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Patients sometimes avoid care because of their doctor

Why patients don’t seek care may be revealed in results from a study that interviewed 93 participants over age 65 who were asked about their experience with restricting back pain. Questions probed for beliefs, behaviors, coping mechanisms, emotional effects, and experiences with doctors. The full study results are reported in the journal BMC Geriatrics.1 Participants often spoke of a reluctance to seek care for their back pain, citing several reasons mostly involving the actions and attitudes of their physicians. That is to say, some participants specifically avoided care because of something their physician did, said, or did not do.

Some interviewees reported beliefs that their back pain was an inevitable result of advanced age. Others reported that providers either did not take their back pain seriously or reinforced the idea that their pain was due to age, sometimes dismissing it with ageist statements.

Another reason patients reported avoiding care for back pain included the relatively short list of available treatments. Participants voiced several concerns with medications including, unpleasant prior experiences, the potential to become habit forming, possible interactions with other medications, and side-effects potentially causing more harm than benefit.

Other participants revealed dissatisfaction with their providers, indicating that they didn’t offer alternatives to medication or surgery, or that the providers don’t spend enough time to explain the condition(s). Communication barriers also led to failed expectations, incongruent goals, and negative perceptions of treatment options.

So how does this apply to doctors of chiropractic? After all, we offer alternatives to drugs and surgery, which was a major concern to participants in this study. However, I don’t think it is that simple. It is entirely reasonable to think that patients could have similar or identical reactions for avoiding chiropractic care.

For example, though chiropractic care may represent an alternative to medication, discussing a single treatment mode, as if other treatments do not exist, is probably not substantially different from someone offering any other single type of therapy. As in the Makris et al. study, chiropractic patients likely have the same concerns and questions about how care might impact other co-morbid conditions. And, any provider type can render comments that blame conditions as an inevitable consequence of age, when that may not be the case. Studies like the one conducted by Makris et al. help us become more aware of how we can inadvertently and adversely affect patients. This awareness can also help us improve our communication.

Reference List
1. Makris UE, Higashi RT, Marks EG, Fraenkel L, Sale JE, Gill TM, et al. Ageism, negative attitudes, and competing co-morbidities–why older adults may not seek care for restricting back pain: a qualitative study. BMC Geriatr. 2015;15:39.

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