The week of spooks, witches, goblins, and ghouls is upon us. The Washington Post today is starting the party early with the extremely informative article on what remains one of the most overutilized procedures in health care- Lumbar Spinal Fusion. The article points to many of the issues we have previously discussed on the blog here and here. It discusses the unprecedented rise in spinal fusion in the last 20 years. It also discusses the lack of evidence supporting the procedure and mentions the one study supporting it was funded by the spinal fusion industry. The facts are the facts. However what is most disturbing is the quotes from actual patients. Patients with back pain are being scared into surgery. Some of the most troubling quotes included why they must have surgery! ”He warned them that they were going to be “crippled” or “in a wheelchair” if they didn’t.” Another patient, “I’d have one and then another,” he said. “I can’t explain it, but I had to have them. Dr. Vinas said if I didn’t have it, I’d have been paralyzed.” This harkens to Bedell et al.’s classic commentary Words that Harm, Words that Heal.
Are physical therapists complicit in this continual march of ever more and more use of ineffective procedures that cause harm? Do we provide a counter opinion for these patients with words that heal? Do we “slow down” the decision making process by providing reassurance to our patients that these are elective procedures and lets focus on improving your functional status and achieving your goals? As this frightening week begins lets commit to being the positive message to counteract the scare tactics often used in medicine.