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Literature Email

Exit forum ID Forum Discussion Literature Email

This topic contains 7 replies, has 1 voice, and was last updated by   William Brady, DC September 5, 2018 at 8:03 am.

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      This was an email I received over the weekend after completing an initial comprehensive exam last week and recommending treatment for lumbar complaint.  I assure you, i did not recommend IAR alone.

      Hi Dr. Zelasko’s office, I have made a decision not to continue with the proposed treatment plan and am requesting you cancel all my scheduled appts as follows:


      My review of current literature on the use of IASTM including an extensive review by the Canadian Chiropractic Association, resulted in efficacy concerns. 

      I appreciate your assessment which was congruent with other practitioners. 

      I’m just curious as to how you guys would respond to this email, approach you would take, etc?  Looking forward to seeing you all this weekend!


      Adam Holen D.C.

        Even at my current patient volume, I would not take that case or even respond. A patient who is that critical of “efficacy” in research is either a hypochondriac, tight on cash or just a general pain in the ass. Genuinely curious patients are fine to explain the process, but this one sounds like they would challenge you every step of the way and be a headache or potentially bad word of mouth. They need you, not the other way around.


        Brandon Cohen DC, CSCS

          I imagine this is a disc complaint. I don’t think I would do much of anything.

          I would like more color on this person though. If your assessment agrees with other providers, they probably have been burned by people telling them they can fix their problem and haven’t delivered.

          Did they seem on board after the ROF, or did it feel like they were lacking information? I love going through these ones because there are some hard lessons and good reminders to be seen.

          Actually, this patient sounds like they need strong guidance and leadership. We agree that IASTM does a terrible job for disc injuries.



            Brandon Cohen DC, CSCS

              This is really odd. If she is that motivated that she would do a research review, why isn’t she already fixed by reading a pamphlet?

              Does she have a cousin who is a chiro/ortho/PT that she has already failed treatment with? It seems like someone might be in her ear telling her things.

              There is no effective way to communicate to her your 14+ years of knowledge, information, and experience. Losers make excuses all the time. This is her current excuse. She now can say she went to you, and it didn’t work, so she can believe her own narrative that she is creating.

              It would be super tempting to provide her with an overwhelming amount of research to convince her otherwise, but that won’t happen.

              Or… you could send her the paper about the genetic component to disc injuries, explain to her that its her parent’s fault, that she was born destined for this problem, also its all in her head and she just needs to work out more. Also explain that nobody understands why she has pain, and its a mystery so increase load and make more bad decisions. Tell her these things just get better if you can think it through….actually do not tell her these things.


              Eric Lambert, DC

                At least she seemed to like your assessment…

                “which was congruent with other practitioners”

                I’m not sure you need to reply with anything except maybe a thanks for letting me know and have a nice day. It’s always best to let patients like this move on elsewhere to be run through the medical system without causing you more headaches in the long run.


                Carl Nottoli, DC

                  Any review of MSK treatment on low back pain has efficacy concerns. Wrap up in bubble wrap and stay home.

                  But in all seriousness, I really like Brandon’s thought process and questions he posed. What happened to make this patient feel the need to do this. What was said or not said (verbally or non-verbally) to make them feel the need to look outside of your expertise.


                  William Brady, DC

                    I love this thread.

                    This is probably the kind of response I would have had (as a lay patient) if I became an engineer instead of a chiropractor. Do a research review and go with the proven treatment. However, we (ID providers) know it’s a naive response. She was kind enough to cancel and let you know why. In the big picture it’s perfectly reasonable.

                    As Brandon stated she may have been burned too many times or just be too analytical to respect the art of healthcare instead of just the research.

                    I would be tempted to explain the difference between IASTM and IAR, explain the addition of MAR, explain load management, explain diagnosis etc… but this would fall on deaf ears. Just reply with “Thanks, we will take you off the schedule. If you change your mind we are here for you.”

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