Blog Post ✍️ | Education is the most valuable service a healthcare provider can offer

I am a healthcare provider, but I am also a healthcare consumer. One of the most challenging things about being a healthcare consumer is selecting your doctor. How do you make the right choice?

Sometimes, the choice is simple and obvious. If you have a fever, contact your primary care provider, usually a GP or a pediatrician. Call 911 or go to the closest emergency department if there is trauma. Call a dentist if you have a tooth problem.

But, if you are struggling with pain or disability relating to muscles, joints, or other physical injuries, how do you pick the right kind of doctor? Should you stick with your primary care physician or pediatrician? Should you go to the emergency department? Should you see a chiropractor or a physical therapist? Do you need an osteopath, an orthopedic surgeon, or a physiatrist? You may need a podiatrist, a massage therapist, or some other specialty like acupuncture.

Even when you select a specific profession, how do you decide between the different options within that profession? Because there are always different subspecialties within every healthcare group. It is up to you as the healthcare consumer to make the best choice, usually with very little information at your disposal.

I have heard this decision-making process described as the “supermarket approach,” where healthcare consumers are confronted with many different treatment options offered by multiple professions, sub-specialists, and commercial vendors selling products, such as supplements.

In general, having options is a good thing. Still, the problem is that treatment varies a lot based on the provider or supplier, and your choice may be made based on salesmanship, marketing, or preconceptions rather than being grounded in evidence-based and cost-effective care specific to your unique needs.

Many people choose their healthcare provider based on recommendations from friends and family. Some people will only select healthcare providers who take their insurance. The choice is financially based. Others make choices based on proximity or availability. Some people look at Google recommendations. There are many ways to select a healthcare provider, and none are wrong. But at the same time, none of these ways appear ideal.

Please allow me to offer a suggestion. When narrowing your options, consider the healthcare providers’ willingness and ability to teach and guide, not just prescribe and treat. This may be something that you’ve never considered, but I would like to make a case for why it should be included in your decision-making process.

Education is an essential part of healthcare that time constraints often hinder or completely eliminate. Short appointments do not offer much time for nuanced discussions and education. Healthcare providers acting as guides and teachers do not fit well within a short appointment time structure. I know many healthcare providers who wish they had more time with patients to offer education and guidance. Unfortunately, insurance reimbursements have a strong influence on doctor-patient interactions. Even though many healthcare providers want to spend more time on education and guidance, it can be hard to keep your doors open if patient volume drops because you are spending too much time with people.

Interestingly, many healthcare providers do not value the education process. As a healthcare provider, I will admit that it is not uncommon to feel like you’ve “heard it all before.” But when this mentality becomes habitual, healthcare providers tend to ask fewer and fewer questions based on the assumption that they know what is best for you (because of their experience). This is a natural tendency that all healthcare providers battle.

I have had some interesting conversations with other chiropractors regarding patient education and our role in facilitating education. Although the advice from other chiropractors has been well-meaning, much of it has been disappointing.

When we look at the published recommendations for managing muscle and joint pain, these recommendations are usually broken down into different categories:

“Should do”
“Could do”
“Don’t do”
“Uncertain”

“Should do” recommendations should be applied in all circumstances unless there is a rationale not to. These are based on strong evidence, such as multiple high-quality studies reporting clinically relevant positive effects.

“Could do” recommendations could be applied depending on the circumstances of individual patients. They are usually based on consistent evidence from multiple lesser-quality studies.

Here are some “Should do” recommendations from a systematic review published in 2019:

Care should be patient-centered. This includes care that responds to the patient's individual context, employs effective communication, and uses shared decision-making processes.
All patients should receive education and information about their condition and management options.
Patients should receive management that addresses physical activity and/or exercise.
If used, hands-on therapy (like chiropractic adjustments) should be applied only in conjunction with other treatments.

In this 2019 paper, where they compared multiple studies, hands-on therapy was a “could do” recommendation in seven studies and a “should do” recommendation in only one study. This is interesting because chiropractic adjustments tend to be the centerpiece of traditional chiropractic care, even though current guidelines regard hands-on therapy as a “could do” option.

One phrase that different chiropractors have said to me multiple times is, “Don’t forget what you went to school for.” When told, this phrase is always accompanied by some type of hand gesture.

Why am I bringing this up? Chiropractors tend to (stereotypically) put most of their emphasis on hands-on therapy. Appointment times are generally short, and patient education is limited. Exercise and/or physical activity recommendations are stereotypically delivered with less emphasis or in a preprogrammed manner by a chiropractic assistant who usually just recites a script.

While it is true that “Chiro” means “hand,” and our profession was founded based on hands-on therapy, I disagree that my hands are my most valuable asset. Actually, far from it! It is funny because I have had chiropractors tell me that I cannot be successful if I don’t fully embrace chiropractic philosophy and become “world-class” with my hands. Chiropractic philosophy is interesting. Chiropractic history is interesting. But I do not want any healthcare provider treating me (or my family) based on philosophy and old theories.

Improving hands-on therapy skills is a great idea, and I completely support the concept of skill development. However, the larger body of evidence suggests we should not use hands-on therapy as a primary treatment method. Nothing indicates that hands-on therapy should be the centerpiece of a treatment plan.

At best, manual therapy is as good as anything else for pain management, including placebos. Chiropractic adjustments can be effective for short-term relief, but joint manipulation (independent of the “should do” recommendations) is not a viable treatment strategy for long-term results.

Cracking backs, massaging muscles, releasing fascia, laser therapy, and all the other passive therapies can be great options if you are trying to reduce pain while working through a recovery strategy. However, these options are best used as adjunct therapies within a more comprehensive treatment plan.

So, what should be the centerpiece of a joint or muscle pain treatment plan? A quality treatment plan should be built on a foundation of education. Pain management tools, like chiropractic adjustments, could be helpful. But if you want more than temporarily getting out of pain, you need to learn something.

If pain is stopping you from doing the fun or the important stuff in your life, then you need to learn as much as you can about your pain so that you can discover a management strategy that works for you. You do not need to be prescribed a cookie-cutter plan. You need someone to help you uncover a unique plan that doesn’t require you to be 100% dependent on a healthcare provider (like a chiropractor) once a month for the rest of your life. You need a strategy rooted in evidence. This plan should be customized to your specific needs, and it must offer options and come with guidance. All of this requires education.

I disagree that a chiropractor’s most important asset is their hands. We should, first and foremost, be educators. Secondarily, we could offer hands-on therapy to supplement the larger treatment plan, which should be built on a foundation of education, mainly incorporating physical activity. Physical activity is commonly called “rehab” in a clinical setting.

I will offer you this quote from Monty Roberts:

“There is no such thing as teaching, only learning. Knowledge cannot be pushed into a brain; it must be willingly drawn into the brain by the recipient.”

For example, everyone knows we should exercise regularly and eat healthy food. This is common knowledge even for those who struggle with obesity, diabetes, and heart disease. How effective is it to tell a person with obesity, diabetes, or heart disease that they should diet and exercise? They probably know this already. And even if diet and exercise are new concepts to someone, how effective is it to simply tell a person to eat better and get a gym membership? These words alone are not teaching them anything and are unlikely to change their behaviors.

Now, let’s assume that you have found a doctor who values education and collaboration. You must be willing to learn if you need to make changes to accomplish your health, pain, or physical activity goals. You need to be receptive and open to change.

For example, much research shows that people who increase their strength and muscle mass improve their health. Yet, many Americans fail to meet the physical activity guidelines that recommend two to three weekly resistance training sessions.

A 2019 study suggests that people who can do more push-ups have a lower risk for heart disease. Heart disease is the leading cause of death worldwide. Studies have suggested that physical activity provides heart health benefits and is associated with a lower incidence of multiple diseases, including heart disease, diabetes, cancer, and Alzheimer's disease.

This 2019 study found that push-up capacity was inversely associated with a 10-year risk of heart disease among men 21 to 66. Push-ups are a simple, no-cost measure that may provide another way to estimate the functional status of middle-aged men and assess their risk for heart issues.

Participants in the 2019 study who were able to perform 11 or more push-ups at baseline had significantly reduced risk of heart issues. Participants who were able to complete more than 40 push-ups were associated with a significant reduction in heart disease compared with those completing fewer than 10 push-ups.

Can you do 11 to 40 push-ups? Most people can’t, and that’s okay. However, as the 2019 paper mentioned, push-ups are free, effective, time efficient, and require no equipment.

So, I just "taught" you that heart disease is the number one killer of men and women worldwide and that push-ups are free and may significantly reduce your risk of heart issues. Did I actually “teach” you by giving you some information? Maybe, but probably not.

Assuming that this push-up data is accurate, is the information powerful enough for you to start training push-ups weekly? Most people won’t read this blog and act on it by dedicating time for two to three push-up sessions per week, even though push-ups and physical activity may play an integral role in preventing heart disease and saving their lives. Simply telling someone information does not mean that they learned anything and probably isn’t going to change their behaviors. Humans just don’t work that way.

If “teaching” people stuff was effective for behavior change, heart disease would be less of an issue, and most people would be able to perform 11 to 40 push-ups.

For those who genuinely believe people should just have willpower and make the apparent changes, I’d ask you, how many push-ups can you do? Is this info strong enough to change your life? No. For most people, it’s not.

I’m “teaching” you, but you didn’t ask me for the lesson. I’m not working with you right now. I’m just regurgitating information. Therefore, I suggest that healthcare education in pamphlets, brief recommendations, or scripted material delivered robotically is ineffective. These delivery methods probably qualify as “teaching” but do not usually change behaviors. Since there is no behavior change, did learning actually occur?

Seek healthcare providers who work with you and offer you options. You must be open to suggestions and prepared to learn and act based on what you learn. Glancing at a pamphlet and thinking about diet and exercise are not strong enough actions to avoid things like heart disease and diabetes. Being “taught” is not enough. You need to learn and demonstrate what you have learned through action. That is the only way to bridge the gap between information and healthcare outcomes.

“There is a difference between informing and advising, and the line between them can be blurry. What matters most is how you hear and receive the education being offered.”

Education in healthcare is vital. It is one of the most important things we can offer as healthcare providers. But learning is a 2-way street.

There is no proof that learning has occurred unless someone tries to put the information into action.

In a clinical setting, rehab teaches people what they can do for themselves. Teaching occurs, information is willingly drawn in, physical action happens based on the information, feedback is offered, questions are asked, answers are given, and more physical action is performed. This is the learning process. This is how education works.

Healthcare rooted in education guides people and helps them develop the skills not to need as much healthcare in the future. Therefore, I recommend that you seek healthcare providers who believe in education and set up their practices so they have time to educate and guide. I also recommend entering the healthcare environment with an open mind and an eagerness to learn. You must be ready and willing to draw in new information, eliminate old information, and actively participate in your healthcare. You cannot learn unless you are ready and willing to learn. And you cannot change without learning. Education and learning are paramount in healthcare because learning involves patient participation. Patient participation builds skills, confidence, and autonomy.

If you pair a person eager to learn with a healthcare provider excited to educate and guide, it is hard not to succeed. You can overwhelm the problem with an excellent solution.

References:

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