Most of us have visited a Healthcare Professional to get help with pain, whether it was a Doctor, an Osteopath or a Physiotherapist. Have you ever experienced the luxury of two Healthcare Professionals handling your care at once? If so, it appears that can only be a positive; after all, two brains are better than one. But what if they disagree with regard to your diagnosis? Which of the diagnoses is correct?
If your Healthcare Practitioners agree on the diagnosis, happy days! You can either choose which treatment suits you without confusion or utilise both treatment strategies. The problem arises when there is a difference of opinion.
This is an experience that many patients/of us? struggle with. Diagnosis is partly art/discipline?, partly science based, and because each diagnostician has a slightly different way of interpreting data and has different experiences, there may be conflicts.
Why would you search for two different opinions?
The first question to be asked is; why would you get two opinions? Sometimes it’s by chance. I have had patients book in with myself while waiting for the NHS to arrange an appointment. The appointment comes in just as we are in the early stages of treatment, and the patient becomes confused.
It may be more of a tactical decision; why not get as many Practitioners to take a look at you as possible? This blog will hopefully answer the downside of that argument, based on my own clinical experiences. We will answer which diagnosis is correct.
Problem 1: Who to visit?
I initially want to touch on who to see if you have a problem. The reality is that you can break it down to two options; NHS or private healthcare. There are certainly pros and cons to both, which we will explore now.
Before continuing, I want to declare I am pro NHS. I think GPs are very well qualified, as are specialists, but the NHS is unfortunately struggling in this period, which is the source for most of the negatives I will outline here.
You’re in pain, so why wouldn’t you get help from the NHS? It seems like the sensible first option, your GP will be well qualified and highly experienced, it’s free and they have many more options to refer you to (rheumatology, radiology etc). The truth is, if the system worked well, it would be a fantastic option. You’d get a thorough check through by a musculoskeletal (MSK) specialist, neurological screening if required, scans quickly if needed.
The main con to this option is time in the current climate. The GPs don’t seem to be able to spend enough time with their patients, the reported average time of 9.22 minutes per consultation (1)[EM1] . As an MSK specialist who will see 10-15 patients a day, I couldn’t carry out a thorough investigation in that time.
The second issue is the clogged system; there are lengthy waiting times to see an NHS Physiotherapist, and you’d typically get 3-5 sessions of hands-off visits. This probably won’t be long enough for patients who require treatment of longer-term issues.
The third major flaw in the NHS is the absence of a follow up appointment with your GP after they have referred you to a specialist? This can be a major issue, because the GP will never know If they were correct or not in their initial diagnosis. This lack of a follow up prevents a valuable learning opportunity. When I see a patient during their follow up appointment, I know within 10 seconds if my diagnosis and suspicions were correct due to the feedback from the patient themselves.
Private healthcare has its’ negatives; cost being the primary one. £40 for 30 minutes may seem expensive, especially compared to free NHS or Groupon massage deals, but in essence, the term ‘you get what you pay for’ springs to mind. Having said that, you are more likely to encounter a therapist that wants to help for the wrong reasons: financial gain. These therapists can be easy to spot, they typically try and block book patients in and entice them with seemingly good deals.
Private Osteopathy and Physiotherapy are competitive, which is an important element in developing excellent clinical skills. Without the drive to be a better therapist than your competitors, there is less incentive to work harder for your patients.
Secondly, we have the opportunity to learn from follow ups. If I make an incorrect diagnosis, I will understand that the next time I see my patient. This constant feedback helps private practitioners like me to cultivate the learning conditions necessary for optimum performance.
Would you trust a Darts Player to Teach you how to Throw a Javelin?
Finally, with respect to GPs, their role is to be a general practitioner. Their primary goal is to establish a quick diagnosis with the available evidence at hand and recommend a specific treatment or escalate the case to another professional. When you see a well-qualified Osteopath or Physiotherapist, they have spent many more hours studying MSK healthcare and are in a much better position to accurately diagnose and recommend treatment for your condition. Realistically, the two professions offer different services at different levels; You wouldn’t trust a darts player to teach you how to throw a javelin, would you?
Problem 2: Comparing two Conflicting Diagnoses, which one is correct?
If you have read the above, but have found you have two good practitioner’s opinions, you still have a problem. Critically appraising the two opinions is challenging, but there is a way to do it.
Validate the sources
What do you do if you don’t know the answer? Research. Medical research is full of jargon which makes it difficult to navigate and understand. Thankfully, there are websites that will offer a breakdown of the research for you. Good quality websites and blogs should analyse the data and present it in an easy-to-understand 1000-word blog. For example, here is a blog I wrote regarding tension headache‘s with all the evidence broken down to understandable language.
You can also ask for a summary from each Practitioner. This should cost very little in terms of time for the Therapist, and it will generate a justification based on the evidence for you. If you have time, you would be able to cross reference what each Therapist has said and figure out which best fits your needs. Please don’t feel anxious about doing this, any Practitioner worth their salt should be able to break down the condition to you, in an easy-to-understand format. Which diagnosis is correct? The one that is presented the best way, and that makes the most sense.
Don’t just go for the cheap option
Finally, I would strongly recommend not to go for the option which is cheaper, easier to get to or based on someone your friend’s dog-walker’s auntie may have suggested. When it comes to healthcare, the best Therapists charge more because there is only a finite number of patients that each Therapist can help in a week. Good private healthcare unfortunately costs, this reality is hard to swallow, but the number of years that it takes to get to a level where you can make consistently sound clinical recommendations is costly and time consuming. Each year, for example, I will spend a minimum of 40 hours on clinical development, around £2000 on clinical courses and other developmental strategies and invest many more hours focussing on planning and reflecting in order to make myself and the team better.
For any further questions, please don’t hesitate to ask:
0161 209 2980
Ed Madeley M.Ost