Value for money - more is not better


In 1991 I was, together with a couple of chiropractors and a few private practice physiotherapists, among the limited offering of private manual healthcare practice available in Dunedin and its surrounding regions. Together with an almost complete absence of therapeutic massage, the 'hands-on' musculoskeletal (MSK) treatment seeking demographic had extremely limited resources upon which to draw other than usual medical treatment and the sometime euphemistically referred to practice of 'shake and bake'.

Times have certainly changed and very much for the better. A growing appreciation for informed evidence-based MSK practice has seen both public demand and knowledge escalate dramatically. Unsurprisingly, the numbers of practitioners in the MSK field has also grown, in significant part due to ACC funding. This arguably provides a wider choice of service and convenience for patients.

Notwithstanding this, MSK practice remains a broad church encompassing significant variations of belief and practice from the evidence-based to the randomly intuitive. Of these approaches, some are clearly more effective than others. Dunedin possesses an exceptional MSK professional community serviced by an array of some of the most highly qualified, research centred individuals in private practice or as part of institutions. Furthermore, the presence and influence of the University and its schools seems inclined to foster an inherent awareness of the value of academic experience and credentials in the wider community.

So, a little research by prospective patients, exercising a smidgin of due diligence in 'discovery' might be useful in addressing wide variations in practice. It helps to keep in mind that more treatment is not as a rule, better. Excessive treatment, pointless over-servicing, particularly delivered in the absence of a stated diagnosis and prognosis must surely be a red-flag to any patient if not, their wallet. Concerning and true, there are patients wracked by continuing pain and anxiety having already received a substantial amount of expensive MSK treatment who seem quite ignorant of what they are being treated for, why, and for how much longer it should continue.

A public with growing health literacy and access to a veritable universe of information should respond to this with a measure of impatience and intolerance. The wisest and most useful thing any patient can do is become as well informed about their presentation as they can, to ask questions and clarify expectations around the management of recovery and rehabilitation.

As in all things, awareness and critical thought will serve you well.

Singh RA, McGrath MC. Editorial - Education for practitioners and patients. Australasian Medical Journal, 2013, 6, 12, 724 - 26.