
THAT’s the one thing every “good” chiropractor will insist on.
