73 - When Patients Don't Get Better: When to Change Course

Hosts Paul Andrews and Dr. Mark Davini discuss what to do when patients don’t progress as expected under chiropractic care. This episode explores why some patients fail to reach clinical goals, how practitioner technique and patient expectations factor in, and the classic 80–10–10 perspective on outcomes.

Topics include a practical 2–4 week clinical algorithm for detecting non-response, objective exams and malingering tests, real-world anecdotes, and the difference between vitalistic and mechanistic approaches. The hosts also debate seasoned versus newer clinicians and evidence-based thinking.

Key takeaways cover when to change treatment, when to refer or co-manage with specialists (MRI, neurologists, orthopedics, rheumatology, physiatrists), how to set realistic expectations with patients, and why humility and collaboration improve outcomes.