Ethical MSK Practices
Ethics, Morality, finding a good Musculoskeletal health professional
There are occasions when the author lacks availability, geographical constraints, or a patient is moving, leading to this article's creation. The initial aim of this article was to help existing patients, their friends, and relatives find a good MSK Therapy practitioner in the author's absence. However, it should be equally helpful to the broader general public to help avoid unethical "bad actors" within the profession.
One might think that finding a good health professional is relatively simple, but sadly this is often not the case. The author has seen an alarming rise in targeted marketing campaigns aimed specifically at primary care practitioners, their practices, and with an emphasis on rapidly increasing patient numbers. Many of these marketing schemes utilise extremely questionable moral and ethical practices, which are highly likely to breach professional codes of practice and ethics. It is equally concerning that some operators of these marketing schemes are using video testimonials from supposed Allied Health Professionals on how effective the systems are at booking lots of patients using a simple script. Speaking from experience, the author has seen many of these dubious practices operating. Sadly, many of these practices seem to have found a home with a highly vocal and relative minority of the Chiropractic profession. Many of these techniques are now rolling out to other disciplines, and the clear focus is money, not the patient. Hence, the patient's ability to carry out due diligence is more important now than ever. Critical takeaways from this article are:-
"If it sounds to good to be true, it probably is"
"Who's best interests are at the heart of the practitioner's decision-making process?"
"Perform due diligence into the practitioner, technique(s) and claims"
The article is broken up into sections covering general considerations when looking to find a good MSK health professional, followed by behaviours that may be associated with good and bad actors within the profession.
- General considerations:-
- The Musculoskeletal Profession
- Musculoskeletal profession training and education
- Regulation and Professional Associations
- Recommendations and reviews
- Award Winning and Vanity Awards
- Good and Bad practitioners/therapists
- Good practitioner behaviours
- Bad practitioner behaviours
- High-pressure sales tactics
- Bundling "free" add-ons
- Sweeping Statements
- Plausible similar injury story
- Negative Narrative or terminology
- Large treatment blocks
- Multiple treatments per week
- Free weekly wellbeing / patient information events
- Payment plans and credit agreements
- Unnecessary chargeable products or procedures
- Inspirational Quotes (Good or Bad)
The Musculoskeletal Profession
As with all professions, there are "good" and "bad" practitioners. The Musculoskeletal - MSK field is no different, and being "good" or "bad" is not necessarily an indication of success or failure. Some highly successful practices within the Musculoskeletal - MSK field operate dubious/unethical practices until they get caught.
There is a wide range of disciplines within the Musculoskeletal - MSK health field, with varying educational requirements, scope-of-practice and professional status. Some of the more commonly known practitioners/therapists within the MSK field include (purely in alphabetical order):- Chiropractors, Exercise Physiologists, Massage therapists, Musculoskeletal Medicine Doctors, Myotherapists, Orthopaedic Surgeons, Osteopaths, Physiotherapists, Podiatrists, Sports Therapists. There are countless other less well-known practitioners, treatments and techniques, some with awe-inspiring and scientific-sounding names, usually encompassing words like Bio, Neuro, Physical or variants of Spine. Chiropractors or ex-Chiropractors have developed many techniques, and the similarities are often uncanny. Practitioners may use Chiropractic drop-tables, inspirational Chiropractic quotes, and similar techniques to diversified Chiropractic. However, such procedures are unregulated, unlike the Chiropractic profession, and the training is considerably less. It is important to remember that anybody can set themselves up to work with patients within the musculoskeletal therapy field and even invent a technique with little to no relevant training or education. Hence, the saying "buyer beware" is very apt, and patients should do their due diligence. As for which practitioner or therapist is the best, there is no specific answer to that question, so patients should not fixate on just one profession to solve any problems. However, there are cases where a particular profession is required, such as when surgical intervention is needed. Fortunately, a conservative treatment approach works in most cases, and surgery is in the minority of situations.
Equally, several factors influence how each practitioner works. Practitioners can be affected by personal interests/experiences, the academic institution they trained at, the higher education level, the specific profession they have chosen to train in and a wide range of other factors, including behaviours. Hence, just because two professionals have training at the same academic institution does not mean they will work (behave) in the same way. Typically, if a patient has a bad experience with one or two individuals from any given profession, that can lead to the patient effectively writing off the entire profession.
Musculoskeletal profession training and education
The base training and education for Allied Health professionals working within the MSK field is more in-depth than that of Myotherapists and other Soft-Tissue Therapists. However, the behaviours associated with how a practitioner then utilises knowledge within a patient context can significantly impact patient outcomes. Chiropractors, Physiotherapists and Osteopaths are required to complete a degree or Masters's level qualifications. Other soft-tissue therapists may have to complete an IV Certificate, Diploma or Advanced Diploma in the case of Myotherapists. Based on the author's experience teaching, there can be surprisingly different levels of knowledge between students from various training providers and yet at the same academic level of qualification. It may be surprising to hear, but the author is aware of cases where practitioners/therapists have been using techniques they are not qualified or trained to use. If somebody is unqualified, there is no way they will be covered by insurance and breach any professional registrations.
Equally, there are many patented or trademarked therapy techniques. Just because something is patented or trademarked does not necessarily mean it is better. It is more a case of protecting intellectual property, which has financial value and providing training can prove highly lucrative. Some such techniques require practitioners to complete the initial training and further yearly continuing professional development/education. By fulfilling the annual, bi-yearly or tri-yearly requirements, practitioners can utilise the trademarked technique name and appear on the relevant technique providers register. The issue of practitioner/therapist skill qualifications or currency is easy to see with a simple example:-
Active Release Technique (ART®) is a reasonably well-known soft-tissue therapy technique with a certified practitioner register. A simple local search for Brisbane and Active Release Technique (ART®) on a search engine highlights many practitioners. However, if one searches the ART® Certified Provider register on activerelease.com, far fewer ART® Certified Providers appear within the same geographical (Brisbane) area. Such a situation raises legal and ethical questions for those practitioners claiming ART® Certified Provider status. There may be potential insurance issues for not maintaining the particular technique's certified provider status. Such a situation may be a genuine mistake or a sign of dubious practices. There is no harm in asking for a practitioner's qualifications and other relevant credentials, and patients should carry out due diligence. That said, as is covered shortly, professional registrations and memberships have stipulations governing acceptable qualifications and other annually recurring criteria.
Although education level has relevance to finding a good professional, it takes no account of how one applies it. Equally, some practitioners only complete the minimum yearly continuing professional education and consider it a chore. For example, a massage therapist could have far more experience and undertake vast amounts of additional relevant training compared to another allied health professional. It is also important to remember there is a significant practical element to treating within the musculoskeletal field. One could be academically brilliant and yet have a terrible "patient bedside manner".
Regulation and Professional Associations
Allied Health Professionals operate with legally protected titles and are regulated, which offers an additional level of protection to members of the general public. Regulated professionals must meet yearly requirements to maintain their practising status, including yearly continuing professional education, code of conduct/practice, ethical considerations, insurance requirements etc. Regulated professionals can face disciplinary councils, have restrictions placed on their practice or get struck off in the most serious cases.
It is straightforward for patients to carry out due diligence and check the registration status of a practitioner or therapist by simply searching the relevant body's register. Regulated professions have searchable records, as do professional associations. Surprisingly, some therapists will tell people that they work as a regulated health professional, such as a Chiropractor, Physiotherapist, Physical Therapist or Osteopath. Regulated health professionals will be on the relevant regulator's register, and it is illegal for a person who professes to be such if they are not on the register.
Myotherapists, soft-tissue therapists and other professionals working within the MSK field tend not to be regulated. That said, reputable professionals will likely hold registrations with relevant professional bodies. Like regulated professions, professional associations operate similar yearly requirements for registrants and can discipline or deregister practitioners who fail to meet the annual requirements. As with regulatory bodies, membership in a professional association(s) offers some level of confidence and protection to members of the general public regarding individual practitioners. The author would advise that patients seek out people who are registered with and or regulated. Both offer the patient some form of protection and recourse if needed. Forms of accountability are highly relevant in light of some marketing practices targeting health professions.
Recommendations and reviews
Although personal recommendations and even online reviews can be helpful when finding a good practitioner, there are things to consider. Consumers must be comfortable with who they see and how that practitioner works with them. We are all different, and what works for a friend or relative may or may not work for us. Also, treatment should be a collaborative process, so people must think honestly about motivation to change or do related exercises. A friend or relative could be highly motivated to return to activity, whereas somebody else may not. Personally, the author would go with a personal recommendation from a friend or relative over online reviews. Unlike a review, one can always ask questions of somebody with first-hand experience. The author has been treating for over sixteen years, and in that time, he has probably had less than twenty online reviews written. Online reviews take time for people to write, and the author has found that it is easier for patients to tell friends and family in person or via social media. Sites like Google also have rules for writing reviews, stipulating that reviews should not be incentivised and unbiased. Equally, reviews do not move from one company or country to the next, as the author knows all too well, though the TotalMSK UK Google Business ® listing still has some reviews, unlike the Australian listing.
The other more severe issue with online reviews is that many fake reviews exist [1,2] . Some unscrupulous companies offering web marketing services have written fake reviews for products and services. Such issues do not just relate to large well, known online retailers. Such marketers have previously contacted the author offering an "X" number of five-star reviews per month for a monthly fee. More recently, the author has been approached by practice acceleration marketers, offering 30 five-star reviews on Google in exchange for a five-star review of their services. The author has seen some very dubious reviews regarding professionals within the musculoskeletal field. Typically, the reviews were concise and positive, with little detail and unusual posting patterns. The chances of 30-40 patients all writing short reviews on the same day or over a few days are slim. Especially when the pattern repeats every few weeks or months. After all, "You can please some of the people all of the time, you can please all of the people some of the time, but you can't please all of the people all of the time" [Poet John Lydgate] is very apt. Hence, based on probability, it might seem unusual that a practitioner can have hundreds or even thousands of only 5-star reviews.
Marketers have used video testimonials from paid actors and genuine customers for years due to the powerful, influential effect on people. Such practices often go hand in hand with before and after pictures as evidence, which are incredibly subjective. Similar video reviews exist within the Musculoskeletal health profession, either from alleged "happy patients" or "allied health practitioners", as mentioned at the start of this article. As a health professional, encouraging and then posting testimonials of patients raises substantial ethical and moral concerns. Again, who's interest is at the heart of getting a patient to record a video testimonial and then post it for the world to see?
"Award Winning"??? and Vanity Awards
Besides, reviews "Award Winning" may appear in descriptions of various musculoskeletal professional's websites or internet search results. Some awards may be genuine and professionally relevant, while others are not. The author has some experience with such awards after being contacted about winning one on multiple occasions.
The awards always had a common theme of a small and usually geographical location, category and sometimes class. Effectively, the narrowness of the criteria above made it clear one would win the award. Advertising legislation in most countries prevents a company from buying or selling awards due to the misleading nature of such behaviour. However, marketers have found a way around this. In essence, one has to pay to attend an overpriced and ticketed black-tie gala event to get the award. There are usually various paid options around publicity packages too. Receiving such an award would have been morally and ethically questionable and misleading to the general public. Hence, it is always worth checking why an award was given, by who and for what? If members of the public feel that a particular award is misleading, then one should report the matter to the relevant authorities.
Good and Bad practitioners/therapists
In essence, "Who's the best interest does the practitioner have at heart, theirs or yours?" Remember that codes of ethical practice for professionals holding registrations with regulators or professional associations have a patient-centred focus. If the author were going to see a musculoskeletal practitioner with only one condition (problem), he would expect a marked change in his symptoms within three treatments, provided he followed aftercare advice. He would find another practitioner if he did not see any improvement within a three-treatment timeframe. Multiple conditions can complicate matters due to one area of the body's impact on others.
Good practitioner behaviours
Good ethical practitioners will have a patient-centred focus, putting the patient at the heart of everything they do, not their bank balance or ego. The patient-centred principle applies from the initial consultation process and throughout any treatment plan if one is warranted. A good practitioner will take a detailed history and time to assess the likely cause of the patient's symptoms and other health-related factors.
A critical difference between good and bad practitioners relates to patient empowerment.
Empowering a patient involves providing a detailed explanation of what is going on (symptoms), why it is going on (injury mechanism), understanding what the patient is looking to get from treatment (goal), agreeing on a plan of action to achieve the patient's goal. Empowering is a process enabling the patient to control their treatment/destiny via a combination of education, self-management strategies and professional support if needed.
Consumers need to understand that treatment is a collaborative approach, and a good practitioner will actively involve patients in the treatment process. Consumers should be given some aftercare advice or homework during any treatment plan, and following any such advice is equally important to any treatment provided. Aftercare advice could include one or a combination of prescriptive exercise, habitual changes or self-treatment.
Bad practitioner behaviours
For this article, a bad or unethical practitioner is one whose actions do not have the patient's best interests at heart. Such therapists can often use a combination of unethical and immoral practices, all of which appear designed to disable (build patient reliance) rather than empower the patient. Consumers should be highly mindful of practitioners exhibiting behaviours designed to disempower them and report them where applicable. If one encounters a variety of the following behaviours as a patient, one might be with a bad actor within the profession.
Marketers have utilised "Emotional Manipulation" to get patients to part with their hard-earned cash for millennia, and such techniques have developed over time. Emotional manipulation is at the core of "bad practitioners" operations, and there are many tell-tale signs of such behaviours and practices. Although reviews and awards may be genuine, it is better to perform due diligence and investigate further. Marketers hope to use emotional manipulation to create a positive impression in the patient's mind and bypass any more detailed thought process. Such a process makes people invest the time in seeing the practitioner first, at which point other techniques may come into play. Once somebody has emotionally invested in a process, it is much harder to extricate themselves from the situation. Social media has become a prime place for practitioners to funnel patients through the clinic door. One will frequently see targeted ads on social media with opening phrases or a call to action like "We're doing something AWESOME" or "We're doing something special". Such adverts then include many attributes or "Hooks" covered below. Equally, such adverts tend only to show positive social media responses, as the advertiser has some control over their adverts. Such advert postings are then regularly repeated, with few, if any, changes.
High-pressure sales tactics
During the author's 15-plus years in practice, he has heard patients describe some extremely unsettling high-pressure sales tactics they have encountered. Typically, such patients had responded to a supposedly hugely discounted (70-80% or more) initial consultation rate advertisement. Such offers invariably involve several sales and marketing techniques to get the patient in the door, and other clever underhand tools come into play to influence patient behaviour.
Such offers invariably involved various patented or, more frequently, trademark-named equipment, scans, colour graphics, x-rays (in some cases) and glossy reports of findings. Just because something is patented or trademarked does not mean it has any clinical relevance for treating a patient. There is a range of expensive and scientific-sounding equipment in use, with various practitioners claiming to measure all kinds of things, including Subluxations (the Chiropractic version). Using such equipment is nothing new, and using two sets of weighing scales to indicate a difference in weight distribution is a classic.
However, collecting and displaying information in various impressive ways is now possible and a good way to influence consumer behaviour. Many manufacturers of such products market their wares as ways to generate new revenue streams for practitioners or to differentiate themselves from the competition. Equally, glossy, colourful images can make a report look better by an unethical practitioner. That said, there are cases where medical imaging (MRI, X-ray, CT, Ultrasound) may be warranted.
For example, the clinical relevance of showing graphical strength improvements during rehabilitation work over time has little relevance for most of the population. A patient would be aware of strength improvements by following the treatment program, and the intricate level of detail is unnecessary. Much of the equipment is expensive, so patients are footing the bill one way or another. The detailed information provided by such equipment may have relevance in professional sports and where absolute maximal performance is necessary. The clinical relevance of such information is also likely to apply to insurance companies or work cover claims, as they generally need lots of detail. Hence, it is worth doing some due diligence regarding the promoted equipment and the value of the data produced.
Bundling "free" add-ons
These sales techniques are frequently used on television shopping channels to sell everything from cooking wares to cosmetics. The pitches always start with supposed problems that the customer may encounter, real or perceived, followed by how the product solves said problems. The adverts then gradually mention the free additional add-ons and explain how you, the customer need them. Some mention of a rough and high price one might expect to pay for such a product or products may then get mentioned between the bundled items or right at the end. Hence, the process makes consumers believe they are getting something amazing for a bargain. Bundling in conjunction with add-ons relies on and encourages emotional decision-making to buy. Emotional decision-making conveniently bypasses our normal higher brain function decision-making processes, affecting the quality of our decisions.
For example, a practitioner might offer a group of individual items with a stated standard cost value for each. The items might include specific techniques, assessment methods, scans or imaging, which may have zero clinical relevance. The indicated value for all items might add up to $290 or more, but the special offer rate might be less than $50 or $100. Whether anybody has ever paid $290 for all of the "special" bundled add-ons is open to debate and usually hard for a potential patient to verify. Typically, bad actors make it hard for consumers to easily compare different practitioners' services by not listing regular general treatment pricing, actual treatment durations or specific bundled items. Some special bundled items may not appear anywhere on the practitioner's website or other marketing literature as individual items/services. Some practitioners treat patients as if they are on a production line under the admirable guise of trying to help as many people as possible. Such a situation frequently occurs with some family wellness Chiropractors. Typically, initial consultations maybe 30 minutes, but often treatment times are 15 minutes or less, though it is not always easy to establish such details. Hence, it is worth taking a few minutes to do due diligence and avoid taking such promotions at face value.
The author has seen a prevalence of such techniques within a minority of Wellness-based Chiropractors. Such Chiropractors may also bundle x-rays within the special offer rate, again with a stated value and thus assumed saving. Offers involving x-rays also include a caveat saying "where indicated", as legally, x-rays need clinical justification. However, justifying exposing a patient to unnecessary radiation is relatively easy for a bad actor in practice. Also, the supposed value saving to the patient for having x-rays taken may not come out of the patient's pocket anyway, with medicare picking up the bill. The special offer rate and the additional x-ray fees can make the bundled promotion worthwhile for an unethical practitioner, with the patient none the wiser.
These offers are often limited, meaning consumers feel they need to be quick or miss out. Such offers may combine with "scarcity" and "exclusivity" to include some other supposed value item for the first 20 new patients, making one feel special and encouraging part-taking in the offer. These offers are often limited, meaning consumers feel they need to be quick or miss out. Such offers may combine with "scarcity" and "exclusivity" to include some other supposed value item for the first 20 new patients, making one feel special and encouraging part-taking in the offer. Many of these limited-time offers appear regularly, which just goes to show how special they are.
Many tried and tested high-pressure sales and marketing techniques work on human psychology (consumer behaviour) and should have no place in ethical healthcare, yet disturbingly they are far too prevalent. Such a technique also involves another powerful method of emotional manipulation, "reciprocity". We usually feel indebted to the other person if given something for free. All of the free add-ons within such offers play on manipulating that natural emotional response. Such offers usually appear on social media, flyers or other short-lived media forms. It is also interesting that such operators make it very difficult to find "normal" pricing on their more permanent web presence. If somebody is hiding treatment costs, there is a reason for doing so.
Statements "Hundreds of patients successfully treated"
Equally, a marketer or health professional could make statements that they expect potential patients' to take at face value. Typical statements might include "hundreds or thousands of patients successfully treated by a given treatment or technique". The simple question is, "Where is the evidence?". Again, one should be mindful of reviews and ideally should try and find multiple sources to confirm claims, especially in cases of social media advertising. Sadly, social media is often a hive of misinformation due to a lack of regulation.
Plausible similar injury story
Sometimes, marketers will use a plausible story personally relatable to potential patients. For example, a practitioner may have a tale of suffering from back pain or similar from early in life or due to injury and then found some treatment that changed their life. Such a story could be genuine, though if the practitioner uses other potentially "emotionally manipulative" techniques, one should be wary. A similar story to potential patients creates a form of "common ground" or "mirroring" and reduces the perceived risks of finding a practitioner who can achieve the patient's goals. Such a process occurs in the patient's mind before they invest the time and effort of seeing the practitioner.
"Never let the truth get in the way of a good story" (Mark Twain, Author).
Negative Narrative or terminology
Clever use of negatively worded terminology and fear-mongering can further disable a patient and make them feel that they have no choice but to see the therapist. Creating fear within a population is a long and well-established way of exerting influence over individuals or groups. The process is often performed gradually over time. Such practices are more evident now than ever, partly due to the advent of social media and the ability to disseminate information rapidly. The author has seen vitalistic or subluxation-based chiropractors using the term "spinal decay" in the health profession. Spinal decay does sound terrible, and the various posters and models of vertebrae in various states of "decay" do not help matters. However, "spinal decay", by definition, is not a medical condition. The use of a negative narrative is not restricted to the Chiropractic profession either. Hence, beware of the terminology used by a practitioner. Is the language in use helpful to you, the patient or not?
Large treatment blocks
Being asked to sign up for large treatment blocks and being offered a supposed discount for doing so is not in the patient's best interest. Such behaviour is generally frowned upon by regulators but not banned. Consumers may feel under undue pressure to sign up when they attend their report findings meeting, which is disempowering by nature. Consumers can effectively become financially and psychologically locked into a protracted treatment process and reliance on the practitioner. Practitioner's using large treatment blocks should provide patients with details of how they can exit such plans and what costs they may incur for doing so.
The other more prominent issue with large treatment blocks is that they take zero account of individual patient differences. How a patient responds to any given treatment can vary primarily due to individual patient differences and following aftercare advice. Occasionally, a patient may require a single treatment, though this is not hugely common. In the 15-plus years the author has been treating, he has never seen a single patient who would have benefitted from a large treatment block.
Particularly unethical practitioners will use potential patients' words to get them to sign up for a treatment block. For example, a practitioner could say at the outset of an initial consultation, "What value do you place on health?" which seems innocent enough. Most people would say that they cannot put a price on health or may need prompting to come to that conclusion by the practitioner. The practitioner may then go through the assessment process and present findings on the day, or the patient may have to return for a report of findings at a later date. Either way, after going through a very slick presentation to the patient and a treatment plan, the total cost of treatment will invariably arise. The patient then learns the plan's cost and the number of treatments necessary, which can often be an eye-watering amount. However, the patient can get a large overall treatment discount for signing up for a block of treatments and make a significant saving on the treatment plan. If the patient questions the plan's cost, even at the discounted rate, they may suggest a credit agreement (see later) or bring up the previous conversation. The fact that the patient agreed that you could not put a price on health then comes into play to influence consumer behaviour and pressure to sign. All are highly unethical and unscrupulous, but sadly such things happen.
Multiple treatments per week
Some practitioners operate multiple weekly appointments with patients, typically two-three appointments a week for "X" weeks. Such treatment frequencies tend to occur with large treatment blocks, though that is not always the case. The rationale for a regular treatment schedule often works with other bad actor practices. Sometimes, the standard treatment schedule is likened to the benefits of regular exercise 2-3 times a week and sold as a proactive long-term solution to wellness. Although there is conclusive evidence about the wide range of health benefits from regular exercise, there is a distinct lack regarding frequent (2-3 treatments a week) long-term spinal-related treatments. Sometimes such practitioners also talk about how damage to the spine through life events and daily activities is not fixable, which has an element of truth. Effectively such a statement resigns one to such facts, which means that logically a regular (2-3 treatments a week) long-term maintenance treatment is the only way to keep things optimal and counter all the damage we have done. Using such statements impression is very disempowering, not how an ethical practitioner should operate. The body is extremely good at healing and adapting to all kinds of trauma, though it sometimes needs a bit of external help. Hence, there is no need for frequent (2-3 treatments a week) long-term for "optimal spinal health and wellness".
Elements of the Chiropractic profession have historically operated such practices, particularly subluxation-based Chiropractors, sometimes called Wellness Chiropractors. The premise is that regular and often short treatments, 2-3 times a week, ensure optimal signals from the brain to the body via the spinal cord. Supposedly, regular visits allow the therapists to monitor optimal spinal health and make small "tune-up" changes where needed. Equally, some Chiropractors believe that subluxations cause interruptions to the correct functioning of the nervous system. Chiropractic subluxation is then the cause of all ill health. Allegedly, treating or removing the subluxations would free the nervous system to communicate and enable the body's "innate" ability to heal itself, creating a miracle cure for everything and anything. Sadly, there are reported cases of patients with serious illnesses dying due to ceasing general medical care and believing that treating blockages in the nervous system would provide a cure.
Other less well-known treatment modalities uncannily place the mantra of correct functioning of the nervous system at the heart of the therapy methods. However, such therapies have a different name for "subluxation" and supposedly do not manipulate and work on soft tissues. However, there are also many other similarities in terms of treatment frequency, treatment duration (short), what the therapy is supposedly doing, and the methods that look uncannily similar to diversified Chiropractic technique setups. The other thing these methods have in common is the rationale of promoting optimal spinal health and wellness, which are deliberately vague terms. The Chiropractic subluxation and the concept of innate intelligence are both long debunked. Yet, there is a small, highly vocal minority in the broader Chiropractic profession who place great emphasis on such outdated philosophical beliefs. Historically, before radiation's dangers were known, Chiropractors would take x-rays to show patients' subluxations. However, even with the advances in various imaging techniques, there is still zero evidence for "Chiropractic Subluxation" and even less evidence for the other therapies with variations on the subluxation doctrine.
It is very disempowering to encourage patients to sign up for large appointment blocks combined with multiple treatments (two-three) per week, not to mention expensive. Such a regular treatment frequency is effectively a form of psychological conditioning, developing a routine, making one feel obliged to be treated and building reliance on the practitioner. Such conditioning can make it very hard for the patient to extract themself from the situation, even when the frequency of treatments is a huge and stressful financial burden. Often one feels great after most types of treatment, typically for a day or two, and then one might start to notice some stiffness as the body adapts. However, being seen every few days barely gives the body time to adapt and respond to the benefits of any treatment or aftercare advice. Hence, as a patient, you never really know things are going, even if you are paying a lot every few days to feel good very short term. Equally, the regular frequency of treatment enables bad actors to use other psychological sales tricks to reinforce the behaviour of regular treatment attendance. Much like if one is going to change their phone contract, a person usually calls to persuade them to stay/renew. A genuine ethical health professional should take a patient-centric recovery-orientated approach and not a personal wealth view. The author has never needed to treat a patient more than twice in any given week, which is a rarity. Occasionally, patients have had a setback or a different injury during a treatment plan, thus requiring additional treatment. Typically, the author has spaced patient visits between seven and eight days apart due to aftercare advice and Soft Tissue Adaptation to activity and injury (see article).
Free weekly wellbeing / patient information events
Fortunately or unfortunately, the author has never had the pleasure of attending one of these such events. The author cannot see any rational or clinical reasoning behind patients attending such general and non-specific weekly well-being events. Such events appear to reinforce the patient's decision to continue with "family wellness" treatment based on conversations with those who have attended such events. If valid, this is particularly concerning and unsavoury behaviour and equivalent to how a cult recruits, retains and grows its following. Much like the multiple regular weekly treatments, attending a weekly event with other patients builds routine and helps condition somebody. The conditioning effect is even more potent because other patients attend the same weekly event, which can add to any perceived legitimacy. Such events are very different to support groups, as support groups focus on the individuals attending them and not the financial interests of a practitioner/clinic.
Payment plans and credit agreements
Being asked to sign up for large treatment blocks and being offered a supposed discount for doing so is not in the patient's best interest. Such behaviour is generally frowned upon by regulators but not banned. Consumers may feel under undue pressure to sign up when they attend their report findings meeting, which is disempowering by nature. Consumers can effectively become financially and psychologically locked into a protracted treatment process and reliance on the practitioner. Practitioner's using large treatment blocks should provide patients with details of how they can exit such plans and what costs they may incur for doing so. As previously mentioned, credit agreements or payment plans are often tied into the "You can't put a price on health" statement and pressure to sign.
Unnecessary chargeable products or procedures
Some practitioners charge additionally for consumables used during treatment, such as needles, tape etc. Such practices can incentivise unethical practitioners to provide treatments that produce the most financial gain rather than what is in the patient's best interest. Equally, some practitioners sell supplements as part of their treatment plan. The author would rather see an expert, such as a higher education qualified professional (nutritionist or dietician), rather than somebody who may have studied a nutrition module. Charging for unnecessary imaging has historically been an issue too.
Inspirational Quotes (Good or Bad)?
Some musculoskeletal health professionals have excellent-looking clinic setups, displaying inspirational quotes inside and outside the clinic. Inspirational quotes can undoubtedly empower the patient on the face of it. However, it is essential to look beyond the inspirational quotes and see what is happening within the clinic environment. It is always better to judge by actions rather than just words. The words may sound empowering, but is everything else designed to build reliance and disempower you, the patient?
There are many examples of such quotes, including "The greatest wealth is health" (Roman Poet Virgil). An unscrupulous practitioner could easily use such a quote and sales techniques to justify a long and expensive treatment course. Logically, most people would agree that you cannot put a price on good health, which is the starting point for said unscrupulous practitioners. If one logically agrees to such a statement, it is much harder to psychologically question the potentially high cost of an excess treatment plan. Such a situation is especially true if the practitioner subsequently raises the patient's point about agreeing that you cannot put a price on health.
The article was written by Terry Davis MChiro, BSc (Hons), Adv. Dip. Rem. Massag., Cert. WHS.
The Morningside clinic occasionally runs promotional treatment rates for new and existing patients, which are available via the online booking calendar. If you liked this article or found it interesting, feel free to share the content with others. There are lots more articles available via the TotalMSK main Health, Wellness and Sports Injury blog page, which has a brief description of all the articles to date.
About the Author
As of December 31st 2020, the author chose to leave the Chiropractic profession due to a planned move back to Australia, where his training and education are not recognised. Terry no longer works as a Chiropractor and works as a Myotherapist in Morningside, Brisbane. He developed an early interest in soft tissue therapy techniques and advanced myofascial release methods in 2006 for treating various conditions. Terry's interests in human performance and trauma have naturally led to him developing a specialism in treating work and sports-related musculoskeletal injuries and Chronic Pain symptoms.
The author possesses an unusual background for somebody who trained in the McTimoney Chiropractic technique. His education, training, and practical experience span over two decades and relate to health's physical and mental aspects. He also needed to push his body and mind to the limits of physical and psychological endurance as part of his time serving in Britain's elite military forces. His education includes a bachelor of science degree in Business Management, with a specialisation in psychology and mental health in the workplace, an Integrated Masters in Chiropractic, MChiro and a multitude of soft-tissue therapy qualifications (see the about section for more details). His soft tissue qualifications range from certificate level right through to a BTEC Level 5 Advanced Diploma in Clinical Sports and Remedial Massage Therapy. He has also taught as a senior course coach at the Advanced Diploma level (Myotherapy / Musculoskeletal Therapy) in Australia, both theoretical and practical aspects, including advanced Myofascial Release Techniques and has certification in training and assessment. Terry will have taught many of the first students to train as Myotherapists in Brisbane. Terry's combination of knowledge through education, training, elite military service, and personal injury history has paid dividends for the patients he sees and has treated over the last 16 years. Terry is still extremely active and enjoys distance running, kayaking, mountain biking and endurance-type activities.