Gaaaagggghhhh, what the pfwwwth. That’s it. I’ve had it up to here with these lot.

I’ve got a patient at C1 who’s got a raging sacroiliac joint and low-lumbar posterior facet syndrome (see this earlier post: http://chiropractor.blog.co.uk/2009/08/21/posterior-facet-syndrome-what-is-it-and-can-chiropractic-help-6775867/)
He had to go and see his GP so that his BUPA cover can be validated (which alone makes me spit - and see why later). The patient said, in an equally exasperated tone as this post, that the GP failed to look at any of his notes from his previous GP, who, incidentally, agreed with the chiro diagnosis. He then told the patient that the diagnosis and treatment we’d been advocating was wrong and that he should start stretching and get some exercise – on a sprained joint with some PFS to boot! Good grief, that’d be like me telling you to stretch an acute sprained ankle and walk about a bit on it. He then added that the only practitioners the patient should see should be osteopaths and then only those with a medical background (such as the one his wife was seeing). Good God, so the MSc level training is not enough to cover musculoskeletal issues such as this. Tellingly the patient, a wise man, said to me:

“I wanted to hit him and was thinking I do not like you now”

and, God bless him, he got up and walked out.

Well this was irritating enough but add to it this gem of resent research and I’m still gritting my teeth. There have been two bits of work done recently in the really solid journal Spine:

The first: Buchbinder R, Staples M, Jolley D. Doctors with a special interest in back pain have poorer knowledge about how to treat back pain. Spine 2009; 34(11): 1218-1226.

The second: Orthopaedists’ and family practitioners’ knowledge of simple low back pain management. Spine 2009; 34(15): 1600-1603.

The background for these studies is that low-back pain (LBP) patients usually first consult with their GP (and then perhaps a specialist). Back pain is the most common musculoskeletal reason for consulting a GP. So you’d think it would be sensible if these GPs had a pretty high level of competence in managing these patients. However these studies show that, taken together, those who are consulted first (in most cases) for LBP are not managing this condition in an evidence-based manner.

The Buchbinder study compared GPs with no special interest to those with a special interest in LBP. Those with a special interest were more likely to believe that complete bed rest (17.8% vs. 9.2%) and work avoidance (24.5% vs. 15.8%) are appropriate management approaches for acute LBP!

The studies showed that:
• 53% of surgeons incorrectly recommended treatment with cyclooxygenase-2 (COX-2) selective NSAIDs as their preferred treatment, versus only 8% of GPs;
• 67% of surgeons and 46% of GPs recommended some form of bed rest;
• Although both groups acknowledged the potential benefit of spinal manipulation, 51% of surgeons and 57% of GPs incorrectly suggested that it was appropriate in all cases of LBP;
• 29% of GPs and 46% of surgeons failed to rate patient explanation and encouragement as “extremely important”;
• 53% of surgeons and 8% of GPs felt imaging was always necessary;
• Overall, seniority was not related to questionnaire scores, and surgeons performed significantly worse (roughly 25%) than GPs (p < 0.0001).
The authors, rightly, then state: “Taken together, these results provide strong evidence that poorer beliefs about management of back pain is driven by a special interest in LBP. These findings raise serious concerns about how back pain is currently being managed among general practitioners with a special interest in LBP.”

Also, it is particularly terrifying that orthopaedist knowledge surrounding simple LBP is lacking, especially when you consider the major risks and poor prognosis linked to their primary intervention (the dreaded and dreadful surgery).

And there is a great quotation in the review where it says that there is a “disappointing picture of medical management of simple LBP.”

More details are available at:

http://www.researchreviewservice.com/content/view/1031/131/

And you wonder why I rage at idiots like this GP.

And breathe