JC Smith, MA, DC
My latest edition of Sports Illustrated contained an advertisement for a local neurosurgeon touting the “new and improved” benefits of titanium baskets for spinal fusion. This is the second ad of his I’ve seen in SI; apparently they have regional ads for local businesses. Of course, the ad reads well, citing how these baskets will replace the old-fashioned methods of spinal fusion.
Coincidentally, just two weeks ago this very same surgeon’s operating room nurse came to me with her ailing low back pain. As many DCs have experienced with hospital nurses, the more rational ones are hesitant about surgery of any sort, especially back surgery. But, like many nurses, she was still skeptical of going to a chiropractor. What convinced her was my cable access TV infomercial which elaborates on the AHCPR guideline and the Manga report which both empathetically recommend SMT over back surgery. (I only wish every major city had similar chiropractic videos touting our wares)
Even though she came in for the initial exams, she was still skeptical and frightened by her own admission. After just a few adjustments on her sacroiliac joint, her pain virtually disappeared. Then she started to open up to me.
The next admission she made was not so startling because I’ve heard it before from other nurses: “I never want to be a patient in my own hospital.”
“Why not?” I asked
“Because they just don’t care about patients. Everyone should be a nurse behind the scenes for one day to see what goes on there, and they would never want to be a patient.”
She works at the Columbia/HCA for-profit hospital in Macon that was indicted for Medicare fraud. As you may recall, the prez of this hospital chain, the largest in this country, was on “60 Minutes” pleading his case a few years ago. By the way, his severance package was $10 million cash and $260 million in stock options. Not bad pay for someone who committed insurance fraud, don’t you think?
After seeing her neurosurgeon’s ad in SI, I asked her how well did these titanium baskets actually work compared to regular spinal fusion. “No better,” she replied. “We still have them all coming back for more surgery, just like with the old fusion method.
“Here’s the typical routine,” she confessed. “First the patient comes in complaining of LBP. The first procedure is a diskectomy. When that doesn’t stop the pain, next comes a regular fusion. When that doesn’t work either, then he does the basket implant. After that fails, he goes back in to take out the basket. By now, the patient is totally disabled and sent home.
“And you know, half the time when he opens up the patient, the disk isn’t ruptured or herniated at all. He and his assistant both have a good laugh, then continue with their procedure.”
“Well then, if the patient doesn’t need a surgery, why don’t they stop and save the patient from all that anguish?” I asked like a naïve boy scout.
“Would you pass up a $20,000 surgery, and the patient would never know the difference?” Her point was well made, but I thought to myself it would only matter if the doc had any ethics.
Just yesterday during her office visit here, she admitted even more to me. By now she is feeling “almost like new” again, and is very happy about her new-found chiropractic care. So, I asked her, “Why didn’t you go to a chiropractor earlier and save yourself a lot of pain.”
“Well, I was quite scared to be adjusted,” she explained, “because the doc always tells patients that chiropractors will paralyze you. For instance, just today I did a pre-consult on a 77 year-old man who had a myelogram and the doc wants him to have a basket implant. First of all, I can’t believe he wants to do surgery on a 77 year old man who doesn’t seem to be in all that much pain anyway.
“I know I might get in trouble if he ever finds this out, but I asked the man if he’s ever considered going to a chiropractor,” she admitted to me. “His wife jumped at this notion, asking me if I had. I told her I was seeing a chiropractor right now for my own low back pain, and that I was feeling much better. I made them promise that they would never mention it to my doc because I might get fired.
“I still can’t believe he wants to do surgery on a 77 year-old man, but it doesn’t surprise me at all. Actually, his office manager [who reportedly wears a mini-skirt and has great legs, as other patients have told me] gets a bonus if she can schedule 8 back surgeries each week. Her latest bonus was a face-lift and a membership at the local spa. They’re more than happy to do surgery on anyone who has the insurance to pay for it.”
It was obvious that she was annoyed by this situation. I could see her face express sympathy for these failed back surgery victims and how they were being exploited. Then she described her doc’s version of the voodoo diagnosis.
“The doc tells every patient that if they don’t have his surgery, they might be paralyzed. ‘If you just turn suddenly the wrong way, you might be crippled. I don’t know how you’ve made it this long without being paralyzed.’ He says that to everyone, scaring them to death.” And right into a surgery, of course.
“Ah,” I thought to myself, “the classic medical voodoo diagnosis.” Too many times I’ve heard this sort of remark from other patients. And, if they do have the nerve to ask about going to a chiropractor first, without hesitation the surgeon’s response is one of ridicule. “If you’re dumb enough to let a quack crack your back, don’t come crawling back to me after you’re paralyzed.” Enough said, fear implanted, case sold.
“By the way, what does he tell them in regard to informed consent?” I asked. Since I attended a NCIMC risk management seminar, my office does written informed consent on everyone, and it includes chiropractic iatrogenic rates as well as medical alternatives and their iatrogenic rates.
She explained to me their version of possible side-effects, such as paralysis, loss of bladder function and so forth. “But, under the heading ‘alternatives’,” she continued, “it simple says ‘none’.”
“How can he say that in this day and age when the AHCPR states SMT is a proven method for many cases of LBP?” I asked.
“Good question,” she replied, knowing he was not telling the truth to his patients.
Of course, I immediately thought of his liability if and when an irate failed back surgery victim gets well under chiropractic care and decides to sue for lack of informed consent. Perhaps this is exactly what needs to happen to force these knife-happy surgeons into doing the right thing—at least informing patients as to all alternatives.
The more she spoke about the con-artistry and greed she experiences daily, the more downcast she seemed. It must be difficult for ethical nurses to work in an environment built on fraud and deception, and at patients’ expense, literally and figuratively.
“I don’t know why he needs to do these unnecessary surgeries,” she confided to me. “He sees enough patients who actually need his service and he has more money than God himself. I just don’t understand why he needs to do surgery on these unsuspecting patients.”
She looked at me for an answer, but I didn’t have a good one. All I could imagine is, “Money sometimes makes good people do strange things. Hopefully we can help you avoid the same messy scenario.”
“Well, that’s why I’m here.”
I applaud her effort to inform her 77 year-old patient about chiropractic care despite her fear of being fired. Isn’t it sad that this truth can’t be known by everyone looking at possible back surgery? She felt culpable in this case as if she were an accessory to a crime, which she was in one sense. Her fear to inform the patient of his option to SMT also conflicted with her sense of ethics.
Indeed, too many well-meaning medical professionals must feel guilty about perpetuating the myths of the medical cartel knowing full well that chiropractic care could help the vast majority of these LBP cases. But with the huge amount of money at stake, I doubt any honest change will happen until these surgeons are forced to by law. Their refusal to acknowledge the AHCPR guideline and their effort to kill the AHCPR altogether illustrates their inherent dislike of anyone telling them what to do. Perhaps once the HCFA battle is done we should find failed back surgery plaintiffs to institute law suits against surgeons who ridicule chiropractic care or who refuse to give patients all their options to make informed consent. Now that’s one law suit I’d love to be a part of!
But, what do I know? I’m just a country chiropractor wondering why knife-happy surgeons get away with professional extortion, slander and perjury. Any thoughts?