Second Opinion Service

Regrettably we are seeing more patients asking us for a second opinion because they have seen another healthcare provider for back or neck pain and something doesn't seem "quite right". More often than not they have gone along for simple back or neck pain, had x-rays and been advised that their problem is "very serious" and they will need vast amounts of treatment. They are encouraged to pay up front, sometimes in excess of £1000, in exchange for a discount.

Fortunately, the overwhelming majority of healthcare providers do have your best interests at heart and it is not that common. However, there are a handful of clinics that don't share this philosophy so here is how you can spot them:

1. Questionable Marketing Techniques.

Health fairs and shopping malls often have healthcare providers giving free spinal examinations. There are a variety of gimmicks designed to procure you as a patient. The most common one is a "postural analysis" which lacks any sort or validity as our bodies are not symmetrical, most everyone will have one shoulder higher on one side or leg length changes by 1 or 2 millimetres which is not a cause for concern. If you have do have poor posture and no pain, a healthcare provider should not want to manipulate you, but instead should design an exercise program for you, or refer you to a therapist or trainer for such a program.

2. Questionable Use of x-rays.

Beware of any healthcare provider who uses x-rays for any reason other than to rule out a fracture, dislocation, or bone disease. If you are under 55 and have don't have any "red flags" such as weight loss, fatigue, the possibility of a fracture or a handful of other problems, then there is unlikely to be any clinical justification for exposing you to ionising radiation (x-rays). No person is perfectly symmetrical; no one's spine is perfectly straight and balanced. If you have low back or neck pain and normal age related wearing changing and your healthcare provider is encouraging vast amounts of treatment (often stating that your case is "very serious") and implying that you could get much worse if you don't have the treatment, get a second opinion before you continue care. In many ways MRI scans have replaced the use of x-rays and the costs have plummeted, a single region MRI scan can be as low as £200.

3. Excessive Treatment.

When a healthcare provider treats you, you should feeling some improvement within 1-2 weeks. Depending on the nature and extent of your problem, after a few visits you should notice modest improvement.

Beware of any healthcare providers who recommends a six or 12-month treatment plan based on your first or second visit. Here is what to look for:

If you go to a healthcare provider, they examine you (often making you watch a video), take x-rays, then invite you to come back a few days later (often with your spouse). They will review your x-rays, demonstrating minute details of normal age related changes implying that your case is "very serious" and that you will need "intensive treatment" recommending a treatment plan of 3 times a week for four weeks, followed by two times a week for 6-weeks, then once a week for 6-weeks and fortnightly for 6-weeks, often a range of 30-50 treatments and encouraging upfront payment in exchange for a discount.

The reason this is wrong is because it is impossible to predict how anyone may or may not respond to treatment. Ideally, if treatment is deemed appropriate, you should have a short trial course of treatment (in a range of up to 8 treatments) and see how you respond, as long as there is good improvement then the goal would be to reduce treatment frequency and guide you through a series of self help exercises until you are recovered or you have reached your maximum point of improvement. If you have not made significant improvement then you should receive a written referral to another healthcare provider (we have strong relationships with a number of local consultants and would be happy to point you in the right direction).

4. Prepayment Plans.

Beware of any healthcare provider who offers extensive prepayment plans with a discount for treatment. In our opinion these are rarely in the patient's best interest. As incredible as it sounds over the past two years we have seen numerous patients who have come to our clinic for a second opinion and have been advised that they will require "intesive" treatment and have been encouraged to prepay for up to 30 treatments sessions at a time. All this has been determined at the first or second visit. There are two possible explanations here, the first being that the clinician has incredible diagnostic skills and is able to predict your response to treatment that you have not yet had, or more likely, the proposed treatment is not in your best interests.

5. No Exercises for Recurrent or Persistent Low Back Pain.

If you are advised by your healthcare provider that your low back pain would not benefit from exercises or it is suggested that only their treatment can help you it should scream "red flag" that something is very wrong. Treatments like chiropractic, osteopathy, physiotherapy and pain management from a hospital can be extremely helpful in reducing specific episodes of low back pain but the key to any sort of good long term outcome is exercising, specifically strength and endurance. Flexibility has an important role in helping recover for an acute episode of low back pain but it has little impact in the long term (if you would like to see a study regarding this go here). Here are some general principles to follow when trying to reduce future episodes:

You need to increase endurance from the bottom or your ribs to the bottom of your buttocks front and back. For exercising to be successful you need four key components; 1. Structure 2. A specific goal to work towards 3. You need to work at a level that is challenging and "a bit hard" and finally 4. Once you have achieved your goal you need to maintain it.

If you are missing even one of these key components, what you are doing is not rehabilitation, you are pfaffing around and you are unlikely to make any difference to your long-term outcome. If you are serious about improving your recurrent or persistent low back pain then come and see us and we can guide you through and proper exercise program.

6. I'm Not Sure If I am Getting Better?

You need to be reassessed a regular intervals, this is know as "measuring outcomes" in clinical practice and should consist of key functional assessments such as mobility and trunk endurance tests; in other words "if we don't know where we have been we don't know where we are going".

When you are first assessed by a healthcare provider they should take a comprehensive history from you to determine the nature and extent of your pain and to rule out "red flags" (conditions that indicate a more serious causation of your back or neck pain). At this same time you need to have certain baseline measurements recorded that can be objectively reassessed every few treatments to ensure you are improving. This is much easier than you would think and all patients should complete baseline and follow-up questionnaires, we use the Bournemouth outcome assessment forms which have been validated in several large scale clinic trials. If you are not having regular reassessments with outcome assessment forms it's probably time to get another opinion.

7. Know Your Rights.

If you have had x-rays taken and would like us to provide you with a second opinion simply request in writing a copy of the x-rays (often on CD) and the written report of the x-rays. Anytime you have had an x-ray taken the healthcare provider is obligated to prepare a written report of what is found on the x-rays. Legally you do not have to provide a reason why you would like a copy of the x-rays, this is guaranteed under the data protection and access to health records acts. However, you may be requested to pay a small fee for a copy of the x-rays (often in the range of £10 but this may vary). Once you have a copy of the x-rays contact us to make an appointment and bring them along and we would be happy to review them with you. Please inform us that you are bringing x-rays for us to review so we can have a laptop ready for you.

Here is a sample letter to simply copy and paste;

As pursuant under the data protection and access to health records act I am hereby formally requesting a copy of the x-rays and the accompanying radiology report of (insert name) that your clinic took of me. I will be by to pick them up on (give them reasonable notice, legally they have 40 days to respond or provide an address where you would like them sent to). If you are unable for some reason to comply with this date please contact me in writing at the above address.

Sign and date the letter and send it by recorded delivery. In the unlikely case that the clinic refuses to comply with your request or demands a reason as to why you would like a copy of your records, simply contact the data protection commissioner by the above link.

7. A Good Healthcare Provider

Good healthcare providers do everything in their power to get you better as fast as possible with as few treatments as necessary. A good healthcare provider will give you advice on how to minimise future problems by guiding you through a specific exercise program to improve the strength and endurance of supportive muscles. A good healthcare provider will only x-ray you when necessary and will not use x-rays as a marketing tool for unnecessary treatment. A good healthcare provider will have a strong working relationship with allied professionals of all speciality's, including general practitioners; consultant orthopaedic surgeons; and MRI facilities. A good healthcare provider will put your needs first. This is our promise to you and this is why we have been chosen by Southend United Football Club to be their exclusive chiropractors.

It's all about the right people doing the right thing, it's time to accept the evidence.

It's what we do, it's what we are good at.