Q:

Hello, I have a chiropractic question.  I have had a patient in the 
office  for 2 months now, she is 23 yrs old and slender.  She is not 
getting better with her low back pain, and she does not listen when I 
tell her not to run on the treadmill on an incline (she has an extreme 
hyperlordosis), she doesnt like to use ice, and heat doesnt help her.  
Ive told her also to get a lumbar brace since she is a nurse and lifts 
patients 3 times a week, she refuse s to wear one.  Yes, I have 
recorded these things in her file, but when do I let her know I'd like 
to monitor her care to see some improvement... At what point do you, 
YOURSELF let a patient go from chiro care when the patient is not 
getting results?  ?What is the chiro rule on letting a patient maybe 
go and try physical therapy for example?  I was told a t Life  11-12 
weeks? Thank you

A:

Thanks for the e-mail. This is only my opinion after 24 years of 
practice. First .. we always try our best to assist our patients but 
they have to cooperate. Many do but most don't. You decide which 
technique to use and what lifestyle habits you wish your patients to 
alter .. they must cooperate. So .. what about those that do not .. that 
take unusually longer times to heal .. that do not hold their 
adjustments when most do?  Well .. first thing don't take it personal 
.. all you can do you are already. Second .. after a discussion and 
allowing them to know of your frustration you can either continue to 
care for them or recommend they seek another chiropractic or 
medical opinion. When you should do this is up to you not a book or 
what teachers explained to you. When you reach the point that your 
patient is not responding with conservative care or they will not 
cooperate allowing your conservative methods to work .. it is time 
to seek another approach.

She is a nurse .. she already understands the medical model .. 
possibly she doesn't want it and will stick it out with you .. but if 
not .. a kind referral to a specialist would be most appreciated. She 
can seek a medical opinion and still see you for chiropractic. If she 
has a primary physician you my recommend she see him/her or refer 
her to an orthopedist .. either way .. they appreciate your concern and 
you notes would reveal that you were concerned and they either did 
or did not accept your recommendations.

I hope this helped

Have a Great Day

Dr. M