David Hanscom, Orthopedic Spine Surgeon

Back in Control; a Chronic Pain Series with David Hanscom, Orthopedic Spine Surgeon transcript powered by Sonix—easily convert your audio to text with Sonix.

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Saul Marquez:
Welcome back to the Outcomes Rocket, Saul Marquez is here and today I have the privilege to host Dr. David Hanscom.

Saul Marquez:
He is an orthopedic spine surgeon whose practice focused on patients with failed back surgeries. He quit his practice in Seattle, Washington, to present his insights into solving chronic pain, which evolved from his own battle with it. The second edition of his book, Back in Control A Surgeon’s Roadmap Out of Chronic Pain, is just a great read. His website Back in control.com presents an action plan on how to get rid of chronic pain, how to cure it. His new book, Do You Really Need Spine Surgery? Take Control with a Surgeon’s Advice, was released this fall 2019. It is intended for health care providers and patients alike to make good decisions about undergoing spinal surgery. We’re going to be diving into health care costs, the use of medicine, the overuse of medicine and chronic pain. And Dr. Hanscom is going to give us his perspective on it. So just such a privilege to have you here. David, thanks so much for joining us.

Dr. Hanscom:
Thank you very much for having me on your show.

Saul Marquez:
So before we dive in to what you guys do at get Back in Control, Dr. Hanscom, I want to better understand what inspires your work in health care. Can you share with us a little bit about that?

Dr. Hanscom:
Well, I’m a little bit of a different perspective in that I spent two years training in internal medicine, so certainly like an internist about the whole patient from the beginning, that it started despite the surgery, went into spinal surgery. And I took sort of a research and approach into internal medicine and vice versa. And around 1990 I developed chronic pain that was extreme. And I was in the 13 years now. I was one of the surgeons who has been on both sides of the fence. I was a very aggressive surgeon. I trained at a top fellowship in Minneapolis and I came out on fire just doing surgery after surgery after surgery and I felt obligated to do it because people are desperate. There’s no other answer. I viewed myself as the end of the line. In 1993, a paper came out of the state of Washington showing that the success rate of spinal fusion for workers compensation to Washington was twenty two percent and my results were better than that, but they weren’t that much better. So I just think that was the first data that came out to show that this operation didn’t work. And then since then, there’s not been one research paper in 60 years that documents that spinal fusion for back pain actually works. And I quit doing practices for back pain. I still do quite a bit of surgery for deformity and repeat back surgery and infections and stuff. But another paper came on in 2006 is set in a very straightforward patient, we did a back fusion. This is out of Stanford. We’re back in a five year fall. The success rate was twenty three percent. So in the meantime I developed chronic pain went off an abyss, so to speak. Capturing anxiety, 17 different physical symptoms. I came out of it in 2003 and started sharing the tools. My patience in a process evolved that was self directed, called The Doc Project Direct your Own Care. And I wrote the book to explain the background of the patients, but usually mostly self-directed process. I watched over 12 or 1500 patients go to pain free, which I never thought was possible. So I started treating patients systematically with the I call it surgeon approach non-operative care, systematically adressing all the literature, just doing what the literature said to do. And people started getting better. They went to Paint Creek. At the same time, spine treatment in the last 10 years, have become an incredibly progressive. Instead of doing one in two of all fusion for back pain that didn’t work, we’re doing eight, 10, 12, 14 fusions that don’t work, except that the complication rate is much higher, as you well know, with the larger fusion. Only three or five patients every week have insurance on a relatively normal spines that they didn’t need. I was watching hundreds of patients go to pain free with minimal risk and no cost. So the difference between became so dramatic to me that in December 2018, I actually quit my practice pretty much at the peak of my career to pursue this process here.

Saul Marquez:
That was three years ago?

Dr. Hanscom:
It was December twenty eighteen.So it’s been around 18 months.

Saul Marquez:
So it’s been almost two years. Man, that’s that’s just incredible. I mean, you know, you’re at the peak of your career and you decide to make a shift. I mean, this this this was a big deal for you. So much so that you decided to change at all.

Dr. Hanscom:
Well, the problem is what people don’t understand is that people are concerned as a last resort and it’s a last resort if there’s something to operate on. But for instance, you have degenerative diseases, which is actually been documented to be a normal finding as you age. It’s been well documented that it is a source of pain. Note, no research paper documents that it works for almost 20 billion dollars a year of its operation, that doesn’t work. And on top of that, with chronic pain, one way to induce depression is to repeatedly dashed hopes. So we’re offering procedures we know don’t work. People get their hopes up. High risk, high cost. The success rate is twenty two percent. And you well know, the data keeps saying that we do more and more money on chronic pain. We’re spending more and more money. The results are getting worse. Opioids are up. Disability up. Medical costs are up. And then I ran across a patient my last year in practice who’s 30 years old. He had a surgery on a stable spondylolisthesis that did not need surgery. Paralyzed. That was it. That was my decision. I’m just done with this. I can’t do this anymore. So my patients every week having services they need, I’m seeing dozens of patients every month going pain free.

Dr. Hanscom:
And probably the cause are going to cost me between five hundred two thousand dollars. It’s a very self-correcting process, maybe five thousand dollars at the most. But these are the worst of the worst patients. These are the five percent of patients who cost 85 percent of medical dollars. So these are not casual patients that go into pain free, a reason that a patient who had 20 years of back. He had twenty seven surgeries in 20 years. How much money do you think that cost? He suicide attempt? Alcoholism, opioid abuse, failed marriage, failed business, the cost to him and society is going to be at least five million dollars, maybe more. He ran across about four years ago who started to take care of them. He ran across my book Back in Control about three and a half years ago. He’s been pain free now for over three years. He is pain free. He says, I haven’t felt this good since I was 30 years old, so think of the cost in medical system of that many surgeries, ongoing medical care, he’s out of the system completely. He doesn’t even see doctors anymore.

Saul Marquez:
This is awesome. So so tell me a little bit about how Back in Control is is adding value to the health care ecosystem. How are you doing it? Right. Because it’s non-traditional. So I love to hear more about how your approaching it and specifically how you’re helping people.

Dr. Hanscom:
Well, I’m some defensive here for a second. So what I’m doing actually is traditional ways. Every treatment of the book is well documented medical care, but it’s not covered by insurance. So there are many documented care pathways that are effective, we know this, but they’re not covered by insurance. So you take my office based stress reduction has been documented to work, it actually decreases the size of the amygdala, which the portion of the brain, the neuroscience research last 10 years has given us a very clear answer to the nature of pain and that anxiety, depression, schizophrenia, heart disease, peripheral vascular disease, chronic pain or all inflammatory disorders. Inflammatory. They’re not psychological. So that debt has been around for a long time. So what’s happened? Mainstream medicine is totally off track. There’s hardly anything that they do right now that actually has been proven by data. Again, no research papers show that doing for back pain works for up to 20 billion dollars a year. That’s not mainstream medicine. So this is flat out. Let’s take one of my exercise, which is called expressive writing and it breaks up this anxiety producing mental thought circuits. It’s been documented in over one thousand research papers to be effective over a thousand. So it improves performance, mood, anxiety, actually cuts wound healing in half, lowers infection rate drops of viral load. And I asked the original author, Dr. Pennebaker, why does this work? He goes, “i don’t know”. The top psychologist in the world when it comes to these obsessive, anxiety producing thought patterns. The only solution they found that works and it does work is this was called expressive writing. Over a thousand research papers. Now, how much money can you make by writing things down? Turn them up? Not much.

Saul Marquez:
So what exactly does expressive writing entail?

So I was in chronic pain for 15 years and I ran across a book where this guy said to start writing things down, which I did. And it was a great book called Feeling Good by David Burns. It’s based on a book based cognitive behavioral therapy. And I thought it was the book. Turns out it was expressive writing. It should be write down your thoughts and you trauma. Positive or negative, it doesn’t matter. What happens, the essence of chronic pain is your it’s your body’s response to a threat which fires up your immune system. And the information the solution revolves around safety. So thoughts, repressed thoughts, repressed emotions are all a threat, but you can’t escape your thoughts. What I think the expressive writing done does is simply separate you from your thoughts. Your thoughts are on the table. You’re here with a space connected with vision, which is part of your unconscious brain. The unconscious brain processes about 20 million bits of information per second. The conscious brain processes 40. So this is not a psychological issue. Anxiety is a pain. Remember, anxiety is a response to a threat is not the cause. So what happens in medicine right now is that we’re actually creating anxiety with promising things that don’t work. We are predatory is that we know these don’t work. Instead of calming people down, we’re fighting them up. And the number one thing I think is causing disability right now is that we’re so production based on procedures that don’t work, that the one factor that I think determines success versus failure is talking to the patient.

So what’s happening? If you will, solve the health care issue, you would triple or quadruple the time spent talking to the patient was primary care insurance or surgeon. That’s the essence of everything. Nothing else really works if you can’t talk to the patient. So if you can’t feel safe with your doctor, where are you going to feel safe? So that one factor of not in fact is the other way around right now is that hospital administrator salaries have gone up, something like three thousand percent, doctor salaries have gone up 15 percent. And there’s a lot of money going into administration and middle management. And what they’re doing, they’re pushing the doctors to be more and more productive. The money is going into their pockets to take it away, our capacity to talk to the patient. So two things happen. First of all, the patient doesn’t feel safe. Guess what, they actually aren’t safe. The same thing is if you’re a patient, you want to know me. I want to know you. So how can you make this massive decision on the first visit? It makes no sense at all. So, again, the solution for chronic pain, chronic disease is safety. It has to start with time with your physician and rewarding, not punishing.

Saul Marquez:
And it’s and it’s difficult to do Right. when insurance pays for operating, not necessarily expressive writing or are spending extra time with your patients. So tell us a little bit about how you’re approaching this and how you’re making this all work.

Dr. Hanscom:
Well, I’ve sort of given up on the question for the moment. There’s many the reason why I think this is solvable is I do think it has to come from the public. The patients. Also remember, the administrators and doctors are also patients themselves, members, your families and friends who are also undergoing medical care. So right now, is that a great instance of safety in helping people who are actually creating disability? And we’re actually creating disease, not solving it. So my thing is public relations going out to the public with protests like this one on National TV, National Radio. I have an app coming out starting in about two months, which basically takes people through this journey with a little bit more of a directing manner. Its designed to create an experience of safety and pleasure. It’s a very entertaining, creative app called the Doc Journey Direct your own care journey. And it’s based on these workshops we did back in New York at the Omega Institute, where we had 15 to 20 people in a room very structured, very safe. And my wife is a tap dancer. My daughter is a soomatic arts therapist. And we shared enjoyable experiences together. Between social connection, structure, laughing about 80 percent of people in pain free in three to five days every time, every workshop. So, again, is it creating a sense of safety that changes the body’s chemistry, lowers inflammation and promote health? So I do think the medical profession, if we’re serious about the health of our country, health of our nation, is going to flip this paradigm. And this pandemic, maybe the reason to do this, because what’s happening with the Wall Street Journal article a few weeks ago said hospitals are losing money because they’re not able to make money on profitable procedures or they’re making money and profitable procedures that have been ineffective.

Dr. Hanscom:
Right., that makes no sense, right? So why should you as a patient be the source of this hospital’s income, the administrators and the physicians income? And the reason why I think this can and should work is that doctors like the patients. So people accuse physicians of being money hungry, should to make money. I’m not against making money making money. I like making money. But it shouldn’t be at the expense of other people’s health. And right now, you have this process of I mean, the whole process. Everybody’s in the game. We have insurances, we have the hospitals. We have everybody making money off of people’s illness. Right now with a pandemic, we, first of all, are under stress and anxiety is a result of a threat. The threat is uncertainty, plus inadequate medical care. So we create a disease. And remember, almost every person that dies of the COVID virus has pre-existing conditions. Where do those come from? So your adult onset diabetes, eating issues, cardiac disease, lung disease, these are risk factors that are created by lack of safety. So right now, this is a come to Jesus moment where hospitals are not able to make money off of procedures for a while, hopefully never and not it now. Right now, we need to create health. We get rewarded tremendously for creating products that are profitable. Particularly if they’re disposable, as you well know. And when it happens, we’re just cranking up revenue really off of hurting people right now and actually let people know that we’re actually asked by hospital ministry here to perform a procedure that I won’t mention that has been documented to be ineffective. And the only reason they wanted us to do the procedure was because it was, quote, comfortable, had a high profit margin.

Saul Marquez:
Well, it’s definitely not right. And as you think about the issue at hand, we’re faced with this problem as individuals with our families as well, and as employers with our employees and all the other lives that we cover through through health benefits. And even as a society, it’s something that that affects all of us. And so talk to us a little bit about how Back in Control your firm is approaching it to make it better, despite the, quote unquote, normal things that happen that aren’t right.

Dr. Hanscom:
Well, first of all, the public education process, it’s about 90 percent self directed. You don’t need pain clinic. You don’t need psychologists. What you do need? he solution to chronic pain, by the way, is a primary care program because it consists of sleep, stress, medications, physical conditioning, all these things really primary care. They’re not psychological. Most of the patients that are getting better are not psychologists. Have never seen a psychologist. So the bottom line is, is that I am working with people, educate primary care physicians to have access to the book and the website and the programming.

Saul Marquez:
Cool.

Dr. Hanscom:
So what it does, it puts the responsibility for care under the patient’s primary care. So it’s premature to be more efficient, it’s more enjoyable and it’s more effective. So from a cost standpoint, it costs a minimal amount to educate the patient. They take control of their own care to direct their own resources. And it’s it’s a big deal. Most certainly a group systems that are Bubeck North Carolina called Integrated Solutions, does use the docproject as a basis for group therapy. They do share appointments of 10 to 12 people in a group they meet once a month.

Dr. Hanscom:
They’ve cut the average marketing equivalent to this group from one hundred male equivalents of morphine a day down to 40. And what happened is that the people that are socially isolated developed chronic pain, so the social connections being a big deal at the end of the year, the patients refused to break up. They had to create a second year curriculum. So we think the group should ensure medical appointment is a big deal. Maybe the best way to actually treat chronic pain, also cost effective in lots of different levels. And so doing that, I’m developing the app also developing an app for physician burnout, because obviously, if you’re a burnout physician it’s hard to be effective and vice versa, ironically, probably the one thing that can prevent reverse physician burnout is talking to the patient.

Saul Marquez:
Goes back to that.

Dr. Hanscom:
Right., because what happens is that medicine’s actually pretty tedious and we offer physical therapy, medications, injection surgery, etc. There’s only about 10 things that we do over and over and over again. Now, what makes it’s an incredibly interesting is the patient. Mm hmm.

Saul Marquez:
Yeah. That’s such a such an interesting approachnd callout. And it’s like you listen to your message, Dr. Hanscom, and you’re like, oh, no kidding. And so and so as you’ve been developing your approach and you have a lot to come with, with these different apps and your approach to chronic pain as a primary care area of expertise, I really like that that idea. What would you say is one of the setbacks you’ve experienced as as you’ve been developing these resources and your approach over the last 18 months? And and what was the key learning from that setback?

Dr. Hanscom:
Well, first of all, I have to continue to embrace my own tools and words. I practice what I preach to my patients. I continue to stay centered. I get pretty viciously attacked. When I left, my hospital was actually one of my friends was told by different administrators how happy they were to see Hanscom retire. Because I was the lowest cost producer, my surgical rate dropped to four and a half percent of new patients. By the time I left, even surgical patients were going pain free. They hated it. So it’s been tough. And what happened is I really had to work on my own tools. I realize that when I was upset, they were tearing this image of David Hanscom, not necessarily me personally. What I stood for. So I learned not to take it personally. I learned to use it would be resilient and tough to stay connected to my own message and just move forward steadily and its made a big difference.

Saul Marquez:
Hmm. Yeah. You know, that’s so well put and it takes a lot of courage. And you went through it yourself. And so maybe that’s where your courage came from to do this. But maybe you could tell us better. I mean, where is your courage coming from to do this? Because it’s not easy?

Dr. Hanscom:
Well, I mean, I have lots of different passions. One of them is the whole physician burnout thing. And I went through a burnout. And what actually kills physicians is anxiety. Anxiety is not psychological. It’s the response to a threat. It is physiological. It’s not being treated correctly. So I was suicidal, I had 19 medical colleagues commit suicide. I look at every day some day as bonus time and then the doctors defense. I would have no insight into this at all if I hadn’t gone through what I went through because we’re just taught the wrong thing. So first of all, I shouldn’t be here. Honestly, I actually started procedure with my own demise. And again, having 19 medical colleagues and counting, by the way disappear has been very sobering. And so I consider it a bonus or a privilege to carry this message forward to. Two, my biggest mentors have taught me that adversity is your opportunity to actually move forward. In other words, embrace opportunity. Every one of my friends said never waste a crisis. And so I don’t like the diversity. I don’t welcome it. But I’ve also learned that each time I comes at me, I just go back to my own basic rules. I teach my patients, get grounded in what I’m doing and just keep moving forward. So I’ve also learned the key word, persistence just one day at a time when podcast one patient. I do a round table every Tuesdays and Thursdays at noon for an hour, about twenty to thirty people around a table. And in three months we’ve already had five people, a group working free. So it’s also inspiring with my patients successes. That actually keeps me going also.

Saul Marquez:
Mm hmm. Wow. That’s a great story, David. And congratulations. I mean, amazing that you got yourself out of that rut and now are working to and are inspired to to help others with their pain. And and there’s a lot of physicians hurting out there as well. And hopefully, if you’re listening to this message, you’re finding some inspiration in Dr. Hanscom’s message and story. So I think it’s awesome what you’re doing, David. And so. What would you say excites you most today?

Dr. Hanscom:
It really comes down to one patient at a time, one person at a time, I think on this roundtable, three eight positions on it and four of them have already turned it around. Just watching people, one person get energized and move forward like that just feels good. Just enjoy it as well. My friends told me I just simply get energized by my patients and I do miss my practice. And I will say I like being in the trenches retired. Not really, but I really do miss being in the trenches and doing what a wonderful, incredible team. We watch patients get better, but it just felt he needed to leverage what I knew more to the real world. So, yeah, I definitely miss that part of my practice, too.

Saul Marquez:
Yeah, he did it for so long and now you’re making this shift. But I see your new practice growing and and it feels more at the heart of what you’re after. So you know that that’s pretty exciting in itself won’t you say yeah.

Dr. Hanscom:
And what I try not to get discouraged about this. We go to one patient at a time because there’s a big system out there to change. And I do think it will come from the ground up. And I do think that the public is understanding that a lot of things should be done to them that are not helpful. They’re starting to seek alternatives. So the last two years, I say there’s a big shift in the public awareness of what might work. There’s also many physicians, of course, that feel the same way I do. And my whole thing is collaboration, collaboration, collaboration. And we’re generally we’re slowly bringing together a group of people who think the same way a certain momentum. Yeah, it’s starting to happen.

Saul Marquez:
Congratulations since it’s awesome. And so, folks, that today we wanted to spend a little bit of time diving into the into the problem of care and overall operation and the issues of burnout. And it’s been a fantastic episode. We’re going to have a part two to this where we dive into Dr. Hanscom’s view on on the solutions. And so we’ve got another exciting podcast coming to you in this small series. But before we conclude, David, I’d love if you could just leave us with the closing thought before we join again next time. And then the best place for the listeners to get in touch with you to continue the conversation and learn more.

Dr. Hanscom:
My main message is to use the tools yourself. The way you actually help your patients is helping yourself. The tools are not very hard to do, but by connecting to yourself, you’ll be able to connect to your patients and vice versa. So it’s all about connected and engaged, thinking about fixing and just being with what is on a given moment that you’re in.

Saul Marquez:
That’s a great takeaway. And where can the listeners get in touch, David?

Dr. Hanscom:
The website is Back in Control.com One word. The new app will be available on that site. The website right now, by the way, is open source. People can always have access to that. The book is on Amazon Back in Control, A Surgeon’s Road Map to Chronic Pain. The other book to really need spine truth, I think is really going to be helpful. It really clarifies very quickly in a clutter who doesn’t and doesn’t need surgery. So I am not against surgery. I’m just against surgery that doesn’t make any sense. So that’s a quick read. It adds a lot of clarity to the decision making and I’m very excited about that book. Also called Do You Really Need Spine Surgery?

Saul Marquez:
Love it. And folks, as Dr. Hanscom mentioned, Back in Control. Dotcom is is the website. You’ll find the books there. You’ll find resources there. You’ll find a link where you could join the Tuesday and Thursday Q&A roundtables, just a wealth of resources and and free guides that he offers. They’re just really brilliant, brilliant stuff. So make sure to check that out. David, thank you so much. This has been a wonderful discussion and I’m excited for our next one.

Dr. Hanscom:
Thank you.

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