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Hallo-fusion- Scaring you into surgery!

October 28, 2013 by

Surgeon HalloweenThe 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.

2 Responses

  1. Gary Keown, PT says:

    I appreciate the fact that spinal fusions are a problem and have observed many patients who “Cascade” from one disc level to the next as the limited motion from the fusion imposes stress on levels above or below.

    I counter that with an appreciation of where my referrals come from. I have had encounters with surgeons who are less than appreciative of the wisdom I impose upon my patients when it runs contrary to what they have told their patients. The risk of loosing a valuable referral base is significant.

    The only way I have found around this is to provide an educational booklet that the patient can then read and, hopefully glean a viewpoint that they can use to question the procedure suggested by the surgeon. This takes most of the “heat” off of me, the therapist, and puts the argument between the author of the booklet and the surgeon and the patient.

    I have seen one booklet that emphatically states “Surgery is not an option” regarding back pain and I think the author was “Blankenship” but I am not recalling the title at this time. McKenzie certainly publishes articles that encourage alternative approaches to back pain. Perhaps other writers to this blog have some suggested “quick read” pamphlets that can be offered to patients?

  2. Kim Lawler-Coyle, PT, DPT says:

    Over 33 years of practice I believe Conservative Treatment 1st, Conservative Treatment 2nd and when all that fails Conservative Treatment should still be considered again. I get that some people do require surgery and it is not possible to avoid, however, from my history as a Physical Therapist I think it makes far more sense to Exhaust Conservative Treatment methods such as Physical Therapy before any consideration of surgery where there is no turning back. Sure, there are situations that this would not apply, but there are many where conservative care remains the best option and is not selected. We just evaluated a patient recently with an exhaustive list of surgeries and a list of 20 medications. Yes, I said 20 medications! She is in very deconditioned and in severe pain and she trusted her surgeons and primary physician to help her make the right decisions. In my opinion, the right decisions regarding surgeries and medications were NOT made for this patient by her surgeons and physicians. Physical Therapy performed with compassion, empathy, skill, and caring along with kindly educating the patient is worth its weight in gold to change a very bad situation into a really good one. In fact, it is life changing where a professional PT took the time that no one else did to lead the patient in the correct direction. I became a Physical Therapist to serve the patient and the community and at the end of the day I have to live with myself by attempting to make the RIGHT decisions.

    Kim

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