Friday, November 4, 2011

Questions About Sports Medicine

The New York Times has been running a series of articles on the topic of sports medicine, written by Pulitzer Prize-winning journalist Gina Kolata. One catalogued the author’s own attempt to recover from an injury, another discussed issues of evidence-based medicine arising around sports medicine, and the most recent discussed the specialty’s alleged overuse of MRI technology. The articles, while fairly open-minded in their investigation, are also sharply critical of sports medicine.

Here’s a brief (very brief) summary for those who are too busy to read the articles: Sports medicine is rife with treatments that are expensive, high force (meaning they involve more forceful interventions such as surgery, as opposed to more moderate interventions like therapeutic exercise), and which may or may not be effective. Patients often experience a long line of treatments but may not gain any relief. Additionally, doctors rely too heavily on expensive imaging procedures without taking adequate case histories, resulting in overtreatment. As I said, these are the criticisms levied by the author.

So what does a naturopathic physician think about all of this?

I’d like to address two main points that these articles have brought to light. The first is one of ethics. A confluence of various economic factors act on all doctors, ranging from med school debt to mortgages to the need to give one’s own children the advantages we’d want them to have. In all professions, there are practitioners who act less scrupulously for economic reasons. This is not owned by any one profession, though it manifests differently in different professions. Some docs order expensive testing, others perform elaborate procedures, still others recommend costly supplement regimens. All professions suffer from economic issues, and sports medicine is no exception. By no means should sports medicine be demonized, and indeed the articles above are full of quotes from sports medicine specialists seeking better work from their colleagues.

I can’t speak to the experiences of my MD colleagues, but at ND school, the ethical practice of medicine was a topic of serious debate. As a naturopathic physician, I place an emphasis on low-cost treatments, such as diet and lifestyle, treatments that require work, but cost little. Not only do these treatments have weighty scientific backing, but they also provide lasting results at minimal cost to the patient. Additionally, I focus on taking a good history, which only costs as much as the visit, and provides the most important clues to diagnosis.

The second point I’d like to address is one of sloppy medicine. Again, this is not owned by any one profession, but is a shared problem, though it may have different permutations in different professions. In my time at med school, the docs I worked with all drilled home the important point that all patients deserve your best effort. Rushing through an intake, jumping to testing before you hear what the patient has to say, employing a gimmicky or faddish treatment, or worse, giving every patient the same treatment, is just bad work. There’s any number of reasons why this can arise, and sports med docs are hardly the only offenders, but patients deserve better.

Here’s the take-home message: Sports medicine has its own unique problems, but isn’t at any more fault than other professions out there. When looking for a doctor to work with, be they a sports medicine doc, a chiropractor, gastroenterologist, or whatever, do some investigating first – look around online and see what their colleagues and patients say. Your work doesn’t stop there – when in the visit, make sure you feel the doctor listens to your story, and ask for a few potential treatment options. The doctor-patient relationship is a two-way street and it requires work on both ends to achieve the best outcome.