Accepting injustice to not risk to make things worse?

Some time ago I started treating a patient with chronic neck and shoulder pain from a colleague. I only got told that she had a discushernie C4/5 and 5/6 some years ago with persisting symptoms.

With the time, the patient told me more and more details about her history: starting with a go-kart accident with symptoms of whiplash she contacted the chiropractor in our village who treated her serveral times, each session leading to aggravation of her condition, finally with loss of strength and sensibility in her right shoulder. After a time, she visited the surgeon specialized for spine of our clinic who diagnosed a stable vertebrae fracture and a discushernie. Surgery was done to stabilize the cervical spine. But the symptoms remained. She told me that she thinks the problems came from the chiropractic treatment. When she asked for the x-rays done by the chiropractor, the secretary told her that they couldn’t find them anymore and she or her insurance never got a bill for the treatments there. Since then, she couldn’t work anymore as hairdresser.

I felt quite irritated about the story and asked our “senior therapist” about that case. She said that the doctor from our clinic asked us to continue the treatment in our clinic. It seemed as if he didn’t want that there was done anything about the case, except trying to do the best we can from therapist side to relieve her symptoms.

From my ideas and principles, it was against justice not to tell the patient that her symptoms could really be due to treatment error by the chirorpractor and that it is illegal to hide patient documents (xrays, case history). Care ethics and law were violated. The responsible seemed to profit from the fact that the patient didn’t know what her rights were and that she told herself that she just always has bad luck and things always go wrong in her case and she has to accept her fate. In my opinion it was misuse of power / dependence and utilizing of the lack of knowledge of the patient.

But it also seemed that she didn’t had a strong wish to fight against this injustice, she didn’t mention anything like hate or anger against the chiropractor. She still made the assignment of guilt to him but seemed to accept her situation

I was in a dilemma between my moral principles but also, I was not sure if getting active in this situation would not only lead to a worse situation: the patient could feel worse in the end when she fully realizes what happened. The chiropractor (in the time retired) could get into problems. And I also could risk to bring myself in a difficult position as I’m working against the team I’m depending on (doctor/clinic).

This all happened in a small village, everybody knowing everybody and a lot of dependence from each other everywhere.

So either I have to break my moral principles and continue being a part of this injustice. Or I hold on them but maybe in the end everyone feels worse… which is ethically seen more arguable?

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4 Replies to “Accepting injustice to not risk to make things worse?”

  1. Hi Bouteang 🙂

    Firstly I must commend you on writing a piece in English, even though it may not be your first language – well done 🙂

    I have quite a few questions (just so I can grasp a better understanding).

    When you say ‘discushernie,’ I’m presuming that is the herniation of the intervertebral disc? What exactly are her persisting symptoms?

    As you mentioned above, you didn’t get much information regarding your patient’s accident and/or condition – but do you perhaps know what exactly the treatment entailed she received from her chiropractor? Also what was your colleagues treatment for this patient and did she find any relief or improvement?

    Did this patient ever tell her chiropractor that his/her treatment was aggravating her condition? Or did they just leave it?

    You mentioned ‘loss of sensibility’ in her right shoulder – did you perhaps mean sensitivity or sensation?

    Correct me if I am wrong, perhaps it is different in your country, do chiropractors take x-rays? or was it maybe a radiologist? X-rays had to have been done at the hospital of her operation in order for the surgeon to identify the fracture and herniation?

    After how long did she wait to go and consult a surgeon? And how long ago was her surgery? When did your colleague and/or yourself start seeing her?

    Were the patients documents actually hidden? or could it have been a misplacement by accident?

    How did the responsible seem to profit if the patient was never billed for her treatment sessions?

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    1. Hi caitlinphysio

      Thank you for replying.

      Yes, it is a herniation of the intervertebral disc (sorry, I used the german word). Her persisting symtpoms are deficit in strength in the right shoulder (Scapulamuscles/ G/H muscles) and ellbow (all muscles around M3), Hand (especially dig I) M2. Lost of sensibiliy around scapula (around 50% to contralateral side, dysaesthesia, problems with proprioception). Sometimes (on “bad days” or periods where she feels worse also dizzinies, dysaesthesia in the right side of the face, sensivity to light or feeling like feeling of constricted throat).
      The symptoms got worse during the treatment by the chiropractor (I think she told him so). She was in treatment therire from 2007-2009-Chiropractors in Switzerland has the same level as other doctors and often have their own x-ray in their praxis or can order MRI done in a clinic. The diagnosis of herniation of the disc and fracture was than in our clinic by MRI. Surgery was done in 2010.
      The chipractor did manual therapy. My colleagues who started their treatment after surgery did manual therapy (soft tissue as well as joints), exercises, neural mobilisation, adapting of facilities, coping strategies. Since I’m treating her (around 4 years now), she had one really bad episode around 2 years ago, but all in all she’s more or less stable, sometimes we can even reduce the therapy intervalls a bit. We also try to focus more and more on strategies how she can help herself to reduce some of the symptoms (especially pain/dizziness/ nausea and tension).
      When she asked for the documents from the chiropractor she was told that they can’t find any (she believed and did not insisted). Later (a few months ago), the chiropractor had a new secretary who didn’t know anything about the case. So my patient called again- and received the xrays… this seems quite strange to me, also that she never paid for the treatment their (but I only know this from what she told me).

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  2. Hello Bouteang

    I really enjoyed reading your piece! It reminded me of an almost, but not really, similar situation that I found myself in a few weeks ago.

    I saw a patient at a community clinic who had general weakness and burning pain down his right lower limb, all the way to his 2 baby toes that often resulted in numbness. For 3 years he had seen many different doctors to determine what was wrong with his leg and after not finding anything on his scans or x-rays they just kept prescribing him pain medication. In the last year he went back to the doctor as he could no longer work anymore due to the pain. A doctor eventually diagnosed him with a degenerative muscular condition without having done any tests or additional x-rays and referred him for Physiotherapy at his local clinic.
    At his first visit the physiotherapy student at the time told him that she could not assist him but gave him a home exercise program and another appointment date. It was with that second appointment that I saw him.
    I was very upset and disappointed by all that this 34 year old man had told me. I could not believe how unjustly he had been treated by all these different health professionals. He however, was determined to find out the real cause of these symptoms as he did not believe the diagnosis the last doctor had given him. After a thorough subjective assessment, while asking the patient about any previous injuries or sporting activities. He mentioned hurting his back during a rugby match 9 years ago but because it was not a major injury he never got treated for it. This started to get me thinking about low back pain, referred pain and mechanical interfaces. Knowing that his x-rays showed no spinal abnormalities or abnormalities in the leg itself, it made sense that perhaps this was all just muscular originating from his low back. The objective assessment confirmed what I was thinking and allowed me to treat him appropriately and develop a home exercise program specific to his condition.
    When this patient came to see me he had no referral letter from any doctor, in fact his patient folder was empty. I had nothing but the patient’s word to fall back on. In a way I am glad because it challenged me to investigate and not treat him based on what someone else had done. I saw this patient again 2 days later and already his pain level had improved and his lower limb symptoms was felt up until his right knee and no longer all the way to the toes.

    I often find myself being angered by the way our patients get treated by others and I am the type of person who shies away from conflict. I never really know what to do in these cases. However, I strongly believe in educating my patients and making them aware of their right. We cannot always stand up for our patients or protect them from other health professionals but we can encourage them to fight for themselves. I think that this in itself is giving them something that perhaps the next therapist would not give them.

    I hope that in a way, these words and my past experience could be of help.
    Shannon

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    1. Hi Shanon
      Thanks for your reply.
      I think your right- sometimes just staying by our ethical principles from our profession and doing at least our job good can help. And as you write- explaining the patient their rights and what they could do and educating them. Because standing up, risking our job can also make the whole situation worse. Also sometimes it’s not easy to see what really happens and what patients tell us. But still it irritates me when things go wrong by patient who may do not know how to bridle themselves and who just trust the doctors that it is taken advantage of that situation. So I often ask myself if -although its my personal impression- the level of suffering from the patient is not that high, and from medical side at the moment everything what can be done is done- is it than ok to “break” the principle of justice? to get maybe get a better result in the meaning of not making things for everybody worse (in a utilitarism thinking)? (at least as long as the chance that the injustice is gonna be repeated in the same way). Or do I just choose this way because I am also rather somebody who shies away from conflict.. trying to find a “easy solution” which still fits for everybody and is morally justifiable..

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