Jul 22, 2009

In no way should this blog be considered medical advice. In fact, even though I took biology in high-school, I only got a C. My opinions on this subject come solely from my many years of trying cases where the issue of Chiropractic versus Traditional Medical care was at issue. In this post, I will be speaking in generalities and tendencies, but this certainly should not be considered an indictment toward any particular treatment modality.

This issue comes up in my office frequently when an injured victim asks, "What sort of care would be best for the case?" My usual thought, whether I express it or not, is that the "the case" is not in need of any care. Though this may seem somewhat unhelpful, it is probably the most truthful answer I can give. It is not "the case" that needs care-it is the injured victim.

Proper medical care is specific to the individual and sometimes, just like BBQ Ribs and a clean white shirt, a patient and a particular treatment just don't go well together. A person who grows up fearful and suspicious of chiropractic care should really not be encouraged, beyond their comfort level, to seek alternative medicine at this critical time.

In the early 1970's, a very famous and wonderful orthopedic surgeon, Dr. Leonard Berk, began encouraging his patients to continue treating with their chiropractor, even after he performed surgery on them. As a young attorney, I became fascinated with this particular doctor. Here was this conservative surgeon who was well-respected by insurance companies, his patients, and fellow surgeons in the community and yet, he regularly went against mainstream thinking by encouraging his patients to go back to their chiropractors after surgery. Just imagine...he was doing this during the Nixon administration when nearly every medical doctor was unified in their disdain for chiropractic care.

In later years, he and I became very close. He attended my wedding and I handled his personal and clinical legal matters. Mind you, Dr. Berk never wore a tie-dyed shirt and nothing about him exhibited anything less than AMA perfection. So I couldn't figure out why this man was such a maverick in his approach to treating his patients. Even though our relationship became quite close and he was like a second father to me, I always felt more comfortable calling him "Doctor" and he too, with that very special old-school formality, always called me "Mr. Hemmat". We kept these pretenses of formality until the last month of his life where he finally broke from them and with great affection we addressed each other by first name. Sometime before this though, I had gained the nerve to question him about his holistic approach to treating his patients. Our conversation went something like this:

Me: Doctor Berk, you are an amazing orthopedic surgeon, yet you seem to be the only one that I know who thinks there is any value in chiropractic care. Why is that?

Dr. Berk: Mr. Hemmat, I have been an orthopedic surgeon since the Vietnam War era, and honestly I don't personally find much about chiropractic care that is either innovative or helpful in the treatment of my patients.

Me: What do you mean, Doctor? I have seen you refer hundreds of your patients, my clients, to chiropractors. How can you as a doctor send patients to chiropractors without finding any value in their treatment?

Dr. Berk: I have never sent anyone to a chiropractor. However, what I have done is send hundreds of patients BACK to their chiropractor who they were treating with prior to their surgery. These chiropractors have a long and established relationship with these patients. The patients tell me the care helps them. No, I have not discovered any value in chiropractic care itself, but what I have discovered is the powerful healing capacity of a person who is comfortable with their particular care. Who am I to tell them differently?

That was quintessential Dr. Berk. Where a chiropractor would declare that an injury is evident because an x-ray shows a "straightening of the neck" instead of a nice comma shaped curve [called Lordosis], Dr. Berk would simply say, "Sometimes people's necks are straight; it doesn't really mean anything." Another "Dr. Berk-ism" that explains this wonderful doctor is this: "Seventy percent of injured people will heal DESPITE the care they receive."

Well, it took me a couple of years to fully understand and apply Dr. Berk's approach into our practice, but I think Dr. Berk would be proud that we finally got it right.

Here goes: In front of a jury of even the most skeptical people, if an injured person describes the care they received from a chiropractor, a massage therapist, or even an acupuncturist as bringing them back from injured to healthy, from not working to being able to work, from disabled to functional, I have never had a problem getting a jury to respect and admire the treatment provider. So, as a trial lawyer who gets asked "what type of care should my case receive," I always tell them that their care should be the type of care with which they are most comfortable. Everything else will work itself out.

There are, however, tendencies I have seen depending on the type of treatment modality chosen by the patient. For example, by and large, patients treating with chiropractors tend to rack up larger treatment charges. There tends to be longer and more active care. This gives the defense attorney or the insurance company the ability to argue that the chiropractor over-treated and that not all of the care is reasonable and necessary. If the jury buys this argument, the client could end up with less, and often much less, awarded to them.

Alternatively, patients who treat only with AMA-approved medical doctors tend to end up with more medications and often surgery. This might look good for the case but can certainly be bad for a patient. Also, this approach give rise to some patients becoming dependent on the medications. When this happens, defense counsel, or the insurance company, suggests that the care and treatment was motivated by the patient's efforts to seek drugs rather than being care that was necessary. If the jury buys this argument, the client may receive very little or no compensation at all.

In recent years, many medical doctors have adopted the approach that Dr. Berk and a few of his colleagues were quietly utilizing (without a name for it) 40 years ago. It's now known as a multi-disciplinary approach. This approach to medical care derives from the notion of "everything in moderation." Many medical doctors are now utilizing traditional Western medicine in combination with some Eastern and alternative treatment, including SOME chiropractic, massage, and even acupuncture. This holistic multi-disciplinary approach seems to be the best of both worlds and avoids some of the pitfalls and arguments generated by insurance companies and their lawyers at trial.

We at Anderson Hemmat think that your decisions about medical treatment and care should be left to your doctors and you, and never orchestrated by lawyers. The care you receive is so important that you, as a patient, have to on board and comfortable with the care you receive. I know Dr. Berk would be very pleased with the approach we take at Anderson Hemmat. It serves as one of my personal tributes to a great man who taught me so much.


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