More is not better


In 1991 I was, together with a couple of chiropractors and one or two physiotherapists, the sole offering of manual healthcare practice available in Dunedin and its surrounding regions. Together with an almost complete absence of therapeutic massage, the 'hands-on' musculoskeletal treatment (MSK) seeking demographic had extremely limited resources on which to draw other than usual medical treatment and the 'shake and bake' brigade. With the severe paucity of practitioners also came limited awareness of the other discrete clinical disciplines of MSK treatment.

Times have certainly changed and for the better. A growing appreciation for informed evidence-based MSK has seen both public demand and knowledge escalate dramatically. Awareness of an alternative or additional manual specialist intervention in conjunction with available pharmacology has led to the appreciation that recovery and rehabilitation need not necessarily be long and painful. Unsurprisingly, the numbers of MSK practitioners available has also grown. This is good for it provides greater choice and convenience for patients.

Dunedin possesses an exceptional MSK professional community serviced by an array of some of the most highly qualified individuals in private practice or as part of institutions. The presence and influence of the University and its schools instals the awareness of a higher bar in the community, one where credentialed experience appears valued.

Notwithstanding this, MSK practice is a wide church with varied beliefs and approaches. Of these approaches, some are clearly better than others, some more evidence-based, rigorous, systematic, scientific and methodical, others far less so, or indeed, non-existent or merely purely anecdotal, placebo and frankly, random. A little research by a prospective patient in 'discovery' might help address such variations in service. It also helps to keep in mind that more is not as a rule, better. Excessive treatment, pointless over-servicing and treatment, particularly delivered in the absence of a diagnosis and prognosis must surely be a red-flag to any patient and their wallet. Concerning and true, there are patients in continuing pain and anxiety having already received a substantial amount of expensive MSK treatment who seem quite ignorant of what they were being treated for, why and for how much longer it was supposedly required.

Far from an ideal state of affairs this should not be tolerated by a public with growing health literacy and access to a veritable universe of information. The wisest and most useful thing any patient can do is become as well informed about their presentation as they can. Stick to well known and readily identifiable institutional web sites to help develop some awareness, knowledge and understanding. Your awareness and critical thought should serve you well. If it doesn't, exercise your choice.

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