Wednesday, October 1, 2014
FAIRFIELD-SUISUN, CALIFORNIA
99 CENTS

How much medical care is enough?

By
From page B10 | January 12, 2013 |

A recent British study of 3,800 whiplash sufferers compared “usual care” at 15 hospitals with “costly, intensive treatment.” The results indicated that treatment outcomes were the same in both groups.

Doctor Sarah Lamb, and fellow investigators of the University of Warwick, detected an identical level of recovery at eight and 12 months, although patients treated more aggressively with physical therapy sessions felt better at four months after the injury. Lamb, interviewed for HealthDay News, concludes, “Emergency departments should continue to provide usual care for whiplash injuries together with a single follow-up physiotherapy advice session for persisting symptoms.”

American medical experts are already citing the British study as justification for a minimalist approach, with little physical therapy, for whiplash injuries.

The whiplash data is in a sense consistent with similar observations with respect to a host of conditions, including low back pain, the common cold, and simple aches and pains. No matter what the doctor does, the human body usually will eventually heal itself.

Nonetheless, as a practicing physician, I find this kind of study a bit troubling. I have no quarrel with the observations or conclusions. Rather, I know that “gatekeepers” and “utilization review” employees tend to use such data as justification for “denying” referrals in cases in which specialized treatment, such as physical therapy, may play a role. The usual process involves citing specific medical studies or guidelines in a rigid manner, with no appreciation for the possibility that a given patient may have special needs.

In many cases, as referral for services is not overtly denied, but rather endlessly delayed. The referring doctor is told to re-submit the referral request with more information. The cycle repeats itself. Yet more information is required. Eventually, the treatment may or may not be realized, depending upon how persistent the referring doctor is.

Indeed, sometimes less is more in medical therapy. For example, it is prudent to avoid the use of antibiotics in most viral respiratory infections. Low back pain sufferers typically get better without surgery or prolonged physical therapy. Whiplash pain will usually resolve with local cold or heat, accompanied by a brief course of anti-inflammatory medication.

Moreover, as health care costs are increasingly reigned in, we may all find ourselves relying more and more upon our own health care recovery strategies. As an example, exercising and avoiding smoking can diminish back pain.

There are, however, specific situations in which a “routine” muscular strain requires more than “routine” care.

I recall seeing a patient who was shuttled from clinic to clinic with neck pain, only to be eventually diagnosed with a bone infection of the cervical spine that was life-threatening. So-called “red flags” may alert a clinician to a severe underlying problem that is not immediately apparent. Classical “red flags” include high fever, night pain, weight loss and unrelenting pain. Especially when neck or back pain occurs in elderly patients, these warning signs deserve careful consideration.

What if your “routine” condition is not taken seriously by your provider network?

In today’s era of managed care, insisting upon care may be an uphill struggle. Discussing your concerns directly with your physician is the best initial approach, if you can reach your doctor. If that does not allay your concerns, recall that many clinics and nursing homes now provide access to an ombudsman, a respected third party who can advocate on your behalf.

I have noticed over the years that patients with concerned relatives seem to do better than more isolated persons. One reason may be health-access advocacy, by concerned spouses, children and parents. Routine health care is generally fine, but sometimes a patient needs treatment beyond the routine level.

Scott Anderson, M.D., Ph.D. (stamdphd@comcast.net) is Clinical Professor of Medicine, Division of Rheumatology, UC Davis. This column is informational, and does not constitute medical advice.

Scott Anderson

LEAVE A COMMENT

Discussion | No comments

The Daily Republic does not necessarily condone the comments here, nor does it review every post. Read our full policy

.

Solano News

 
Middle school students put school candidates on the hot seat

By Susan Winlow | From Page: A1 | Gallery

 
Suisun City candidates get lively in 2nd council forum

By Ian Thompson | From Page: A1, 4 Comments | Gallery

 
Solano focuses on rail safety

By Barry Eberling | From Page: A3, 1 Comment

 
 
Booz and Brewz benefit for the Blue Star Moms

By Amy Maginnis-Honey | From Page: A4

Police search for missing man

By Glen Faison | From Page: A4 | Gallery

 
Caltrans cancels nighttime Highway 37 closures

By Barry Eberling | From Page: A5

Salvation Army gears up for annual Red Kettle campaign

By Amy Maginnis-Honey | From Page: A5, 1 Comment | Gallery

 
Blessing of the animals slated Sunday

By Amy Maginnis-Honey | From Page: A5, 2 Comments

 
Travis airman killed in motorcycle accident

By Ian Thompson | From Page: A5

 
Theaters primed for bevy of new movies

By Amy Maginnis-Honey | From Page: A7

Suisun City police log: Sept. 29, 2014

By Susan Hiland | From Page: A9

 
Fairfield police log: Sept. 27, 2014

By Glen Faison | From Page: A9, 2 Comments

Suisun City police log: Sept. 28, 2014

By Glen Faison | From Page: A9

 
Suisun City police log: Sept. 27, 2014

By Glen Faison | From Page: A9

Fairfield police log: Sept. 28, 2014

By Glen Faison | From Page: A9, 2 Comments

 
Fairfield police log: Sept. 29, 2014

By Susan Hiland | From Page: A9, 2 Comments

 
FBI announces reward for Vacaville bank robber

By Jess Sullivan | From Page: A10

American Legion seeks Korean War veterans for award

By Susan Hiland | From Page: A10

 
Third Annual Ride to Defeat Diabetes is Sunday

By Susan Hiland | From Page: A10

4-H Achievement Night honors county members

By Susan Winlow | From Page: A10

 
Measure A committee plans weekend precinct walk

By Susan Winlow | From Page: A10

.

US / World

Forest areas reopen after huge fire

By The Associated Press | From Page: A6

 
Hong Kong leader refuses to meet with protesters

By The Associated Press | From Page: B7

Secret Service chief on hot seat for WH breach

By The Associated Press | From Page: B7

 
Afghan pact signed amid questions on Iraq pullout

By The Associated Press | From Page: B7

Police on manhunt find pipe bombs in woods

By The Associated Press | From Page: A9

 
Oklahoma man charged with murder in beheading

By The Associated Press | From Page: A9

Luck, instinct determined fates of volcano hikers

By The Associated Press | From Page: A9

 
Government confirms first case of Ebola in US

By The Associated Press | From Page: A9

Mayor of suburban Los Angeles city killed

By The Associated Press | From Page: A9, 1 Comment

 
Crash, suspicious device lead to 101 closure in LA

By The Associated Press | From Page: A9

Gov. Brown governor vetoes ethics bills

By The Associated Press | From Page: A9, 6 Comments

 
California becomes first state to ban plastic bags

By The Associated Press | From Page: A11, 6 Comments

Bay Area looks to expand overnight transit options

By The Associated Press | From Page: A12

 
Gov. Jerry Brown signs California gun restriction

By The Associated Press | From Page: A12, 12 Comments

.

Living

Today in History: Oct. 1, 2014

By The Associated Press | From Page: A2

 
Community Calendar: Oct. 1, 2014

By Susan Hiland | From Page: A2

 
Horoscopes: Oct. 1, 2014

By Holiday Mathis | From Page: B5

One simple slicing trick to bake a beautiful tart

By Sara Moulton | From Page: B6

 
A speedy, kitchen sink approach to pumpkin bread

By J.M. Hirsch | From Page: B6

The flavor of fall – pumpkin pie in a cinnamon bun

By The Associated Press | From Page: B6

 
.

Entertainment

TVGrid

By Daily Republic Syndicated Content | From Page: A5

 
Morgan: ‘Can’t believe’ Walmart blaming him

By The Associated Press | From Page: A7

.

Sports

Raiders make Tony Sparano interim coach after firing Allen

By The Associated Press | From Page: B1

 
Royals beat A’s 9-8 in 12 in AL wild-card thriller

By The Associated Press | From Page: B1 | Gallery

 
Local report: Rodriguez volleyball team downs Armijo

By Daily Republic staff | From Page: B1

Pirates’ Volquez looks to continue revival against Giants

By The Associated Press | From Page: B1 | Gallery

 
FCC will consider petition to ban ‘Redskins’

By The Associated Press | From Page: B2

Training camp essential for NBA’s new head coaches like Warriors’ Kerr

By The Associated Press | From Page: B2 | Gallery

 
No. 14 Stanford trying to jolt stagnant offense

By The Associated Press | From Page: B2

NC State coach apologizes for fake injury remarks

By The Associated Press | From Page: B2

 
NFL says Abdullah should not have been penalized

By The Associated Press | From Page: B2

NFL has laundry list of verboten celebrations

By The Associated Press | From Page: B2

 
Government: NFL TV ‘blackout’ rule unsportsmanlike

By The Associated Press | From Page: B2

Olympian Michael Phelps apologizes for DUI arrest

By The Associated Press | From Page: B2

 
Gravely injured Giants fan sues Dodgers again

By The Associated Press | From Page: B2, 1 Comment

Ex 49ers RB James agrees to terms with Dolphins

By The Associated Press | From Page: B2

 
49ers’ Wilhoite filling the injury void at linebacker

By The Associated Press | From Page: B8 | Gallery

 
.

Business

EU says Apple gets illegal tax benefits in Ireland

By The Associated Press | From Page: A9

 
Could a merger follow the PayPal-eBay split?

By The Associated Press | From Page: A9

.

Obituaries

John ‘Bo’ M. Miller

By Nancy Green | From Page: A4

 
David Earl Butenhoff-Forristall

By Nancy Green | From Page: A4

Marte Abad Lubag

By Nancy Green | From Page: A4

 
Clara May Clift Triplett

By Daily Republic staff | From Page: A4, 3 Comments

.

Comics

Blondie

By Daily Republic Syndicated Content | From Page: B4

 
B.C.

By Daily Republic Syndicated Content | From Page: B4

Pickles

By Daily Republic Syndicated Content | From Page: B4

 
Garfield

By Daily Republic Syndicated Content | From Page: B4

Get Fuzzy

By Daily Republic Syndicated Content | From Page: B4

 
Baby Blues

By Daily Republic Syndicated Content | From Page: B4

For Better or Worse

By Daily Republic Syndicated Content | From Page: B4

 
Baldo

By Daily Republic Syndicated Content | From Page: B4

Zits

By Daily Republic Syndicated Content | From Page: B4

 
Wizard of Id

By Daily Republic Syndicated Content | From Page: B4

Dilbert

By Daily Republic Syndicated Content | From Page: B4

 
Beetle Bailey

By Daily Republic Syndicated Content | From Page: B4

Rose is Rose

By Daily Republic Syndicated Content | From Page: B4

 
Frank and Ernest

By Daily Republic Syndicated Content | From Page: B4

Sally Forth

By Daily Republic Syndicated Content | From Page: B4

 
Peanuts

By Daily Republic Syndicated Content | From Page: B4

Bridge

By Daily Republic Syndicated Content | From Page: B5

 
Crossword

By Daily Republic Syndicated Content | From Page: B5

Cryptoquote

By Daily Republic Syndicated Content | From Page: B5

 
Sudoku

By Daily Republic Syndicated Content | From Page: B5

.

Breast Cancer Awareness 2014

Breast cancer in younger women

By Green Shoot Media | From Page: BCA2

Talking with your doctor

By Green Shoot Media | From Page: BCA3

Breast cancer myths

By Green Shoot Media | From Page: BCA4

Diet linked to cancer

By Green Shoot Media | From Page: BCA9

Giving emotional support

By Green Shoot Media | From Page: BCA10

After the treatment

By Green Shoot Media | From Page: BCA12

Join the fight: Get involved

By Green Shoot Media | From Page: BCA15