Chiropractic on SDN Forums

[FoughtFyr]

What do you think of this study?

Coulter I, Adams A, Coggan P, Wilkes M, Gonyea M.
A Comparative Study of Chiropractic and Medical Education.
Altern Ther Health Med. 1998; 4 (5): 64–75

"The results suggest that, while medical students spend more time gaining clinical experience (1405 hours for chiropractic vs. 5227 hours for medicine, which includes a 3–year residency), chiropractic students spend more time in lectures and laboratories learning basic and clinical sciences (3790 hours for chiropractic vs. 2648 hours for medicine). Other comparisons showed that some subjects such as microbiology were equally represented in both curricula, while others, such as anatomy, physiology and pathology, were emphasized more in the chiropractic colleges."

I'd have to see the methodology. Without the phrase "which includes a three year residency" I would agree. My calculations above show roughly 5000 hours of clinical experience in medical school. I think the lecture and lab hours could be right, they seem to jibe with the JAMA numbers. I also have a difficult time with the implication of the last sentence, that being chiropractic curricula are more extensive than medical. I firmly believe you have more training in anatomy and physiology. But mircobiology and pathology? To say nothing of other courses (e.g., pharmacology, histology, immunology, genetics, embryology, and behavioral sciences).

Lastly, as a means of "proof" to my questions above, the ACGME has instituted a 80 average work week limit for residents. Now trust me when I tell you that, in reality, the average resident works to the limit. (There are many popular media sources to support this, especially since Johns Hopkins and Yale have both had programs go "on probation" for work hour rules violations). But for the sake of argument, lets dial it down a notch and assume a 70 hour work week. Given three weeks of vacation (the industry standard), the average resident works 3430 hours per year, and thus 10,290 hours in a three year residency. Roughly double what the article suggests from just residency alone.

- H

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[BackTalk]

That was the only study I could find on the topic. I wanted to investigate it a little further but was unable to find the actual study online. Your numbers were good and close to what they had. I wouldn't agree with the last sentence either. Lack of residency certainly would make a medical education more extensive. Also it doesn't say anything about the quality of education.

I'm not disagreeing with the rigors of residency but it does make one think twice about going to the hospital and putting themselves at the mercy of someone who has been up for 36 hours.

http://www.news.harvard.edu/gazette/2004/10.28/01-sleep.html

There have been numerous articles written on the subject. Do you feel that residents should have normal work hours (8 hour shift)? Or do you feel its part of being a doctor and you had to do it so everyone should have to do it? You're the attending right? Have you ever had a resident so exhausted they could not function and you had to send them home? What happens in a situation where a resident is sent home?

 

[FoughtFyr]

That was the only study I could find on the topic. I wanted to investigate it a little further but was unable to find the actual study online. Your numbers were good and close to what they had. I wouldn't agree with the last sentence either. Lack of residency certainly would make a medical education more extensive. Also it doesn't say anything about the quality of education.

I don't think there is a valid study on the topic of "how many hours is medical school" but chiropractic seems to quote a 4,200 hour figure for DC training in many places. Which is a good deal of time, but considerably less than what is likely in medical school. The JAMA article I posted is a pretty extensive look at MD education. I did find many articles on chiropractic education, but they were all from the 1960s and 70s and were written primarily as slams on the profession and had very questionable methods. I just thought you might enjoy looking at the actual differences. And I think it pretty well puts the comparison issuue to rest. Does it upset you that chiropractic colleges "sell" their education as comparable to entice premedical students who have found medical school entry too difficult?

I'm not disagreeing with the rigors of residency but it does make one think twice about going to the hospital and putting themselves at the mercy of someone who has been up for 36 hours.

http://www.news.harvard.edu/gazette/2004/10.28/01-sleep.html

See, now we come back to a concern of mine regarding chiropractic. At the hospital, you are not "at the mercy of someone who has been up for 36 hours". There are dozens of people (nurses, techs, pharmacists, attendings, etc.) who have not been there more than a "usual" shift. According to our quality assurance personnel, there are 29 steps between my writing an order and a patient getting the medication. That is a lot of checks and balances. That figure is reduced by 1 (to 28 steps) if the prescriber is a staff physician. Who checks a chiropractor's work?

There have been numerous articles written on the subject. Do you feel that residents should have normal work hours (8 hour shift)? Or do you feel its part of being a doctor and you had to do it so everyone should have to do it? You're the attending right? Have you ever had a resident so exhausted they could not function and you had to send them home? What happens in a situation where a resident is sent home?

As usual, we have wandered far afield from the OP. With the new ACGME guidelines mandating no more than an 80 hour work week, no more than 24 consectutive hours of patient care responsibility, no more than 30 consectutive hours "in house" and a 10 hour required minimum between shifts, I think the workload is reasonable. As for a complete discussion off work hours and conditions, I think that should be taken up in the residents' issues forum.

- H

 

[BackTalk]

I don't think there is a valid study on the topic of "how many hours is medical school" but chiropractic seems to quote a 4,200 hour figure for DC training in many places. Which is a good deal of time, but considerably less than what is likely in medical school. The JAMA article I posted is a pretty extensive look at MD education. I did find many articles on chiropractic education, but they were all from the 1960s and 70s and were written primarily as slams on the profession and had very questionable methods. I just thought you might enjoy looking at the actual differences. And I think it pretty well puts the comparison issuue to rest. Does it upset you that chiropractic colleges "sell" their education as comparable to entice premedical students who have found medical school entry too difficult?



See, now we come back to a concern of mine regarding chiropractic. At the hospital, you are not "at the mercy of someone who has been up for 36 hours". There are dozens of people (nurses, techs, pharmacists, attendings, etc.) who have not been there more than a "usual" shift. According to our quality assurance personnel, there are 29 steps between my writing an order and a patient getting the medication. That is a lot of checks and balances. That figure is reduced by 1 (to 28 steps) if the prescriber is a staff physician. Who checks a chiropractor's work?



As usual, we have wandered far afield from the OP. With the new ACGME guidelines mandating no more than an 80 hour work week, no more than 24 consectutive hours of patient care responsibility, no more than 30 consectutive hours "in house" and a 10 hour required minimum between shifts, I think the workload is reasonable. As for a complete discussion off work hours and conditions, I think that should be taken up in the residents' issues forum.

- H

Do you think that most students of chiropractic were medical student rejects? A student who went to chiropractic school who wanted to go to medical school will never be happy. They will try to make themselves into something they’re not and become dangerous or will quit altogether. Some chiropractors have given up on chiropractic and have gone on to medical school and some have become physician assistants. I’m not disagreeing with you that perhaps some student’s chose the chiropractic route over medical school because entrance requirements were easier, but I feel most people chose the chiropractic career path for different reasons. Many chiropractic students have followed in the footsteps of a parent or siblings. Also, many had been to a chiropractor and were helped or cured of a condition when no one else was able to help and this inspired them to also become a chiropractor. I know that may sound a little strange but hey you have to be a little strange to be a chiropractor. Some people are just intrigued by being part of a profession that is different.

I think chiropractors and chiropractic colleges spend too much time comparing themselves to MD’s. I think we just want to be accepted and want the public to know that becoming a chiropractor is not as easy as one might think. I agree with you that the two forms of education are not the same. I think we have come a long way to agree that certain aspects of the education are comparable.

I find confusion as you do with how the numbers add up as far as classroom hours. I’m not disagreeing on the overall clock hours but would also like to see a more concrete breakdown of the courses. Some chiropractors have the comparison on their web sites and the totals vary from site to site.

“Who checks the chiropractors work?” Good question. The board of chiropractic examiners or the medical board depending on state. Being in solo practice we do not have the ability to have a “checks and balances” system similar to what you have in the hospital. What about medical doctors who are in solo practice?

 

[PublicHealth]

http://www.chiroweb.com/archives/17/20/01.html

 

[FoughtFyr]

Do you think that most students of chiropractic were medical student rejects?

No, but I know from experience that a slew of Chiropractic College marketing materials came my way after I signed up for the MCAT. Most of them tried to equate Chiropractic education to medical school.

A student who went to chiropractic school who wanted to go to medical school will never be happy. They will try to make themselves into something they’re not and become dangerous or will quit altogether.

We agree.

I’m not disagreeing with you that perhaps some student’s chose the chiropractic route over medical school because entrance requirements were easier, but I feel most people chose the chiropractic career path for different reasons. Many chiropractic students have followed in the footsteps of a parent or siblings. Also, many had been to a chiropractor and were helped or cured of a condition when no one else was able to help and this inspired them to also become a chiropractor. I know that may sound a little strange but hey you have to be a little strange to be a chiropractor. Some people are just intrigued by being part of a profession that is different.

Right. Which was my question - don't you think it is a little bit wrong to market toward those taking the MCAT versus trying to inspire people toward the profession more "naturally" (i.e., not as a replacement for medical school)?

I think chiropractors and chiropractic colleges spend too much time comparing themselves to MD’s. I think we just want to be accepted and want the public to know that becoming a chiropractor is not as easy as one might think. I agree with you that the two forms of education are not the same. I think we have come a long way to agree that certain aspects of the education are comparable.

I don't think it is easy. 4200 hours, given any breakdown, is one hell of a load. Especially since (I assume) that Chiropractic College is similar to Medical School in one other regard - the classroom time to study time needed ratio is ungodly high. We would cover a chapter of text in an hour long lecture. That meant at least three more hours to study the chapter enough to know the material.

I find confusion as you do with how the numbers add up as far as classroom hours. I’m not disagreeing on the overall clock hours but would also like to see a more concrete breakdown of the courses. Some chiropractors have the comparison on their web sites and the totals vary from site to site.

Yeah, but I've never found a Chiro site that even comes close to crediting MDs with the amount of time we actually spend. I'll stick with the JAMA article for MDs and the CCE-USA for Chiro.

“Who checks the chiropractors work?” Good question. The board of chiropractic examiners or the medical board depending on state. Being in solo practice we do not have the ability to have a “checks and balances” system similar to what you have in the hospital. What about medical doctors who are in solo practice?

Yes, there are checks for a solo practice. We've discussed this before. A hospital credential review can look at anything a physician with privledges does (even if it is in their private office). Nurses are a part of any practice, and included within their professional responsibilities are patient advocacy and safety. And as far as any pharmacotherapy, the pharmacist is also a key overseer.

The board of Examiners or Medical Boards in any state, for Chiro or MD/DO are regulatory bodies, not quality control.

- H

 

[FoughtFyr]

http://www.chiroweb.com/archives/17/20/01.html

As usual, you post without comment. This is a five year old article, and as a Minnesota Physician, I greatly disagree with the assertion that we are "under the HMO's thumbs." Now, I am also not sure that I buy any of this; and BTW the paper he cites is the one BT posted above, which we have decided is a bit skewed.

I have never claimed that any MD is good (or that any specific chiropractor is bad). Dr. Lorrie Day, MD is a great example of how irrational and misguided an MD can be. (She's a quack who believes she has cured cancer by macrobiotics). So one MD deciding to go to Chiropractic College does not convince me of anything. Especially since there are a far greater number of DCs who try and obtain the MD or DO degree.

Also interesting is that there has been no follow-up to what he was doing. I think the articles posted by BT about DC in the ED were far more interesting (but I'm biased).

BTW - if we are going to start posting old outdated anecdotal articles, shall I fetch the AMA papers decring chiropractic from the time of the antitrust suit? Or how about any of the myriad of papers written by the DCs turned MD/DOs that just bash the profession?

- H

 

[50960]

Ya, I hear you. PH is in his own world with his own struggles. I think we need to get away from thinking MD's are always OK. They have rigorous training as do most of us, but as such can turn out as screwed up as the next person. Dr. so-and-so is not always right, or for that matter OK. Whomever you see, MD, DC, FNP, especially surgeons, and many others...make sure you are comfortable with them before you agree to anything...

 

[PublicHealth]

Here come the RCTs...

Look for published reports of NCCAM-supported studies on chiropractic (http://nccam.nih.gov/clinicaltrials/chiropractic.htm) in the next few years.


Ann Intern Med. 2004 Dec 21;141(12):901-10.

Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial.

Berman BM, Lao L, Langenberg P, Lee WL, Gilpin AM, Hochberg MC.

University of Maryland School of Medicine, Baltimore, Maryland 21207, USA.

BACKGROUND: Evidence on the efficacy of acupuncture for reducing the pain and dysfunction of osteoarthritis is equivocal. OBJECTIVE: To determine whether acupuncture provides greater pain relief and improved function compared with sham acupuncture or education in patients with osteoarthritis of the knee. DESIGN: Randomized, controlled trial. SETTING: Two outpatient clinics (an integrative medicine facility and a rheumatology facility) located in academic teaching hospitals and 1 clinical trials facility. PATIENTS: 570 patients with osteoarthritis of the knee (mean age [+/-SD], 65.5 +/- 8.4 years). INTERVENTION: 23 true acupuncture sessions over 26 weeks. Controls received 6 two-hour sessions over 12 weeks or 23 sham acupuncture sessions over 26 weeks. MEASUREMENTS: Primary outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function scores at 8 and 26 weeks. Secondary outcomes were patient global assessment, 6-minute walk distance, and physical health scores of the 36-Item Short-Form Health Survey (SF-36). RESULTS: Participants in the true acupuncture group experienced greater improvement in WOMAC function scores than the sham acupuncture group at 8 weeks (mean difference, -2.9 [95% CI, -5.0 to -0.8]; P = 0.01) but not in WOMAC pain score (mean difference, -0.5 [CI, -1.2 to 0.2]; P = 0.18) or the patient global assessment (mean difference, 0.16 [CI, -0.02 to 0.34]; P > 0.2). At 26 weeks, the true acupuncture group experienced significantly greater improvement than the sham group in the WOMAC function score (mean difference, -2.5 [CI, -4.7 to -0.4]; P = 0.01), WOMAC pain score (mean difference, -0.87 [CI, -1.58 to -0.16];P = 0.003), and patient global assessment (mean difference, 0.26 [CI, 0.07 to 0.45]; P = 0.02). LIMITATIONS: At 26 weeks, 43% of the participants in the education group and 25% in each of the true and sham acupuncture groups were not available for analysis. CONCLUSIONS: Acupuncture seems to provide improvement in function and pain relief as an adjunctive therapy for osteoarthritis of the knee when compared with credible sham acupuncture and education control groups.

 

[rooster]

Another study:
In "Spine"(not jmpt, as per FFyr request) That addresses some of the issues discussed above:

http://www.ncbi.nlm.nih.gov/entrez/...t=Abstract&list_uids=12221360&itool=iconabstr

This is an important study many like to ignore.

 

[BackTalk]

don't you think it is a little bit wrong to market toward those taking the MCAT versus trying to inspire people toward the profession more "naturally" (i.e., not as a replacement for medical school)?

You know when I graduated chiropractic school, I received numerous solicitations from Caribbean medical schools.

 

[PublicHealth]

This is the first step toward a large-scale RCT of chiropractic treatment for cervicogenic headache. With increased funding from the NIH, you will see more and more of these studies. The data is just beginning to emerge, and over time, will elucidate the types of conditions that may respond to chiropractic treatment. I applaud these authors' efforts. Chiropractic desperately needs to evaluate their interventions with systematic research. In a world that constantly demands proof, validation, and evidence, this will serve chiropractic well.


J Manipulative Physiol Ther. 2004 Nov-Dec;27(9):547-53.

Dose response for chiropractic care of chronic cervicogenic headache and associated neck pain: a randomized pilot study.

Haas M, Groupp E, Aickin M, Fairweather A, Ganger B, Attwood M, Cummins C, Baffes L.

Objective To acquire information for designing a large clinical trial and determining its feasibility and to make preliminary estimates of the relationship between headache outcomes and the number of visits to a chiropractor. Design Randomized, controlled trial. Setting Private practice in a college outpatient clinic and in the community. Subjects Twenty-four adults with chronic cervicogenic headache. Methods Patients were randomly allocated to 1, 3, or 4 visits per week for 3 weeks. All patients received high-velocity low-amplitude spinal manipulation. Doctor of Chiropractics could apply up to 2 physical modalities at each visit from among heat and soft tissue therapy. They could also recommend modification of daily activities and rehabilitative exercises. Outcomes included 100-point Modified Von Korff pain and disability scales, and headaches in last 4 weeks. Results Only 1 participant was insufficiently compliant with treatment (3 of 12 visits), and 1 patient was lost to follow-up. There was substantial benefit in pain relief for 9 and 12 treatments compared with 3 visits. At 4 weeks, the advantage was 13.8 ( P = .135) for 3 visits per week and 18.7 (P = .041) for 4 visits per week. At the 12-week follow-up, the advantage was 19.4 (P = .035) for 3 visits per week and 18.1 (P = .048) for 4 visits per week. Conclusion A large clinical trial on the relationship between pain relief and the number of chiropractic treatments is feasible. Findings give preliminary support for the benefit of larger doses, 9 to 12 treatments, of chiropractic care for the treatment of cervicogenic headache.

 

[PublicHealth]

Because FoughtFyr only trusts Cochrane reviews:


Spine. 2004 Jul 15;29(14):1541-8.

A Cochrane review of manipulation and mobilization for mechanical neck disorders.

Gross AR, Hoving JL, Haines TA, Goldsmith CH, Kay T, Aker P, Bronfort G; Cervical Overview Group.

McMaster University, Faculty of Health Sciences, School of Rehabilitation Sciences, Institute of Applied Health Sciences, Hamilton, Ontario, Canada. [email protected]

STUDY DESIGN AND OBJECTIVES: Our systematic review of randomized trials assessed whether manipulation and mobilization relieve pain or improve function/disability, patient satisfaction, and global perceived effect in adults with mechanical neck disorders. SUMMARY OF BACKGROUND DATA: Neck disorders are common, disabling, and costly. METHODS: Computerized bibliographic databases were searched up to March 2002. Two independent reviewers conducted study selection, data abstraction, and methodologic quality assessment. Relative risk and standardized mean differences were calculated. In the absence of heterogeneity, pooled effect measures were calculated using a random effects model. RESULTS: Of the 33 selected trials, 42% were high quality trials. Single or multiple (3-11) sessions of manipulation or mobilization showed no benefit in pain relief when assessed against placebo, control groups, or other treatments for acute/subacute/chronic mechanical neck disorders with or without headache. There was strong evidence of benefit favoring multimodal care (mobilization and/or manipulation plus exercise) over a waiting list control for pain reduction [pooled standardized mean differences -0.85 (95% CI: -1.20 to -0.50)], improvement in function [pooled SMD -0.57 (95% CI: -0.94 to -0.21)] and global perceived effect [standardized mean differences -2.73 (95% CI: -3.30 to -2.16)] for subacute/chronic mechanical neck disorders with or without headache. CONCLUSIONS: Mobilization and/or manipulation when used with exercise are beneficial for persistent mechanical neck disorders with or without headache. Done alone, manipulation and/or mobilization were not beneficial; when compared to one another, neither was superior. There was insufficient evidence available to draw conclusions for neck disorder with radicular findings. Factorial design would help determine the active agent(s) within a treatment mix.

 

[truthseeker]

This is the first step toward a large-scale RCT of chiropractic treatment for cervicogenic headache. With increased funding from the NIH, you will see more and more of these studies. The data is just beginning to emerge, and over time, will elucidate the types of conditions that may respond to chiropractic treatment. I applaud these authors' efforts. Chiropractic desperately needs to evaluate their interventions with systematic research. In a world that constantly demands proof, validation, and evidence, this will serve chiropractic well.


J Manipulative Physiol Ther. 2004 Nov-Dec;27(9):547-53.

Dose response for chiropractic care of chronic cervicogenic headache and associated neck pain: a randomized pilot study.

Haas M, Groupp E, Aickin M, Fairweather A, Ganger B, Attwood M, Cummins C, Baffes L.

Objective To acquire information for designing a large clinical trial and determining its feasibility and to make preliminary estimates of the relationship between headache outcomes and the number of visits to a chiropractor. Design Randomized, controlled trial. Setting Private practice in a college outpatient clinic and in the community. Subjects Twenty-four adults with chronic cervicogenic headache. Methods Patients were randomly allocated to 1, 3, or 4 visits per week for 3 weeks. All patients received high-velocity low-amplitude spinal manipulation. Doctor of Chiropractics could apply up to 2 physical modalities at each visit from among heat and soft tissue therapy. They could also recommend modification of daily activities and rehabilitative exercises. Outcomes included 100-point Modified Von Korff pain and disability scales, and headaches in last 4 weeks. Results Only 1 participant was insufficiently compliant with treatment (3 of 12 visits), and 1 patient was lost to follow-up. There was substantial benefit in pain relief for 9 and 12 treatments compared with 3 visits. At 4 weeks, the advantage was 13.8 ( P = .135) for 3 visits per week and 18.7 (P = .041) for 4 visits per week. At the 12-week follow-up, the advantage was 19.4 (P = .035) for 3 visits per week and 18.1 (P = .048) for 4 visits per week. Conclusion A large clinical trial on the relationship between pain relief and the number of chiropractic treatments is feasible. Findings give preliminary support for the benefit of larger doses, 9 to 12 treatments, of chiropractic care for the treatment of cervicogenic headache.

I am a PT. over the last two years of gathering outcome data, I average 3 visits for treatment of cervicogenic headaches. Where are the comparisons to exercise alone vs exercise plus manipulation or even better, exercise plus mobilization vs exercise plus manipulation?

 

[PublicHealth]

I am a PT. over the last two years of gathering outcome data, I average 3 visits for treatment of cervicogenic headaches. Where are the comparisons to exercise alone vs exercise plus manipulation or even better, exercise plus mobilization vs exercise plus manipulation?

Apply for a grant and conduct such a study.

 

[FoughtFyr]

Another study:
In "Spine"(not jmpt, as per FFyr request) That addresses some of the issues discussed above:

http://www.ncbi.nlm.nih.gov/entrez/...t=Abstract&list_uids=12221360&itool=iconabstr

This is an important study many like to ignore.

Really, an important study? That many ignore? It shows that of thirteen people, five MDs and 8 DCs, interrater agreement was a low as 0.44 (among the five chiropractors not identified as chiropractic radiologists). Now a kappa of 1.0 means complete agreement, and they scored a 0.44 (meaning they agreed on the findings in only 44% of the films). Second, look at the study design itself, 13 people looked at 300 x-rays to detect an abnormality (present in 50 films). So what! I have said that I do not doubt, necessarily, a DCs skill in NMS, but in non-NMS conditions. Besides, with thirteen participants, I really question the power of the study.

And lastly, lets look at some conclusions here. "The intraobserver agreement showed mean kappas of 0.58, 0.68, and 0.72, respectively. The difference between the chiropractic radiologists and medical radiologists was not significant. However, there was a difference between the chiropractors and the other professional groups. {emphasis added}. "The medical radiologists were more specific than the others." "Good professional relationships between the professions are recommended to facilitate interprofessional consultation in case of doubt by the chiropractors." {emphasis added}. Yep Rooster, this is an important study that we ignore. The AMA now has a hit out on you for bringing it to out attention!

- H

 

[FoughtFyr]

You know when I graduated chiropractic school, I received numerous solicitations from Caribbean medical schools.

See, I completely disagree with that. I hope you fired off a strong letter or two.

- H

 

[FoughtFyr]

Because FoughtFyr only trusts Cochrane reviews:


Spine. 2004 Jul 15;29(14):1541-8.

A Cochrane review of manipulation and mobilization for mechanical neck disorders.

Gross AR, Hoving JL, Haines TA, Goldsmith CH, Kay T, Aker P, Bronfort G; Cervical Overview Group.

McMaster University, Faculty of Health Sciences, School of Rehabilitation Sciences, Institute of Applied Health Sciences, Hamilton, Ontario, Canada. [email protected]

STUDY DESIGN AND OBJECTIVES: Our systematic review of randomized trials assessed whether manipulation and mobilization relieve pain or improve function/disability, patient satisfaction, and global perceived effect in adults with mechanical neck disorders. SUMMARY OF BACKGROUND DATA: Neck disorders are common, disabling, and costly. METHODS: Computerized bibliographic databases were searched up to March 2002. Two independent reviewers conducted study selection, data abstraction, and methodologic quality assessment. Relative risk and standardized mean differences were calculated. In the absence of heterogeneity, pooled effect measures were calculated using a random effects model. RESULTS: Of the 33 selected trials, 42% were high quality trials. Single or multiple (3-11) sessions of manipulation or mobilization showed no benefit in pain relief when assessed against placebo, control groups, or other treatments for acute/subacute/chronic mechanical neck disorders with or without headache. There was strong evidence of benefit favoring multimodal care (mobilization and/or manipulation plus exercise) over a waiting list control for pain reduction [pooled standardized mean differences -0.85 (95% CI: -1.20 to -0.50)], improvement in function [pooled SMD -0.57 (95% CI: -0.94 to -0.21)] and global perceived effect [standardized mean differences -2.73 (95% CI: -3.30 to -2.16)] for subacute/chronic mechanical neck disorders with or without headache. CONCLUSIONS: Mobilization and/or manipulation when used with exercise are beneficial for persistent mechanical neck disorders with or without headache. Done alone, manipulation and/or mobilization were not beneficial; when compared to one another, neither was superior. There was insufficient evidence available to draw conclusions for neck disorder with radicular findings. Factorial design would help determine the active agent(s) within a treatment mix.

Look at the conclusion here. "Mobilization and/or manipulation when used with exercise are beneficial for persistent mechanical neck disorders with or without headache. Done alone, manipulation and/or mobilization were not beneficial; when compared to one another, neither was superior. There was insufficient evidence available to draw conclusions for neck disorder with radicular findings. Factorial design would help determine the active agent(s) within a treatment mix" Doesn't say much in favor of Chiropractic. Again, risk v. benefit.

And yes, Cochrane reviews are the most accepted review articles. Thanks!

- H

 

[PublicHealth]

FoughtFyr,

What are your thoughts regarding the Haas et al (2004) article?

 

[FoughtFyr]

FoughtFyr,

What are your thoughts regarding the Haas et al (2004) article?

Two quick problems with it. First, modern study ethics call for a new treatment to be measured against the existing "gold standard", or in the absence of a concensus standard, against common practices. There is no "non-chiropractic" arm to the design, and this, in my opinion, violates that tenent. The previously funded NIH study did compare directly. Secondly, the "loss to follow-up" and "non-compliance" rates were high.

Even without these problems, the study does not get to the question of risk-benefit, as there is no measure of how the diagnoses were made, what co-morbid conditions might exist and how medical management of those conditions might effect the study, nor is there any objective end point measure. I think it is about as error riddled and poor a paper as most in JMPT.

- H

 

[rooster]

Really, an important study? That many ignore? It shows that of thirteen people, five MDs and 8 DCs, interrater agreement was a low as 0.44 (among the five chiropractors not identified as chiropractic radiologists). Now a kappa of 1.0 means complete agreement, and they scored a 0.44 (meaning they agreed on the finding of only 44% of the films). Second, look at the study design itself, 13 people looked at 300 x-rays to detect an abnormality (present in 50 films). So what! I have said that I do not doubt, necessarily, a DCs skill in NMS, but in non-NMS conditions. Besides, with thirteen participants, I really question the power of the study.

And lastly, lets look at some conclusions here. "The intraobserver agreement showed mean kappas of 0.58, 0.68, and 0.72, respectively. The difference between the chiropractic radiologists and medical radiologists was not significant. However, there was a difference between the chiropractors and the other professional groups. {emphasis added}. "The medical radiologists were more specific than the others." "Good professional relationships between the professions are recommended to facilitate interprofessional consultation in case of doubt by the chiropractors." {emphasis added}. Yep Rooster, this is an important study that we ignore. The AMA now has a hit out on you for bringing it to out attention!

- H

A companion study:

Spine. 1995 May 15;20(10):1147-53; discussion 1154.


Interpretation of abnormal lumbosacral spine radiographs. A test comparing students, clinicians, radiology residents, and radiologists in medicine and chiropractic.

Taylor JA, Clopton P, Bosch E, Miller KA, Marcelis S.

Department of Radiology, University of California, Medical Center, San Diego, USA.

STUDY DESIGN. Controlled comparison of radiographic interpretive performance based on training and experience. OBJECTIVES. This study compared each of these groups in medicine and chiropractic by testing abilities to interpret abnormal plain film radiographs of the lumbosacral spine and pelvis. SUMMARY OF BACKGROUND DATA. Low back pain is a common and costly problem that is evaluated and treated primarily by medical physicians, orthopedists, and chiropractors. Although radiology is used extensively in patients with low back pain, the radiographic interpretations of students, clinicians, radiology residents, and radiologists have never been compared. METHODS. Four hundred ninety-six eligible volunteers from nine target groups completed a test of radiographic interpretation consisting of nineteen cases with clinically important radiographic findings. The nine groups included 22 medical students, 183 chiropractic students, 27 medical radiology residents, 13 chiropractic radiology residents, 66 medical clinicians (including 12 general practice physicians, 25 orthopedic surgeons, 21 orthopedic residents, and 8 rheumatologists), 46 chiropractic clinicians, 48 general medical radiologists, 55 chiropractic radiologists, and 36 skeletal radiologists and fellows. RESULTS. The test established a high level of internal consistency reliability (0.880) and revealed that, in the interpretation of abnormal plain film radiographs of the lumbosacral spine and pelvis, significant differences were found among professional groups (P < 0.0001). Post hoc tests (P < 0.05) revealed that skeletal radiologists achieved significantly higher test results than did all other medical groups; that the test results of general medical radiologists and medical radiology residents was significantly higher than those of medical clinicians; that test results of medical students was significantly poorer than that of all other medical groups; that the performance of chiropractic radiologists and chiropractic radiology residents was significantly higher than that of chiropractic clinicians and chiropractic students; that no significant differences was revealed in the mean values of performance of chiropractic clinicians and chiropractic students; that the test results of chiropractic radiologists, chiropractic radiology residents, and chiropractic students was significantly higher than that of the corresponding medical categories (general medical radiologists, medical radiology residents, and medical students, respectively); that no significant difference in test results was identified between chiropractic radiologists and skeletal radiologists or between chiropractic and medical clinicians; and that the length of time in practice for clinicians and radiologists was not a significant factor in the test results. CONCLUSIONS. These data demonstrate a substantial increase in test results of all radiologists and radiology residents when compared to students and clinicians in both medicine and chiropractic related to the interpretation of abnormal radiographs of the lumbosacral spine and pelvis. Furthermore, the study reinforces the need for radiologic specialists to reduce missed diagnoses, misdiagnoses, and medicolegal complications.

PMID: 7638657 [PubMed - indexed for MEDLINE]

The diagnosis of what is causing back pain is often made by interpreting x-rays. But the type of health care provider interpreting those films may have a great influence on what is found (or missed). When various providers were tested for the ability to interpret abnormal lumbosacral spine radiographs, here is how they placed:
(horizontal graphs using x-ray graphic in different colors)


Provider Group Average correct

Chiropractic Radiologist - 71%
Skeletal Radiologist & Fellows - 70.18%
Chiropractic Radiology Residents - 61.54%
General Medical Radiologists - 51.64%
Medical Radiology Residents - 44.64%
Medical Clinicians - 31.26%
Chiropractic Clinicians - 28.38%
Chiropractic Students - 20.45%
Medical Students - 5.74%
While one would expect a difference between the provider groups, specialists appear to be twice as accurate as non-specialists.
----------------------------- SOURCE: Taylor JAM, et al. Interpretation of abnormal lumbosacral spine radiographs. Spine 1995;20:1147-1154.

 

[PublicHealth]

Two quick problems with it. First, modern study ethics call for a new treatment to be measured against the existing "gold standard", or in the absence of a concensus standard, against common practices. There is no "non-chiropractic" arm to the design, and this, in my opinion, violates that tenent. The previously funded NIH study did compare directly. Secondly, the "loss to follow-up" and "non-compliance" rates were high.

Even without these problems, the study does not get to the question of risk-benefit, as there is no measure of how the diagnoses were made, what co-morbid conditions might exist and how medical management of those conditions might effect the study, nor is there any objective end point measure. I think it is about as error riddled and poor a paper as most in JMPT.

- H

The study was designed to determine the feasibility of conducting a chiropractic intervention study for cervicogenic headache. You do have to keep in mind that chiropractic research is just beginning to take form, so there aren't dozens of clinical trials comparing chiropractic to existing "gold standard" interventions. Given time, you will see more and more of these trials. I would imagine that these larger-scale RCTs will take the issues you raise into consideration. That being said, while RCTs may evaluate the efficacy of a particular intervention, they do not evaluate its effectiveness. Controlled research environments, inclusion/exclusion criteria, and statistical correction does not equal real-life, everyday clinical practice.

 

[truthseeker]

A companion study:

Spine. 1995 May 15;20(10):1147-53; discussion 1154.


Interpretation of abnormal lumbosacral spine radiographs. A test comparing students, clinicians, radiology residents, and radiologists in medicine and chiropractic.

Taylor JA, Clopton P, Bosch E, Miller KA, Marcelis S.

Department of Radiology, University of California, Medical Center, San Diego, USA.

STUDY DESIGN. Controlled comparison of radiographic interpretive performance based on training and experience. OBJECTIVES. This study compared each of these groups in medicine and chiropractic by testing abilities to interpret abnormal plain film radiographs of the lumbosacral spine and pelvis. SUMMARY OF BACKGROUND DATA. Low back pain is a common and costly problem that is evaluated and treated primarily by medical physicians, orthopedists, and chiropractors. Although radiology is used extensively in patients with low back pain, the radiographic interpretations of students, clinicians, radiology residents, and radiologists have never been compared. METHODS. Four hundred ninety-six eligible volunteers from nine target groups completed a test of radiographic interpretation consisting of nineteen cases with clinically important radiographic findings. The nine groups included 22 medical students, 183 chiropractic students, 27 medical radiology residents, 13 chiropractic radiology residents, 66 medical clinicians (including 12 general practice physicians, 25 orthopedic surgeons, 21 orthopedic residents, and 8 rheumatologists), 46 chiropractic clinicians, 48 general medical radiologists, 55 chiropractic radiologists, and 36 skeletal radiologists and fellows. RESULTS. The test established a high level of internal consistency reliability (0.880) and revealed that, in the interpretation of abnormal plain film radiographs of the lumbosacral spine and pelvis, significant differences were found among professional groups (P < 0.0001). Post hoc tests (P < 0.05) revealed that skeletal radiologists achieved significantly higher test results than did all other medical groups; that the test results of general medical radiologists and medical radiology residents was significantly higher than those of medical clinicians; that test results of medical students was significantly poorer than that of all other medical groups; that the performance of chiropractic radiologists and chiropractic radiology residents was significantly higher than that of chiropractic clinicians and chiropractic students; that no significant differences was revealed in the mean values of performance of chiropractic clinicians and chiropractic students; that the test results of chiropractic radiologists, chiropractic radiology residents, and chiropractic students was significantly higher than that of the corresponding medical categories (general medical radiologists, medical radiology residents, and medical students, respectively); that no significant difference in test results was identified between chiropractic radiologists and skeletal radiologists or between chiropractic and medical clinicians; and that the length of time in practice for clinicians and radiologists was not a significant factor in the test results. CONCLUSIONS. These data demonstrate a substantial increase in test results of all radiologists and radiology residents when compared to students and clinicians in both medicine and chiropractic related to the interpretation of abnormal radiographs of the lumbosacral spine and pelvis. Furthermore, the study reinforces the need for radiologic specialists to reduce missed diagnoses, misdiagnoses, and medicolegal complications.

PMID: 7638657 [PubMed - indexed for MEDLINE]

The diagnosis of what is causing back pain is often made by interpreting x-rays. But the type of health care provider interpreting those films may have a great influence on what is found (or missed). When various providers were tested for the ability to interpret abnormal lumbosacral spine radiographs, here is how they placed:
(horizontal graphs using x-ray graphic in different colors)


Provider Group Average correct

Chiropractic Radiologist - 71%
Skeletal Radiologist & Fellows - 70.18%
Chiropractic Radiology Residents - 61.54%
General Medical Radiologists - 51.64%
Medical Radiology Residents - 44.64%
Medical Clinicians - 31.26%
Chiropractic Clinicians - 28.38%
Chiropractic Students - 20.45%
Medical Students - 5.74%
While one would expect a difference between the provider groups, specialists appear to be twice as accurate as non-specialists.
----------------------------- SOURCE: Taylor JAM, et al. Interpretation of abnormal lumbosacral spine radiographs. Spine 1995;20:1147-1154.

In this study, who defined what is "correct"? and at what point in medical/chiropractic school are the medical/chiropractic students?

 

[PublicHealth]

In this study, who defined what is "correct"? and at what point in medical/chiropractic school are the medical/chiropractic students?

Why don't you live up to your screen name and read the article to look up this information instead of posing as some kind of research expert in an on-line chatroom.

 

[PublicHealth]

A more up-to-date, related study (small samples):

Spine. 2002 Sep 1;27(17):1926-33; discussion 1933.

Reliability and validity of lumbosacral spine radiograph reading by chiropractors, chiropractic radiologists, and medical radiologists.

de Zoete A, Assendelft WJ, Algra PR, Oberman WR, Vanderschueren GM, Bezemer PD.

Department of Radiology, Medical Center Alkmaar, Alkmaar, The Netherlands.

STUDY DESIGN: A cross-sectional diagnostic study was conducted in two sessions. OBJECTIVE: To determine and compare the reliability and validity of contraindications to chiropractic treatment (infections, malignancies, inflammatory spondylitis, and spondylolysis-listhesis) detected by chiropractors, chiropractic radiologists, and medical radiologists on plain lumbosacral radiographs. SUMMARY OF BACKGROUND DATA: Plain radiography of the spine is an established part of chiropractic practice. Few studies have assessed the ability of chiropractors to read plain radiographs. METHODS: Five chiropractors, three chiropractic radiologists and five medical radiologists read a set of 300 blinded lumbosacral radiographs, 50 of which showed an abnormality (prevalence, 16.7%), in two sessions. The results were expressed in terms of reliability (percentage and kappa) and validity (sensitivity and specificity). RESULTS: The interobserver agreement in the first session showed generalized kappas of 0.44 for the chiropractors, 0.55 for the chiropractic radiologists, and 0.60 for the medical radiologists. The intraobserver agreement showed mean kappas of 0.58, 0.68, and 0.72, respectively. The difference between the chiropractic radiologists and medical radiologists was not significant. However, there was a difference between the chiropractors and the other professional groups. The mean sensitivity and specificity of the first round, respectively was 0.86 and 0.88 for the chiropractors, 0.90 and 0.84 for the chiropractic radiologists, and 0.84 and 0.92 for the medical radiologists. No differences in the sensitivities were found between the professional groups. The medical radiologists were more specific than the others. CONCLUSIONS: Small differences with little clinical relevance were found. All the professional groups could adequately detect contraindications to chiropractic treatment on radiographs. For this indication, there is no reason to restrict interpretation of radiographs to medical radiologists. Good professional relationships between the professions are recommended to facilitate interprofessional consultation in case of doubt by the chiropractors.

 

[PublicHealth]

Likely biased, but may add some fuel to our fire...


J Manipulative Physiol Ther. 2000 May;23(4):239-45.

Patient characteristics, practice activities, and one-month outcomes for chronic, recurrent low-back pain treated by chiropractors and family medicine physicians: a practice-based feasibility study.

Nyiendo J, Haas M, Goodwin P.

Research Division, Western States Chiropractic College, Portland, OR 97230, USA. [email protected]

BACKGROUND: Chronic low-back pain is a significant public health problem for which few therapies are supported by predictable outcomes. In this report, practice activities and 1-month outcomes data are presented for 93 chiropractic patients and 45 medical patients with chronic, recurrent low-back pain. DESIGN: A prospective, observational, community-based feasibility study involving chiropractors and family medicine physicians. SETTING: Forty private chiropractic clinics, the outpatient clinic of the Department of Family Medicine at Oregon Health Sciences University, and 5 other Portland area family medicine clinics. Outcomes Measures: The main outcome measures were pain severity, functional disability, sensory and affective pain quality at 1 month, and patient satisfaction assessed at 7 to 10 days and at 1 month. RESULTS: Although differences were noted in age, sex, education, and employment, the patients were closely matched at baseline with respect to frequency, severity, and type of low-back pain and the psychosocial dimensions of general health. The treatment of choice for chiropractors was spinal manipulation and physical therapy modalities; for medical physicians antiinflammatory agents were most frequently used. Chiropractic patients averaged 4 visits, and medical patients averaged 1 visit. On average, chiropractic patients showed improvement across all outcomes: 31% change in pain severity, 29% in functional disability, 36% in sensory pain quality, and 57% in affective pain quality. Medical patients showed minimal improvement in pain severity (6%) and functional disability (1%) and showed deterioration in the sensory (29%) and affective (26%) dimensions of pain quality. Satisfaction scores were higher for chiropractic patients. Outcomes for medical patients were heavily dependent on psychosocial status at baseline. CONCLUSION: Patients with chronic low-back pain treated by chiropractors show greater improvement and satisfaction at 1 month than patients treated by family physicians. Nonclinical factors may play an important role in patient progress. Findings from the Health Resources and Services Administration-funded project will include a report on the influence of practice activities, including more frequent visits by chiropractic patients, on the clinical course of low-back pain and patient outcomes. (J Manipulative Physiol Ther 2000;23:239-45).

 

[jdig]

as a former dc now ms3 i can honestly say that chiropractic is on a self destruct mode... you can only scam insurance and personal inury so long... (does it strike anyone odd that many providers pay 30 visits a year, and chiro students are taught to see pts 3x a week for 2 weeks, 2x a week for 3 weeks, and once a week for 4-6 months?) anyway, you can only scam so long before you bring the whole thing down on your head. prioviders are denying benefits more and more and pretty soon chiro will be on a cash basis, which will be good for all because it will put the scammers out of business and those that want/need chiro care will be paying cash, and only those d.c's that do quality work (ie fix true musculo-skeletal problems in a timely manner) will survive.
any chiro students feel free to pm me for the scoop on exactly what this profession entails. like it or not you must also be a salesman, and man it gets old. i did well for the 14 months i owned my practice, but quickly realized the only way i could ever make more than a few grand a month would be to start scamming. between that and not being able to fully help patients, i got out and into allopathic medicine.

 

[PublicHealth]

Support or stretch?

http://www.chiro.org/ChiroZine/archive/zine/2002/bio_computation.shtml

 

[BackTalk]

as a former dc now ms3 i can honestly say that chiropractic is on a self destruct mode...

I agree.

you can only scam insurance and personal inury so long... (does it strike anyone odd that many providers pay 30 visits a year, and chiro students are taught to see pts 3x a week for 2 weeks, 2x a week for 3 weeks, and once a week for 4-6 months?)

I agree there are plenty of scams going on concerning workman's comp and personal injury. Chiropractors are not the only ones running "PI Mill's". That doesn't make it right but all professions play the game. As far as insurance companies paying for thirty visits, I don't know where you live but that is a thing of the past. Very rarely do we find an insurance company paying for more than twenty visits and most of the office visit is paid by the patient in the form of a copay. I'm not sure where you went to college but we weren't taught the treatment schedule that you posted. It is true that initial treatment may begin at 3X per week for 3-6 weeks depending on the patient's condition, but 1X per week for 4-6 months?? I don't think so. Some patients I treat on a daily basis the first week. PT and some other professions usually see patients in a similar fashion at the beginning of care.

anyway, you can only scam so long before you bring the whole thing down on your head. prioviders are denying benefits more and more

I know of many MD's who have the same problems we have. Insurance really sucks no matter what health profession you're in. Reimbursement continues to go down, it's harder for providers to get paid, patient premiums are increasing and copays and deductibles continue to go up as well.

and pretty soon chiro will be on a cash basis, which will be good for all because it will put the scammers out of business and those that want/need chiro care will be paying cash

A lot of chiropractors are "cash only" and have been for a looooong time. You're wrong about "putting the scammers" out of business. Most of the good chiropractors are those who are providers for the health insurance companies. The scammers are typically the cash doctors who convince their patients they need a year of care for $4000. If you choose to pay for it all at once, they will even give you a discount.

Many other professions are starting to do the same thing (that is as far as being all cash). Look at the Lasik centers in the US who ask for $4800 cash. Orthodontists have been cash only for years and seem to do just fine. Maybe they're not cash by choice but either way they seem to be doing fine. They make more money and don't have to deal with the insurance.

only those d.c's that do quality work (ie fix true musculo-skeletal problems in a timely manner) will survive.

Nope, they will be the ones who will be gone. The cash scammers and subluxoids will be the ones who will survive.

any chiro students feel free to pm me for the scoop on exactly what this profession entails. like it or not you must also be a salesman, and man it gets old.

Like any self-employment business, it's hard to get started and survive. Also, you pretty much have to be a salesman no matter what health career you choose. If you are a dentist you have to "sell" what it is you do, If you are a plastic surgeon or and orthopedist you pretty much have to do the same thing. That includes working for a hospital. I see advertisements all the time from the local hospital promoting knee and hip replacements or a cardiac scans just to name a few. They even set up lectures from various doctors to "sell" their services. Last week was "dessert with the doc" titled "how to avoid knee surgery" Its funny as the whole point of the lecture is to get new patients who qualify for knee replacements.

i did well for the 14 months i owned my practice, but quickly realized the only way i could ever make more than a few grand a month would be to start scamming. between that and not being able to fully help patients, i got out and into allopathic medicine.

Whatever . I feel you wanted to go to medical school from the get go and settled for chiropractic. You don't have to be a scammer to be successful. I assuming you were saying you weren't able to help patients "fully" because of a limited scope of practice and limited form of treatment. I agree that a chiropractor does not have all the tools or training to treat beyond NMS complaints. Also, there are conditions within the NMS realm that chiropractors aren't able to treat. I guess it all depends on what type of services you would like to offer patients. I'm perfectly happy treating back and neck pain.

Good luck with medical school.

 

[FoughtFyr]

Likely biased, but may add some fuel to our fire...


J Manipulative Physiol Ther. 2000 May;23(4):239-45.

Patient characteristics, practice activities, and one-month outcomes for chronic, recurrent low-back pain treated by chiropractors and family medicine physicians: a practice-based feasibility study.

Nyiendo J, Haas M, Goodwin P.

Research Division, Western States Chiropractic College, Portland, OR 97230, USA. [email protected]

No fuel. This shows that in a bad study, chiropractors, with poorly matched controls, seem to better treat LBP than FPs using limited methods. FP treatment of LBP is hardly the standard of care, but hey, the entire study design sucks (no matched controls, no randomization, poor, non-objective outcomes measures).

- H

 

[FoughtFyr]

A more up-to-date, related study (small samples):

Spine. 2002 Sep 1;27(17):1926-33; discussion 1933.

Reliability and validity of lumbosacral spine radiograph reading by chiropractors, chiropractic radiologists, and medical radiologists.

de Zoete A, Assendelft WJ, Algra PR, Oberman WR, Vanderschueren GM, Bezemer PD.

Department of Radiology, Medical Center Alkmaar, Alkmaar, The Netherlands.

STUDY DESIGN: A cross-sectional diagnostic study was conducted in two sessions. OBJECTIVE: To determine and compare the reliability and validity of contraindications to chiropractic treatment (infections, malignancies, inflammatory spondylitis, and spondylolysis-listhesis) detected by chiropractors, chiropractic radiologists, and medical radiologists on plain lumbosacral radiographs. SUMMARY OF BACKGROUND DATA: Plain radiography of the spine is an established part of chiropractic practice. Few studies have assessed the ability of chiropractors to read plain radiographs. METHODS: Five chiropractors, three chiropractic radiologists and five medical radiologists read a set of 300 blinded lumbosacral radiographs, 50 of which showed an abnormality (prevalence, 16.7%), in two sessions. The results were expressed in terms of reliability (percentage and kappa) and validity (sensitivity and specificity). RESULTS: The interobserver agreement in the first session showed generalized kappas of 0.44 for the chiropractors, 0.55 for the chiropractic radiologists, and 0.60 for the medical radiologists. The intraobserver agreement showed mean kappas of 0.58, 0.68, and 0.72, respectively. The difference between the chiropractic radiologists and medical radiologists was not significant. However, there was a difference between the chiropractors and the other professional groups. The mean sensitivity and specificity of the first round, respectively was 0.86 and 0.88 for the chiropractors, 0.90 and 0.84 for the chiropractic radiologists, and 0.84 and 0.92 for the medical radiologists. No differences in the sensitivities were found between the professional groups. The medical radiologists were more specific than the others. CONCLUSIONS: Small differences with little clinical relevance were found. All the professional groups could adequately detect contraindications to chiropractic treatment on radiographs. For this indication, there is no reason to restrict interpretation of radiographs to medical radiologists. Good professional relationships between the professions are recommended to facilitate interprofessional consultation in case of doubt by the chiropractors.

Since you reposted the study Rooster posted, I'll repost my thoughts on it. It shows that of thirteen people, five MDs and 8 DCs, interrater agreement was a low as 0.44 (among the five chiropractors not identified as chiropractic radiologists). Now a kappa of 1.0 means complete agreement, and they scored a 0.44 (meaning they agreed on the finding of only 44% of the films). Second, look at the study design itself, 13 people looked at 300 x-rays to detect an abnormality (present in 50 films). So what! I have said that I do not doubt, necessarily, a DCs skill in NMS, but in non-NMS conditions. Besides, with thirteen participants, I really question the power of the study.

And lastly, lets look at some conclusions here. "The intraobserver agreement showed mean kappas of 0.58, 0.68, and 0.72, respectively. The difference between the chiropractic radiologists and medical radiologists was not significant. However, there was a difference between the chiropractors and the other professional groups. {emphasis added}. "The medical radiologists were more specific than the others." "Good professional relationships between the professions are recommended to facilitate interprofessional consultation in case of doubt by the chiropractors." {emphasis added}.


- H

 

[FoughtFyr]

CONCLUSIONS. These data demonstrate a substantial increase in test results of all radiologists and radiology residents when compared to students and clinicians in both medicine and chiropractic related to the interpretation of abnormal radiographs of the lumbosacral spine and pelvis. Furthermore, the study reinforces the need for radiologic specialists to reduce missed diagnoses, misdiagnoses, and medicolegal complications.

Well, since chiropractors do not currently have "overreading" of their radiographs by radiologists, this argues against chiropractic, not for it. As I've said before, there are no "checks" or controls to insure that chiropractors accurately find pathology. And, in my experience, many will treat with no, or incomplete, diagnoses.

- H

 

[BackTalk]

Well, since chiropractors do not currently have "overreading" of their radiographs by radiologists, this argues against chiropractic, not for it.

I'll assume you're not implying that ALL chiropractors do not have overreads. I don't know the exact numbers, but chiropractors do have their films read. I have my films read by both medical and chiropractic radiologists (just depends on who gets the film at the center). If a chiropractor or any other medical professional does not have overreads they're taking a gamble. I'm not a radiologist and I'm not about to take a chance on missing something. I would assume most family doctors and internists don't have an x-ray in their offices. They send the patient out and by doing so; the film is automatically read by a radiologist. Actually, that's the whole point of them sending the patient out for films. Most of them aren't interested in seeing the films and just want the report.

As I've said before, there are no "checks" or controls to insure that chiropractors accurately find pathology.

I agreed that we do not have the checks and balances that one would have working in a hospital. This is why you need to hire a chiropractor as part of your pain management team in the ER.

And, in my experience, many will treat with no, or incomplete, diagnoses.

But what if the diagnosis is a subluxation?? LOL

 

[FoughtFyr]

I'll assume you're not implying that ALL chiropractors do not have overreads. I don't know the exact numbers, but chiropractors do have their films read. I have my films read by both medical and chiropractic radiologists (just depends on who gets the film at the center). If a chiropractor or any other medical professional does not have overreads they're taking a gamble. I'm not a radiologist and I'm not about to take a chance on missing something. I would assume most family doctors and internists don't have an x-ray in their offices. They send the patient out and by doing so; the film is automatically read by a radiologist. Actually, that's the whole point of them sending the patient out for films. Most of them aren't interested in seeing the films and just want the report.

Actually, most do (have x-ray). They usually contract out with radiologists to overread their films. I'm glad to hear that Chiros do as well. I would be interested to know about the actual numbers that have contracted overreads. And, how many of those overreads are medical versus chiropractic radiologists?

I agreed that we do not have the checks and balances that one would have working in a hospital. This is why you need to hire a chiropractor as part of your pain management team in the ER.

Actually that oversight exists outside of the hospital too. But I agree with you, the article describing Chiropractic for ED pain control is interesting. I would love to see a head-to-head with that system versus PT in the same capacity. Either way (Chiro or PT), such a program could be helpful.

But what if the diagnosis is a subluxation?? LOL

Then you are in the wrong office to begin with!

- H

 

[jdig]

bcbs is about the number one provider here in the southeast, and they go 30 per year. i had more pts from them than anyone. i only charged on average $15 for copays. i agree with you that these problems are not at all limited to chiro, but you must agree that by percentage there are more d.c's doing "creative" billing than any other health care providers, because unfortunately the general public has no desire to seek them and many feel they must submit 5 codes on every hicfa form to get the most $$ possible. it has gotten so bad that 98940's are often noteven included but instead pt codes in hopes that the provider will somehow not pick up that they are dc's.

re-imbursement is on the downswing for everyone, but you sure don't see providers denying coverage in any profession as much as chiro. and the fundamental reason is because your predecessors chose to abuse the system.
i agree wholeheartedly that it is a scam to sell a pt on a 4k year long care plan. its disgraceful!! and it just looks so shady...
i think that what you are not agreeing with (and thats ok) is that if all chiros go to cash basis, most wont survive. there is a difference in getting care when your provider foots most of the bill, but you wont see many patients doing 20-30 visits a year out of pocket, at least not at the same rate. we averaged $67 per visit for insured, $32 for cash. simple math says i have to see 2 cash patients for every insurance pt, and thats pretty tough.

"The cash scammers and subluxoids will be the ones who will survive. "

man i hope not. i want to see the guys who do good work like yourself do well, but the profession in general is headed in a bad direction. if a few bad apples spoil the bunch, well, you know...

as far as selling chiro, all jobs are sales jobs in some capacity, but why did you take patient education classes? because you are selling a product! chiros have the further bad luck to have to try to sell a product that most wont buy anyway. in medicine, the product sells itself, except (generally) when a new procedure is developed. but you dont see your local fp setting up spinal screenings at a mall somewhere, it just looks ridiculous and surely you cringe when you see it. it makes the dc degree look silly!




Whatever . I feel you wanted to go to medical school from the get go and settled for chiropractic.

sort of a rude comment there but thats ok. you are wrong. i feel i was brainwashed to be honest, as many students are.

I am assuming you were saying you weren't able to help patients "fully" because of a limited scope of practice and limited form of treatment.
CORRECT i referred like crazy for things thatwere simple to hwelp with but beyong my scope. many chiros feel this way as you know. those like yourself that refer as they should are few and far between.

i think that you are probably very successful in your field because you know exactly what chiro is and you do not try to make it the cure all. you probably are respected among your peers and among other healthcare providers. congrats on that. i only hope that the scammers and subluxation scammers dont sink your ship.
please understand that the medical disapproval on your profession is mostly aimed at those two groups mentioned above, and with good reason. it sounds like you are a true nms dc and i congratulate you for that. if the others were like you the profession might have some respect.
good luck.

 

[jdig]

I'll assume you're not implying that ALL chiropractors do not have overreads. I don't know the exact numbers, but chiropractors do have their films read.

hmmmmmm... i dont know any dc's that send out films, and i know quite a few. i am happy to hear you do, it protects you as you know and gives you patients the proper standard of care. but the vast majority do not, nor are they taught to.

 

[BackTalk]

Hi Jdig, sorry if I came across as arrogate, but that was not my intention.

bcbs is about the number one provider here in the southeast, and they go 30 per year. i had more pts from them than anyone. i only charged on average $15 for copays. i agree with you that these problems are not at all limited to chiro, but you must agree that by percentage there are more d.c's doing "creative" billing than any other health care providers, because unfortunately the general public has no desire to seek them and many feel they must submit 5 codes on every hicfa form to get the most $$ possible. it has gotten so bad that 98940's are often noteven included but instead pt codes in hopes that the provider will somehow not pick up that they are dc's.

BCBS is usually a great plan except there aren't many people in my area on it anymore. UnitedHealthCare, which absolutely sucks, has won a lot of the BCBS contracts in my area. We had patients with great coverage. Some had a $100 deductible and no out of pocket expense from there. Also, they had no monetary limits or visits limits. A lot of the UHC members have $25-$35 copays. Now we have caught word that they are going to raise copays to $50 (specialist). They preach to the employers on how they cover chiropractic care. We are paid a $44 global fee on UHC patients so if the patient has to pay $50 copay they essentially have no chiropractic benefits. As you know it is hard to have a patient follow through with the treatment program when they have such large copay per visit.

I agree that we have DC's who practice "creative billing". Sometimes it's a game with the insurance and other times it's to get as much money as you can per visit. Some DC's are scammers and others are just trying to get paid enough to cover their bills. I understand what you are saying. Submitting 5 codes per visit is ridiculous and I would imagine is a "red flag" for the insurance. They better hope they have good documentation and can prove medical necessity for each procedure. As far as chiropractors being the ones who do more creative billing than anyone else, I'm not so sure. I'm not saying it's not true but have you ever seen a hospital bill? I find it funny that some DC's like to avoid chiropractic codes as they think the insurance won't recognize them. The thing is, the insurance knows as the provider number tells all and is on the HCFA.

re-imbursement is on the downswing for everyone, but you sure don't see providers denying coverage in any profession as much as chiro. and the fundamental reason is because your predecessors chose to abuse the system.

Yes, they sure did abuse the system. But regardless, if they did or didn't the insurance was headed for managed care anyway. It wasn't the chiropractors who turned the health insurance industry into managed care. Chiropractic claims are a very small portion of most insurance companies claims, as only about 15% of the population (that's what every says) uses chiropractic services. The chiro's weren't the ones running the well dry. As far as other providers having their care denied as bad as us, I really do not know. It wouldn't surprise me if they have the same troubles but on a smaller scale.

i agree wholeheartedly that it is a scam to sell a pt on a 4k year long care plan. its disgraceful!! and it just looks so shady...

Makes us all look bad and is a total scam and unfortunate. Those chiropractors can do well because in this world there is a sucker born everyday. There will always be someone out there who just doesn't know any better. If the chiropractor tells them they need 90 visits, the patient doesn't know if they do or not. They figure the chiropractor is a doctor so it must be true. The subluxoids are not doctors in any sense, they're technicians. They don't diagnosis nor do they claim any responsibility to do so. Their only purpose is to find and remove vertebral subluxations. The thing is, when a patient enters your office, you are responsible for the whole patient not just the imaginary vertebral subluxations. You are trained to recognize things that are outside your scope of practice so you can lead the patient to the proper doctor or just send them to their PCP and get checked out. I do this all the time. By doing this I think it bruises some DC's ego's because they are unable to treat the problem. It doesn't bruise mine. At least MD's know their specialty and have no problem sending the patient to whoever they need to see. I had an orthopedist in my office and was telling him I felt like I was getting the flu. He said "I'm an orthopedist; go see your family doctor". I always thought that was funny. I'm like "your frickin MD first"! But I guess when they specialize they concentrate on the one thing. Whether you are an MD or DO or whatever, no one can know it all or do it all alone. The body is way too complicated and we need to have specialists. My patients know who I am and what it is I treat. They don't expect me to fix their hypertension or diabetes because that's not something I do or any of us should do.

i think that what you are not agreeing with (and thats ok) is that if all chiros go to cash basis, most wont survive. there is a difference in getting care when your provider foots most of the bill, but you wont see many patients doing 20-30 visits a year out of pocket, at least not at the same rate. we averaged $67 per visit for insured, $32 for cash. simple math says i have to see 2 cash patients for every insurance pt, and thats pretty tough.

My practice as it stands is insurance dependant. If we lost all insurance coverage or it became so bad, I would have to move into foughtfyr house and have him get me a job in his ER . Actually I'd go all cash and do the best I could. I'm not going to give up and I'm not implying you did. If that doesn't work I will be sitting next to you in medical school brother. Actually, I would go to dental school as managed care isn't as much an issue.

I really don't think 20-30 visits is that big of a deal for a cash paying patient. So if your patient pays for 25 visits at $32 a visit that's $800. Now I know that is not pocket change, but I feel it is reasonable. Look at the cost of a patient going to the local PT department at the hospital and $800 pales in comparison. What about an injection? That's anywhere from $1000-$1500. If you had 20 new patients a month you would have a 200K practice. Your numbers are good and I know its tough brother. I have the same troubles. Honestly, my practice is not that busy. I just do the best I can to keep overhead down and collections high and I also sublease for additional income. I'm a one man show. I do it all from the x-rays to doing the rehab. My wife runs the front office and does all the administrative work. I will have to hire someone down the road and have been holding off as long as I can. The practice is getting to the level where it can't grow without additional help.

man i hope not. i want to see the guys who do good work like yourself do well, but the profession in general is headed in a bad direction. if a few bad apples spoil the bunch, well, you know...

I agree. I think a very important obstacle that has to be overcome is getting the chiropractic school at FSU. I believe it was approved but is getting a lot of opposition from the medical staff as they feel it will cheapen the medical schools reputation. I really do not know if that would happen but I understand their concern. "Hey your that quack MD who went to the chiropractic school at FSU"...hehe. All I can say is we have to start somewhere and it may be unfortunate for them, but were coming in. This will at least start some sort of standardization in chiropractic education.

 

[BackTalk]

Continued.....

as far as selling chiro, all jobs are sales jobs in some capacity, but why did you take patient education classes? because you are selling a product! chiros have the further bad luck to have to try to sell a product that most wont buy anyway. in medicine, the product sells itself, except (generally) when a new procedure is developed. but you dont see your local fp setting up spinal screenings at a mall somewhere, it just looks ridiculous and surely you cringe when you see it. it makes the dc degree look silly!

Why did I take patient education classes? I didn't nor did I or do host them. Chiropractic practice is 90% sales and 10% chiropractic (that's what I've been told). Most patients have no clue as to the benefits of chiropractic, you have to explain it to them; they want to know what they are getting for their money. Same for a pain management doctor doing an injection. The patient wants to know the purpose of the treatment and expected results. You are selling a form of patient care. Should they go and get the pain injection for $1000-$1500 or see the chiropractor for $800? Which one is safer? Which one lasts longer? Which one is more likely to correct the problem?

It does make me cringe as a mall or the local grocery store is not a proper venue to do a screening. All it does is cheapen the profession. Listen, I've seen FP at health fairs. Granted, it isn't Wal-Mart but I see more and more medical doctors doing things to bring in business. I had a booth at the "Working Womans Survival Show" and there were 10 plastic surgeons and a few OB/GYNS and a couple pediatricians and about a 500 chiropractors!

Then we have the "dessert with the doc" orthopedist looking for knee replacements. We invented this form of advertising and were slammed for it and now look at who's doing the same thing.

sort of a rude comment there but thats ok. you are wrong. i feel i was brainwashed to be honest, as many students are.

That was a little rude, sorry. Many times I see chiropractors who were fed up with chiropractic and just left the profession. Usually it's the same old song and dance. They blame the profession for their practice failures when they have the opportunity to practice the way they want. You don't have to be a scammer or a subluxation quack to be successful as a chiropractor. There are many variables that determine the success of a practice. What if you had no personality at all? Do you think patients would want to come to you? That doesn't have anything to do with chiropractic but is one thing that can make a practice fail.

I have heard this thing about brainwashing, specifically what do you mean?

CORRECT i referred like crazy for things thatwere simple to hwelp with but beyong my scope. many chiros feel this way as you know. those like yourself that refer as they should are few and far between.

Well I think the problem is that most of the time the referrals are a one way street. I really don't care about that as I get my own patients. The thing that pisses me off is when I send the patient to the MD and they turn around and attempt to send my patient for PT when I sent them there for a non-NMS related complaint such as hypertension. Or the neurosurgeon or orthopedist sends a report to the patients PCP when I'm the phucking one who referred the patient to them in the first place. I've even had radiologists do this when I sent the patient for an MRI. I'm like "where the hell is my MRI report" only to find out they sent it to the PCP. So I'm very selective on who I refer to. I'm telling you, if most MD's just played ball, especially physiatrists, neurologists or orthopedists, they would have tapped a goldmine in patient referrals. If they want to play ball they need to know the rules.

i think that you are probably very successful in your field because you know exactly what chiro is and you do not try to make it the cure all. you probably are respected among your peers and among other healthcare providers. congrats on that. i only hope that the scammers and subluxation scammers dont sink your ship.

Thanks for the compliments. I really don't know if I have any good professional relationships with most of the MD's in my town. I only have one or two that refer to me every once in a blue moon. I had a few others that were good but left the area due to rising malpractice costs. I usually do not have any problems getting a referral for insurance purposes but to me that is not a real referral but rather a demand from the patient. Most of the chiropractors in my area probably hate me and I could care less. I let patient's know when they're duped by the clowns down the street. I even run advertisements that explain to the public we don't practice that way and all my treatment programs have a beginning, middle and an end as we don't keep you coming forever. I actually get patients from their office when I do this.

I'm not worried about the subluxation scammers as most of the time they sink their own ship. Most people don't like having 90 visits crammed down their throat. I tell them what they need (which is not 90 visits) and give them what they want with a smile.

please understand that the medical disapproval on your profession is mostly aimed at those two groups mentioned above, and with good reason.

I know that. Many good doctors on this site have pointed this out. I think I'm beginning to agree more with them than disagreeing. Hey, just remember you're still a DC and this is OUR profession. Doesn't really doesn't matter that you will also have an MD behind your name. With those credentials you could probably do some good for this profession.

it sounds like you are a true nms dc and i congratulate you for that. if the others were like you the profession might have some respect.

Thanks again. If chiropractors would just stick with what chiropractic is good for, we all would be so busy we wouldn't know what to do.

hmmmmmm... i dont know any dc's that send out films, and i know quite a few. i am happy to hear you do, it protects you as you know and gives you patients the proper standard of care. but the vast majority do not, nor are they taught to.

You're probably right that most probably do not have their films read. I've requested films before from other chiropractors that were horrible and weren't even diagnostic. I've also requested films and of course no rad report. I will send them out and have them read if that is the case.
Where I went to school the DACBR's all preached about why we need our films read. As I said, I'm no radiologist and don't claim to be. I for one feel my diagnostic skill at reading radiographs is rather good but I will admit that I have missed things here and there and I'm glad I have a radiologist who's got my back. That's part of my checks and balances. I have neurologists and orthopedists that are also part of that team.

 

[FoughtFyr]

That's part of my checks and balances. I have neurologists and orthopedists that are also part of that team.

Now, make such a system of checks and balances mandatory (as it is for MD/DOs), include in that system comparisons against your peers for metrics such as time required to treat specific diagnostic codes and costs (as it is for MD/DOs), and include analysis of referral patterns and proper scope of practice (again, as it is for MD/DOs). To go one up on us, add EBM as a required analysis (o.k., I'm dreaming - I've just spent so much time pushing for that in medicine)! Make this required across the profession and I'll stop b!tching.

Unfortunately, as we have discussed before, you couldn't, even if you wanted to. The profession of chiropractic can not even decide itself what practices are in their scope, who can perform them, etc. under the current, less structured system. For example, there exists {shudder} a diplomate in pediatric chiropractic, yet any chiropractor is free to treat children at will. Why? At what diagnostic or therapuetic endpoint is an intra-profession referral needed? These points are well defined in a medical practice. The chiro community must sense the need for higher training to treat children, as evidenced by the creation of the diplomate. So when is the accepted time to transfer care? What is the penalty for not doing so? Why are any and all chiropractors allowed to advertise their treatment of children regardless of training? Oh yeah, lack of standards.

Look BackTalk, you are, seemingly, an honest man; looking to help his patients. But do you really think that defending a profession, that as a whole is so dervisive and fractionated, is really a sword you should fall on? Or is this just the result of cognitive dissonance created by your having spent so much time and effort to train, and build a practice in chiropractic? I guess I'm asking, in total, do you really see the advancement of chiropractic (as it exists now) as a positive, or are there other, safer and more effective ways to meet the same ends?

- H

 

[rooster]

hmmmmmm... i dont know any dc's that send out films, and i know quite a few. i am happy to hear you do, it protects you as you know and gives you patients the proper standard of care. but the vast majority do not, nor are they taught to.

It always amazes me when broad generalizations with little to no substance are made. Every dc I know(which is also quite a few) has overreads. In fact, my films are read 3x(myself, a dc rad and a md rad). Actually, it may come as a surprize to some here, but the dc and md rads practice together. Those that insist on promoting the "us vs them" mentality are becoming quite antiquated.

Please document your source(s) regarding the "vast majority" you so authoratively post.

 

[BackTalk]

Now, make such a system of checks and balances mandatory (as it is for MD/DOs), include in that system comparisons against your peers for metrics such as time required to treat specific diagnostic codes and costs (as it is for MD/DOs), and include analysis of referral patterns and proper scope of practice (again, as it is for MD/DOs). To go one up on us, add EBM as a required analysis (o.k., I'm dreaming - I've just spent so much time pushing for that in medicine)! Make this required across the profession and I'll stop b!tching.

Easier said than done and I know you already knew that.

Unfortunately, as we have discussed before, you couldn't, even if you wanted to. The profession of chiropractic can not even decide itself what practices are in their scope, who can perform them, etc. under the current, less structured system.

I totally agree with you.

For example, there exists {shudder} a diplomate in pediatric chiropractic, yet any chiropractor is free to treat children at will. Why?

I understand what you are saying but isn't it the same way in medicine? I know many general practitioners treat kids and even infants. I know they have pediatrics as part of their medical background but is it enough to function in that capacity? The reason I ask is because I had a patient who had brought her son to a new doctor in town who wasn't a pediatrician but had training in pediatrics. The kid had a sore throat. The doctor was looking in the kid's throat and said "his tonsils look fine". My patient thought "that's odd; he had his tonsils removed a few years ago". Also, what do you think about FP functioning as OB/GYN's doing pelvics, paps and delivering babies?

You probably know more about the diplomate in peds more than I do with concern to chiropractic. There is a quack not far from me who preaches he has a diplomate in pediatrics. He was the same guy I brought my daughter to when she had ear infections. Anyway, he went to Life College of Chiropractic, so a diplomate in pediatrics can't be very challenging.

At what diagnostic or therapuetic endpoint is an intra-profession referral needed? These points are well defined in a medical practice. The chiro community must sense the need for higher training to treat children, as evidenced by the creation of the diplomate.

There really are no intra-profession referrals within chiropractic. Chiropractors look at each other as competition as we all do the same type of treatments. The only ones not really considered competition are the chiropractic radiologist or neurologists. They typically do not treat but rather are relied upon diagnostically. I guess a DC with a diplomate in nutrition wouldn't necessarily be looked upon as competition either. We really do not need these specialties within chiropractic. I mean, if someone has a neurological condition that can't be helped from chiropractic care, why would I refer them to a chiropractic neurologist? What do I need a chiropractic radiologist for when we have medical radiologists who have far more training? Why do I need a chiropractic pediatrician when we have medical pediatricians?

So when is the accepted time to transfer care? What is the penalty for not doing so? Why are any and all chiropractors allowed to advertise their treatment of children regardless of training? Oh yeah, lack of standards.

Lack of standards. That pretty much sums it up.

Look BackTalk, you are, seemingly, an honest man; looking to help his patients. But do you really think that defending a profession that as a whole is so derisive and fractionated, is really a sword you should fall on?

Well that's a good question and many times I ask myself the same thing. I guess I'm a glutton for punishment. When we have such a dysfunctional profession that won't change and in fact fight every attempt to change, why should I be the one to take on the challenge of changing it? Many times I get so fed up I want to quit altogether and do something different.

Or is this just the result of cognitive dissonance created by your having spent so much time and effort to train, and build a practice in chiropractic? I guess I'm asking, in total, do you really see the advancement of chiropractic (as it exists now) as a positive, or are there other, safer and more effective ways to meet the same ends?

I think chiropractic will continue to grow in a positive manner. I feel that since the invention of the internet, people are more educated on the different professions out there and what to watch out for. Chiropractic continues to grow and is becoming more and more recognized. Chiropractors are showing up in movies such as Liz Hurley in Double Whammy, which of course flopped, Jacobs latter (Danny Aiello) and also a few sitcoms such as Two and Half Men (Charlie Sheens brother is a chiropractor on the show). Many professional athletes have thanked chiropractors publicly for helping them get to the Super Bowl or the World Series. Chiropractors are officially part of the Olympic medical team. Many chiropractors are team chiropractors for many professional sports teams.

Is there a "safer and more effective ways to meet the same ends"? I don't think there is. Physical therapists lack equal training in manipulative therapy expertise and in diagnosis, Osteopath education exceeds ours in training but lacks in manipulative therapy expertise.

 

[rooster]

Now, make such a system of checks and balances mandatory (as it is for MD/DOs), include in that system comparisons against your peers for metrics such as time required to treat specific diagnostic codes and costs (as it is for MD/DOs), and include analysis of referral patterns and proper scope of practice (again, as it is for MD/DOs). To go one up on us, add EBM as a required analysis (o.k., I'm dreaming - I've just spent so much time pushing for that in medicine)! Make this required across the profession and I'll stop b!tching.

Unfortunately, as we have discussed before, you couldn't, even if you wanted to. The profession of chiropractic can not even decide itself what practices are in their scope, who can perform them, etc. under the current, less structured system. For example, there exists {shudder} a diplomate in pediatric chiropractic, yet any chiropractor is free to treat children at will. Why? At what diagnostic or therapuetic endpoint is an intra-profession referral needed? These points are well defined in a medical practice. The chiro community must sense the need for higher training to treat children, as evidenced by the creation of the diplomate. So when is the accepted time to transfer care? What is the penalty for not doing so? Why are any and all chiropractors allowed to advertise their treatment of children regardless of training? Oh yeah, lack of standards.


- H

It appears from the above and several previous posts that you have been the victim of quite a bit of misinformation. But hey, there is a lot of misinformation out there. I suggest you take a look at:

Principles and Practices of Chiropractic
by Scott Haldeman, (Hardcover - March 1, 2004)
http://www.amazon.com/gp/reader/0071375341/ref=sib_dp_pt/002-7341732-4098448#reader-link

2. Guidelines for Chiropractic Quality Assurance and Practice Parameters: Proceedings of the Mercy Center Consensus Conference
by Mercy Center Consensus Conference, et al
http://www.amazon.com/exec/obidos/t...f=sr_1_2/002-7341732-4098448?v=glance&s=books

 

[rooster]

>>>I think chiropractic will continue to grow in a positive manner. I feel that since the invention of the internet, people are more educated on the different professions out there and what to watch out for. Chiropractic continues to grow and is becoming more and more recognized. Chiropractors are showing up in movies such as Liz Hurley in Double Whammy, which of course flopped, Jacobs latter (Danny Aiello) and also a few sitcoms such as Two and Half Men (Charlie Sheens brother is a chiropractor on the show). Many professional athletes have thanked chiropractors publicly for helping them get to the Super Bowl or the World Series. Chiropractors are officially part of the Olympic medical team. Many chiropractors are team chiropractors for many professional sports teams.<<<


Add to that list-
DCs are now in the VA, http://www.dcmilitary.com/navy/test er/9_27/national news/30017-1.htm , www.vacareers.com/chiropractor.htmlactic-care.php A growing number of hospitals are engaging DCs, www.osu.edu- recruiting DCs for salaried positions in Integrative medicine dept., http://www.chiroweb.com/archives/18/14/16.html Division of Chiropractic at Doctors' Hospital of Staten Island, http://www.chiroweb.com/archives/10/21/11.html Franklin Square Hospital in Philadelphia, Pennsylvania, to name just a few, DCs are increasing in multi disciplinary clinics eg: http://www.texasback.com/chiroprhttp://, and DC schools are coordinating rotations with hospitals, http://www.txchiro.edu/health.asppageid=421, http://www.logan.edu/pages/hosp_rotation.asp
http://www.chiroweb.com/archives/ahcpr/chapter12.htm Add to that the increasing collaborative research projects.

 

[FoughtFyr]

It appears from the above and several previous posts that you have been the victim of quite a bit of misinformation. But hey, there is a lot of misinformation out there. I suggest you take a look at:

Principles and Practices of Chiropractic
by Scott Haldeman, (Hardcover - March 1, 2004)
http://www.amazon.com/gp/reader/0071375341/ref=sib_dp_pt/002-7341732-4098448#reader-link

2. Guidelines for Chiropractic Quality Assurance and Practice Parameters: Proceedings of the Mercy Center Consensus Conference
by Mercy Center Consensus Conference, et al
http://www.amazon.com/exec/obidos/t...f=sr_1_2/002-7341732-4098448?v=glance&s=books

Really? Misinformation? Please, enlighten me. There are now peer review panels that meet to discuss practice privledges of chiropractors? There are generally agreed to definitions as to scope of practice? Whose - the straights, mixers, or psuedo-mixers? And what is the penalty for violating them? So, if a stright believes he can treat the patient with cancer and does not refer the patient out, that is o.k.? There are certainly chiropractors who feel that way. Of course there are also chiropractors who would think that person a quack. So who is right? Please, I haven't read these books - tell us all, what do they say?

Be realistic, medical physicians are some of the most "watched" professionals on the planet. Between nurses at the bedside, pharmacists and therapists following patients, peer review committees for hospital privledges, case managers watching practice patterns for reimbursement, and morbidity and mortality meetings disecting bad outcomes, everything I do is looked at by a myriad of other professionals in settings both open and closed to the public.

Who watches chiropractors?

Don't find a couple of textbooks that describe what "ought to be" and claim they describe what "is". There are no standards, a chiropractor can take their practice as far as they want. There are no peer review oversights to determine if the "right" things are being done. There are few "case managers" determining if one chiropractor treats as effectively as others treating the same condition with respect to time and costs. These things are part and parcel of medicine - what is chiropractic afraid of? Oh yeah, I forgot, the "fountainhead" was devinely inspired by the "innate", no oversight needed.

- H

 

[FoughtFyr]

Rooster,

Since two things are obvious here, 1. you are a DC or a DC student, and 2. you have not bothered to read the numerous threads in these forums dealing with Chiropractic, I'll tell you that the Chiros in VA (here: http://forums.studentdoctor.net/showthread.php?t=138478), Chiros being hired for their PhDs (here: http://forums.studentdoctor.net/showthread.php?t=144654) and Chiropractic in general (here: http://forums.studentdoctor.net/showthread.php?t=133855) have been discussed ad nauseum, but thanks for the links to the articles.

Now as an (I assume) educated person, what is your opinion/reaction to these studies?

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=10768681&dopt=Abstract

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7884327&dopt=Abstract

http://www.cmaj.ca/cgi/content/full/166/12/1531

http://www.cmaj.ca/cgi/content/full/166/12/1544

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=11340209

The often quoted NIH studies "in favor" of chiropractic, detailed in other threads, indicate that chiropractic is only "as effective" as traditional therapy. Given the risks demonstrated above, why is it that medicine should "accept" chiropractic? No real improvements and lots of risks...

Or are you a straight who believes that Palmer was some sort of health deity devinely inspired to "discover" innate?

- H

 

[50960]

Perhaps I am showing my ignorance here, but if you are "on staff" at a hospital you are overseen ad nauseum! This doesn't just apply for MD's as far as I know. I am a psychologist on the medical staff at a hospital with MD's DDS's DPM's, but if we had any DC's I am sure they would have to be on the medical staff to practice there. PT's, SLP's etc.. do not have to be on staff as they do not have independent licenses, and are monitored by their own processes. Perhaps DC's in private arenas do not have peer reviews, or credentialing etc, but neither do psychs or MD's unless the work is attached to a hospital.

 

[jdig]

It always amazes me when broad generalizations with little to no substance are made. Every dc I know(which is also quite a few) has overreads. In fact, my films are read 3x(myself, a dc rad and a md rad). Actually, it may come as a surprize to some here, but the dc and md rads practice together. Those that insist on promoting the "us vs them" mentality are becoming quite antiquated.

Please document your source(s) regarding the "vast majority" you so authoratively post.

oh me... God bless the internet...
of course you realize i have no "source" for my general statement. it was just a generalization. but being a dc, you allready know that the MAJORITY of dc's do not send out films. heck, many dont even TAKE them!
i am not trying to start a war with chiro, i used to be one. it is just that since going to med school, i have seen a tremendous difference in the quality of education. 2 years of basic sciences followed by 2 years of "clinic" does not properly teach dc's to be primary health care providers. it simply isnt enough. it teaches you to treat musculoskeletal disorders, and as backtalk stated, if you guys stuck to that there would be all the business you could handle. but many dc's try to "play God" by telling pts chiro can handle everything, which is endangering the general public who often dont know that the term "dr" can mean many different things.
am i alone in this thought?

 

[FoughtFyr]

Perhaps DC's in private arenas do not have peer reviews, or credentialing etc, but neither do psychs or MD's unless the work is attached to a hospital.

Not true. If a physician has credentials at a hospital (and almost all do) ANY work they do is subject to peer review (not just that associated with the hospital). Secondly, almost all physicians have an office nurse (if they are outside of a hospital). Part of the nursing role is patient advocacy and safety. The coding (and reimbursement) for Medicare/Medicaid is based on expected length of treatment, and almost all insurers use that system, so individual insurance case managers also "oversee" treatment in terms of expected length and cost. Therapists (OT, PT, RT, etc.) provide "checks" on diagnosis and treatment as well. Most offices are listed under JCAHO, and are insepted by them and arwe held to their standards. Finally pharmacists provide some oversight as well toward pharmacotherapy.

- H

 

[BackTalk]

So if the MD is in private practice and not affiliated with any hospitals, then where are the checks and balances other than the pharmacist filling their prescriptions? Why would a family practitioner be affiliated with any hospital? Most services a hospital offers can be found elsewhere. Is it for admitting purposes? Doesn't the ER doctor usually do that? Or is the PCP notified and then they have to make a decision on what the next move is or do they right the orders? Not trying to start a war just curious.

What about a physiatrist? Why would they need to have hospital privileges?

 

[FoughtFyr]

So if the MD is in private practice and not affiliated with any hospitals, then where are the checks and balances other than the pharmacist filling their prescriptions? Why would a family practitioner be affiliated with any hospital? Most services a hospital offers can be found elsewhere. Is it for admitting purposes? Doesn't the ER doctor usually do that? Or is the PCP notified and then they have to make a decision on what the next move is or do they right the orders? Not trying to start a war just curious.

What about a physiatrist? Why would they need to have hospital privileges?

Nope, I don't think you are trying to start a war. I would not recommend going to a physician who has no office nursing staff and who does not have privledges at any hospital. From experience, I can tell you such a physician is VERY rare.

An FP or an internist for that matter, have privledges for admissions purposes. An ED physician can admit, but for continuity of care, we prefer to admit to the patient's PCP. FPs also maintain privledges for birthing, usually. Physiatrists, I imagine, also maintain privledges as most PT practices are affiliated so that their physicians can order x-rays and labs through the hospital. Some might not be, I am not a physiatrist, and as an EP, I do not admit patients to their care. The ones I refer patients to are.

I just thought of the other reason most physicians maintain privledges - ED referrals. We have a rotating list of generalists and specialists affiliated with the hospital who we refer patients to when they need a physician.

And the oversight from JCAHO and insurance companies are nearly ubitquitous also...

- H