If you're routinely sending "symptomatic" spondylosis for "further evaluation," you're wasting time and money. You're also needlessly worrying your patients, or setting them up with the false expectation that they may require surgery to correct a congenital defect.
I actually don't think you and I are that far apart on this one. I've already said "further evaluation" should not be routine. Most patients w/ L/S spondylolistheses will do just fine with conservative care. But, you can't disagree with me that there will be those cases for whom conservative care isn't working. For these cases, additional diagnostics are warranted. Surely you are aware that occasionally these patients will need surgery for their spondylolisthesis?
All you're really doing here is pretending like your field is unified around a coherrent theoretical model to explain a practice that is effective. Really none of these things are true.
I'm simply informing you that, while for some reason you'd prefer to believe that the chiropractic profession is frozen in the year 1895, research has been done and continues to be done in an effort to better understand pain, spinal instability, chiropractic's role in clinical management of these patients, the biological effects of spinal manipulation, etc. The old "bone out of place choking off a nerve that is then cured by popping the bone back in place" model is long gone for most of the profession. Sometimes I wonder if the main reason that notion even sticks around is that it is such an easy concept for patients to grasp, therefore it has gotten repeated and repeated. In fact, that concept is so deeply ingrained in our society that even many medical students and physicians continue to believe it, as evidenced by many comments here on SDN.
Manipulation is somewhat effective for a specific syndrome (LBP), but not particularly more effective than other available treatments (many of which are far less expensive).
But not less effective either, and arguably considerably safer than other alternatives. And there are cost-effectiveness studies that have been done, by the way, that wouldn't agree with your assertion on costs.
My last patient today is a good example. She fell about 3 months ago. Saw PCP, got meds, didn't help. Referred to ortho, who referred to PT, which didn't help after about 6 weeks. Her PT, bless their soul, suggested she see a chiropractor. So here she is. We'll see how she does; I hope I can help her. If she fails with me, I'll suggest pain management to see what her injection options are. My point is that not everyone does well with the typical first-line treatments, and as you know some patients don't tolerate meds for one reason or another (or the meds just don't work well, which I find to be fairly frequent and with which the literature agrees). At the very least for this subset of patients, you are doing a disservice by out-of-hand dismissing a trial of chiro care. Doing so goes against the current clinical practice guidelines (of which there are many from around the world).
Many different writers have proposed different models for why manipulation might actually do something, but no significant agreement exists, and many of your fellow DCs (including those prominent in your academic institutions) still adhere to older theories that border on cultish, metaphysical faith-beliefs. In the end, you might do something that provides short-term pain relief.
Yes, there have been any number of theories over the years. I don't think that's necessarily a bad thing. To the contrary, I think it exemplifies the desire to better understand the human condition and specifically chiropractic's role in the treatment of said humans. As the science evolves, some theories/models fall to the wayside while others take more spotlight. Make no mistake, we know way more, for example, about the effects of spinal manipulation today than we did even a decade or two ago.
And let's not pretend there aren't disagreements or differences of opinion about any number of issues in medicine.
You're right, I don't actively read the chiropractic journals. I don't even know their names. But I do read more about your field than you think, and you and I both know that I'm hardly the first allopath to summarize the studies on Chiro this way.
So, in effect, what you are saying is that you don't read the real science, you simply read and repeat the same ill-informed biased crap that then allows this misinformation to become perpetuated, as we see even in this very thread. I see.
I'm not an outlier; I'm pretty much par for the course when it comes to physician opinions on the value of chiropractic manipulation.
I've been around long enough to have seen quite a shift in attitudes among many MDs as it relates to chiropractic. I'm not saying most MDs are singing our praises from the rooftops. What I'm saying is that, in contrast to the days when an MD would tell a patient they are forbidden to see a DC, I get referrals from MDs all the time now. At the very least, many MDs, when asked by a patient about seeing a chiro, will today say 'give it a shot'. While some of that shift may be due to an increased appreciation for the existence of chiro-related research, I think most of it simply stems from the fact that so many of their patients have been helped in some way by a chiropractor.
Tired, I'm sure you give it your all when you see your patients. Seriously, I don't doubt that. I do wish you'd be a little more true to your evidence-based approach and consider recommending a trial of chiro care for your patients who may benefit. Making that referral is completely consistent with current practice guidelines (which in turn are evidence-based), so you shouldn't feel as though you are taking some great leap of faith in doing so.
This year I started taking supplements and spending limited time in the sun, sans sunscreen. I swear I feel more energetic, but that's not exactly a scientific result.
