In our previous podcasts, we have focused on the differences in scope of practice between physicians and nurse practitioners. But other medical practitioners are also wading into the diagnosis and treatment of conditions that have previously been the domain of physicians. Today we are going to discuss care provided by chiropractors, specifically when chiropractors step outside of their traditional role in providing spinal adjustments and into medical treatment for neurological conditions.
To help us understand this topic, we are joined today by two special guests, patient Nancy Murphy and her neurologist Dr. Dhrupad Joshi.
Dr Joshi's website: https://wecareneuro.com/
PhysiciansForPatientProtection.org
In our previous podcasts, we have focused on the differences in scope of practice between physicians and nurse practitioners. But other medical practitioners are also wading into the diagnosis and treatment of conditions that have previously been the domain of physicians. Today we are going to discuss care provided by chiropractors, specifically when chiropractors step outside of their traditional role in providing spinal adjustments and into medical treatment for neurological conditions.
To help us understand this topic, we are joined today by two special guests, patient Nancy Murphy and her neurologist Dr. Dhrupad Joshi.
Dr Joshi's website: https://wecareneuro.com/
PhysiciansForPatientProtection.org
Welcome to'patients at risk' a discussion of the dangers that patients face when physicians are replaced with non physician practitioners. I'm your host, Dr. Rebekah Bernard. And tonight I am joined by two very special guests patient Nancy Murphy and her neurologist, Dr. Dhruv Joshi. Today we're going to talk about some of the differences in training and education between chiropractors, and physicians, specifically, neurologists. Nancy Murphy is here to tell us a little bit about her story. And her neurologist will help us to understand some things about her condition and some of the differences between chiropractors and neurologists. Both of you, I want to welcome you so much to the program. Thank you for joining us. Thank you, Nancy, I understand that you've been struggling with a medical condition called neuropathy, can you tell us what you've been going through?
Nancy Murphy:For probably two and a half years, I've been going through numbness in my toes more like they feel like they're frostbitten. I didn't look into anything about it for about a year and a half. And I found a place on the TV. So I went to them for service, and they did a consultation. And then I went back for the results. And the results came back that if I didn't take care of this matter at the time, I would be putting myself in jeopardy of losing my feet. So their process was now they didn't tell me how many visits, they didn't explain any thing pacifically and I ended up paying them $8,000 For what turned out to be 10 treatments of electrical, those patches that you put on and they give you electrical treatments, and then a boot that you put on that had lights in it, and I did that for actually 20 weeks, because when the bottom line came to try to go back, they told me I didn't have any more visits, and that they had actually given me 10 extra visits. And I had zero results program. But after first continuing with the program, they had a chalkboard with products from health food stores, that this is how you had to eat, which was never mentioned in my consultation with them pretty much needed to live on a paleo Mediterranean diet. And they gave me a cookbook. So at the very end when I you know had no results from them. They said, Well, if you don't need to live on the cookbook. And that was their final solution with me. So no, I got no results for my $8,000
Rebekah Bernard MD:Wow. So you it sounds like you were really suffering and you were looking for help. And so you saw this TV commercial for a clinic. And it was a chiropractic clinic right?
Unknown:no, they didn't say chiropractic. that there is no nothing on their folder with all the information that you know, I quickly signed so they could quickly get me started, which was it was such a quick process of impressing me I didn't feel comfortable at that point anyways. So basically to get me started because I don't have that kind of money. They said oh, we can get to $1,950 We'll start the program. So they got me loans through a care insurance. And then I got the results and the brochure called to my boyfriend and he said'Well, if that's what you need to do to get your feet better, then that's what we have to do.' So I paid them that $8,000 and never really talked to never saw the man in there that I did my consultation with and I only saw the man in there again that helped me sign up for the money he actually had his secretary or one of their front end girls come in and do it he didn't even know how to do it. And and I just you know sign sign check on the dotted line because you're just in so much distraught, pain, whatever you can possibly do to get yourself back to your real personality because it's drawn my it's just drawing all the air out of my wing. Do you know and then I had a guy that took care of me on it. They call him doctor, but nothing in their paperwork nor their business card says for any doctor in that office whatsoever,
Rebekah Bernard MD:wow, they took a lot of your money and you really didn't get results like you thought you would. And then after all was said and done, it sounds like they made it sound like it was your fault that you didn't follow some kind of special diet. I'd like to have Dr. Joshi weigh in. He's a neurologist and Dr. Joshi. Tell us a little bit about your practice. And tell us a little bit about neuropathy, if you could,
Dhruv Joshi MD:yeah, so I'm actually an academic neurologist. And I see a lot of neuropathy patients, quite a few patient recently that I have seen, have went to this kind of centers where they got this non FDA approved treatments. And basically, it's a non medication treatments, and they advertise in a way that medication has a side effects and you don't want to take a medication, not gonna make you better versus the treatment will eventually reverse your neuropathy and make you better, if you don't do it, you're gonna lose your feet, and you will lose your balance and you will be end up in a wheelchair. So that's the way they try to convince people who are already in lot of pain and suffering, to get to sign up for this non approved treatments. And when I say non approved because there's a reason for it, because these treatments are not approved for because it's not effective, a lot of time it has a great placebo effect, when the patient gets the treatment, they temporarily will feel better, maybe for our for a few hours, or maybe for a day or after that once they stop, they will return back to how they were before or maybe when worse. And this center is are not run by neurologist or any physicians actually these are run by most of them are run by chiropractor, and chiropractor. It's a doctorate degree, they just introduced themselves as a doctor, whatever the last name is. And if you ask them more questions about their degree and their experience with neuropathy, they just avoid those kinds of questions I have experienced with this kind of center, they literally span span less than five minutes. And then then you will be dealing with another person who are mostly like a salesman, and they want to sell you their treatments and products. So yes, this is big money making scams and centers there are popping up everywhere, even in the small community or small local suburbs or rural areas as well. And they these are not run by real doctors, though I actually try to educate patient whenever I can to avoid this kind of places. Because these treatments don't work. This neuropathy is a degenerative process, and there is no real cure for it. It's anything it's you can only manage the pain.
Rebekah Bernard MD:Well, it sounds like it's very uncomfortable and disturbing to have these symptoms like Nancy was mentioning, it sounds like patients really are desperate to seek some kind of treatment or get some relief. And these organizations are taking advantage of patient's symptoms and offering them something that really isn't going to actually help them. How can this even be allowed is Do you know anything about the legalities of advertising these kind of services?
Dhruv Joshi MD:I guess the most of these services are cash based so they don't have to run to the insurance. And if there is some patient who's willing to pay cash for some treatment, even though it's not approved, there is no no laws there stopping them from giving them the treatment as long as patient understood the risks and benefits. But I don't think they're even talking about the risk benefit and alternatives that we do in our clinic for any procedures. The only discussion that I know of is all about benefits. And that's it. They don't even mention that what if this doesn't work? What's the cause of it? Like when I went to one of the centers, I said, I have neuropathy, and then they gave me the treatment like what? Okay, they're offering me the treatment.
Rebekah Bernard MD:Wait, wait. So you actually went into one of these centers to kind of find out what it was all about?
Dhruv Joshi MD:Yes. So I went to one of the centers just to get a consultation to see what they offer. They don't really dig deeper into whether a I even have neuropathy or not. They just took my words for and there is no workup to confirm what kind of neuropathy I have or even if I even I would have a neuropathy or not, what are the possible causes?
Rebekah Bernard MD:And what are some of the possible causes of neuropathy as a neurologist?
Dhruv Joshi MD:A lot of a lot of the time it's a chronic condition. So if you have chronic diabetes, uncontrolled or borderline diabetes, you can get that if you're poor blood supply to the extremities, you can get that or some vitamin deficiencies can cause that to heavy metals in body if you're eating a lot of fish and having some increased level of some metals can cause that. And a lot of the times there are some genetic factors as well. If there is a family members who are similar condition, you might get that as well. And also a lot of autoimmune disease can cause neuropathy is too. So there are multiple reasons. A lot of times you may not find any obvious reason for why someone has a neuropathy. And I have seen that, especially in young people when they don't have any underlying medical condition, but they still have some symptoms of neuropathy,
Rebekah Bernard MD:but they could have something underlying so typically, if a patient comes to you with neuropathy symptoms, you would do a medical workup to check for all of those things, right? Because maybe there's something reversible that you could actually fix.
Dhruv Joshi MD:yeah, so there is a standard neuropathy labs I do. And also there's some more detail labs based on their age, or their risk factors and other comorbidities. So there are some initial workup that we have to do to find the reason for it. And then also at the same time, we have to find some reasonable treatment for it that that is effective and FDA approved. And it's known that it's going to be effective for those condition. So yes, we do we just don't throw treatments on the patient. There will be some workup involved in the beginning,
Rebekah Bernard MD:because there are actually treatments that can help patients with neuropathy. And Nancy, did you actually see a medical doctor before you went to this treatment center? Was this your first time getting treatment for neuropathy?
Nancy Murphy:This was my first time getting treatment for neuropathy. And they only took cash,
Rebekah Bernard MD:oh, that's probably a red flag, I guess for people listening, that might be a concern.
Nancy Murphy:At the time, I had spoke to my MD for a long, long time, saying, you know, my toes hurt, my toes hurt. And, you know, I believed in my MD till the day I die, because he saved me from cancer. If I had not gone to him as a new patient, and had all the tests and colonoscopies and all that done, I would have never known that I had colon cancer. And actually, I've been dead in six months. And so I, you know, I hadn't mentioned it to him. But I have a lot of stress problems. So he just is always trying to keep all that under control for me. And so I have insurance programs that I can, I can't pick my own doctor. So I was thinking that I would have to get a referral from him. And I didn't. So that's why when I went here, because I found out after I went there and talk to other people everything with cash pay.
Rebekah Bernard MD:Nancy, did you make any complaints about the care that you got or the loss of your money for this service that really didn't help you?
Nancy Murphy:At this moment, Dr. Joshi, just helping me with that. Just real quick, something that happened, you didn't that's that's how I got to the bottom line of my treatment, I fell at a mall in some water. So when I come home, my toes were really bothering me, like really bothering me, I lost my balance. So your, your body doesn't want to go where your feet want to go from neuropathy. I was having that problem for probably a year and a half, two years not knowing what it was. So I tried to get a hold of neuropathy office. So I could come in for some treatment, because I hadn't had those spells since I started the treatment. That was one thing I hadn't had. But I still had the pain in my feet every single day. Never did it ever go away. Matter of fact, after the light boot treatment, it would get worse. So when I caught there, she informed me that that doctor, which ended up being a chiropractor was with the patient. And she would have them call me then it was local to where I was. So I thought I could just run over there and get some treatment. And then that got no call back. So I was still there. I called also again, and he came to the phone. And he said if you don't stop calling me I will not find time to take care of my patients. So I can call you when I get off for work at five o'clock. And I said oh okay, when you do that, then I have not heard of that place. Then I have called management twice. They never returned my calls. I have not heard one word from them. Well, the girl said that you had 10 treatments and he gave you 10 treatments for free. Well, why did I pay $1,000 for a cookbook and 10 treatments and you're willing to give me 10 more treatments for free.
Rebekah Bernard MD:That's so upsetting. So after all this happened is that when you found Dr. Joshi is your neurologist? Yes. And has he been able to help you or make any progress with your neuropathy?
Nancy Murphy:To be honest. I have to say it's never been better.
Rebekah Bernard MD:Oh, that's such great news.
Nancy Murphy:I called him the other day because I'm so happy. Of six days one day, I had some partial pain in my feet.
Rebekah Bernard MD:Wow. And I bet Dr. Joshi did not charge you$8,000. for that. We won't ask how much but it sounds like my guess is he's on your insurance plan or it's a reasonable fee.
Nancy Murphy:No, I paid out of pocket. And it was very, very, very cheap. I was surprised because I thought, okay, man, if I have to keep going to see him, I need to find out how much more each appointment is going to be. And he explained to me if I wanted to be on like a management program, is that what you call that?
Dhruv Joshi MD:It's a it's a membership. I have a direct care membership option.
Rebekah Bernard MD:Ah, this just got even more interesting for me, because I'm sure you know, Dr. Joshi. But I have a direct primary care practice. Or I don't know if you knew that. So you're doing a membership practice as a neurologist?
Dhruv Joshi MD:Yes, I have a hybrid practice. So I do take some insurance and the rest, I do offer membership options. And yeah, so it's a combination of both.
Rebekah Bernard MD:So my guess is that patients like in my practice, many of my patients come to me because they don't have insurance or they have a high deductible plan, or because they're looking to use it more as a doctor that spends a little bit more time with you. Is that what you're seeing in your practice?
Dhruv Joshi MD:Yes, so for me, like I'm in an area where it's not a very affluent area. So most of my patient who are a member, they're uninsured. So rather than going to big hospital clinic, which will be too expensive for them, they just pay me a monthly membership. And with that, a includes unlimited amount of consultation. So follow up with me.
Rebekah Bernard MD:I'm getting excited when I hear this because we have such a shortage of neurologists in my area, and I have so many patients without insurance that I would love to find a neurologist offering this kind of model in my area. So I hope we can put up your information on our podcast notes so that other people can find you and maybe other neurologist and specialists can get inspired to open a similar type of practice where they are now Nancy, how did you find Dr. Joshi?
Nancy Murphy:I got on the internet, and I just looked for someone now local to my area, and then asked about their treatment. And also how much visit would be I have insurance, I have free county date insurance, and 100% covered on everything you can think of but it has to be within my HMO, right? And it wasn't. So I was still under happy to pay out of my pocket. But you know, like you say I paid the $8,000 which I have never in 31 years took one penny from my boyfriend. But that's how much pain you're in and affects my driving. Also, I have a brand new car and I just did $5,000 with a damaged with it because I cannot focus on the road and try to eat something else at the same time. And for certain things with cars and stuff. It affects your your mental state a lot. I had no choice, you know, I have to do something or I'm just gonna commit suicide or just cut my feet off.
Rebekah Bernard MD:Well, it's so good that you saw his advertisement. And then you took another chance because you had a negative experience with the last advertisement you followed. But it turned out to be excellent, because this time instead of going to a clinic.
Nancy Murphy:I was just gonna say Dr. Joshi actually looked into the place for me and then told me that there was not a doctor there. I knew you didn't know at the time. And I was Yeah, that's amazing. I will try a real neurologist.
Rebekah Bernard MD:So like you would probably advise other patients that have neuropathy that they should look for a physician and specifically a neurologist to help them out.
Nancy Murphy:Yeah, most definitely. And yet, this isn't a huge advertisement on our TV and it says neurology / neuropathy clinic, you know, they don't call it clinic. It's a center.
Dhruv Joshi MD:Yeah, these locations are websites they have and the actual location. They do everything in their power to not let the patient know that they're not real physician. On their website. They don't have any information about the doctors. They have generic pictures of people in their white coat on their website and reviews. They are in the waiting room and the exam room and everywhere they have TVs, playing constant reviews, testimonial video testimonial of the people, which we don't know if they're real or not. But that's what they do so, and they, I don't know, if they intentionally make you wait half an hour, one hour before they come up with a treatment plan, because the treatment plan plan was basically you need Five, five session or 10 session. And that's it. So there is no way for them to need half an hour to come up with a treatment plan. But when I figured that that the video length that they're playing is about half an hour, so they do want you to finish up the whole video, before they come up and tell you the same thing.
Rebekah Bernard MD:It sounds like everybody gets pretty much the same treatment, you get this boot with the laser or some kind of lights. Is there any evidence that any of that works at all?
Dhruv Joshi MD:If there is it's very small studies, and it's not validated yet. So and most of the studies, it does have a significant placebo effect, if you have neuropathy acting up in your legs. And if you do some kind of electric stimulation, the nerves will come down for momentarily, but that doesn't mean that you're getting better. It's just momentarily that electric shock therapy hyperpolarize the nerve and it's not going to depolarize again. So the I think that's my theory. So it says the placebo effect and it doesn't really cure anything it just momentarily make you feel better. And then maybe next day, you will get the same problem.
Rebekah Bernard MD:Dr Joshi what would you say to patients that are listening that might be having raw neuropathy or other types of nerve pain or problems? What should they know?
Dhruv Joshi MD:Oh, the biggest thing is they have to have a proper workup for why they have neuropathy. And at the end, about 50% of the people will end up having idiopathic neuropathy, meaning we don't know why it's happened. But there is a reason for it, it's just a we have not able to figure it out yet. And at that point, people should focus on the treatment and treatment should be approved and covered by the insurance. If it's not approved and not covered by insurance, then the treatment is an experimental treatment. And it may or may not work at all, most likely it may not work, and it will have a significant placebo effects. So I would stay away from from any treatment that cost your arms and legs. And if you're not comfortable, if someone tell you this is gonna be in 1000s or hundreds of dollars, I would get a second opinion before even you act on that particular treatment. And second opinion, make sure that you see a neurologist specialised in neuropathy. And that's where you will get the most up to date information. And also you might be able to enroll in some neuropathy trials that are going on across the country. So you will get those new treatments that are in the research for free.
Rebekah Bernard MD:It's so great to hear that and to hear a lot of times people worry that, you know, physicians don't listen or that they're going to be very expensive. But here you're hearing a story from an amazing neurologist, a physician who offers affordable prices to patients, and is able to help improve their quality of life by applying the principles of medical practice that he's learned through many years of school and training. And so he has, he's just like the perfect example of the heart and training of a physician. And so I want to thank you so much for taking the time to come on. Nancy, I want to thank you very, very much for telling your story. Because I know it's not easy to talk about what you went through and also to kind of feel taken advantage of in that way. And I hope your story will help other people to be a little bit wary and not be taken advantage of and to make sure that they ask for a physician and know who's taking care of them. To learn more about this topic. I encourage all of our listeners to get the book patients at risk the rise of the nurse practitioner and physician assistant in healthcare. We would love for you to subscribe to our podcast and also to our YouTube channel patients at risk. And if you're a physician and you'd like to learn more about this topic, please join us physicians for patient protection.org Thanks so much and we'll see you on the next podcast.