Hey all. I'm kinda new to the studentdoctor.net forums. I'm a first year student in the Midwest. For the first time since starting medical school, I was totally pissed off by a chiropractor (well known to me) who thinks she/he knows as much as I do about medicine. She/he probably does at this point, but what about in a couple years? I immediately, of course, thought about that, and realized that I haven't seen anything about that on here in the allopathic forums in the past few months and was wondering what you all thought.

She/he started asking me 'why do MD's start all their patients on furosemide without potassium supplementation?' It felt like a total attack, and was wondering if all your thoughts were the same...Found some interesting websites though...

Chirobase06

Many patients I've had this year I do put on K-dur along with lasix, especially if they have a h/o MI or are s/p CABG. However, I don't if a pt has renal insufficiency, among other reasons.

A complete drug history & past labwork is required to evaluate if potassium supplementation is required. Other medications, especially for htn (ie ACE inhibitors) will contribute to a reduced need for potassium supplementation even if a loop diuretic is used. If a loop diuretic is added to a thiazide or a combination thiazide/triamterene, supplementation is not required and can be dangerous without close lab monitoring.

sorry - should have said....supplementation *may* not be required - there is no hard & fast rule

You should've responded by saying "Because MD's earned that right to decide whether they need K+ supplementation or not by going to med school while Chiropracters didn't." If they don't like the way it's being handled, they should go to med school then.

Hey all. I'm kinda new to the studentdoctor.net forums. I'm a first year student in the Midwest. For the first time since starting medical school, I was totally pissed off by a chiropractor (well known to me) who thinks she/he knows as much as I do about medicine. She/he probably does at this point, but what about in a couple years? I immediately, of course, thought about that, and realized that I haven't seen anything about that on here in the allopathic forums in the past few months and was wondering what you all thought.

She/he started asking me 'why do MD's start all their patients on furosemide without potassium supplementation?' It felt like a total attack, and was wondering if all your thoughts were the same...Found some interesting websites though...

Chirobase06

You should've responded by saying "Because MD's earned that right to decide whether they need K+ supplementation or not by going to med school while Chiropracters didn't." If they don't like the way it's being handled, they should go to med school then.


Chirpractors for sure, not arguable, know more about the anatomy of the entire humany body, at least right out of school anyway. Beyond that, the physician is the expert.
Interstingly, the depth with which they study this goes well beyond that taught in medical school. This is true of PTs as well. Chiros take many of the same courses taught in the first two years of medical school, except pharm. So they learn all about disease and the biochemistry, etc behind it.
Although the formal training is quite different, as a future physician, your knowledge will not be based on what your learned in medical school, but instead your ability to be a lifelong student. So, there may be some things that a chiropractor is very knowledgeable about because they constantly read, study, adn attend seminars- just as you will do. The best possible treatment for your patient will likely come from a collaborative effort among you, other docs, and other healthcare providers. If you run into a chiro or PT or whoever that rubs you the wrong way, simple take what they are saying into consideration as it may help you decide the best treatment for your patient. Doctors are managers, so ultimately it is your decision. But the key to being a manager is to not take on all tasks, but rather devide them up appropriately and bring eveyones strengths and input to the table.

Chirpractors for sure, not arguable, know more about the anatomy of the entire humany body. The depth with which they study this goes well beyond that taught in medical school. This is true of PTs as well. Chiros take all the same courses taught in the first two years of medical school, except pharm. So they learn all about disease and the biochemistry, etc behind it. Although the formal training is quite different, as a future physician, your knowledge will not be based on what your learned in medical school, but instead your ability to be a lifelong student. So, there may be some things that a chiropractor is very knowledgeable about because they constantly read, study, adn attend seminars- just as you will do. The best possible treatment for your patient will likely come from a collaborative effort among you, other docs, and other healthcare providers. If you run into a chiro or PT or whoever that rubs you the wrong way, simple take what they are saying into consideration as it may help you decide the best treatment for your patient. Doctors are managers, so ultimately it is your decision. But the key to being a manager is to not take on all tasks, but rather devide them up appropriately and bring eveyones strengths and input to the table.

Um, not more than physicians.

Um, not more than physicians.
Um, can you elaborate sir? You think a PGY1, for example, right fresh outta medical school knows more anatomy than a fresh outta chiro or PT school person? Or do you mean something else?

Ok, let me rephrase what I have said- I may have mispoken. CHIRO and PT graduates have a better understanding of anatomy than med graduates.
There, that's better. If you think about what a PT and CHIRO due in their daily roles, and keep in mind that eveything they learn and practice is dependent upon their understanding of the anatomy of the human body, then it is relatively easy to acknowledge that this makes sense.

Um, can you elaborate sir? You think a PGY1, for example, right fresh outta medical school knows more anatomy than a fresh outta chiro or PT school person? Or do you mean something else?

Ok, let me rephrase what I have said- I may have mispoken. CHIRO and PT graduates have a better understanding of anatomy than med graduates.


Are you saying that a surgical intern at Johns Hopkins or MGH doesn't know human anatomy as well as a rookie D.C. from [insert name of illustrious chiropractic school here]??? :laugh: :laugh: :laugh:

Are you saying that a surgical intern at Johns Hopkins or MGH doesn't know human anatomy as well as a rookie D.C. from [insert name of illustrious chiropractic school here]??? :laugh: :laugh: :laugh:

A rookie DC vs a rookie MD- yeah, sure.

Yet another BS chiro thread. Haha davematthews knowledge is laughable :laugh: chiros know more about anatomy than docs :laugh: chiros are con artists, sorry to break it to you.

Yet another BS chiro thread. Haha davematthews knowledge is laughable :laugh: chiros know more about anatomy than docs :laugh: chiros are con artists, sorry to break it to you.

Oh come on, they must be experts in the field--after all, they have those ultra-professional-looking plastic skeletons dangling in the corner of their shopping mall kiosks!

A rookie DC vs a rookie MD- yeah, sure.

Which textbooks did you study? How much time in a cadaver lab?

Which textbooks did you study? How much time in a cadaver lab?

LOL- I am not a chiropractor or a PT. CHiro schools, for example NCC, spend a year and a half dissecting. Seems a bit crazy, most med school spend a few months tops. They spend longer because they have to know every detaill and know it extemely well. Actually, if you talk with your anatomy professor (if they are older) they will tell you that they had to know a lot more than med students now. It's really not that big of a deal- I would hope they know more, their job depends on it.

Yet another BS chiro thread. Haha davematthews knowledge is laughable :laugh: chiros know more about anatomy than docs :laugh: chiros are con artists, sorry to break it to you.

Yes, your right, it is laughable. BUt, if you are right, you must be smarter and than quite a few physicians at Northwestern University and the Rehabilitation Institute of CHicago ("the #1 ranked rehad hospital" in the country for the last decade by USNEWS with prolly the most compettive residency programs for PMR in the country) who have chiros in their clinics whom they send off their patients to...

sorry to break it to you.

Don't worry, it takes more than someone simply stating an opinion without any logical reasoning to "break it to me".
What do you think of acpuncture? (Although I think I know your an advocate I am curious)

Um, can you elaborate sir? You think a PGY1, for example, right fresh outta medical school knows more anatomy than a fresh outta chiro or PT school person? Or do you mean something else?

Ok, let me rephrase what I have said- I may have mispoken. CHIRO and PT graduates have a better understanding of anatomy than med graduates.
There, that's better. If you think about what a PT and CHIRO due in their daily roles, and keep in mind that eveything they learn and practice is dependent upon their understanding of the anatomy of the human body, then it is relatively easy to acknowledge that this makes sense.

A PGY-1 DO DOES.

PT's & DC's don't have any more understanding than a DO does.

Sorry to burst your bubble.

I should have been specific when I said physician with "DO" or "MD trained in OMM."

A PGY-1 D.O. DOES.

(I'm a D.O. student.)

LOL- touche.

Well, since you learn OMM you would probably agree that if forces you to learn and understand anatomy much more than simple dissection- yes?

LOL- touche.

Well, since you learn OMM you would probably agree that if forces you to learn and understand anatomy much more than simple dissection- yes?

Yes, I would agree.

However, you could not say that a chiropractor or physical therapist knows more anatomy than an osteopathic physician, now can you?

A PGY-1 DO DOES.

PT's & DC's don't have any more understanding than a DO does.

Sorry to burst your bubble.

I should have been specific when I said physician with "DO" or "MD trained in OMM."

There's no bubble- and no need to say that. I would NOT say a DC/PT understands more than a fresh DO, but I dont think a DO knows more than a DC/PT. You know, it may be more appropriate t to narrow this down further to say the muscleskeltal system-

There's no bubble- and no need to say that. I would NOT say a DC/PT understands more than a fresh DO, but I dont think a DO knows more than a DC/PT. You know, it may be more appropriate t to narrow this down further to say the muscleskeltal system-

Quick! Explain to me how a practicing chiropractor knows more about the musculoskeletal system than a practicing osteopathic physician who specializes in osteopathic manipulative medicine.

Ready?

1...2...3...GO !

Quick! Explain to me how a practicing chiropractor knows more about the musculoskeletal system than a practicing osteopathic physician who specializes in osteopathic manipulative medicine.

Ready?

1...2...3...GO !

I am talking about anatomy, not anatomy and physiology, maybe not quite the way you are thinking.
I hope you dont talk to people like there a piece of SH3t or your are better than them when you first meet (in person) like you are here. It is pointless and immature. I am not getting offended or upset because I am a chiro or PT or cause I want to be-cause I don't. But I don't disrespect people just because I dont like what they are saying. And maybe it is cause this is "online" and that is how a lot of these forums are. Maybe face to face you wouldn't say, "Quick! Explain to me..." If you did you would look like an a@@ Even online it doesn't make much sense to me and it makes people sound bitter, arrogant, and insecure. I have spent enough time on this thread, so I shall bid you adeau (sp?)

Chirpractors for sure, not arguable, know more about the anatomy of the entire humany body, at least right out of school anyway. Beyond that, the physician is the expert.
Interstingly, the depth with which they study this goes well beyond that taught in medical school. This is true of PTs as well. Chiros take many of the same courses taught in the first two years of medical school, except pharm.


Can you elaborate on how exactly a PT or chiro grad goes into anatomy in more depth than a med student? I'm not seeing it. Also, as far as expectation of knowledge to be learned, give you give an example of a question that a PT/chiro grad should know that a med student wouldn't know?

I am talking about anatomy, not anatomy and physiology, maybe not quite the way you are thinking.
I hope you dont talk to people like there a piece of SH3t or your are better than them when you first meet (in person) like you are here. It is pointless and immature. I am not getting offended or upset because I am a chiro or PT or cause I want to be-cause I don't. But I don't disrespect people just because I dont like what they are saying. And maybe it is cause this is "online" and that is how a lot of these forums are. Maybe face to face you wouldn't say, "Quick! Explain to me..." If you did you would look like an a@@ Even online it doesn't make much sense to me and it makes people sound bitter, arrogant, and insecure. I have spent enough time on this thread, so I shall bid you adeau (sp?)

I guess that means you agree with me, then?

:laugh:

Don't worry, it takes more than someone simply stating an opinion without any logical reasoning to "break it to me".
What do you think of acpuncture? (Although I think I know your an advocate I am curious)

I have in other threads expanded on my reasoning that Chiros are con artist. As I asked in those other threads for any scientific studies that had concluded that chiro practices are 1)based on valid scientific data/understanding and not completely made up and 2) efficacious in treatment of any medical condition. As of yet noone has shown me such evidence. I would gladly entertain all scientific evidence and open the debate, but it is not up to me to find studies that conclude chiro is made up. I am claiming that due to complete lack of evidence the field is a crock. And simply because you spend longer in a class doesn't mean you learn more, you can learn something slower. You could also learn tons of useless crap. I assure you we learned the entire human body in our semester of Anatomy. What is a subluxation? Is there an anatomical basis? How about you research the history and modern practice of chiro before coming here with incorrect facts and idiotic assertions.As for acupuncture all studies I have seen have concluded that acupuncture may be efficacious at treating certain conditions (i.e. hypertension) but that the "chi map" on which the philosophy is based is incorrect and has no anatomical basis. I would not advocate a patient see an acupunturist unless I saw evidence that it would positively benefit them beyond placebo effect. Furthermore, as I stated in the other chiro thread, chiropracty is not only false, it is actually dangerous in certain circumstances (cervical manipulation tearing the vertebral artery).

I have in other threads expanded on my reasoning that Chiros are con artist. As I asked in those other threads for any scientific studies that had concluded that chiro practices are 1)based on valid scientific data/understanding and not completely made up and 2) efficacious in treatment of any medical condition. As of yet noone has shown me such evidence. I would gladly entertain all scientific evidence and open the debate, but it is not up to me to find studies that conclude chiro is made up. I am claiming that due to complete lack of evidence the field is a crock. And simply because you spend longer in a class doesn't mean you learn more, you can learn something slower. You could also learn tons of useless crap. I assure you we learned the entire human body in our semester of Anatomy. What is a subluxation? Is there an anatomical basis? How about you research the history and modern practice of chiro before coming here with incorrect facts and idiotic assertions.As for acupuncture all studies I have seen have concluded that acupuncture may be efficacious at treating certain conditions (i.e. hypertension) but that the "chi map" on which the philosophy is based is incorrect and has no anatomical basis. I would not advocate a patient see an acupunturist unless I saw evidence that it would positively benefit them beyond placebo effect. Furthermore, as I stated in the other chiro thread, chiropracty is not only false, it is actually dangerous in certain circumstances (cervical manipulation tearing the vertebral artery).

How do you feel about physical therapists?

How do you feel about physical therapists?

Ok look I'm not gonna sit and explain my position on every single health care type provider. My general position is that if evidence supports a treatment beyond placebo effect and the treatment is not dangerous I am ok with it, and I may or may not refer patients to said treatment depending on the case. As I said in the other thread chiros can't do anything a massage therapist can't do, except that in addition 1)certain chiro treatments are dangerous and 2)chiros aren't doctors as they portray themselves as which is what the whole previous thread was on. Obviously physical therapists are an important part of recovery as someone needs to be willing to work one on one with the patient for long periods of time to regain motion, etc. Why would I feel any different?

Ok look I'm not gonna sit and explain my position on every single health care type provider. My general position is that if evidence supports a treatment beyond placebo effect and the treatment is not dangerous I am ok with it, and I may or may not refer patients to said treatment depending on the case. As I said in the other thread chiros can't do anything a massage therapist can't do, except that in addition 1)certain chiro treatments are dangerous and 2)chiros aren't doctors as they portray themselves as which is what the whole previous thread was on. Obviously physical therapists are an important part of recovery as someone needs to be willing to work one on one with the patient for long periods of time to regain motion, etc. Why would I feel any different?

With the knowledge that the techniques employed by physical therapists closely resemble that done by osteopathic physicians, how do you feel about osteopathic physicians who practice osteopathic manipulative medicine?

Ok look I'm not gonna sit and explain my position on every single health care type provider.

u act like a prick- you may not be, or you may not know you sound like it, but there you go. Many physiatrists and physicians working with chronic pain refer to chiro, and have them working in their clinics- this includes, if you saw my earlier post, "top notch" academic facilities like NOrthwestern and the Rehad Institute of Chicago. So your collegues at these institutions must be fools in your eyes, and so you alone are the know it all. I could "show" you more that supports chiro in the treatment of certain conditions, but you act like a prick and this blog is no longer fun or interesting it-

u act like a prick- you may not be, or you may not know you sound like it, but there you go. Many physiatrists and physicians working with chronic pain refer to chiro, and have them working in their clinics- this includes, if you saw my earlier post, "top notch" academic facilities like NOrthwestern and the Rehad Institute of Chicago. So your collegues at these institutions must be fools in your eyes, and so you alone are the know it all. I could "show" you more that supports chiro in the treatment of certain conditions, but you act like a prick and this blog is no longer fun or intersting because of a few people in it-

First of all your Argument ad Populum (http://philosophy.lander.edu/logic/popular.html) is not evidence of the efficacy of chiro. Second you like many others claim to be able to show me evidence of chiros efficacy, but you as well as them have failed to provide any evidence. If such evidence existed it surely could easily have been provided by now. The fact is that aside from anecdotal account, hearsay testimony, and case studies there is no evidence that I have seen that supports chiros. And OSUDoc I don't understand your question. I am not very knowledgable about what OMM is so I can't claim that it is or is not efficacious, but I obviously have no problem with either DO's or PT's. Perhaps you could rephrase the question, though I don't see how it matters what my opinion is on the matter.

Second you like many others claim to be able to show me evidence of chiros efficacy, but you as well as them have failed to provide any evidence.

No, I never "claimed" I was going to provide evidence about anything- that was never the subject of the thread anyway...

ok... later

CHIROBASE



lol- thats pretty good.
www.chirobase.org

No, I never "claimed" I was going to provide evidence about anything- that was never the subject of the thread anyway...

ok... later

No, you said I could "show" you more that supports chiro in the treatment of certain conditions to which I replied that you as others claim that you have such evidence, yet none would provide it. In other words I am saying no, you could not show me such evidence as none exists, and that you should not come onto a thread saying DC's know more than physicians about anatomy and such nonsense when you are uninformed and ignorant of the facts.

I have in other threads expanded on my reasoning that Chiros are con artist. As I asked in those other threads for any scientific studies that had concluded that chiro practices are 1)based on valid scientific data/understanding and not completely made up and 2) efficacious in treatment of any medical condition. As of yet noone has shown me such evidence. I would gladly entertain all scientific evidence and open the debate, but it is not up to me to find studies that conclude chiro is made up. I am claiming that due to complete lack of evidence the field is a crock. And simply because you spend longer in a class doesn't mean you learn more, you can learn something slower. You could also learn tons of useless crap. I assure you we learned the entire human body in our semester of Anatomy. What is a subluxation? Is there an anatomical basis? How about you research the history and modern practice of chiro before coming here with incorrect facts and idiotic assertions.As for acupuncture all studies I have seen have concluded that acupuncture may be efficacious at treating certain conditions (i.e. hypertension) but that the "chi map" on which the philosophy is based is incorrect and has no anatomical basis. I would not advocate a patient see an acupunturist unless I saw evidence that it would positively benefit them beyond placebo effect. Furthermore, as I stated in the other chiro thread, chiropracty is not only false, it is actually dangerous in certain circumstances (cervical manipulation tearing the vertebral artery).


Read these:
http://www.jcca-online.org/client/cca/JCCA.nsf/objects/V48-1-P29/$file/V48-1-P29.pdf

http://www.joem.org/pt/re/joem/abstract.00043764-200006000-00018.htm;jsessionid=EqbB3OPdknKkDQnV6ctW5A6cL12dm iAznJXQ15XzN1ihXVndCthv!-420709791!-949856145!9001!-1


http://scholar.google.com/scholar?hl=en&lr=&q=cache:pyq_T_xovakJ:216.87.30.118/jvsr/license/2298-0032_changes.pdf+surface+EMG+chiropractic

I found these three articles in a matter of minutes with a simple search using Google Scholar. I think skepticism is beginning to fall off of the table and medicine is moving toward an integration with alternative therapies such as acupuncture and chiropractic. If you do not see this shift in the American culture then you need to take off your blinders.

Read these:
http://www.jcca-online.org/client/cca/JCCA.nsf/objects/V48-1-P29/$file/V48-1-P29.pdf

http://www.joem.org/pt/re/joem/abstract.00043764-200006000-00018.htm;jsessionid=EqbB3OPdknKkDQnV6ctW5A6cL12dm iAznJXQ15XzN1ihXVndCthv!-420709791!-949856145!9001!-1


http://scholar.google.com/scholar?hl=en&lr=&q=cache:pyq_T_xovakJ:216.87.30.118/jvsr/license/2298-0032_changes.pdf+surface+EMG+chiropractic

I found these three articles in a matter of minutes with a simple search using Google Scholar. I think skepticism is beginning to fall off of the table and medicine is moving toward an integration with alternative therapies such as acupuncture and chiropractic. If you do not see this shift in the American culture then you need to take off your blinders.

Tip: Don't use Google to search for articles as references for anything. Also, instead of citing articles from obscure canadian journals, make sure its a reputable journal article. So, go to pubmed, type in alternative medicine, or physical therapy, or whatever, and look for some reputable journal entries. I remember reading some good articles in the Annals of Internal Medicine a while back on efficacy of different alternative medicine modalities. The summary consensus after reading many of these types of articles, is that compared to placebo, many of these modalities don't offer significant therapeutic benefit. The only alternative medicine therapy that i've read about having a statistically significant benefit is acupuncture; and this is for pain and or nausea relief ONLY. Many practitioners assert that you can heal just about anything with acupuncture; same with chiropractic. Good hunting.

Tip: Don't use Google to search for articles as references for anything.

When I first began gad school everyone used pubmed- when I left we all used google, including a handful of professors. You have access to finding exactly the same research articles and links, but the google search engine is MUCH more user friendly. i.e. If you type in the first author and any part of the title of a research article, your article will amost always show up immediately. This sort of searching can be a nightmare on Pubmed, of which sometimes you can have almost the entire article's name in the search box and it will still not pull up your article. Google is ridiculously easy and useful as a search engine. Googlescholar is a powerhouse academic search engine and some good stuff!

When I first began gad school everyone used pubmed- when I left we all used google, including a handful of professors. You have access to finding exactly the same research articles and links, but the google search engine is MUCH more user friendly. i.e. If you type in the first author and any part of the title of a research article, your article will amost always show up immediately. This sort of searching can be a nightmare on Pubmed, of which sometimes you can have almost the entire article's name in the search box and it will still not pull up your article. Google is rediculously easy and useful as a search engine. Googlescholar is a powerhouse academic search engine and some good stuff!

Kool. Maybe i'll mess around with it awhile, and check it out a bit more.

Read these:
http://www.jcca-online.org/client/cca/JCCA.nsf/objects/V48-1-P29/$file/V48-1-P29.pdf

http://www.joem.org/pt/re/joem/abstract.00043764-200006000-00018.htm;jsessionid=EqbB3OPdknKkDQnV6ctW5A6cL12dm iAznJXQ15XzN1ihXVndCthv!-420709791!-949856145!9001!-1


http://scholar.google.com/scholar?hl=en&lr=&q=cache:pyq_T_xovakJ:216.87.30.118/jvsr/license/2298-0032_changes.pdf+surface+EMG+chiropractic

I found these three articles in a matter of minutes with a simple search using Google Scholar. I think skepticism is beginning to fall off of the table and medicine is moving toward an integration with alternative therapies such as acupuncture and chiropractic. If you do not see this shift in the American culture then you need to take off your blinders.

Ok your first article is a test of 44 individuals broken into 2 groups of roughly equal size on which is measured the EMF before and after low force chiro adjustment. Aside from the small sample side the article fails to make any link between EMF meaasurements at the body surface and any disease. Instead it mentions some alleged correlations between general man made EMF and diseases, and it fails to support any evidence that a reduction in said body EMF was beneficial to the patient in any way, or linked to any particular disease, instead simply stating basic physiology. In addition the conclusion still rests that there is no understanding how said treatment works. The second abstract (not article) you provided simply states that "surface electromyography assessment of the paraspinal muscle activity may be a useful objective diagnostic tool in the comprehensive evaluation of CLBP." This is hardly chiro specific nor is it any new knowledge, of course paraspinal muscle activity can be detected by surface electromyography, it stands to reason with our knowledge of physiology. In any case it has nothing to support chiro. I don't have to to read the 3rd link right now but at cursery it didn't seem to support chiro treatment in any substantial way. I have yet to see evidence presented that supports that subluxations exhist or have any anatomical basis (the foundational philosophy of chiro is the subluxation!), that chiro is any more productive at treating chronic back pain that massage therapy or physical therapy, or drugs, etc. Nor is evidence available that the techniques they use have any scientific basis. In addition as stated cervical manipulation and other techniques are dangerous. You saw the chirobase website that had a lot of info, just read the wiki entry which even has a ton of criticism and it was written by a chiro in defense of practice (that's why its being debated NPV). http://en.wikipedia.org/wiki/Chiropracty

Ok your first article is a test of 44 individuals broken into 2 groups of roughly equal size on which is measured the EMF before and after low force chiro adjustment. Aside from the small sample side the article fails to make any link between EMF meaasurements at the body surface and any disease. Instead it mentions some alleged correlations between general man made EMF and diseases, and it fails to support any evidence that a reduction in said body EMF was beneficial to the patient in any way, or linked to any particular disease, instead simply stating basic physiology. In addition the conclusion still rests that there is no understanding how said treatment works. The second abstract (not article) you provided simply states that "surface electromyography assessment of the paraspinal muscle activity may be a useful objective diagnostic tool in the comprehensive evaluation of CLBP." This is hardly chiro specific nor is it any new knowledge, of course paraspinal muscle activity can be detected by surface electromyography, it stands to reason with our knowledge of physiology. In any case it has nothing to support chiro. I don't have to to read the 3rd link right now but at cursery it didn't seem to support chiro treatment in any substantial way. I have yet to see evidence presented that supports that subluxations exhist or have any anatomical basis (the foundational philosophy of chiro is the subluxation!), that chiro is any more productive at treating chronic back pain that massage therapy or physical therapy, or drugs, etc. Nor is evidence available that the techniques they use have any scientific basis. In addition as stated cervical manipulation and other techniques are dangerous. You saw the chirobase website that had a lot of info, just read the wiki entry which even has a ton of criticism and it was written by a chiro in defense of practice (that's why its being debated NPV). http://en.wikipedia.org/wiki/Chiropracty

alright man, if you're going to be this dismissive of something at least take the time to spell everything right in your scathing post... it just makes you look silly not to.

alexander pink, MD. lol.

.

Oi! so much energy expended on trying to battle ignorance. This is insane. Coming from a family of chiropractors and me being in medical school, I can pretty much guarantee that for any musculoskeletal disorder I come up with, I will be heading straight to my trusted Chiropractor and NEVER to another MD. In addition, I can pretty much assume that my dad will always do a better job at the musculoskeletal portion of the physical exam than I ever will. We joke a lot and I tell him I'll give him some tips on listening to hearts and he gives me a hard time about overprescribing. It's great banter, and I love that he's set me up to have such an awesome relationship with alternative healthcare providers. I'm a big fan of "if the patient feels better and retains their quality of life and it's what they want out of the visit, then any form of medical treatmnet is valid". I do agree that there are fields that are probably better at assessing different things and so I respect that and I applaud providers who refer to others and know their limitations. For the ones who have the drive to basically piss on professions like chiropractic, osteopathic, physical therapy, acuptuncture, and chinese medicine, I'm sure karma will remind you in future years when you lose some of your patients to these field practioners. Have some tolerance my friends.

Someone a year out of chiro school knows more anatomy than an ortho intern finishing their PGY-1 year? Really?

When I urinate, the stream extends 13.79 meters from my body.

I really don't understand the hostility towards chiropractic and physical therapy? I am a sports chiropractor and work with orthopaedic surgeons and physiatrists. I have also had ortho residents round with me, and have corrected them on their diagnoses and physical examinations.

MD, DC, DO, PT etc... are all great professions and generally attract good people who have a passion to serve others.

There is no need for immaturity or personal attacks based on unfounded claims or mere ignorance.

As DaveMatthews said, it is important to continue learning through CME seminars and consulting with various specialists.

On side note; with respect to MSK educations, MDs are lacking (see short article below with sources):

-----

Musculoskeletal Education: MDs Still Fail the Test

In October 1998, the Journal of Bone and Joint Surgery featured a study that confirmed what most doctors of chiropractic have long suspected. The study, which examined the competency levels of nearly 90 recent medical school graduates, revealed that most medical and surgical residents "failed to demonstrate basic competency" in their knowledge of musculoskeletal medicine. The results prompted the authors of the study to conclude that the training provided in musculoskeletal medicine "is inadequate."
Now, more than six years later, a new study, again published in the Journal of Bone and Joint Surgery, shows that today's medical students and young physicians appear to be just as woeful in their understanding of musculoskeletal medicine as their cohorts were several years ago.

In the new study, 334 medical students, residents and staff physicians, specializing in various fields of medicine, were asked to take a basic cognitive examination consisting of 25 short-answer questions - the same type of test administered in the 1998 study. Each question was worth a maximum of one point, with partial credit given for some questions that required multiple answers. Test scores were then multiplied by a factor of four, for a maximum score of 100. A score of 73.1% was determined to be a passing grade.

While the questions used in the 2005 exam were different from the 1998 test, the results were surprisingly similar. In fact, the average score among medical doctors, students and residents who took the exam in 2005 was 2.7 points lower than those who took the exam in 1998.

Just over half of the staff physicians (52%) scored a passing grade or higher on the 2005 exam. Only 21% of the residents registered a passing grade, and only 5% of the medical students passed the exam (see chart above).

As with the 1998 exam, medical doctors and students with training or experience in orthopedics scored higher on the 2005 exam than subjects who lacked such experience. Among the 124 participants who reported taking a required or elective course in orthopedics, the average score was 69%. Among the 210 participants who had not taken an orthopedics course, the average score was 50%. Similarly, the 155 participants who stated they were comfortable with their ability to perform a musculoskeletal examination attained an average score of 66%. Subjects who felt uncomfortable in performing a musculoskeletal exam achieved an average score of just 49%.

In the original Journal of Bone and Joint Surgery article seven years ago, the authors stated that "all students must be instructed in musculoskeletal medicine," and that medical schools needed to revise their educational standards, either by adding more contact hours in specified training, or by providing additional training in musculoskeletal medicine during one's residency.

Those recommendations appear to have fallen on deaf ears, as the same sentiments continue to be echoed in the new study. As the authors note in their conclusion:

"This study strongly suggests that there is a lack of basic musculoskeletal education in medical school and during nonorthopaedic residency training. Improvements in education in musculoskeletal medicine should be pursued in all medical schools and residency training programs."

Given that musculoskeletal complaints are one of the leading reasons people seek the services of a doctor for care, one wonders why the medical profession is apparently unconcerned when it comes to educating the doctors of the future on the finer points of musculoskeletal medicine. Perhaps the moral to this story is one you already know: Patients would be best served by receiving care from a health care provider with more musculoskeletal training - a doctor of chiropractic.

-------------
References

Freedman KB, Bernstein J. The adequacy of medical school education in musculoskeletal medicine. Journal of Bone and Joint Surgery October 1998;80(10):1421-1427.

Matzkin E, Smith EL, Freccero D, Richardson AB. Adequacy of education in musculoskeletal medicine. Journal of Bone and Joint Surgery February 2005;87(2):310-314.

I really don't understand the hostility towards chiropractic and physical therapy? I am a sports chiropractor and work with orthopaedic surgeons and physiatrists. I have also had ortho residents round with me, and have corrected them on their diagnoses and physical examinations.
MD, DC, DO, PT etc... are all great professions and generally attract good people who have a passion to serve others.
There is no need for immaturity or personal attacks based on unfounded claims or mere ignorance.
As DaveMatthews said, it is important to continue learning through CME seminars and consulting with various specialists.

So glad you could bring back a 7-months-dead flame war :meanie:

tic,

I'm new here and was surfing through the posts. Do you have anything of value to add to this discussion? If you note my tone on my previous posts was not of an adversarial nature, so I don't see it as opening a "7 month old flame war" as you put it.

tic,
I'm new here and was surfing through the posts. Do you have anything of value to add to this discussion? If you note my tone on my previous posts was not of an adversarial nature, so I don't see it as opening a "7 month old flame war" as you put it.

I know you weren't adversarial, but did you read the rest of the thread? It's a can of worms, just don't know why you want to be a troublemaker and reopen it. Meh, guess it's better than that other 2-years-dead chiropractic post you reopened. I don't have anything of value to the conversation, except to say (in my best Dr. Cox), "Newbie, I don't know if they taught you this in the land of fairies and puppy-dog tails," but the list of things guaranteed to start a flame war are: 1) comparing MDs and DOs; 2) talking about chiropracty, homeopathic medicine, or anything else un-MD in the MD forum; 3) overweight people; 4) minorities; 5) anything that could come within a city block of religion; 6) pretty much any other thread if it goes on long enough. I didn't make the rules, please don't shoot the messenger. Welcome to SDN!

You should've responded by saying "Because MD's earned that right to decide whether they need K+ supplementation or not by going to med school while Chiropracters didn't." If they don't like the way it's being handled, they should go to med school then.

:thumbup: :thumbup: :thumbup:

On side note; with respect to MSK educations, MDs are lacking (see short article below with sources):

-----

Musculoskeletal Education: MDs Still Fail the Test

In October 1998, the Journal of Bone and Joint Surgery featured a study that confirmed what most doctors of chiropractic have long suspected. The study, which examined the competency levels of nearly 90 recent medical school graduates, revealed that most medical and surgical residents "failed to demonstrate basic competency" in their knowledge of musculoskeletal medicine. The results prompted the authors of the study to conclude that the training provided in musculoskeletal medicine "is inadequate."
Now, more than six years later, a new study, again published in the Journal of Bone and Joint Surgery, shows that today's medical students and young physicians appear to be just as woeful in their understanding of musculoskeletal medicine as their cohorts were several years ago.

In the new study, 334 medical students, residents and staff physicians, specializing in various fields of medicine, were asked to take a basic cognitive examination consisting of 25 short-answer questions - the same type of test administered in the 1998 study. Each question was worth a maximum of one point, with partial credit given for some questions that required multiple answers. Test scores were then multiplied by a factor of four, for a maximum score of 100. A score of 73.1% was determined to be a passing grade.

While the questions used in the 2005 exam were different from the 1998 test, the results were surprisingly similar. In fact, the average score among medical doctors, students and residents who took the exam in 2005 was 2.7 points lower than those who took the exam in 1998.

Just over half of the staff physicians (52%) scored a passing grade or higher on the 2005 exam. Only 21% of the residents registered a passing grade, and only 5% of the medical students passed the exam (see chart above).

As with the 1998 exam, medical doctors and students with training or experience in orthopedics scored higher on the 2005 exam than subjects who lacked such experience. Among the 124 participants who reported taking a required or elective course in orthopedics, the average score was 69%. Among the 210 participants who had not taken an orthopedics course, the average score was 50%. Similarly, the 155 participants who stated they were comfortable with their ability to perform a musculoskeletal examination attained an average score of 66%. Subjects who felt uncomfortable in performing a musculoskeletal exam achieved an average score of just 49%.

In the original Journal of Bone and Joint Surgery article seven years ago, the authors stated that "all students must be instructed in musculoskeletal medicine," and that medical schools needed to revise their educational standards, either by adding more contact hours in specified training, or by providing additional training in musculoskeletal medicine during one's residency.

Those recommendations appear to have fallen on deaf ears, as the same sentiments continue to be echoed in the new study. As the authors note in their conclusion:

"This study strongly suggests that there is a lack of basic musculoskeletal education in medical school and during nonorthopaedic residency training. Improvements in education in musculoskeletal medicine should be pursued in all medical schools and residency training programs."

Given that musculoskeletal complaints are one of the leading reasons people seek the services of a doctor for care, one wonders why the medical profession is apparently unconcerned when it comes to educating the doctors of the future on the finer points of musculoskeletal medicine. Perhaps the moral to this story is one you already know: Patients would be best served by receiving care from a health care provider with more musculoskeletal training - a doctor of chiropractic.

-------------
References

Freedman KB, Bernstein J. The adequacy of medical school education in musculoskeletal medicine. Journal of Bone and Joint Surgery October 1998;80(10):1421-1427.

Matzkin E, Smith EL, Freccero D, Richardson AB. Adequacy of education in musculoskeletal medicine. Journal of Bone and Joint Surgery February 2005;87(2):310-314.


1. Chripractors don't study musclolskeletal medicine, They study the spine. You are not trained to diagnose disease of the foot, ankle, shoulder, knee, legs, soft tissue etc. And when it comes to the back you are limited to very basic diagnosis of back treatments. You don know your spine medicine well in theory. But you don't know how to mange many back problems. You use manipulation of the back for almost all its ailments. REMEMBER THE OLD SAYING "IF YOU HAVE A HAMMER EVERYTHING IS A NAIL".

Chiropractic manipulation has been shown to have short term effectiveness in many acute and chronic back problems. There is a place for it in treatment of back problems.

2. STOP CALLING YOURSELVES DOCTORS. People think you know what you are talking about when it comes to medicine because you call yourselves doctors. You don't. You don't know how do to diagnose and manage 95% of medical problems. So stop calling yourselves doctors. It confuses the patients.

There is a place for chiropractic in the medical field. They help many back patients in acute and some chronic settings. But you lose credibility when you misrepresent yourselves.

3. As far MDs not being well trained in musculoskeletal medicine when they come out of medical school, They don't need as that much training. We have PM&R specialist and orthopedics an FPs and FPS with sport medicine training that take this role one during residency. In fact since there is soooo much more medicine to be learned other than musculoskletal we choose to focous on the most important first.

4. By the way, since chiropractors are not trained in "musculoskeleta medicine" isnt this the pot calling the kettle black?

Who knows more about a car? A mechanic that pops the hood and puts the car on a lift or someone that pops dents out of a fender for a living.

>>>1. Chripractors don't study musclolskeletal medicine, They study the spine.<<<

This is a very amusing declaration. Please provide your resource/documentation to support this assertion.

So glad you could bring back a 7-months-dead flame war :meanie:

Someone has gone through and reopened a fair number of chiro threads.

Waste of time. The world is divided into those who drink the Kool-aid and those who don't.

- H

Someone has gone through and reopen a fair number of chiro threads.

Waste of time. The world is divided into those who drink the Kool-aid and those who don't.

- H
And those who are old enough to get the Kool-aid reference and those who aren't.:D

I would like to thank those who participated in this thread and supported the chiropractic profession.:thumbup: Seems chiropractic is always a touchy subject on this board. It's nice to see other professions offering us some support. It seems that many doctors' minds will never change. No sense in even attempting to change them. I never went to medical school so I do not have first hand experience with their gross anatomy requirements. I can tell you that anatomy in chiropractic school is overly detailed. Every single structure is studied. Not one area is overlooked and every area is studied in detail. Not only are the structures covered but function is also tied into everything. All muscle origin and insertions, blood supply and nerve supply is covered. All organ systems are studied the same way. It is an absolute nightmare. We spend a full year in the anatomy lab. On top of this, we have a separate course in spinal anatomy and another in neuroanatomy. We also get even more anatomy in pathology lab and still more in x-ray/imaging diagnosis. I have to say a chiropractor has a very solid education in anatomy. So who knows more? Who cares? It's stupid that a student is upset because a DC is acting like he knows something. You should take what he knows and use it like another poster suggested. Does he know more than you? Hell yes he does. As far as what the DC said, it makes sense. What is the argument? If he was telling the patient they need to take potassium that would be a different story. I don't get involved with that, I do what I do and let the MD do what they do. It pisses a MD off when another doctor contradicts their treatment or questions it to the patient. You guys don't like that do you? Well we feel the same way when you do it to us.:mad:

I would like to thank those who participated in this thread and supported the chiropractic profession.:thumbup: Seems chiropractic is always a touchy subject on this board. It's nice to see other professions offering us some support. It seems that many doctors' minds will never change. No sense in even attempting to change them. I never went to medical school so I do not have first hand experience with their gross anatomy requirements. I can tell you that anatomy in chiropractic school is overly detailed. Every single structure is studied. Not one area is overlooked and every area is studied in detail. Not only are the structures covered but function is also tied into everything. All muscle origin and insertions, blood supply and nerve supply is covered. All organ systems are studied the same way. It is an absolute nightmare. We spend a full year in the anatomy lab. On top of this, we have a separate course in spinal anatomy and another in neuroanatomy. We also get even more anatomy in pathology lab and still more in x-ray/imaging diagnosis. I have to say a chiropractor has a very solid education in anatomy. So who knows more? Who cares?

Yep. Lots of classes. Hey, check this site out: http://www.ahs.uic.edu/bhis/programs/bvis/curriculum.php. It would seem that someone with a Master's degree is medical illustration has more anatomy training than either of us. Perhaps we should both close up shop and leave healthcare to the artists... I mean really, I can tell you from personal experience in both medical school and residency, I have rarely gone to the anatomy lab without seeing medical illustration students there. But you can't take anatomy (or even physiology) as the "end all, be all" of medical education. The reality is that chiropractic students rarely see truly sick patients. There is little scientific proof for chiropractic treatment. The length of training is far shorter, and the heavy use of DCs within basic science faculty at chiropractic colleges also makes the instruction suspect. An MD/DO has (in most cases) four years of medical school followed by at least three years of residency. In those years the physician will care for literally thousands of patients in the inpatient (read seriously ill) setting. The three years of chiropractic education, which accounts for both the basic science and the clinical training simply can't compare.

It's stupid that a student is upset because a DC is acting like he knows something. You should take what he knows and use it like another poster suggested. Does he know more than you? Hell yes he does. As far as what the DC said, it makes sense. What is the argument? If he was telling the patient they need to take potassium that would be a different story. I don't get involved with that, I do what I do and let the MD do what they do. It pisses a MD off when another doctor contradicts their treatment or questions it to the patient. You guys don't like that do you? Well we feel the same way when you do it to us.:mad:

Come on these are old arguments, thus the problem with resurrecting old threads. Do we really need to dance this dance everytime someone mentions chiropractic in these forums? Face facts, you aren't going to change minds here any more than I would on chiroweb. Be in your camp, treat your patients, accept the referrals from those MDs willing to refer to you, and move on. But a forum for student doctors (MD/DOs) isn't going to be the spot to win converts to Palmer's mythology.

- H

Come on these are old arguments, thus the problem with resurrecting old threads. Do we really need to dance this dance everytime someone mentions chiropractic in these forums? Face facts, you aren't going to change minds here any more than I would on chiroweb. Be in your camp, treat your patients, accept the referrals from those MDs willing to refer to you, and move on. But a forum for student doctors (MD/DOs) isn't going to be the spot to win converts to Palmer's mythology.

- H

It is foolish to speak to those who wont listen....

It is foolish to listen to those who are idiots...

I would like to thank those who participated in this thread and supported the chiropractic profession.:thumbup: Seems chiropractic is always a touchy subject on this board. It's nice to see other professions offering us some support. It seems that many doctors' minds will never change. No sense in even attempting to change them. I never went to medical school so I do not have first hand experience with their gross anatomy requirements. I can tell you that anatomy in chiropractic school is overly detailed. Every single structure is studied. Not one area is overlooked and every area is studied in detail. Not only are the structures covered but function is also tied into everything. All muscle origin and insertions, blood supply and nerve supply is covered. All organ systems are studied the same way. It is an absolute nightmare. We spend a full year in the anatomy lab. On top of this, we have a separate course in spinal anatomy and another in neuroanatomy. We also get even more anatomy in pathology lab and still more in x-ray/imaging diagnosis. I have to say a chiropractor has a very solid education in anatomy. So who knows more? Who cares? It's stupid that a student is upset because a DC is acting like he knows something. You should take what he knows and use it like another poster suggested. Does he know more than you? Hell yes he does. As far as what the DC said, it makes sense. What is the argument? If he was telling the patient they need to take potassium that would be a different story. I don't get involved with that, I do what I do and let the MD do what they do. It pisses a MD off when another doctor contradicts their treatment or questions it to the patient. You guys don't like that do you? Well we feel the same way when you do it to us.:mad:


Who cares how much anatomy you had. Anatomy doesn't even touch the surface of real medicine. so what if you know where things attach to what. It's not even releavant half the time.

Real Medicine deals with disease and the proper management of disease. Not some wack job that thinks he can fix everything by jumping on your back.

I told you chiropractors can help with acute back pain and some studies support this. But that is it.

I think what should happen is that they should just teach the MDs and like the DOs to do what you do in like what, one semester. They can eliminate chiropractic school all together. The DOs understant that they don't need 4 years to learn how to crack someones back. GET REAL. STOP TRYING TO JUSTIFY YOU EXISTANCE IN HERE.

It pisses us off when another doctor changes our treatment plan, yes, another doctor not a wack job. We just want to strangle the wack jobs that destroy our doctor patient relationship by telling our patient lies. :mad:

2nd request-


erichaj posts:
>>>1. Chripractors don't study musclolskeletal medicine, They study the spine.<<<

This is a very amusing declaration. Please provide your resource/documentation to support this assertion.

Foughtfyr dishonestly posts:


>>>"The three years of chiropractic education,...."

"the heavy use of DCs within basic science faculty at chiropractic colleges...."<<<


You have been repeatedly corrected on these erroroneous and inaccurate declarations, yet persist..........

What flavor of kool-aid are you drinking?

Foughtfyr dishonestly posts:


>>>"The three years of chiropractic education,...."

"the heavy use of DCs within basic science faculty at chiropractic colleges...."<<<


You have been repeatedly corrected on these erroroneous and inaccurate declarations, yet persist..........

What flavor of kool-aid are you drinking?


I am sorry. Three and one third calendar years (or five "chiropractic" years). Still doesn't reach the seven calendar (or eleven "chiropractic" years) that MD/DOs do. And let's talk patient contacts, acutity, etc. And there is a "heavy" use of DC faculty at chiropractic colleges (and a few foriegn trained non-practicing MDs). It is not exclusively DC, there are some Ph.D.s. I readily acknowledge that. So where are the errors or inaccuracies of substance?

- H

I am sorry. Three and one third calendar years (or five "chiropractic" years). Still doesn't reach the seven calendar (or eleven "chiropractic" years) that MD/DOs do. And let's talk patient contacts, acutity, etc. And there is a "heavy" use of DC faculty at chiropractic colleges (and a few foriegn trained non-practicing MDs). It is not exclusively DC, there are some Ph.D.s. I readily acknowledge that. So where are the errors or inaccuracies of substance?

- H

You well know the difference between calender years and academic years.....all academic institutions operate on the same system. Quit trying to morph it into something it isn't to suit your personal bias/agenda.

You have been repeatedly directed to DC basic science faculty degree documentation......that disproves your declarations. Give it up. Your assertions are based only in your fanatical mind. If you have documentation to the contrary.........prove it.

You well know the difference between calender years and academic years.....all academic institutions operate on the same system. Quit trying to morph it into something it isn't to suit your personal bias/agenda.

You have been repeatedly directed to DC basic science faculty degree documentation......that disproves your declarations. Give it up. Your assertions are based only in your fanatical mind.


Are you honestly trying to claim that DCs have more schooling than MDs? And I'm the one who is fanatical?

And you are saying there are no DCs on academic basic science faculty at chiro schools? Every web reference you have ever shown demonstrates that there are...

If you have a comprehensive list of even a majority of chiropractic college faculty, please share. If not...

I mean do you really think you are trained to the level of an MD/DO? Honestly?

Wow!

- H

Are you honestly trying to claim that DCs have more schooling than MDs? And I'm the one who is fanatical?

And you are saying there are no DCs on academic basic science faculty at chiro schools? Every web reference you have ever shown demonstrates that there are...

If you have a comprehensive list of even a majority of chiropractic college faculty, please share. If not...

I mean do you really think you are trained to the level of an MD/DO? Honestly?

Wow!

- H

>>>Are you honestly trying to claim that DCs have more schooling than MDs? And I'm the one who is fanatical?.......................<<<

Are you DISHONESTLY trying to misrepresent my post in order to cover up your lack of evidence/supportation of your fictious "CLAIMS"? "WOW!"

It is impossible to coorelate your(this) post with mine! You are fooling no one!

BUSTED!!!

WHAT is the flavor of your kool-aid?

>>>Are you honestly trying to claim that DCs have more schooling than MDs? And I'm the one who is fanatical?.......................<<<

Are you DISHONESTLY trying to misrepresent my post in order to cover up your lack of evidence/supportation of your fictious "CLAIMS"? It is impossible to coorelate your(this) post with mine! You are fooling no one!

BUSTED!!!

WHAT is the flavor of your kool-aid?

Busted with what? Chiropractic colleges (at least the ones most oft discussed here) appear to be on the trimester system with two trimesters equalling one academic year. 10 trimesters in the program, thus 5 academic years. Where you are dead wrong is in your statement "all academic institutions operate on the same system". That is simply not true. Some use units, some use semesters, and some use calendar years. I will agree that the trimester system IS well designed to maximize financial aid eligibility. BUT, lets compare apples to apples shall we? You are disingenuous to claim that chiropractic college is 5 years while medical school is four. Yes, most medical schools give the summer off between first and second year, but that is the only break. This makes medical school 11 trimesters long. Looks almost equal. Except that fails to account for the (at least) 12 additional trimesters (16 if we used physiatrists - the closest MD/DO to a chiropractor) that comprise residency training. At best, chiropractic training is 47% of medical training in length.

Now, from National:
http://www.nuhs.edu/show.asp?durki=163 Anatomy, 2 of 6 DC faculty
http://www.nuhs.edu/show.asp?durki=529 Pathology, Microbiology and Public Health, 1 of 3 total faculty is DC only
http://www.nuhs.edu/show.asp?durki=530 Physiology and Biochemistry, 2 of 7 DC faculty

So where is my dishonesty?

I seriously don't know what you hope to achieve here. You are not going to convince folks in a pre/post MD/DO education forum that chiropractic is valid anymore than I could convince a similarly DC aligned audience that it is not.

But please, quit calling me a liar just because the facts don't suit your argument.

- H

Busted with what? Chiropractic colleges (at least the ones most oft discussed here) appear to be on the trimester system with two trimesters equalling one academic year. 10 trimesters in the program, thus 5 academic years. Where you are dead wrong is in your statement "all academic institutions operate on the same system". That is simply not true. Some use units, some use semesters, and some use calendar years. I will agree that the trimester system IS well designed to maximize financial aid eligibility. BUT, lets compare apples to apples shall we? You are disingenuous to claim that chiropractic college is 5 years while medical school is four. Yes, most medical schools give the summer off between first and second year, but that is the only break. This makes medical school 11 trimesters long. Looks almost equal. Except that fails to account for the (at least) 12 additional trimesters (16 if we used physiatrists - the closest MD/DO to a chiropractor) that comprise residency training. At best, chiropractic training is 47% of medical training in length.

Now, from National:
http://www.nuhs.edu/show.asp?durki=163 Anatomy, 2 of 6 DC faculty
http://www.nuhs.edu/show.asp?durki=529 Pathology, Microbiology and Public Health, 1 of 3 total faculty is DC only
http://www.nuhs.edu/show.asp?durki=530 Physiology and Biochemistry, 2 of 7 DC faculty

So where is my dishonesty?

I seriously don't know what you hope to achieve here. You are not going to convince folks in a pre/post MD/DO education forum that chiropractic is valid anymore than I could convince a similarly DC aligned audience that it is not.

But please, quit calling me a liar just because the facts don't suit your argument.

- H

Let's examine Fought's "Kool-aid" statements:

>>>"You are disingenuous to claim that chiropractic college is 5 years while medical school is four."<<<<

I eagerly await your documentation that I have declared such. I am sure you will promptly provide?


>>>"I seriously don't know what you hope to achieve here"<<<

How about:.......An accurate representation of the facts.........not your intentionally misrepresented, twisted, kool-aid version, of your personal distortions.

Foughtfyr declares:

>>>"the heavy use of DCs within basic science faculty at chiropractic colleges...."<<<

Then attempts to support that statement by:


>>>"Now, from National:
http://www.nuhs.edu/show.asp?durki=163 Anatomy, 2 of 6 DC faculty
http://www.nuhs.edu/show.asp?durki=529 Pathology, Microbiology and Public Health, 1 of 3 total faculty is DC only
http://www.nuhs.edu/show.asp?durki=530 Physiology and Biochemistry, 2 of 7 DC faculty"<<<

How is this, (2/6, 1/3, and 2/7),by any standards, considered "heavy"?

Foughtfyr declares:

>>>"the heavy use of DCs within basic science faculty at chiropractic colleges...."<<<

Then attempts to support that statement by:


>>>"Now, from National:
http://www.nuhs.edu/show.asp?durki=163 Anatomy, 2 of 6 DC faculty
http://www.nuhs.edu/show.asp?durki=529 Pathology, Microbiology and Public Health, 1 of 3 total faculty is DC only
http://www.nuhs.edu/show.asp?durki=530 Physiology and Biochemistry, 2 of 7 DC faculty"<<<

How is this, (2/6, 1/3, and 2/7),by any standards, considered "heavy"?

Umm, 5 of 16 is quite a bit when we are talking about education. I'd hate to know that almost 1/3 of any class is taught by unqualified personnel. So yes, I find that "heavy" for basic science faculty whose academic credentials for teaching basic science are the DC degree without a Ph.D. or Sc.D.

- H

Let's examine Fought's "Kool-aid" statements:

>>>"You are disingenuous to claim that chiropractic college is 5 years while medical school is four."<<<<

I eagerly await your documentation that I have declared such. I am sure you will promptly provide?

Sure. The idiocy I was stupid enough to respond to was:

Foughtfyr dishonestly posts:


>>>"The three years of chiropractic education,...."

"the heavy use of DCs within basic science faculty at chiropractic colleges...."<<<


You have been repeatedly corrected on these erroroneous and inaccurate declarations, yet persist..........

What flavor of kool-aid are you drinking?

Now, ask almost any medical student, pre-med or MD/DO how long medical school is and the answer will be "four years". Not "11 trimesters" not "five and one half academic years" but "four years". In that lexicon, chiropractic school is three years long. I do agree, in calendar years it is 3 and 1/3 years long. So for the 1/3 of a year I apologize, but that doesn't change the substance of the argument that DCs are far less trained (in time, number of patient contacts, and patient acuity) than MD/DOs.

- H

Your kidding right?

Last time I checked there was not a single chiropractor who could treat or was allowed to treat an MI. or CHF or Diabetes or real back problems that need intervention.

In fact I don't think they can even correctly write for antibiotics or do basic general medical care.

One last time.

YOU ARE NOT DOCTORS.

STOP CALLING YOURSELF DOCTORS.

THERE SHOULD NOT EVEN BE SUCH A THING AS CHIROPRACTIC SCHOOL.

It should just be taught in Medical school for one semester.

YOU CAN'T CURE ALL THE DESEASES. SOOOOO, STOP TELLING PEOPLE YOU CAN.

I'm asking that we get back onto the topic and not the MD/DO vs. DC debate. Because this could go on for hours on end ... Thanks.

I'm asking that we get back onto the topic and not the MD/DO vs. DC debate. Because this could go on for hours on end ... Thanks.

:confused:
I'm sorry can you speak a little louder I did not hear you.

Size does matter. lol

Your kidding right?

Last time I checked there was not a single chiropractor who could treat or was allowed to treat an MI. or CHF or Diabetes or real back problems that need intervention.

In fact I don't think they can even correctly write for antibiotics or do basic general medical care.

One last time.

YOU ARE NOT DOCTORS.

STOP CALLING YOURSELF DOCTORS.

THERE SHOULD NOT EVEN BE SUCH A THING AS CHIROPRACTIC SCHOOL.

It should just be taught in Medical school for one semester.

YOU CAN'T CURE ALL THE DESEASES. SOOOOO, STOP TELLING PEOPLE YOU CAN.

Quite amusing!!

A request for documentation/support of declarations (regarding MSK education) yields the above..........

Apparently- erichaj prefers to not answer the question.....and instead posts the above non-sequitor.

I will interpret that as: (as well as anyone else reading here, should).........YOU HAVE NONE!

WOW! So much anger. I hope no one ends up in FoughtFyr's ER with a stroke. Atleast they will get good care!

Quite amusing!!

A request for documentation/support of declarations (regarding MSK education) yields the above..........

Apparently- erichaj prefers to not answer the question.....and instead posts the above non-sequitor.

I will interpret that as: (as well as anyone else reading here, should).........YOU HAVE NONE!

How does a chiropractor approach patellarfemoral syndrome, or a torn acl.

That is MDK right?

How do you approach that?

Don't look it up now. I doubt you would know where to look it up.:laugh:

erichaj posted:

>>>1. Chripractors don't study musclolskeletal medicine, They study the spine.<<<

I responded:

"This is a very amusing declaration. Please provide your resource/documentation to support this assertion".

He has now posted several times-----------NONE answering/addressing the inquiry. His subsequent rants/attempts at diversion, is quite amusing.

I will repeat(for the 3rd time) my request for him to document/support his declaration/assertion of:

>>>1. Chripractors don't study musclolskeletal medicine, They study the spine.<<<

erichaj posted:

>>>1. Chripractors don't study musclolskeletal medicine, They study the spine.<<<

I responded:

"This is a very amusing declaration. Please provide your resource/documentation to support this assertion".

He has now posted several times-----------NONE answering/addressing the inquiry. His subsequent rants/attempts at diversion, is quite amusing.

I will repeat(for the 3rd time) my request for him to document/support his declaration/assertion of:

>>>1. Chripractors don't study musclolskeletal medicine, They study the spine.<<<

All of them clearly tell me the classes they take and they are not focused on MSK medicine. They are focused on vooodooooo spine BS.

All of them clearly tell me the classes they take and they are not focused on MSK medicine. They are focused on vooodooooo spine BS.

It is VERY evident now, (after 3 requests)--------erichaj is unable to provide documentable support for his verbose pontifications.

It is VERY evident now, (after 3 requests)--------erichaj is unable to provide documentable support for his verbose pontifications.

You know what wyttkk, it is a sad, sad day that you have to go through soooo much trouble to justify the validity of your profession.

It is VERY EVIDENT that you don't have any data at any time for telling people that:

1. You are a real doctor.
2. You can treat medical problems
3. That those herbs you sell work. they don't.

I mean get real buddy, pontify on the fact that your job has is riddled BS.

I have nothing more to say to you.

I'm not trying to justify anything. So, post away.

I have nothing more to say to you.

I'm not trying to justify anything. So, post away.

Hey "Buddy" -----I am not asking you to "justify" anything.........Merely requesting that you backup/provide support of your verbose pontifications with some verifiable documentation. Apparently this a new concept for someone that considers themself a legend in their own lunch-hour! :eek:

I see from NU Web Site that DCs are qualified to practice as primary care physicians. I also have seen this statement on many of the DC's advertising pages both on the Net and Yellow Pages. Forgive me for being naive but are DCs viewed as PCPs in the States? How can a person treat a patient without being able to perscribe medications or do physical examinations? DP

I see from NU Web Site that DCs are qualified to practice as primary care physicians. I also have seen this statement on many of the DC's advertising pages both on the Net and Yellow Pages. Forgive me for being naive but are DCs viewed as PCPs in the States? How can a person treat a patient without being able to perscribe medications or do physical examinations? DP

That is the crux of the argument here. It is not the length of curriculum nor the educational level of those who taught it.

I'm a pharmacist who went to school in a major medical center. My school was 4 years, the medical school was 4 years, the dental school was 4 years. We all took the same anatomy, biochemistry, physiology, histology, microbiology...in fact...we were all in the same lecture hall & labs at the same time.

But..that in itself doesn't make me a physician nor a dentist. After those basic sciences were done...we split off....dentists learned their diagnostic & treatment field, physicians learned theirs & I studied pharmacology, pharmaceutical chemistry, pharmacokinetics & dynamics. I did not learn how to diagnose illness at all. I could no more tell a ....what was that...patellarfemoral syndrome (I had to go back & look it up) from an MI.

So...do I have no purpose? Yes - I'm a provider, educator & monitor of medications & how they are used. Do I know as much about the cardiac implications of ACE inhibitors than a cardiologist - absolutely not - that individual has training far beyond mine. However, when the orthopedic surgeon calls me up & asks me what Femara is....I can help him/her. When the pt comes back from seeing that cardiologist & is confused about what medications do what - I'm there to answer their questions...over & over & over again. I'm in the hospital to give some direction to the dosing of that aminoglycoside in the renal failure pt. However...I would never in a million years ever say I was capable of providing complete medical care.

We all have our purpose & the reasons we chose what we did. We all have our limitations as well. I know medications very, very well...but when I guessed my kids had strep throat....I didn't just give them amoxicillin because I had it handy....I made the appt with their pediatrician & had them treated.

My four years of school (I refuse to count the number of trimesters - I was on quarters) taught me to be a pharmacist. DC's are just that - DC's. You can like &/or approve of them or not....but they are not primary care physicians.

That is the crux of the argument here. It is not the length of curriculum nor the educational level of those who taught it.

I'm a pharmacist who went to school in a major medical center. My school was 4 years, the medical school was 4 years, the dental school was 4 years. We all took the same anatomy, biochemistry, physiology, histology, microbiology...in fact...we were all in the same lecture hall & labs at the same time.

But..that in itself doesn't make me a physician nor a dentist. After those basic sciences were done...we split off....dentists learned their diagnostic & treatment field, physicians learned theirs & I studied pharmacology, pharmaceutical chemistry, pharmacokinetics & dynamics. I did not learn how to diagnose illness at all. I could no more tell a ....what was that...patellarfemoral syndrome (I had to go back & look it up) from an MI.

So...do I have no purpose? Yes - I'm a provider, educator & monitor of medications & how they are used. Do I know as much about the cardiac implications of ACE inhibitors than a cardiologist - absolutely not - that individual has training far beyond mine. However, when the orthopedic surgeon calls me up & asks me what Femara is....I can help him/her. When the pt comes back from seeing that cardiologist & is confused about what medications do what - I'm there to answer their questions...over & over & over again. I'm in the hospital to give some direction to the dosing of that aminoglycoside in the renal failure pt. However...I would never in a million years ever say I was capable of providing complete medical care.

We all have our purpose & the reasons we chose what we did. We all have our limitations as well. I know medications very, very well...but when I guessed my kids had strep throat....I didn't just give them amoxicillin because I had it handy....I made the appt with their pediatrician & had them treated.

My four years of school (I refuse to count the number of trimesters - I was on quarters) taught me to be a pharmacist. DC's are just that - DC's. You can like &/or approve of them or not....but they are not primary care physicians.

Thank you for your reply. The body is too much to know and that is why there are different specialties within medicine since the brain can't hold all the knowledge needed to properly treat the whole body. The same goes with dentistry (there are nine different specialties ) as I make frequent referrals to my colleagues for diagnosis and treatments. DCs are well qualified to perform the service within their scope such as mucoskeletal related disciplines but I can't see them rendering services as a primary care MD/DOs because they are not trained in such. And all the advertisements in the newspapers about how chiropractic visits can prevent childhood diseases or cure them all just baffled me. It is possible that the CNS is the key to curing all ailments but I need evidence that is so before I can accept what DCs are telling me. I believe that sound research on chiropractic and its role in treatment human illness is badly needed. DP

This may not be the case, but sometimes providers are classified as PCPs in order to get state L&I money.

Thank you for your reply. The body is too much to know and that is why there are different specialties within medicine since the brain can't hold all the knowledge needed to properly treat the whole body. The same goes with dentistry (there are nine different specialties ) as I make frequent referrals to my colleagues for diagnosis and treatments. DCs are well qualified to perform the service within their scope such as mucoskeletal related disciplines but I can't see them rendering services as a primary care MD/DOs because they are not trained in such. And all the advertisements in the newspapers about how chiropractic visits can prevent childhood diseases or cure them all just baffled me. It is possible that the CNS is the key to curing all ailments but I need evidence that is so before I can accept what DCs are telling me. I believe that sound research on chiropractic and its role in treatment human illness is badly needed. DP



Which musculoskeletal treatments are DCs qualified to treat?

The word musculoskeletal is very broad. In my office as a PCP MD, I can treat many musculoskeleta issues. This includes diagnosis and treatment of fractures (non-complicated, the rest go to the orthopods), soft tissue injuries and joint issues. I do not do back manipulation. (the data suggests that it may help some people).

So when someone tells me that a DC is qualified to do musculoskeletal medicine, I have to ask which ones and to what extent.

I know that in DO programs they spend about the equivalant of one to two sememster in ONE of their courses teaching and practicing spinal manipulation. They feel that is plenty. The rest of the time they spend learning hardcore medicine.

So I question the value of DC school.

But, I just want someone to tell me what exactly it is in the field of musculoskeletal medicine that DCs treat.

How can the CNS be the answer to cure all diseases? Just becasue you have a hammer does not mean everything is a nail.

In medical school we are taught the "systems approach". The CNS is certainly related to the system. But the way these DCs make it sound is like all the MDs are crazy and all you have to do to get cured is to get you back adjusted a few times and take some of those wonderfull vitamins they are selling.

Which musculoskeletal treatments are DCs qualified to treat?


So I question the value of DC school.

But, I just want someone to tell me what exactly it is in the field of musculoskeletal medicine that DCs treat.



That is why I feel that it would be an educational opportunity for all of us here at SDN to have a Chiropratic as well as Oriental Medicine/ND Forum so we can learn from each other. I keep an open mind and tend not to be biased in my judgments. However, I have hard time swallowing some of the beliefs that the DCs hold such as no need for immunization, pinched nerve can lead to systemic diseases or pediatric chiropractic adjustments can prevent childhood illnesses. DP

I see from NU Web Site that DCs are qualified to practice as primary care physicians. I also have seen this statement on many of the DC's advertising pages both on the Net and Yellow Pages. Forgive me for being naive but are DCs viewed as PCPs in the States? How can a person treat a patient without being able to perscribe medications or do physical examinations? DP
There are states where by law DC's are defined as primary care physicians. Florida is one of those states. Why do you have to be an MD to do a routine physical examination?

So they are allowed to order lab tests and perform male/female physical examinations and all? I am just curious on the scope of their practice as a primary care physician. DP

Yes, just no surgery or Rx.

Yes, just no surgery or Rx.

Just on a personal level, I'd have a hard time with a DC trying to listen to my heart sounds to differentiate one diagnosis from another or evaluating tissue changes on my Pap since I'm a DES child.

Likewise, there is an interesting thread on the psych forum....a pt newly presented with tardive dyskinesia - past hx - methadone maintenance x 7yr & Hep C. In my small world, I wanted it to be a side effect of long term methadone (which can cause this)...but the MDs presented all sorts of differentials & it ultimately was a lesion in the brain. But this was a psych MD who ordered all the tests & the important part here - was able to evaluate them!!!

Now...how, possibly, could a DC dx this? I've had to order plenty of chemistries on acute pts in my job writing tpn orders, but in a complex pt with changing fluid statuses....even if that pt is home & the fluids shift due to pulmonary, liver or renal influences.....it is not such an easy task to evaluate those tests properly. For myself & my family...I'd want that person to be able to tx as well as evaluate & I'd want plenty of years of experience behind that. I think most interns would say they are scared to death when they begin in July. They know a lot,but they learn so much more after they graduate. How much more exposure do DC's get?

I don't know...its a personal decision for everyone, obviously. I don't fault those who choose it, but as a pharmacist....I don't encourage the purchase of the supplements which are recommended. For the poster who asked for evidence...there is no supportive well designed double blind studies for some of the claims they make. As for the claim of not believing in immunizations - I'm off to give influenza vaccine & pneumococcal pneumonia vaccine - not believing in that is just crazy. Sorry!

I was just pointing out what the particular state law is, not that a DC should practice every aspect of healthcare. My guess is you would not want the family doc reading a pap smear either. A DC needs to utilize diagnostic tools (which includes testing not performed in the office) to know when and when NOT to treat a patient

I was just pointing out what the particular state law is, not that a DC should practice every aspect of healthcare. My guess is you would not want the family doc reading a pap smear either. A DC needs to utilize diagnostic tools (which includes testing not performed in the office) to know when and when NOT to treat a patient

I just do not see how a DC can be adequately trained to perform as a primary care physician. I personally would be extremely hesitant to have a DC provide differential diagnosis on me. I really would like to know to what scope can a DC be called a PCP? Can he perform prostate exams or rx birth control pills or treat me for strep throat? How can a person who cannot write medications be allowed to be designated as a PCP? I am not trying to put down DC, it just does not make sense to me. DP

Again, it is the state law. You make some valid points. Of course a DC can perform a prostate exam but the better choice would be the MD, better yet the Urologist. As I said before, the DC has to be trained to initially diagnose and recognize conditions that he can and cannot treat.

I was just pointing out what the particular state law is, not that a DC should practice every aspect of healthcare. My guess is you would not want the family doc reading a pap smear either. A DC needs to utilize diagnostic tools (which includes testing not performed in the office) to know when and when NOT to treat a patient

There is an old Taoist teaching that states "The eyes can not see what the mind does not know". This is the crux of the problem that most MD/DOs have with DCs in general. Even if we grant that chiropractic college is equivalent to medical school (a supposition I am not willing to concede), any differential diagnosis arrived at by a DC would be at best equal to that of an intern. I wouldn't trust that at all. The other difference is that the intern will "run the case" by a more senior physician. Not only does this protect the patient, but adds to the intern's learning. The findings are then validated, with feedback in place to further facilitate learning. Last night I worked supervising several interns (a common occurrence). A 24 year old female presented with right flank pain, colicky, causing writhing and increased activity. The intern, appropriately, suggested renal colic, caused by a stone. Except that all tests were negative for urolithiasis. So now what? The intern came up with a few alternative diagnoses, and they were good, but he missed the actual diagnosis - in this case a severe pulmonary embolism. Both my attending physician and I independently suggested the correct diagnosis (later confirmed on CT). Why? Because our experience led us to consider subtler signs in the patient's presentation. The three years of residency is only designed to start that learning process. The QI/QA mechanisms in place in modern medical care insure that learning is lifelong.

Not only are chiropractors limited by the length of their education, but also in the severity of illnesses they see. If you don't see even "classic" presentations of advanced or severe disease, how are you to pick up more subtle ones? It is very easy to perform a physical on a healthy person, but how can you be sure?

Chiropractors, like many sCAM providers, simply play the odds. In all likelihood your patients, healthy enough as they are to seek your care, do not really need much help. So, what you do, while of no real benefit, can be made to look beneficial.

Let me give you an example - if 20 people get a splinter and remove that splinter with a tweezer, and ten of them eat a hot dog on the day of the "splinterectomy", and none of those ten get an infection, are hot dogs protective against infection? It sure looks that way - especially if one of the ten "non-hot dog eaters" incidentally gets an infection. To test a outcome, there needs to be a difference in outcome to test. This is why LBP "works" so well for chiropractic. Good studies have shown that chiropractic may be as effective but no more so than conventional therapy and neither chiropractic nor conventional therapy are truly effective in altering the natural course of the disease (or dis-ease) process. From: http://www.annals.org/cgi/reprint/138/11/871.pdf
"We found no evidence that spinal manipulative therapy is superior to other advocated therapies, including analgesics, exercises, physical therapy, and back schools. Neither did we find evidence that these therapies are superior to spinal manipulative therapy. Therefore, we conclude that spinal manipulative therapy is one of several options of only modest effectiveness for patients with low back pain. Truly effective therapy for such patients remains elusive."

I don't doubt your motivations. What I question is the sufficiency of your training to safely and effectively do what you claim.

- H

Hi folks,

I'm a former DC and now a 4th-year med student. Going through this thread, some issues stood out to me of which I'll try to address succinctly:

1) Chiropractors are trained to diagnose a surprisingly broad range of musculoskeletal disorders and conditions affecting the musculoskeletal system. This not only includes the spine but also bone and joint you can think of and associated rheumatologic, neurologic, and malignant disorders. Chiropractors are also trained to order the appropriate imaging studies and lab tests. In reality, their training is severely limited by actual exposure to patients with these conditions.

2) The anatomy is just as in-depth as it is in medical school. Upon graduation, my observation is that chiropractic students in general know their musculoskeletal anatomy (origins, insertions, innervation, blood supply) very well. Medical students will know their anatomy depending on chosen specialty. Treatment is limited to manipulation and anything else a physical therapist would be able to do (unless the chiropractor has 'alternative' tendencies). Referral to the appropriate medical specialist as necessary.

3) Length of training and names of classes have nothing to do with quality.

4) Chiropractors are also trained in physical diagnosis much like in medical school. However, by the time students graduate they will be a less proficient than med students in a general physical exam but more proficient with a musculoskeletal exam than a med student will be. Sure, you could have a chiropractor perform your annual physical but why? Chiropractic students have very limited exposure and training in managing sick patients. And yeah... believe it or not, we were taught how to perform prostate, vaginal, and breast exams. I'm not sure whether it was state law or CCE requirements but it was just treated as a formality that we had to go through.

5) Chiropractic organizations like to have their own definition of being a primary care physician. They contend that chiropractors have training in differential diagnosis of the entire body, in ordering imaging and lab studies, as well as training in referring to an appropriate medical specialist, and an ability to treat a "broad range of conditions nonpharmacologically". According to them, that's all that is needed to be "primary care."

Just out of curiousity, how would you compare the education of an MD who attended a large university based research institution to a DO who attended one of the many new DO schools that are popping up everywhere?

Just out of curiousity, how would you compare the education of an MD who attended a large university based research institution to a DO who attended one of the many new DO schools that are popping up everywhere?

As long as the school is accredited by the American Osteopathic Association’s Commission on Osteopathic College Accreditation (COCA), then minimum standards for patient exposure, education, and evaluation have been met. But remember, the medical school training is only one half of the training for an MD/DO. And the patients seen during training are generally inpatient and quite ill.

- H

But is the initial medical school training equal to that of an osteopathic school that has just opened their doors? I am not comparing chiropractic colleges for this question.

How can one possibly compare DeBusk to Vanderbilt?

How can one possibly compare DeBusk to Vanderbilt?

Well, I'll leave aside all of the times that you have admonished this forum that graduates of National are the far superior chiropractors.

There will, of course, be variations. For that reason, accrediting bodies have set forth minimum standards to help regulate and standardize MD/DO training. But don't discount smaller schools or remote campuses. I was at a remote campus of a large medical school. The hospitals I trained at as a medical student had no residents. Students worked 1-to-1 with attendings. The amount of "hands-on" experience was awesome. I scrubbed in as first assist almost daily during my surgery rotation, I ran the service during call night on IM, and delivered babies on OB. At a more traditional school these opportunities would never occur. I would, instead, have the benefit of more didactic teaching by the residents and fellows on my team and an even greater exposure to interesting cases. It all comes out in the wash.

- H

Hi folks,

I'm a former DC and now a 4th-year med student. Going through this thread, some issues stood out to me of which I'll try to address succinctly:

1) Chiropractors are trained to diagnose a surprisingly broad range of musculoskeletal disorders and conditions affecting the musculoskeletal system. This not only includes the spine but also bone and joint you can think of and associated rheumatologic, neurologic, and malignant disorders. Chiropractors are also trained to order the appropriate imaging studies and lab tests. In reality, their training is severely limited by actual exposure to patients with these conditions.

2) The anatomy is just as in-depth as it is in medical school. Upon graduation, my observation is that chiropractic students in general know their musculoskeletal anatomy (origins, insertions, innervation, blood supply) very well. Medical students will know their anatomy depending on chosen specialty. Treatment is limited to manipulation and anything else a physical therapist would be able to do (unless the chiropractor has 'alternative' tendencies). Referral to the appropriate medical specialist as necessary.

3) Length of training and names of classes have nothing to do with quality.

4) Chiropractors are also trained in physical diagnosis much like in medical school. However, by the time students graduate they will be a less proficient than med students in a general physical exam but more proficient with a musculoskeletal exam than a med student will be. Sure, you could have a chiropractor perform your annual physical but why? Chiropractic students have very limited exposure and training in managing sick patients. And yeah... believe it or not, we were taught how to perform prostate, vaginal, and breast exams. I'm not sure whether it was state law or CCE requirements but it was just treated as a formality that we had to go through.

5) Chiropractic organizations like to have their own definition of being a primary care physician. They contend that chiropractors have training in differential diagnosis of the entire body, in ordering imaging and lab studies, as well as training in referring to an appropriate medical specialist, and an ability to treat a "broad range of conditions nonpharmacologically". According to them, that's all that is needed to be "primary care."


I don't agree because of one simple reason. Why even have medical school if chiropractors can do so much. Why not just have the chiropractors do spinal surgery.

What you are saying is at best an attempt to justify chiropractic practice.
It is malpractice to have a chiropractor do a general physical examination of a patient. It's like having a 2nd year medical student or a nursing student do this without supervsion.

Just because you have been taught how to treat a shoulder injury or I should say you have talked about it in chiropractic school does not mean you can do one. Thats where experience comes in.

I went to a CME course once that showed MD's how to do spinal manipulation. I was curious about it.

I saw it done several times. Now I can say I can do spinal manipulation. Right?

That is the exact reasoning that the chiropractors are using to say they can be primary care docs.

You know this or you would not be in medical school. so stop trying to justify chiropractic school.

Yes, you do know you anatomy. So what.

How can one possibly compare DeBusk to Vanderbilt?

Because they both the DO degree and MD degree have similar curriculum throughout 4 years of medical school... and take similar tests (USMLE 1+2 and COMPLEX 1+2)... additionally many DOs take the USMLE. Both have clinical rotations in different specialties (OBGYN, Surgery, Internal Medicine, Pediatrics and Psychiatry).... Not to mention the shelf exams.

Your argument of Vanderbilt vs DeBusk is moot... like arguing is Washington State equivilant to Harvard.... they are both universities and run their curriculum according to a dictated approved process. How much better is one school from the other will be noted by their publications/graduates/exam scores.

When DC schools start becoming as intense and more importantly inclusive of medical topics like DO or MD schools then you can discuss which is better. DC at best makes you a "special therapist" which is not a bad thing but it does not make you a "primary care doctor". Missing a tumor (or insert your favorite rare disease) diagnosis is not acceptable and just because 99% of the population dont have tumors (insert your favorite rare disease), it doesn't mean its okay to ignore the tumor training (insert your favorite disease knowledge). You aren't primary if you are missing the Dx that the primary MDs and DOs are not missing. A minimum level of competency needs to be set (and is infact set in some states).

Because they both the DO degree and MD degree have similar curriculum throughout 4 years of medical school... and take similar tests (USMLE 1+2 and COMPLEX 1+2)... additionally many DOs take the USMLE. Both have clinical rotations in different specialties (OBGYN, Surgery, Internal Medicine, Pediatrics and Psychiatry).... Not to mention the shelf exams.

Your argument of Vanderbilt vs DeBusk is moot... like arguing is Washington State equivilant to Harvard.... they are both universities and run their curriculum according to a dictated approved process. How much better is one school from the other will be noted by their publications/graduates/exam scores.

When DC schools start becoming as intense and more importantly inclusive of medical topics like DO or MD schools then you can discuss which is better. DC at best makes you a "special therapist" which is not a bad thing but it does not make you a "primary care doctor". Missing a tumor (or insert your favorite rare disease) diagnosis is not acceptable and just because 99% of the population dont have tumors (insert your favorite rare disease), it doesn't mean its okay to ignore the tumor training (insert your favorite disease knowledge). You aren't primary if you are missing the Dx that the primary MDs and DOs are not missing. A minimum level of competency needs to be set (and is infact set in some states).


What you say makes perfect sense to me. However, why is it that many states allows DCs to call themselves Primary Care Physicians? Just look into the Yellow Pages and they will be listed in the Physicians Directory. Sometimes, DCs do not use the initials but rather with the Dr. Prefix. and that can be confused with a MD or DO. DP

What you say makes perfect sense to me. However, why is it that many states allows DCs to call themselves Primary Care Physicians? Just look into the Yellow Pages and they will be listed in the Physicians Directory. Sometimes, DCs do not use the initials but rather with the Dr. Prefix. and that can be confused with a MD or DO. DP


No one is checking on them. For the same reason that no one really goes after the idiots that sell and promote lies on TV about herbal supplements.

I don't agree because of one simple reason. Why even have medical school if chiropractors can do so much. Why not just have the chiropractors do spinal surgery.

What you are saying is at best an attempt to justify chiropractic practice.
It is malpractice to have a chiropractor do a general physical examination of a patient. It's like having a 2nd year medical student or a nursing student do this without supervsion.

Just because you have been taught how to treat a shoulder injury or I should say you have talked about it in chiropractic school does not mean you can do one. Thats where experience comes in.

I went to a CME course once that showed MD's how to do spinal manipulation. I was curious about it.

I saw it done several times. Now I can say I can do spinal manipulation. Right?

That is the exact reasoning that the chiropractors are using to say they can be primary care docs.

You know this or you would not be in medical school. so stop trying to justify chiropractic school.

Yes, you do know you anatomy. So what.


I'm with you on just about everything you're saying. I think you need to re-read my post. I have long been opposed to chiropractic colleges stating that chiropractors are primary care. It's misleading. With regards to chiropractic education and training, I did say that their training is "severely limited to actual exposure to patients with these disorders."

I was just trying to bring out the facts with regards to chiropractic education and training. If you're going to make an argument against something, you might as well have the facts (instead of the misconceptions). Another example is that you just stated that "it is malpractice for a chiropractor to do a general physical examination of a patient." As much as you or I would like it to be, it is not malpractice. As an example, in California chiropractors can be the primary physician in a Worker's Compensation case and perform physicals for applicants of commercial drivers' licenses. It's all in the state regulations. You also suggested that I have only talked about treating shoulder injuries in chiropractic school when in fact I have treated shoulders, wrists, knees, ankles, elbows, etc. during my time as a chiropractic student. Of course, I never saw actual patients with acute coronary syndromes or pneumonia as a chiropractic student. Again, my point is to make your arguments against chiropractic with facts.

With all that said, I think we both can agree that chiropractors should not be labeled as physicians or primary care because the training really is not up to par.

No one is checking on them. For the same reason that no one really goes after the idiots that sell and promote lies on TV about herbal supplements.

Actually Erich, as wrong as this may be, many states specifically allow chiropractors to advertise as PCPs as a matter of law. It is not that "no one is checking on them", the ads are legal. There is nothing to check.

- H

A girlfriend with normal anatomy has an uncomplicated UTI. A PCP can take care of it. Is there a chiro who can?

Chiros are not PCPs.

ncc

Actually Erich, as wrong as this may be, many states specifically allow chiropractors to advertise as PCPs as a matter of law. It is not that "no one is checking on them", the ads are legal. There is nothing to check.

- H

He means no one is checking on them when they miss the diagnosis or try and treat something that their treatments shouldn't be able to cure/treat.


If you have been taking garlic pills for your cholestrol for 10 years because Dr. XXXX who went to YYYY institute of whatever-science and your cholestrol doesn't drop because of them and you don't care to sue the Doc for false treatment... does the government come and sue the doc for you? Nope. Apply the same concept to spinal manipulation that misses a tumor or attempts to fix progressive ALS.

Should there be a panel of physician-scientists that make sure all pcps are competent? Yes... there is one in each state because the states refuse to federalize it.. they all have different requirements and different requirements are placed by different people... some who might not know crap from good and do it according to what they hear not what they know. State policy makers are not made of scientists or academicians... they are made of regular people who ask people that whom they believe have valuble opinions.

Examples of limitations of having a DC as your PCP


A 45 year old white male with a BP of 170s/90s on more than 3 seperate occasions. What can a DC (who advertise as a PCP) do in this situation?

A 50 year old white male, with DM2, is in for a routine annual physical/checkup. No other complaints. What can a DC (who advertise as a PCP) do in this situation?


A 6 month old, brought in by his parents, is in for a routine 6-month checkup. What can a DC (who advertise as a PCP) do in this situation?

An 18-year old is in for a college physical before heading off to college (away from home). What can a DC (who advertise as a PCP) do in this situation?

A 14-year old is in for a routine physical. You find out that he gets short of breath easily while involved with physical activity. Mom states that he does a lot of coughing at night while asleep. What can a DC (who advertise as a PCP) do in this situation?

A 55 year old female comes in for a routine physical. She states that her son is in Iraq for his second-tour of duty. Lately she finds herself very tired and have lack of energy. She sleeps 1-2 hrs a night. She use to be very social but lately have stayed home more often, watching the news. What can a DC (who advertise as a PCP) do in this situation?

Actually Erich, as wrong as this may be, many states specifically allow chiropractors to advertise as PCPs as a matter of law. It is not that "no one is checking on them", the ads are legal. There is nothing to check.

- H


So is it legal or illegal to have this on my business card? Let's say I am a DC.

Dr. Dai Phan

Primary Care Physician

So is it legal or illegal to have this on my business card? Let's say I am a DC.

Dr. Dai Phan

Primary Care Physician

As many posters suggested....you'd have to check with your own state's laws for the legality.

Ethical? Everyone has a different take on this - some of us would say no, its not ethical, but others have clearly justified this in their way.

Misleading? I think it is because of the "reasonable man" expectation group_theory explained so clearly. When presented with medical situations which a "reasonable man" would expect a PCP to be able to evaluate, dx & tx with current medical theory....then I feel the DC is being misleading by representing himself/herself as a PCP because he/she cannot provide that treatment nor is fully capable of evaluating for a complete differential dx.

One caveat.....there are those who seek out PCP's who practice only alternative medication. I think if you clearly represent yourself as that...the "reasonable man" would not expect you to do other than alternative therapies. So it would be ethical to have on your card PCP specializing in alternative therapies or some such. That would allow me to ask you if you'd treat my hbp with traditional therapy concomittantly with alternative therapies & you would have to reply, No, I cannot.

That's just the way my mind sorts it. Others won't think the same way, obviously.

So is it legal or illegal to have this on my business card? Let's say I am a DC.

Dr. Dai Phan

Primary Care Physician

Legal (in many states). That said, most chiropractors won't list it that way. It is usually

Dr. H. Foughtfyr, DC

Primary Care Physician.

You can count on the ignorance of the American public to assume that the training between a DC and an MD are equivalent. In fact, if you go on public sites such as "Yahoo! asks", you will discover that many people believe chiropractors are MD/DO who did their residency training in "back problems". Given the heated debate on this forum, among (supposedly) educated people, regarding the equivalence of the training, how can the public distinguish? They can't. Which aids chiropractic marketing tremendously.

- H

Legal (in many states). That said, most chiropractors won't list it that way. It is usually

Dr. H. Foughtfyr, DC

Primary Care Physician.

You can count on the ignorance of the American public to assume that the training between a DC and an MD are equivalent. In fact, if you go on public sites such as "Yahoo! asks", you will discover that many people believe chiropractors are MD/DO who did their residency training in "back problems". Given the heated debate on this forum, among (supposedly) educated people, regarding the equivalence of the training, how can the public distinguish? They can't. Which aids chiropractic marketing tremendously.

- H

With all respect to all DCs who are experts in their discipline as much as the oral surgeons in their wisdom teeth removal to OB/GYNs who deliver babies, I cannot see how a DC should be classified as a PCP. I now understand that it is legal in many states and I personally have DCs addressed themselves to me as physicians. But looking at the vast different in the medical school and chiropratic school cirriculum, DCs in my humble opinion are not adequate trained to diagnose total human body condition. I personally would not let an oral and maxilofacial surgeon with a DDS/MD diagnose me for a swelling on my arm simply because they are not trained in familiy medicine. I think that telling the public that you are PCP as a DC is misleading (although it is legal to do so) since that equates DC as a family pratice MD/DO in which you are not due to differences in medical training. If the advertising says "Primary Care Physician in Chiropractic Medicine" then I would accept it but as a PCP alone, then no. DP

I agree. Just because a state or insurance carrier considers a Chiropractor to be a primary care physician, I do not see any DC's holding themselves out to be as such. In my state the reason for insurance carriers who classify a DC as primary care is because they do not require a referral to see a DC under an HMO plan. Chiropractic care is open access. The reason this came about years ago is that most, but not all MD's, will not refer to a DC yet the patient's insurance plans had Chiropractic benefits and not being able to get a referral made it impossible to access those Chiropractic benefits.

Legal (in many states). That said, most chiropractors won't list it that way. It is usually

Dr. H. Foughtfyr, DC

Primary Care Physician.

You can count on the ignorance of the American public to assume that the training between a DC and an MD are equivalent. In fact, if you go on public sites such as "Yahoo! asks", you will discover that many people believe chiropractors are MD/DO who did their residency training in "back problems". Given the heated debate on this forum, among (supposedly) educated people, regarding the equivalence of the training, how can the public distinguish? They can't. Which aids chiropractic marketing tremendously.

- H

FYI: It's H. Foughtfyr, DC or Dr. H. Foughtfyr, Chiropractic Physician but not Dr. H. Foughtfyr, DC (The DC's can be substituted with MD:laugh: )

I'm with you on just about everything you're saying. I think you need to re-read my post. I have long been opposed to chiropractic colleges stating that chiropractors are primary care. It's misleading. With regards to chiropractic education and training, I did say that their training is "severely limited to actual exposure to patients with these disorders."

I was just trying to bring out the facts with regards to chiropractic education and training. If you're going to make an argument against something, you might as well have the facts (instead of the misconceptions). Another example is that you just stated that "it is malpractice for a chiropractor to do a general physical examination of a patient." As much as you or I would like it to be, it is not malpractice. As an example, in California chiropractors can be the primary physician in a Worker's Compensation case and perform physicals for applicants of commercial drivers' licenses. It's all in the state regulations. You also suggested that I have only talked about treating shoulder injuries in chiropractic school when in fact I have treated shoulders, wrists, knees, ankles, elbows, etc. during my time as a chiropractic student. Of course, I never saw actual patients with acute coronary syndromes or pneumonia as a chiropractic student. Again, my point is to make your arguments against chiropractic with facts.

With all that said, I think we both can agree that chiropractors should not be labeled as physicians or primary care because the training really is not up to par.

I see your point on the state laws. I think they are flawed. As far as treating shoulders and wrist in chiropractic school. You should not have. Chiropractic school is for backs.

I do see your point and we do agree on most everything.

All I'm saying is, why go to chripractic school if you want to be a PCP?
Why go through all the BS your going to catch and know that at the end of the day you can't treat people correctly.

I had a guy in here trying to justify how chiropractors knew so much about medicine and musculoskeletal medicine. In theory they may have read all the books.

FYI: It's H. Foughtfyr, DC or Dr. H. Foughtfyr, Chiropractic Physician but not Dr. H. Foughtfyr, DC (The DC's can be substituted with MD:laugh: )

I know how it is supposed to be, but I've seen many chiropractors putting both the "Dr." and the ",DC" on business cards and marketing materials.

As for the chiropractor holding themselves out as primary care physicians, come on. Just about every chiropractor in the Chicago area does. And if you'd prefer more scientific evidence, this article from 1995 (! - a bit before this debate even came to a head nationally) http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=7790784&query_hl=1&itool=pubmed_docsum found that "the majority of respondents (90.4%) considered themselves primary care practitioners". The PCP title is used not only for billing but also for marketing and you know it. I mean in Illinois a DC can perform school athletic physicals - now that is scary!

- H

I know how it is supposed to be, but I've seen many chiropractors putting both the "Dr." and the ",DC" on business cards and marketing materials.

As for the chiropractor holding themselves out as primary care physicians, come on. Just about every chiropractor in the Chicago area does. And if you'd prefer more scientific evidence, this article from 1995 (! - a bit before this debate even came to a head nationally) http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=7790784&query_hl=1&itool=pubmed_docsum found that "the majority of respondents (90.4%) considered themselves primary care practitioners". The PCP title is used not only for billing but also for marketing and you know it. I mean in Illinois a DC can perform school athletic physicals - now that is scary!

- H

In our state school athletic physicals consist only of height, weight, BP, pulse, resp., heart, lungs, and hernia. Anyone could do a minimal athletic physical. EKG's and any other tests are not required, although it would not be a bad idea. When you say DC's hold themselves out to be primary care physicians, do they use that exact verbiage or does their advertising convey the idea that they are pcp's and treat problems pcp's would treat? I have never seen DC's use the term "pcp" in their promotional material. Another reason insurance companies consider DC's PCP's in many cases, is that the PCP copays are usually less than the specialist copay. So if it is a carrier that considers the DC to be a PCP then they may only collect the PCP copay.

I know how it is supposed to be, but I've seen many chiropractors putting both the "Dr." and the ",DC" on business cards and marketing materials.

As for the chiropractor holding themselves out as primary care physicians, come on. Just about every chiropractor in the Chicago area does. And if you'd prefer more scientific evidence, this article from 1995 (! - a bit before this debate even came to a head nationally) http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=7790784&query_hl=1&itool=pubmed_docsum found that "the majority of respondents (90.4%) considered themselves primary care practitioners". The PCP title is used not only for billing but also for marketing and you know it. I mean in Illinois a DC can perform school athletic physicals - now that is scary!

- H
Wholy crap you are right! http://www.nuhs.edu/show.asp?durki=508
How dare they teach this course in primary care Chiropractic. I bow to your superior intelligence.:idea: You see, good does come out of sharing ideas!

In our state school athletic physicals consist only of height, weight, BP, pulse, resp., heart, lungs, and hernia. Anyone could do a minimal athletic physical. EKG's and any other tests are not required, although it would not be a bad idea. When you say DC's hold themselves out to be primary care physicians, do they use that exact verbiage or does their advertising convey the idea that they are pcp's and treat problems pcp's would treat? I have never seen DC's use the term "pcp" in their promotional material. Another reason insurance companies consider DC's PCP's in many cases, is that the PCP copays are usually less than the specialist copay. So if it is a carrier that considers the DC to be a PCP then they may only collect the PCP copay.

You say anyone can do a school athletic physical. I stongly do not agree.
You see, although most are going to have negative findings, chiropractors are not trained nor do they have the experience to find the positive findings of murmurs in heart, respiratory issues, or even to diagnose a hernia correctly. So, not anyone can do those exams. Although they seem simple to do, they can present with complications that only a trained MD can diagnose and treat.

You should not minimize such exams.

You say anyone can do a school athletic physical. I stongly do not agree.
You see, although most are going to have negative findings, chiropractors are not trained nor do they have the experience to find the positive findings of murmurs in heart, respiratory issues, or even to diagnose a hernia correctly. So, not anyone can do those exams. Although they seem simple to do, they can present with complications that only a trained MD can diagnose and treat.

You should not minimize such exams.
You are wrong, but who's counting.

FYI: It's H. Foughtfyr, DC or Dr. H. Foughtfyr, Chiropractic Physician but not Dr. H. Foughtfyr, DC (The DC's can be substituted with MD:laugh: )

In California, if a chiropractor precedes his/her name with "Dr." then "DC" or "Chiropractor" must follow as well. Maybe this is the same for other states as well.

I see your point on the state laws. I think they are flawed. As far as treating shoulders and wrist in chiropractic school. You should not have. Chiropractic school is for backs.
Actually, it is the CCE (the chiropractic version of the LCME) that determines what is taught in all chiropractic schools. Disorders and physiotherapy of the extra-axial musculoskeletal system is a heavy part of the curriculum at most chiropractic schools. And if you get the hands-on training and seeing real patients with shoulder problems, why not?

I do see your point and we do agree on most everything.

All I'm saying is, why go to chripractic school if you want to be a PCP?
Why go through all the BS your going to catch and know that at the end of the day you can't treat people correctly.

I had a guy in here trying to justify how chiropractors knew so much about medicine and musculoskeletal medicine. In theory they may have read all the books.
Some people really believe that chiropractors have the necessary training to be PCP's especially in the chiropractic sense. I say in the "chiropractic sense" because it really is a difference of culture how they apply a different meaning to the term "primary care." Actually, I'd say that there are two "types" of primary care even in the chiropractic profession. One, primary care as much of the chiropractic profession defines it is really what we in medicine would refer to as direct access (such as what the PT's are doing these days). They maintain "primary care" label for the sole purpose of seeing patients without referral such as an optometrist or physical therapist might. Primary care in chiropractic can also mean being able to treat people with alternative means (vitamins, herbs, manipulation, etc.). There are many DC's who consider themselves primary care even though they will not hesitate to tell their patient to see their MD for their asthma. Confusing? Yes. Strange? Yes. I stopped trying to make sense of the chiropractic profession long ago.

You say anyone can do a school athletic physical. I stongly do not agree.
You see, although most are going to have negative findings, chiropractors are not trained nor do they have the experience to find the positive findings of murmurs in heart, respiratory issues, or even to diagnose a hernia correctly. So, not anyone can do those exams. Although they seem simple to do, they can present with complications that only a trained MD can diagnose and treat.

You should not minimize such exams.

Taking PD1 does not qualify someone to do physicals. What is the old saying see 100, do 100, teach 100. I highly doubt if most DCs see 50, do 10, teach 1. Heck as a DPM, I would say the same and we do pre-op H&Ps everyday. That is why most DPMs have PCPs do the H&Ps

Taking PD1 does not qualify someone to do physicals. What is the old saying see 100, do 100, teach 100. I highly doubt if most DCs see 50, do 10, teach 1. Heck as a DPM, I would say the same and we do pre-op H&Ps everyday. That is why most DPMs have PCPs do the H&Ps


LOL, PCPs which ones? The ones who call themselves chiropractors? I'm kidding. But see how easily this can confuse the patients when they need a real doctor to treat their heart or asthma or chf.

PCP is a term used by insurance companies and it started getting used by MDs, DOs to say that they are the patients home. The doctor who takes care of and can take care of most of their needs.

The reason DOs can practice medicine is because they spend the majority of their training learning systemic medicine. Then they do residency etc.
Your a DPM and it sounds like you did a residency for surgery. Imagine if a chiropractor tried to treat one of your ankle injury patients or diabetic patients.

They are not qualified.

All I'm saying is if you want to be a doctor then go to medical school.

You are wrong, but who's counting.

Explain to me how I'm wrong. I'm a board certified MD who is telling you that not anyone can do physicals.

How is that wrong. Can "anyone" without proper training find a murmur in a patient. Can anyone find fibrotic lung disease or joint abnormalities in a patient. Can anyone find a hernia? How many kinds of hernia are there and can anyone diagnose it.

Sounds to me that you are wrong and that comes from being ignorant.

So I guess you are ignorant, but who is counting.

You are wrong, but who's counting.


Each year child athletes die of HOCM. Finding this difficult diagnosis before it strikes is a very real and very scary part of any athletic or school physical. To say nothing of post-concussion (or "second hit") syndrome, exertional asthma, eating disorders, and steroid abuse. I'm sorry, but a school or athletic physical is not to be taken lightly. But, again, if you play the odds, you'll be fine. Most kids will be o.k. And if you miss the one or two that you will see in a career who have a diagnosable condition, well that's o.k. right? I mean after all, you won't be the one to face the family afterward, an MD will take care of that for you. And hey, you can always blame the vaccinations they recieved from their drug company whore pediatrician or the evil awful DRUGS the ED physicians bought after a junket to Aruba that were used in an attempt to revive them.

:thumbdown

- H

Another thing to keep in mind is that patients are being discharged from hospitals sicker than they were years years ago. These patients are expected to follow-up with their primary care physicians.

Can you expect a DC, who has ZERO inpatient ward experience, let alone zero MICU/CCU experience, to receive these patients as their "PCP".


There are great sayings in medicine:
"The eyes does not see what the mind does not know"
and
"See one, do one, teach one"
and
"Diseases do not read textbooks"

If DC students never see acute cases or pathology or presentations while in school (see one), how are they suppose to accuately pick up on diagnosis or develop that clinical sense/suspicion (do one), let alone teach these set of skills to new generations of DCs (teach one).

A PGY-1 in July is afraid even though he/she has already spent the last 2 years on rotation, most of them inpatient settings and have passed Step 1 and Step 2 of the boards. Why can't a DC who, at best shadowed some teams in hospitals, display the same sense of fear and trepidation?


Edit: Can you blame a patient if he/she thinks his chiropractor can be his/her primary care physician? Take a look at this site, which belongs to the International Chiropractors Association: http://www.chiropractic.org/index.php?p=chiroinfo/main
Among the stuff listed:

Doctors of Chiropractic receive extensive, demanding professional education on par with medical doctors (MDs) and osteopaths (DOs).
Doctors of Chiropractic are primary health care providers. According to the Center for Studies in Health Policy, "The DC can provide all three levels of primary care interventions and therefore is a primary care provider, as are MDs and DOs."
Chiropractic is recognized by governmental health care programs. Chiropractic is included in Medicare, Medicaid, Federal Employees Health Care Benefits Programs, Federal Workers' Compensation and all state workers' compensation programs.

A PGY-1 in July is afraid even though he/she has already spent the last 2 years on rotation, most of them inpatient settings and have passed Step 1 and Step 2 of the boards. Why can't a DC who, at best shadowed some teams in hospitals, display the same sense of fear and trepidation?

They show no fear because they have no more sense of the potiential outcome than does the public. DCs do not pronounce death or even diagnose severe, life altering disease. They have never paused outside a door, knowing full well that once they walk through it and speak, the lives of the occupants will be FOREVER changed. They have never watched death, up close and personal, on a professional level. It is easy to be brave when you are naive. Medical students have all had their eyes opened in the third and fourth year. 1 MICU rotation is enough to demonstrate the stakes you are playing for. Surgery is a mandatory rotation of all medical students. Did anyone get through that without at least one major disaster patient? Did anyone get through their mandatory internal medicine rotation without watching the devastation that a new CVA causes on a family? Or having to witness the termination of resus efforts? Chiropractors get through their entire training in the outpatient setting (or, at some schools shadowing hospital teams without call or patient care responsibilities). Of course vaccines are bad if all you've ever done is seen local soft tissue reactions. Tell one mother her child is dead of Hib meningitis, then come back and talk to me...

- H

They show no fear because they have no more sense of the potiential outcome than does the public. DCs do not pronounce death or even diagnose severe, life altering disease. They have never paused outside a door, knowing full well that once they walk through it and speak, the lives of the occupants will be FOREVER changed. They have never watched death, up close and personal, on a professional level. It is easy to be brave when you are naive. Medical students have all had their eyes opened in the third and fourth year. 1 MICU rotation is enough to demonstrate the stakes you are playing for. Surgery is a mandatory rotation of all medical students. Did anyone get through that without at least one major disaster patient? Did anyone get through their mandatory internal medicine rotation without watching the devastation that a new CVA causes on a family? Or having to witness the termination of resus efforts? Chiropractors get through their entire training in the outpatient setting (or, at some schools shadowing hospital teams without call or patient care responsibilities). Of course vaccines are bad if all you've ever done is seen local soft tissue reactions. Tell one mother her child is dead of Hib meningitis, then come back and talk to me...

- H
So this is what is called the "God" complex?

Each year child athletes die of HOCM. Finding this difficult diagnosis before it strikes is a very real and very scary part of any athletic or school physical. To say nothing of post-concussion (or "second hit") syndrome, exertional asthma, eating disorders, and steroid abuse. I'm sorry, but a school or athletic physical is not to be taken lightly. But, again, if you play the odds, you'll be fine. Most kids will be o.k. And if you miss the one or two that you will see in a career who have a diagnosable condition, well that's o.k. right? I mean after all, you won't be the one to face the family afterward, an MD will take care of that for you. And hey, you can always blame the vaccinations they recieved from their drug company whore pediatrician or the evil awful DRUGS the ED physicians bought after a junket to Aruba that were used in an attempt to revive them.

:thumbdown

- H
Back to the discussion. So what is the answer for school physicals (they are actually called screenings here?) You have a form to fill out with specific areas to check. Obviously if that is all that is checked something serious could be missed. So what does the doctor do, add thousands of dollars of tests which most student football players cannot afford? Regardless of who does the physical, what is the practical answer here?

Back to the discussion. So what is the answer for school physicals (they are actually called screenings here?) You have a form to fill out with specific areas to check. Obviously if that is all that is checked something serious could be missed. So what does the doctor do, add thousands of dollars of tests which most student football players cannot afford? Regardless of who does the physical, what is the practical answer here?

Ya right, like you even begin to understand why the tests are done... obviously Hypertrophic Cardiomyopathy never entered your Dx book. Ya cause when the sport team sues the doc for the player suddenly dropping dead cause of missing the Dx of the myopathy because the doc did not order 'the thousands of dollar tests' for .... he will then tell them... "But the Chiropracter said it's too expensive and unncessary."

You are what I call DK-Cube.... You don't know that you don't know what you don't know.... and those are the scariest people in medicine.

Ya right, like you even begin to understand why the tests are done... obviously Hypertrophic Cardiomyopathy never entered your Dx book. Ya cause when the sport team sues the doc for the player suddenly dropping dead cause of missing the Dx of the myopathy because the doc did not order 'the thousands of dollar tests' for .... he will then tell them... "But the Chiropracter said it's too expensive and unncessary."

You are what I call DK-Cube.... You don't know that you don't know what you don't know.... and those are the scariest people in medicine.
Please answer the posted question. Practically, what should be done. If all the necessary testing is done we will not have any student athletes. What is your solution to this dilema?

I'd like to know your solution. Also, a simple echo which would diagnose this problem is not thousands of dollars worth of tests.

H&P skills are the most important thing for diagnosing any disease including hypertrophic cardiomyopathy. If you are not used to the simple exam tests and the questions necessary to diagnose, it would cost thousands in test.

I personally do not feel that DCs are strong enough in general PD w/o any residency training. The difference between a DO, MD, and DPM education versus a DC is medical school is only the foundation of the medical education; you learn to be a doctor in residency. That is lacking in the DC program.

Please answer the posted question. Practically, what should be done. If all the necessary testing is done we will not have any student athletes. What is your solution to this dilema?

There is no practical answer here... you must do whatever the Sports Medicine doc is telling you to do for multiple reasons.... even if you say that the chance of hypertrophic cardiomyopathy is very small..... You will get pushed by the team to order the test (a lot of times, the primary docs don't even get paid for the tests because they arent even the ones doing them... they just schedule them or refer them so it's not an issue of money.) So why does the team want the doc to order them as well? Because they dont want to lose an important player in the middle of the season due to a missed hypertrophic cardiomyopathy or another random but hidden disease that the athlete has but never knew about.... oh yeah... you will also save the athlete's life... but I am sure he will be ungrateful since you killed his/her chance to join the team when you discovered their asymptomatic patent foreman ovale.

Having said all the above... you need an answer from a Sport Medicine doc not me.... at least I know that even with all my training, I know I can be missing what the experienced Sport doc wont/less-likely be.

So this is what is called the "God" complex?

No....its not the "God" complex! How arrogant!

I'm a pharmacist (I won't say "just" a pharmacist because I contribute a lot to the hospital setting), but I have been in the periphery when some of these exact circumstances have occurred.

Yeah...when someone dies in the OR....there are a whole bunch of us who watch that surgeon before he/she actually goes out to see the pt. He walks right by the OR pharmacy on his way out so I see everyone - in & out. The word has already gotten around the OR so we know the look on his face & let me tell you it is not God-like at all. It is tragic, sad, agonized.

I've seen it when I've responded to a code requiring extra medication to resucitate a child in the ER & the efforts failed. Those physicians are not God-like. They look heartbroken.

When I sit on the M&M conference....the discussion is not about how great the physicians all were - its about what could have been done differently to prevent the morbidity or mortality.

I would not want to have to deliver the news they sometimes must. You are sadly mistaken if you think these individuals feel they are omnipotent. Sometimes...their best efforts fail & they've had years and years of exposure to give their best.

arrogant...hmmmm, interesting.

The rate of student loan default for Chiros (http://www.defaulteddocs.dhhs.gov/discipline.asp) is relatively high. This might explain part of the motivation that seems to lead so many of them to unscrupulous business practices and outlandish claims inflating their scope of practice. Personally, I'd have more respect for chiropractic as a profession if they stuck to what they're trained to do - treat the musculoskeletal system.

The rate of student loan default for Chiros (http://www.defaulteddocs.dhhs.gov/discipline.asp) is relatively high. This might explain part of the motivation that seems to lead so many of them to unscrupulous business practices and outlandish claims inflating their scope of practice. Personally, I'd have more respect for chiropractic as a profession if they stuck to what they're trained to do - treat the musculoskeletal system.

You are correct. Most do.

The rate of student loan default for Chiros (http://www.defaulteddocs.dhhs.gov/discipline.asp) is relatively high. This might explain part of the motivation that seems to lead so many of them to unscrupulous business practices and outlandish claims inflating their scope of practice. Personally, I'd have more respect for chiropractic as a profession if they stuck to what they're trained to do - treat the musculoskeletal system.

Looking at the amount of default made me shook my head. Someone defaults for less than 6 grands while others over half a mil! How can someone who has so much education ends up being that irresponsible !!! Can you imagine how damaging loan default can do to your credit score? Not pretty. DP

You are correct. Most do.


I totally agree. It is their advertising that makes the profession look questionable in the public eye. DP

So this is what is called the "God" complex?

No, the "God Complex" occurs when one believes that what they wish to be true, is true, despite all evidence to the contrary.

Sound like a profession we both know and you love?

- H

Please answer the posted question. Practically, what should be done. If all the necessary testing is done we will not have any student athletes. What is your solution to this dilema?

The answer is not increased testing but rather the judicious use of testing in cases where the pre-test probability based on clinical findings raises above baseline. I realize this concept is quite foreign to a profession where 20-25 visits are needed for every patient, but try and keep up, o.k.?

Before you get all uppity about the skills of the chiropractor lets go back to some chiropractic research that you and I have discussed before (but that you always seem to leave out when a new thread comes along). For brevity's sake, I am cut and pasting from one of my previous posts.

--
So lets see the scientific evidence:

J Manipulative Physiol Ther. 2005 Jun;28(5):336-44.

Assessment of knowledge of primary care activities in a sample of medical and chiropractic students.

Sandefur R, Febbo TA, Rupert RL.

Cleveland Chiropractic College, Kansas City, MO 64131, USA. ruth.sandefur@cleveland.edu

OBJECTIVE: To examine the influence of chiropractic education on knowledge of primary care tasks. Scores received on a test of knowledge of primary care tasks were compared between 3 samples of chiropractic students and 1 small sample of medical students. DATA SOURCES: The taxonomy of primary care tasks that was previously published provided the basis for test items used in this study. A team of test writers prepared an evaluation instrument that was administered to final-term chiropractic students at 3 colleges and to a small sample of medical students as they were entering their residency programs. RESULTS: The chiropractic students scored below the medical students on the primary care examination in every area except musculoskeletal conditions. Chiropractic students scored higher than medical students on the musculoskeletal portion of the examination. CONCLUSIONS: In this sample, chiropractic students performed almost as well as medical students on a test that was designed to measure knowledge of primary care tasks. If the premise is accepted that medical school is the gold standard of primary care instruction, that chiropractic students fared almost as well as medical students is noteworthy.
_______

So, what they did was give a test to on basic primary care to three groups of chiropractic students in their final terms in chiropractic college (groups 1, 2 and 3) and one group of recent medical school graduates who had yet to start residency. The test was created by "2 DCs who also hold bachelor's degrees, 1 DC with a diplomate in radiology, a DC enrolled in the final year of a radiology residency program, and 2 MDs". It was a 100 question test broken into two 50 question sections and some description of attempts to validate the instrument for use on chiropractic students is offered by the authors. So here is what they found...

Group 1: 21 students, raw scores 32.7, % scores 65.4, SD 4.6
Group 2: 22 students, raw scores 28, % scores 56, SD 5
Group 3: 79 students, raw scores 32.1, % scores 64.2, SD 4.4
Groups 1 to 3 (combined): 122 students, raw scores 31.4, % scores 62.8, SD 4.7
Group 4: 20 students, raw scores 36.7, % scores 73.4, SD 3.3

Now, while the medical student sample size is low, the performance of the chiropractic students is abyssmally low. 68% of all of the chiropractic students (who are very soon to enter practice) taking the test, a test designed and validated by DCs, scored between 58.1% and 67.5%?!? This is noteworthy? Yes, it is! It succinctly proves the point that DCs are very ill prepared to serve as primary care physicians. As for the medical students, 68% scored between 70.1% and 76.7%. While I would normally bristle at these data as the sample size is so small, it should be noted that the SD was the narrowest, by a considerable amount, in this group. This leads me to question the need to validate the instrument not only with chiropractic students (as was done) but also with medical students (not done in this study). These results seem to indicate a very tight "clumping" of scores in the medical student group, which may suggest that areas of the test represented material outside their scope of instruction.

Other results:
Percentage scores of all students on 5 major categories of primary care tasks
Primary care activities (% correct)
Information gathering Group 1 - 60.12, 2 - 57.04, 3 - 64.72, 4 - 76.64
Screening and prevention Group 1 - 35.72, 2 - 27.09, 3 - 38.93, 4 - 63.10
Other diagnostic procedures Group 1 - 66.94, 2 - 57.64, 3 - 65.83, 4 - 74.34
Counseling and education Group 1 - 69.05, 2 - 75.00, 3 - 87.74, 4 - 95.24
Management of acute/chronic conditions Group 1 - 65.71, 2 - 57.04, 3 - 64.69, 4 - 73.01

By these data, chiropractic does not perform information gathering or screening and prevention well at all.

I'm not going to post the data on all individual "subcategories of management of acute and chronic conditions". Suffice it to say that group four handily out performed all of the other groups in every area except one:
Musculoskeletal (% correct) Group 1 - 71.04, 2 - 56.95, 3 - 54.75, 4 - 48.02
(but group four did outperform the others in neuro!:
Neurological (% correct) Group 1 - 78.1, 2 - 61.67, 3 - 78.99, 4 - 82.86)

My most significant concern on their methodology is this - the test was given to medical students about to enter residency training and to final term chiropractic students about to enter practice (presumably). Now, the article acknowledges a gap, but that gap should only grow as the medical students have at least three years of training remaining. Also, no attempt was made to identify what area of medicine the MD students were entering. I would argue that given the latitude to self direct fourth year cirricula to a certain degree, students heading into primary care would likely outperform a random sample from all medical students on this examination as they would have more training in this area than the "average" medical student.

Lastly, the conclusions do not match the data. It is not "noteworthy", in a positive sense, that chiropractic students about to enter the workforce score abyssmally low on a test of basic primary care skills. Comparing them to MD graduates with at least three years of training remaining is comparing apples and oranges. And even given the disparity in time remaining in training, the MD students quite significantly outperformed the chiropractors. This paper completely demonstrates what I have been saying since I started coming to this forum. Chiropractors are not equipped to act as primary care physicians.
--


When "Information gathering, Screening and prevention, and Other diagnostic procedures" are such obvious weaknesses for chiropractor, yes, I worry about the school or athletic "screening" or examination being performed by them. Do you have any data to suggest you can perform them safely? Or is it just "innate" knowledge that you can?

- H

The rate of student loan default for Chiros (http://www.defaulteddocs.dhhs.gov/discipline.asp) is relatively high. This might explain part of the motivation that seems to lead so many of them to unscrupulous business practices and outlandish claims inflating their scope of practice. Personally, I'd have more respect for chiropractic as a profession if they stuck to what they're trained to do - treat the musculoskeletal system.

Curious change of subject..........HMMMMMM

While most DCs limit to NMS, there are some unscrupulous wingnuts in the profession. However, "unscrupulous business practices" is by no means limited to, or the exclusive domain of the DC profession. Unfortunately, there are some that do dishonestly promote that implication.

I have to wonder what " might explain part of the motivation" for this:

At UMDNJ, an attempt to cover up $36M fraud
Monitor: No-show jobs for MDs led to referrals

Sunday, November 12, 2006
BY JOSH MARGOLIN AND TED SHERMAN
Star-Ledger Staff

The state's medical university took in $36 million in illegal Medicare and Medicaid payments as part of a kickback scheme designed to bolster its troubled cardiac surgery program, and top school officials conspired to cover it all up, according to the school's federal monitor.

The scheme involved 18 cardiologists at the University of Medicine and Dentistry of New Jersey who were given essentially no-show teaching jobs at salaries of $150,000 or more. In return, they were expected to refer patients to the cardiac surgery program, the monitor alleges in a report sent to the U.S. Attorney and expected to be released tomorrow. The doctors were paid almost $6 million over four years. (more here...)

http://www.nj.com/news/ledger/index.ssf?/base/news-10/1163310480126950.xml&coll=1

Curious change of subject..........HMMMMMM

While most DCs limit to NMS, there are some unscrupulous wingnuts in the profession. However, "unscrupulous business practices" is by no means limited to, or the exclusive domain of the DC profession. Unfortunately, there are some that do dishonestly promote that implication.

I have to wonder what " might explain part of the motivation" for this:

At UMDNJ, an attempt to cover up $36M fraud
Monitor: No-show jobs for MDs led to referrals

Sunday, November 12, 2006
BY JOSH MARGOLIN AND TED SHERMAN
Star-Ledger Staff

The state's medical university took in $36 million in illegal Medicare and Medicaid payments as part of a kickback scheme designed to bolster its troubled cardiac surgery program, and top school officials conspired to cover it all up, according to the school's federal monitor.

The scheme involved 18 cardiologists at the University of Medicine and Dentistry of New Jersey who were given essentially no-show teaching jobs at salaries of $150,000 or more. In return, they were expected to refer patients to the cardiac surgery program, the monitor alleges in a report sent to the U.S. Attorney and expected to be released tomorrow. The doctors were paid almost $6 million over four years. (more here...)

http://www.nj.com/news/ledger/index.ssf?/base/news-10/1163310480126950.xml&coll=1

And your point? You are not possibly trying to assert that corrupt business practices are even nearly as common in traditional medicine than they are in sCAM providers are you?

- H

Curious change of subject..........HMMMMMM

While most DCs limit to NMS, there are some unscrupulous wingnuts in the profession. However, "unscrupulous business practices" is by no means limited to, or the exclusive domain of the DC profession. Unfortunately, there are some that do dishonestly promote that implication.

I have to wonder what " might explain part of the motivation" for this:

At UMDNJ, an attempt to cover up $36M fraud
Monitor: No-show jobs for MDs led to referrals

Sunday, November 12, 2006
BY JOSH MARGOLIN AND TED SHERMAN
Star-Ledger Staff

The state's medical university took in $36 million in illegal Medicare and Medicaid payments as part of a kickback scheme designed to bolster its troubled cardiac surgery program, and top school officials conspired to cover it all up, according to the school's federal monitor.

The scheme involved 18 cardiologists at the University of Medicine and Dentistry of New Jersey who were given essentially no-show teaching jobs at salaries of $150,000 or more. In return, they were expected to refer patients to the cardiac surgery program, the monitor alleges in a report sent to the U.S. Attorney and expected to be released tomorrow. The doctors were paid almost $6 million over four years. (more here...)

http://www.nj.com/news/ledger/index.ssf?/base/news-10/1163310480126950.xml&coll=1

Is your point that hospital officials and MD cannot be corrupt? How does that invalidate them medically? Are you saying when you need a heart valve replacement you go see a chiropractor...

Nice dodging.:barf:

And your point? You are not possibly trying to assert that corrupt business practices are even nearly as common in traditional medicine than they are in sCAM providers are you?

- H

My "point" (which you chose to edit out) was quite clear and unambiguous, and which you now, disengenueously, attempt to distort.

As for: "You are not possibly trying to assert that corrupt business practices are even nearly as common in traditional medicine than they are in sCAM providers are you?"

HMMMMMMM................

Although not my original "assertion", I will indulge you. Let's take a look at just a few this past month:

--------------------------------------
Ohio Pain Management Specialist Scams Insurers for $60 Million
November 15, 2006

Patients often came to Dr. Jorge Martinez screaming in agony from chronic pain.
The Ohio pain-management specialist was their last hope. He exploited their misery to shake down insurers for an incredible $60 million in fraudulent billings

http://www.claimsguides.com/news/midwest/2006/11/15/74254.htm

-------------------------

Georgia Doctors, Hospital Settle Medicare Lawsuit for $6.4 Million
October 23, 2006

Atlanta's Northside Hospital and two doctors groups have agreed to pay $6.37 million to the federal government to resolve allegations in a whistleblower lawsuit.

The suit alleged that the hospital and doctors groups violated the false claims act by submitting claims to the Medicare program that were tainted by improper financial and referral relationships, the U.S. Attorney's office said.

http://www.claimsguides.com/news/southeast/2006/10/23/73517.htm

------------------------------


Okla. Doctor Pleads Guilty to Defrauding Medicare, Private Insurers
October 12, 2006

An Alva, Okla., doctor faces up to 10 years in prison and a $250,000 fine after pleading guilty to defrauding Medicare out of $1 million.
.......... for prescription drugs used to treat anemia and arthritis.

http://www.claimsguides.com/news/southcentral/2006/10/12/73245.htm
--------------------------

So, to answer your question:
In light of the evidence.......The only valid conclusion is: Yes

My "point" (which you chose to edit out) was quite clear and unambiguous, and which you now, disengenueously, attempt to distort.

As for: "You are not possibly trying to assert that corrupt business practices are even nearly as common in traditional medicine than they are in sCAM providers are you?"

HMMMMMMM................

Although not my original "assertion", I will indulge you. Let's take a look at just a few this past month eek: :--------------------------

So, to answer your question:
In light of the evidence.......The only valid conclusion is: Yes

Honestly, you want to do this?

Are you sure?

Beside the fact that ANY chiropractic treatment is actually a scam since it DOESN'T work, there are (according to the Department of Labor) 53,000 chiropractors in the U.S. (http://www.bls.gov/oco/ocos071.htm) and there are 567,000 physicians and surgeons (http://www.bls.gov/oco/ocos074.htm), so for every ten physician cases you list, I only need to find one chiro case. Let's look at some chiro fun shall we?

"Delusional" chiropractor loses license.

James C. Burda, D.C., of Athens, Ohio, has signed a voluntary license relinquishment that permanently revokes his license to practice chiropractic. The state chiropractic board's announcement states:

"Dr. Burda made up the term "Bahlaqeem" to describe a form of treatment in which he claimed to treat individuals anytime, anywhere, who are not in his presence and without physical contact.

"The Board determined that "Bahlaqeem" is not an acceptable form of treatment according to acceptable and prevailing standards of chiropractic care and constitutes practicing beyond the scope of the practice of chiropractic.

"Dr. Burda is also unable to practice chiropractic according to acceptable and prevailing standards of care due to mental illness, specifically, Delusional Disorder, Grandiose Type. "

Burda charged $60 per 24-hour period to use mental vibrations to heal by methods that he christened "Bahlaqeem Vina" and "Bahlaqeem Jaqem." He also claimed to be able to go back in time to the moment a patient had been injured. His Web site http://www.bahlaqeem.com, which is is still posted, states:

"This is what happens when I get a request to be treated. As soon as I get a request for vina, I think of you, the person to whom the correction is being directed, and then silently ask if you can be treated. This is a request for permission to perform vina and is done before all vina is made. If I do not get a positive answer, I stop and nothing is done at that time. I may ask again and if I get the same response I do not attempt the vina. I will communicate this to you. If, however, after asking permission for vina and a positive response is received, the vina is performed right away.

"The diagnostic procedure involves asking questions either out loud or silently as to how different bones are misaligned, twisted, rotated or displaced. Once the diagnosis is completed, the correction is made either by telling the bone to shift to its proper position or by hand-directing it. The vina is performed while thinking about the area that needs to change. This is the gift, which I have been given, my ability to tell the body to make changes."

and

"It does not matter that you call what is being done, vibrational vina or jaqem which includes the previously know maneuver where the bones are forcibly pushed back into proper position by hand or mechanical device. The result is the same: increased activity with less pain and more ability to do things. This technique is brand new and being developed every day and therefore current terms of how bones and joints, are reorganized may not be appropriate. Pain is often the result of joint disorganization and twisted or rotated bones, all of which can be affected by what I can do."

Comment from Dr. Stephen Barrett: Much of chiropractic is based on delusions that spinal misalignments ("subluxations") are the underlying cause of disease and that correcting them can restore health. The Ohio Board's action indicates that chiropractic delusions that are not "standard" or "prevalent" may be unacceptable.

Workers' Comp costs reduced in California.

The Workers Compensation Insurance Rating Bureau (WCIRB) of California has reported that since a reform bill (SB228) took effect, the utilization of chiropractic services for workers' compensation has dropped 77% and the use of physical therapy services had dropped 61%. SB228, which took effect on January 1, 2004, limits employees to no more than 24 chiropractic and 24 physical therapy visits per industrial injury. The billópart of a 6-bill package intended to curb runaway costsówas passed in the wake of reports that the costs of treating back strains and sprains for injured workers with physical medicine services, such as manipulations, exercise, hot and cold packs and massage were greater when the care was directed by chiropractors than when managed by physicians. However, it is not clear the extent to which the decreases are attributable to the SB 228 limitations rather than other reform provisions such as new utilization guidelines and the creation of medical utilization networks. [2006 Legislative Cost Monitoring Report. San Francisco: WCIRBCalifornia, released Sept 27, 2006]

###

"Personal belief" vaccination exemptions lead to higher pertussis rates.

A study of immunization requirements has concluded that states that permit "personal belief" exemptions and/or easily grant exemptions are associated with higher rates of exemptions and whooping cough infections. All states allow medical exemptions, 48 permit exemptions based on religious objections, but 19 also allow exemptions based on philosophical or other personal beliefs. Some states make it easy for parents to claim an exemption by simply signing a prewritten statement on the school immunization form. Others make it harder by requiring a signature from a local health official, a personally written letter, notarization, or annual renewal. The study compared the ease of getting exemptions, the rates of nonmedical exemptions at school, and data on disease incidence for people aged 18 years or younger. [Omer SB. Nonmedical exemptions to school immunization requirements: Secular trends and association of state policies with pertussis incidence. JAMA 296:1757-1763, 2006] http://jama.ama-assn.org/cgi/content/abstract/296/14/1757?etoc

Delicensed chiropractor sentenced for insurance fraud.

Former chiropractor Markell D. Boulis, has been sentenced to 41 months imprisonment and ordered to pay restitution of $1,100,000 Ohio Bureau of Workers' Compensation and ten insurance companies that he and two of his companies cheated in a fraudulent billing scheme between 1999 and 2003. Boulis was also ordered to pay restitution to Medicare and the Internal Revenue Service. In April, Boulis and two of his companies, Practice Solutions, Inc., and National Insurance Auditors, LLC, pled guilty to one count of health care fraud. Court documents indicate that Boulis set up a "practice management" consulting business for chiropractors about three months after the state of Pennsylvania suspended his chiropractor's license. Practice Solutions, Inc. would sponsor "practice building" seminars for chiropractors throughout the country. During the seminars, participants were told that National Insurance Auditors, LLC, was a separate, independent company comprised of "experts" in the review of patient records. This company could help attendees identify "lost" income resulting from services which had not been properly reimbursed by insurers due to incorrect coding, or a failure to bill for the services. Chiropractors were encouraged to contract with National Insurance Auditors, LLC for "back-billing" services as a means to generate additional income. As part of the scheme, Boulis's associates promised to audit the chiropractors' records to look for services that had been performed but not billed. However, government investigators found that the auditors merely copied the records and the billing company billed for new or additional services that had not been performed. [Chiropractic consultant sentenced for defrauding private insurance companies and the Ohio Bureau of Workers' Compensation. USDOJ news release, Sept 19, 2006] http://www.usdoj.gov/usao/ohs/Press/09-19-06.pdf

"Alternative" cancer treatments fail to stop cancer progression.

Researchers have found that cancer patients who chose "alternative" therapies instead of standard treatment tended to have increased recurrence and death. The analysis included 33 patients:

**Of 11 who initially refused surgery, 10 developed disease progression.
**Of 3 who refused adequate lymph node sampling, 1 developed nodal recurrence.
**Of 10 who refused local control procedures, 2 developed local recurrences and 2 died of metastatic disease.
**By refusing chemotherapy, 9 patients increased their estimated 10-year mortality rate from 17% to 25%.

The authors concluded: "Alternative therapies used as primary treatment for breast cancer are associated with increased recurrence and death. Homeopathy instead of surgery resulted in disease progression in most patients." [Chang EY and others. Outcomes of breast cancer in patients who use alternative therapies as primary treatment. American Journal of Surgery 192:471-473, 2006]

High court agrees that subluxation-based chiropractor recommended excessive care.

The Supreme Court of South Australia has upheld a decision by the Chiropractors Board of South Australia that George Michael Belle, who operates the Acacia Chiropractic Centre in Morphett Vale, had engaged in unprofessional conduct in his management of a patient who consulted him for back pain in 2002. The evidence showed that Belle had treated her back pain for three visits but proposed a long-term "corrective care" program of neck care that was inappropriate because it was "insufficiently tailored to her individual circumstances and the number of treatments proposed . . . was excessive." The judge concluded:

"The effect of the Board's finding is that the appellant was not so much concerned with treating Mrs Hill's low back pain in three to six treatments as with promoting the corrective care plan to cure her postural curvature by a régime of treatments requiring 88 visits at a cost of $2,692. . . . The appellant's conduct was clearly unprofessional. There is no basis for disturbing this finding of the Board."

The judge also upheld the Board's conclusion that Belle had acted unprofessionally by making disparaging remarks about orthopedists and physical therapists. Chirobase has additional information about the case and a link to the judge's ruling. http://www.chirobase.org/08Legal/belle.html Shortly before the ruling was issued, Belle failed in an attempt to get elected to the chiropractic board.


YAWN.

But let's get to the biggest one of all...

The latest OIG report on chiropractic available here: oig.hhs.gov/oei/reports/oei-09-02-00530.pdf and pro-chiro account here: (look, I don't even quote the WCA! :laugh: ) http://www.chiroweb.com/archives/23/16/11.html

From http://www.ncahf.org/digest05/05-27.html :
"OIG reports chiropractic overpayment. The Office of the Inspector General has concluded that in 2001, the U.S. Government paid chiropractors $285 million for services that should not have been billed to Medicare. The questionable payments amounted to 57% of what Medicare spent on chiropractic services that year. Chiropractors are entitled to payment for spinal manipulation for active therapy for certain conditions, but not for "maintenance care." (Under the Medicare program, active therapy is treatment that provides "reasonable expectation of recovery or improvement of function" and maintenance care is "a treatment plan that seeks to prevent disease, promote health, and prolong and enhance the quality of life; or therapy that is performed to maintain or prevent deterioration of a chronic condition." The improper payments included $186 million for maintenance and $24 million for manipulation of other areas or other treatments such as massage. The OIG report concluded that (a) about 40% of chiropractic services to Medicare patients are for maintenance care; (b) as chiropractic care extends beyond 12 treatments in a year, it becomes increasingly likely that individual services are medically unnecessary; and (c) lack of necessity increases even more significantly after 24 treatments. [Chiropractic Services in the Medicare Program: Patient Vulnerability Analysis. OIG Report #OEI-09-0200530, June 2005] Many chiropractors advise lifetime periodic spinal examinations and adjustments for what they call "preventative maintenance." Because "maintenance care" lacks a plausible rationale and has never been proven beneficial, insurance plans do not knowingly pay for it. The Medicare overpayment rate may improve because as of October 1, 2004, chiropractors must specify on their claims forms whether active or maintenance care was rendered. "

I love the finding "the strong correlation between the number of services a beneficiary receives and the likelihood a service is not medically necessary". They are close, actually none of the treatments are "medically necessary", but the report is a good start.


LADIES AND GENTLEMEN - notice the latest in our line of freaks, cheats, and snake-oil salesmen - the chiropractor. Yep, step right up and see how as each of his arguments falls (in this thread - chiropractors questioning potassium supplements in patients on diuretics, chiropractors knowledge of anatomy and the question of that knowledge indicating that the chiro is the better practitioner :laugh:, the use of DCs as basic science instructors in chiropractic college, the role of the chiropractor in primary care and their utter lack of preparation to do so, and now an assertion that physicians are bigger frauds than chiropractors) he changes the subject. Neat huh!

- H

You well know I was not the one to "change the subject".

Anyone following this thread has evidence of that.

Just another example of your dishonest proclamations.

You well know I was not the one to "change the subject".

Anyone following this thread has evidence of that.

Just another example of your dishonest proclamations.

Since I assume you tell your patients that what you do is a valid and proven methodology of treatment, you claiming that I have made "dishonest proclamations" smacks of the "pot calling the kettle black". But I'll play along, what statements have I made that have not been backed up with facts?

And you did change the subject by refusing to answer the arguments you lose, instead grabbing another post and answering that. I mean look, we realize it is hard work trying to convince educated people of the validity of the pseudo-science you push on your customers, but when you have no answer, just say so, don't try and start a new debate.

You know as well as I do that chiropractors have no business questioning an MD/DO's prescription. You know that while you may spend more time in anatomy class than an MD/DO (which is probably a "little bus" thing as opposed to more training) that has little to do with ability as a physician. You know that chiropractors have FAR less training and education than an MD/DO does. You also know that chiropractors are not adequately prepared to function as primary care providers. You know that study after study compares senior chiropractic students to senior medical students in failed attempts to equate the two when the senior medical student is, in fact, only halfway through their training. You know that an MD/DO sees many, many more patients who are far more seriously ill during training than a chiropractor does. And you also know that many more chiropractors engage in questionable business practices than MD/DOs do.

I mean come on - are you really so deluded to believe that a chiropractor is, in any way, shape or form even an adequate healthcare provider, yet alone equal to an MD/DO?

- H

Honestly, you want to do this?

Are you sure?

....(My editorial delete, based on unsubtantiated opinion of poster)there are (according to the Department of Labor) 53,000 chiropractors in the U.S. (http://www.bls.gov/oco/ocos071.htm) and there are 567,000 physicians and surgeons (http://www.bls.gov/oco/ocos074.htm), so for every ten physician cases you list, I only need to find one chiro case. Let's look at some chiro fun shall we?

"Delusional" chiropractor loses license.

James C. Burda, D.C., of Athens, Ohio, has signed a voluntary license relinquishment that permanently revokes his license to practice chiropractic. The state chiropractic board's announcement states:

"Dr. Burda made up the term "Bahlaqeem" to describe a form of treatment in which he claimed to treat individuals anytime, anywhere, who are not in his presence and without physical contact.

"The Board determined that "Bahlaqeem" is not an acceptable form of treatment according to acceptable and prevailing standards of chiropractic care and constitutes practicing beyond the scope of the practice of chiropractic.

"Dr. Burda is also unable to practice chiropractic according to acceptable and prevailing standards of care due to mental illness, specifically, Delusional Disorder, Grandiose Type. "

Burda charged $60 per 24-hour period to use mental vibrations to heal by methods that he christened "Bahlaqeem Vina" and "Bahlaqeem Jaqem." He also claimed to be able to go back in time to the moment a patient had been injured. His Web site http://www.bahlaqeem.com, which is is still posted, states:

"This is what happens when I get a request to be treated. As soon as I get a request for vina, I think of you, the person to whom the correction is being directed, and then silently ask if you can be treated. This is a request for permission to perform vina and is done before all vina is made. If I do not get a positive answer, I stop and nothing is done at that time. I may ask again and if I get the same response I do not attempt the vina. I will communicate this to you. If, however, after asking permission for vina and a positive response is received, the vina is performed right away.

"The diagnostic procedure involves asking questions either out loud or silently as to how different bones are misaligned, twisted, rotated or displaced. Once the diagnosis is completed, the correction is made either by telling the bone to shift to its proper position or by hand-directing it. The vina is performed while thinking about the area that needs to change. This is the gift, which I have been given, my ability to tell the body to make changes."

and

"It does not matter that you call what is being done, vibrational vina or jaqem which includes the previously know maneuver where the bones are forcibly pushed back into proper position by hand or mechanical device. The result is the same: increased activity with less pain and more ability to do things. This technique is brand new and being developed every day and therefore current terms of how bones and joints, are reorganized may not be appropriate. Pain is often the result of joint disorganization and twisted or rotated bones, all of which can be affected by what I can do."
------------------------------------

Workers' Comp costs reduced in California.

The Workers Compensation Insurance Rating Bureau (WCIRB) of California has reported that since a reform bill (SB228) took effect, the utilization of chiropractic services for workers' compensation has dropped 77% and the use of physical therapy services had dropped 61%. SB228, which took effect on January 1, 2004, limits employees to no more than 24 chiropractic and 24 physical therapy visits per industrial injury. The billópart of a 6-bill package intended to curb runaway costsówas passed in the wake of reports that the costs of treating back strains and sprains for injured workers with physical medicine services, such as manipulations, exercise, hot and cold packs and massage were greater when the care was directed by chiropractors than when managed by physicians. However, it is not clear the extent to which the decreases are attributable to the SB 228 limitations rather than other reform provisions such as new utilization guidelines and the creation of medical utilization networks. [2006 Legislative Cost Monitoring Report. San Francisco: WCIRBCalifornia, released Sept 27, 2006]
----------------------------------
###

"Personal belief" vaccination exemptions lead to higher pertussis rates.

A study of immunization requirements has concluded that states that permit "personal belief" exemptions and/or easily grant exemptions are associated with higher rates of exemptions and whooping cough infections. All states allow medical exemptions, 48 permit exemptions based on religious objections, but 19 also allow exemptions based on philosophical or other personal beliefs. Some states make it easy for parents to claim an exemption by simply signing a prewritten statement on the school immunization form. Others make it harder by requiring a signature from a local health official, a personally written letter, notarization, or annual renewal. The study compared the ease of getting exemptions, the rates of nonmedical exemptions at school, and data on disease incidence for people aged 18 years or younger. [Omer SB. Nonmedical exemptions to school immunization requirements: Secular trends and association of state policies with pertussis incidence. JAMA 296:1757-1763, 2006] http://jama.ama-assn.org/cgi/content/abstract/296/14/1757?etoc
----------------------------------------
Delicensed chiropractor sentenced for insurance fraud.

Former chiropractor Markell D. Boulis, has been sentenced to 41 months imprisonment and ordered to pay restitution of $1,100,000 Ohio Bureau of Workers' Compensation and ten insurance companies that he and two of his companies cheated in a fraudulent billing scheme between 1999 and 2003. Boulis was also ordered to pay restitution to Medicare and the Internal Revenue Service. In April, Boulis and two of his companies, Practice Solutions, Inc., and National Insurance Auditors, LLC, pled guilty to one count of health care fraud. Court documents indicate that Boulis set up a "practice management" consulting business for chiropractors about three months after the state of Pennsylvania suspended his chiropractor's license. Practice Solutions, Inc. would sponsor "practice building" seminars for chiropractors throughout the country. During the seminars, participants were told that National Insurance Auditors, LLC, was a separate, independent company comprised of "experts" in the review of patient records. This company could help attendees identify "lost" income resulting from services which had not been properly reimbursed by insurers due to incorrect coding, or a failure to bill for the services. Chiropractors were encouraged to contract with National Insurance Auditors, LLC for "back-billing" services as a means to generate additional income. As part of the scheme, Boulis's associates promised to audit the chiropractors' records to look for services that had been performed but not billed. However, government investigators found that the auditors merely copied the records and the billing company billed for new or additional services that had not been performed. [Chiropractic consultant sentenced for defrauding private insurance companies and the Ohio Bureau of Workers' Compensation. USDOJ news release, Sept 19, 2006] http://www.usdoj.gov/usao/ohs/Press/09-19-06.pdf
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"Alternative" cancer treatments fail to stop cancer progression.

Researchers have found that cancer patients who chose "alternative" therapies instead of standard treatment tended to have increased recurrence and death. The analysis included 33 patients:

**Of 11 who initially refused surgery, 10 developed disease progression.
**Of 3 who refused adequate lymph node sampling, 1 developed nodal recurrence.
**Of 10 who refused local control procedures, 2 developed local recurrences and 2 died of metastatic disease.
**By refusing chemotherapy, 9 patients increased their estimated 10-year mortality rate from 17% to 25%.

The authors concluded: "Alternative therapies used as primary treatment for breast cancer are associated with increased recurrence and death. Homeopathy instead of surgery resulted in disease progression in most patients." [Chang EY and others. Outcomes of breast cancer in patients who use alternative therapies as primary treatment. American Journal of Surgery 192:471-473, 2006]
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High court agrees that subluxation-based chiropractor recommended excessive care.

The Supreme Court of South Australia has upheld a decision by the Chiropractors Board of South Australia that George Michael Belle, who operates the Acacia Chiropractic Centre in Morphett Vale, had engaged in unprofessional conduct in his management of a patient who consulted him for back pain in 2002. The evidence showed that Belle had treated her back pain for three visits but proposed a long-term "corrective care" program of neck care that was inappropriate because it was "insufficiently tailored to her individual circumstances and the number of treatments proposed . . . was excessive." The judge concluded:

"The effect of the Board's finding is that the appellant was not so much concerned with treating Mrs Hill's low back pain in three to six treatments as with promoting the corrective care plan to cure her postural curvature by a régime of treatments requiring 88 visits at a cost of $2,692. . . . The appellant's conduct was clearly unprofessional. There is no basis for disturbing this finding of the Board."

The judge also upheld the Board's conclusion that Belle had acted unprofessionally by making disparaging remarks about orthopedists and physical therapists. Chirobase has additional information about the case and a link to the judge's ruling. http://www.chirobase.org/08Legal/belle.html Shortly before the ruling was issued, Belle failed in an attempt to get elected to the chiropractic board.


YAWN.

But let's get to the biggest one of all...

The latest OIG report on chiropractic available here: oig.hhs.gov/oei/reports/oei-09-02-00530.pdf and pro-chiro account here: (look, I don't even quote the WCA! :laugh: ) [url]http://www.chiroweb.com/archives/23/16/11.html[/url

- H


While most of your (ahemmm/:sleep: )argument is either about homeopaths, or well over a year old(while mine were ALL within the last 45 days!), or just totally non-relevant("making disparaging remarks about orthopedists and physical therapists"--yeah right- big "unscrupulous" fraud here!! gag!) :barf:

You reference the "biggest one of all":

"The latest OIG report on chiropractic available here: oig.hhs.gov/oei/reports/oei-09-02-00530.pdf and pro-chiro account here: (look, I don't even quote the WCA! ) http://www.chiroweb.com/archives/23/16/11.html"


I am SOOOO glad you brought THIS one up!!!
Let's take a look at this:
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OIG Finds 90% of Claims for Physical Therapy Wrong
More than 90% of all physical therapy claims paid by Medicare to physicians in the first six months of 2002 did not meet program requirements and resulted in $136 million in overpayments, the Health and Human Services Office of Inspector General (OIG) said in a report released May 4.

http://www.g2reports.com/issues/GCR/2006_6/1608705-1.html

GEEZ!! you and your minions----- out-frauded us again!!

[Or is it just "unscrupulous" (the "term" originally platformed?)]

BTW- Your "chirobase opinion" is totally without merit. Using it makes you look desperate.

Tell ya what... when you get older (and we all do) and you start having heart palpatations or find yourself losing a lot of weight... don't see an MD or a DO... I am sure a chiropractor will be enough and a couple of adjustments will make it all go away.

While most of your (ahemmm/:sleep: )argument is either about homeopaths, or well over a year old(while mine were ALL within the last 45 days!), or just totally non-relevant("making disparaging remarks about orthopedists and physical therapists"--yeah right- big "unscrupulous" fraud here!! gag!) :barf:

You reference the "biggest one of all":

"The latest OIG report on chiropractic available here: oig.hhs.gov/oei/reports/oei-09-02-00530.pdf and pro-chiro account here: (look, I don't even quote the WCA! ) http://www.chiroweb.com/archives/23/16/11.html"


I am SOOOO glad you brought THIS one up!!!
Let's take a look at this:
--------------------------------------

OIG Finds 90% of Claims for Physical Therapy Wrong
More than 90% of all physical therapy claims paid by Medicare to physicians in the first six months of 2002 did not meet program requirements and resulted in $136 million in overpayments, the Health and Human Services Office of Inspector General (OIG) said in a report released May 4.

http://www.g2reports.com/issues/GCR/2006_6/1608705-1.html

GEEZ!! you and your minions----- out-frauded us again!!

[Or is it just "unscrupulous" (the "term" originally platformed?)]

BTW- Your "chirobase opinion" is totally without merit. Using it makes you look desperate.


Hmm, 53,000 chiros defraud the government for 285 million for an average of $5,377 per. 567,000 physicians defraud the government by 136 million for an average of $240 per. Yep. Those dang MDs.

Notice you still haven't answered any of the other challenges in this thread - other than to call me a liar.

But since you wanted more chiro cases, o.k.... (since Sept. 06)

http://cbs5.com/local/local_story_265140318.html

http://www.northjersey.com/page.php?qstr=eXJpcnk3ZjczN2Y3dnFlZUVFeXk1NCZmZ2Jl bDdmN3ZxZWVFRXl5NzAxNjA0OSZ5cmlyeTdmNzE3Zjd2cWVlRU V5eTM=

http://www.insidebayarea.com/dailyreview/localnews/ci_4579245

http://home.businesswire.com/portal/site/google/index.jsp?ndmViewId=news_view&newsId=20061011005951&newsLang=en

http://biz.yahoo.com/prnews/060926/netu046.html?.v=30

http://www.wral.com/news/9913853/detail.html

Come on, is this really what you want to do? Seriously, this is how you are trying to "defend" chiropractic? Do you really think it is that hard to find dishonest chiropractors? Remember 10:1 physician to chiropractor ratio, so you "owe" about 60 physician cases... And as for the MD/DOs, it is a risk/benefit equation. At least the MD/DOs could help their patients (although there are dishonest ones who choose not to).

- H

Hmm, 53,000 chiros defraud the government for 285 million for an average of $5,377 per. 567,000 physicians defraud the government by 136 million for an average of $240 per. Yep. Those dang MDs.

Notice you still haven't answered any of the other challenges in this thread - other than to call me a liar.

But since you wanted more chiro cases, o.k.... (since Sept. 06)

http://cbs5.com/local/local_story_265140318.html

http://www.northjersey.com/page.php?qstr=eXJpcnk3ZjczN2Y3dnFlZUVFeXk1NCZmZ2Jl bDdmN3ZxZWVFRXl5NzAxNjA0OSZ5cmlyeTdmNzE3Zjd2cWVlRU V5eTM=

http://www.insidebayarea.com/dailyreview/localnews/ci_4579245

http://home.businesswire.com/portal/site/google/index.jsp?ndmViewId=news_view&newsId=20061011005951&newsLang=en

http://biz.yahoo.com/prnews/060926/netu046.html?.v=30

http://www.wral.com/news/9913853/detail.html

Come on, is this really what you want to do? Seriously, this is how you are trying to "defend" chiropractic? Do you really think it is that hard to find dishonest chiropractors? Remember 10:1 physician to chiropractor ratio, so you "owe" about 60 physician cases... And as for the MD/DOs, it is a risk/benefit equation. At least the MD/DOs could help their patients (although there are dishonest ones who choose not to).

- H

Don't waiste your breath on this guy or the whole chiropractor issue. It is a waiste of time. Even the guys on TV pimping "male enhancement" have followers.

This is one of those arguments that will go nowhere.