Cranial is a joke...

Burrell College of Osteopathic Medicine
This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Members do not see this ad.
Jagger, is that not the biggest issue you have with chiropractors? Taking money from unsuspecting consumers using unproven and unscientific techniques? Or is it that they don't disclose the fact that the methods are not scientifically sound?
 
HealingDoc said:
There is a definite value of antecdotal evidence in clinical medicine, but because it bypasses the scientific method, many don't find it to be an adequate basis to use in order to treat patients. But I think after all of the anecdotal evidence I have heard and seen, I would be doing myself and my patients a disservice if I didn't treat with cranial.
Click to expand...

But at what point does a vacuum of any real supportive evidence trump anecdotal evidence? More than 110 years??

My fiance was "diagnosed" with asymptomatic low CSF pressure about 6 months ago. When she told me this I asked "oh, did you get an MRI? CT scan? lumbar puncture? How did they figure this out and why did they do the test?" no, she said, the doctor pressed around on my head with his fingers. To which I replied ??????!!?????!!? That just intuitively made no sense to me, and after looking it up and finding out about the lack of any meaningful studies showing efficacy or diagnostic accuracy I was very confused as to why any doctor would still be practicing cranial. To paraphrase Carl Sagan, extraordinary evidence should be required if we are going to put any credence to extraordinary treatments or diagnostic tools, especially if the general public is going to look to us as experts on these things and we are going to take their money.
 
HealingDoc said:
I have decided that I am not afraid to learn something that has worked for patients in the past, even if the theories may be faulty and the scientific evidence lacking. The more tools in my tool box, the better.
Click to expand...

This is the same malarkey that homeopaths, chiropractors, and other alternative practitioners use to justify their methods. As true physicians we need to start holding ourselves to a higher standard than this. Cranial osteopathy wasn't invented yesterday. If it truly works, we as a profession have had more than enough time to prove it.
 
Last edited:
taylormade2006 said:
Jagger, is that not the biggest issue you have with chiropractors? Taking money from unsuspecting consumers using unproven and unscientific techniques? Or is it that they don't disclose the fact that the methods are not scientifically sound?
Click to expand...

Here's my whole outlook on the situation:

As long as it's not going to harm patients (chiropractic manipulation won't) and patients understand the situation ... then I have absolutely no problem with a patient's right to chose. If they feel comfortable or like chiropractic care - God bless.

Here is my issue:

When non-physician practitioners act as primary care providers and do not encourage patients to seek traditional medicine/treatments when they feel like something is wrong or by telling the patient they don't need to. When people overstep their bounds and enter this realm of 'primary care provider' where medical advice is given (without medical school or residency training to back it up), patients aren't being treated effectively, and I take issue with this.

9/10 times, DCs, per the example you brought up, have no interest in doing this. They are effective at spinal manipulation, and that's what they provide. However it's the 1/10 DCs who advertises themselves as a 'primary care provider,' and advocates against vaccines and big pharma (all under the guise that they have been trained in the US medical school model to do so), that I take issue with.

In an ideal world ... all patients would seek the most effective, proven treatments, and modalities like cranial osteopathy - which hasn't been proven effective or fact based in its 100 year existence, would be reviewed, tested, and cut from the ranks of legitimate medical programs.

However, this isn't realistic. In reality, patients like to integrate CAM, and legitimate physicians (MD and DOs alike) subscribe to some 'funny' practices from time to time. Do I think patients should be well informed and understand that what they're undergoing (which is their choice to do so) is unproven and anecdotal? Yes. Do I think EVERYTHING should be proven safe before practiced on a patient? Yes - and to a certain, reasonable extent, this is true. However, if a professional is going to perform the service; the patient understands what they are receiving; and no one is hurt from doing so (keep in mind that discouraging proven medical care also counts as 'hurt' in my book), then I definitely think the practitioner should be compensated (fairly) for their time.
 
The facts: health care is now evidenced based for reimbursement purposes. Chiropractic is evidence based, off the research of NIH that we can afford to produce, and also what DO/MD do because they can afford it. The attitude expressed downplaying DC is outdated (circa 1980's-1990's). Chiropractic is limited in scope because that is what the AMA lobbies for and will remain this way into the foreseeable future. DC's are okay with this. Oregon needs to get its act together. NY needs to take the rollerpin out of its ***.
 
vanbamm said:
Chiropractic is limited in scope because that is what the AMA lobbies for and will remain this way into the foreseeable future.
Click to expand...

So, hypothetically, if the AMA weren't lobbying for the limited scope of chiropractic, as you say, what would be its scope?
 
Greater ability to manage paraspinal pathologies as they relate to the spine (extremities) because of the biomechanical relationships that exist and may be influenced in regard to spinal malfunction. ABility to conduct screening exams (only to the benefit of the PCP whose patient is getting chiro care), ability to integrate into the military and be part of national programs of health care....basic access from the greater public instead of being outcasted.
 
vanbamm said:
Chiropractic is limited in scope because that is what the AMA lobbies for and will remain this way into the foreseeable future. DC's are okay with this.
Click to expand...

I love how every MD/DO tells me the AMA is powerless, impotent and a waste of oxygen with no relevance to the physicians or medical field. Then every MLP and 'alternative' medicine practitioner (I shouldn't lump DCs in there, but right now I cant think of a more appropriate category name to include every other option out there. My apologies) tells me that the AMA is a monolithic legislation creating monster who is able to hold them back left and right.

Really i cant understand how it can be both ways. To be fair, while we could throw our weight and money around to bully MLPs and alternative medicine practitioners we really dont because we have so many "physician-centric" issues that require our money. Lobbying against you guys is not anything the AMA does in any active sense, unless you want to use the name 'physician.' The AMA has a tantrum if you do that. Anyway, the AMA declared most discriminations and limitations of practice illegal policy in 1980. Most of the complaints i see are based on a 1965 clause that was repealed in multiple ways and wordings from then to 1980.

I'm sure you know more about this than I do and will point out something I missed that is holding you guys back, but I really don't think there is any active force preventing you from expanding your scope of practice except for your own perceptions of some force holding you back, the public opinion (if its against this at all, idk) and sitting lawmakers who dont think its necessary. But the lobbying power of the AMA has better stuff to do, as far as I have been informed and has no standing policy, that I can find, on chiropractic except that they can't call themselves physicians or residents. Thats not a big loss.
 
If I recall correctly, the Wilk case made it illegal for the AMA to intentionally try to defame or hold back the chiropractic profession. I do not believe that the AMA is actively lobbying against chiropractors.

I think it is reasonable for the AMA and/or medical doctors to have issues with unearned and unwarranted requests for scope of practice expansion as well as careless or dangerous marketing and patient recruiting efforts.
 
The type of restraints are indirect- after going to NCLC and speaking with politicians on the topic, there are reasons far beyond the issues of expansion and inclusion- right now the goal is to get the system in place to finally work (reform) before others issues can be manipulated- one of the biggest being the lack of primary care docs- while the AMA is not against DC's, it is trying to ensure that the docs it represents are getting what they need, and so as a side effect, other types of practitioners may be hit a little- as far as "unearned" and "unwarranted" scope of practice, while the MD/DO has 4 yrs of school + min 3 year residency, DC have 4 yrs ( trimesters, 1 break a year. Add those 4 summers, it is 5 years) which concentrates on non-surgical spinal health. I would argue we begin our education specializing in the spine while the MD/DO has a very broad education and doesn't invest in one area until residency- therein lies the difference- MD/DO is trained in many aspects, but at the same time DC offer a needed service for non-surg care- what I really like and what I have near my school and the med school here is a neurosurgery center where the neurosurgeons eval cases and have some candidates get chiro tx with the DC on staff, and then do surg if and when needed, which they see as last resort...
 
vanbamm,
That is why chiropractors should never be considered primary care.
 
Agreed.
 
vanbamm said:
Greater ability to manage paraspinal pathologies as they relate to the spine (extremities) because of the biomechanical relationships that exist and may be influenced in regard to spinal malfunction. ABility to conduct screening exams (only to the benefit of the PCP whose patient is getting chiro care), ability to integrate into the military and be part of national programs of health care....basic access from the greater public instead of being outcasted.
Click to expand...

Three questions:

What kinds of paraspinal pathologies?
What kind of screening exams?
Which national programs of health care?

vanbamm said:
one of the biggest being the lack of primary care docs . . . . while the MD/DO has 4 yrs of school + min 3 year residency, DC have 4 yrs ( trimesters, 1 break a year. Add those 4 summers, it is 5 years) which concentrates on non-surgical spinal health. I would argue we begin our education specializing in the spine while the MD/DO has a very broad education and doesn't invest in one area until residency- therein lies the difference- MD/DO is trained in many aspects, but at the same time DC offer a needed service for non-surg care
Click to expand...

I'm having a difficult time understanding the reasoning here. You're saying the MD/DO is broadly trained in numerous aspects of medicine before they specialize, but a chiropractor doesn't get that broad training and instead specializes from the get-go. I don't see how this supports their expansion into filling the needs of primary care. If anything, it argues against it.

On a side note, I frequently see the chiropractic community insist that their education is indeed longer than it appears on paper, neglecting that the same could be said for many other healthcare fields in which they are comparing. Why has this been the trend?
 
st2205 said:
Three questions:

What kinds of paraspinal pathologies?
What kind of screening exams?
Which national programs of health care?



I'm having a difficult time understanding the reasoning here. You're saying the MD/DO is broadly trained in numerous aspects of medicine before they specialize, but a chiropractor doesn't get that broad training and instead specializes from the get-go. I don't see how this supports their expansion into filling the needs of primary care. If anything, it argues against it.

On a side note, I frequently see the chiropractic community insist that their education is indeed longer than it appears on paper, neglecting that the same could be said for many other healthcare fields in which they are comparing. Why has this been the trend?
Click to expand...

Underlined:
1. I am guessing NMS complaints originating at the spine. (sciatica, brachial plexus, erector spinae, hip flexors, glutes), which I do not know of any state or organization that limits chiropractic care in these areas. He/she could also be referencing extremity manipulation or peripheral neuropathies, however, only a few states prohibit extraspinal chiropractic treatment.

2. I'm not sure what kind of screening exams DC's are excluded from performing. Nearly every state allows access to all forms of radiology (including MRI, CT, plain film x-ray, bone scan, PET scan). Additionally, nearly every state allows not only the ordering of blood testing, but the actual retrieval of the specimen sample. I can't think of any screening procedures relevant to chiropractic practice that are not allowed within the scope of practice of most states.

3. Chiropractic is allowed (but significantly restricted) by Medicare. This may be what he/she is referencing. Medicare only reimburses chiropractors for manual manipulations of the spine. It does not cover any preceding physical or regional examinations (mandatory to meet standard of care), nor does it cover any diagnostic testing or imaging modalities. It also does not cover any adjunct therapy (i.e. soft tissue treatments, exercise prescription, or passive modalities. Excluding passive modalities is a reasonable exclusion, in my opinion.

Bold - I totally agree and seems that he/she does, too. I do not believe anything short of significant hands-on medical training is sufficient to provide prudent primary medical care.
 
It doesn't support DC inclusion into primary care- that is not something I endorse for the profession. As far as restrictions, I speak of NY specifically- there is a way around it (connecting the pathology to the spine) but it's a hassle. Chiropractic modalities actually are covered within diagnosis and treatment codes. Regional evaluation is also covered, again as they relate to the spine (IE relating shoulder redic to cervical malposition) The screening is again, in NY at least, restricted to the point where it is indirect- in order to get a CT or MRI with most carriers, the DC must ask the MD/DO to order it and present why, making it relevant to what the MD/DO is treating that case for...in terms of national systems, I'm talking military, loan forgiveness, greater inclusion for VA, health corps inclusion. The problem is, the priority is getting the healthcare system together to begin with before anything can be altered.
 
vanbamm said:
It doesn't support DC inclusion into primary care- that is not something I endorse for the profession.
Click to expand...

So then why more screening exams?

in terms of national systems, I'm talking military, loan forgiveness, greater inclusion for VA, health corps inclusion. The problem is, the priority is getting the healthcare system together to begin with before anything can be altered.
Click to expand...

As far as loan forgiveness, this only applies to primary care physicians (don't even mention the hypothetical 'work for 10 years in the public sector' BS), so there are numerous physicians who wouldn't even qualify due to specialty.
 
More screening because typically people that use the chiropractor go regularly (once a month or more) but don't go to their primary as often, or until they are ill. Having the ability to screen for more things is twofold: 1. Detecting pathology that would contraindicate chiro care 2. Passing the info along to the PCP for medical care....the point- to detect developing pathology in its early stages and get that info to the doc. This will in the long run, cut costs for tx. Prevention is the key.
 
vanbamm, Are you talking about blood/urinalysis or using radiography as a screening modality?

I looked up the statues for NY and you are correct that blood analysis is not permitted to be used for diagnostic purposes by a chiropractor. Additionally, you are correct that the only form of ionizing radiation permitted to be used by a chiropractor is x-ray. It didn't directly address magnetic resonance imaging.

Despite this, I assure you that NY is not the norm. Most states allow for all of those things already, however, that probably doesn't help you much if you desire to practice in NY.
 
vanbamm said:
Having the ability to screen for more things is twofold: 1. Detecting pathology that would contraindicate chiro care
Click to expand...

Isn't it your responsibility to consider any contraindications to chiropractic before you even begin treating someone? You don't need any special screening for that.
 
vanbamm said:
More screening because typically people that use the chiropractor go regularly (once a month or more) but don't go to their primary as often, or until they are ill. Having the ability to screen for more things is twofold: 1. Detecting pathology that would contraindicate chiro care 2. Passing the info along to the PCP for medical care....the point- to detect developing pathology in its early stages and get that info to the doc. This will in the long run, cut costs for tx. Prevention is the key.
Click to expand...

In theory, I have no disagreements with you. In practicality, however, I disagree. On the issue of it cutting costs, it must be understood that (in my opinion) incompetent physicians drive up the costs of healthcare by ordering tests. I use the term incompetent loosely, but what I really mean is that if they're using a shot-gun approach at diagnosis it will be very expensive. Keep in mind, these are people who have been through four years of medical school and at least 3 years of residency that still have a difficult time forming an appropriate DDx from H&P to be able to r/i and r/o the appropriateness of specific tests. I don't say this to fault them, because I'm positive I'm likely going to make the same mistakes numerous times, especially during residency (which chiropractors, as you are aware, do not complete). I think the biggest thing taught in medical school and residency is how to get the pertinent history to guide further testing. That comes through experience, experience learned by actually doing it (and having experienced attendings guide your decision making). In my opinion, I don't see chiropractors having the experience, training, or clinical knowledge for understanding when tests are appropriate or inappropriate given a particular H&P, especially considering it is a screening for something outside of their scope of practice. I think this only drives up cost, but that's my opinion. I think it makes more economical sense to simply refer them to a PCP upon complaint rather than jumping into tests and then making the referral after results (and who's to say they would be able to properly interpret results to conclude for certain, "No, this is fine. You won't need to see a PCP.") Trust in the PCP to do the workup, as it would probably be must more cost-effective (in my opinion) for him/her to do so. You'd also have to extend this to other things, such as dentists doing HbA1c's, audiologists BMPs, optometrists CBCs, or physical therapists ABGs and pelvic ultrasounds. If all of those were implemented there would be a significant amount of pathology caught, but on the other hand there would be a lot of money wasted, in addition to the fact that despite doing the tests there's still a lot of pathology missed because they don't have the experience and training to do further workup when a particular test is 'negative'. Is this a responsibility you would feel it appropriate to assume?

In the future, I'd hope I'd allow the PCP to do their job. I would hope chiropractic would do the same.
 
Last edited:
I agree, that ordering tests costs money- but what is the trade off- if your clinical impression suggests pathology, and tests aren't ordered (a good DC will talk with the PCP if available to confirm) what will the costs be down the road for treatment- I can't speak on behalf of all DC bc schools have varying philosophies, but I will be evidenced based and practice accordingly- I know I am proficient in ms problems and limited in other areas bc even in internship DC's do not see a wide enough variety of cases to be 100 percent in diagnosis, making it imperative to refer- opinion of DC shouldn't be an assumption but a judgement based on clinical interaction- I do trust in the MD/DO because you do your residency have many more hours and experience-my point is identification of problems via tests to limit costs for tx on the patients end in the longrun- to get healthcare and be american is expensive and a lot of ppl struggle
 
vanbamm said:
I agree, that ordering tests costs money- but what is the trade off- if your clinical impression suggests pathology, and tests aren't ordered (a good DC will talk with the PCP if available to confirm) what will the costs be down the road for treatment- I can't speak on behalf of all DC bc schools have varying philosophies, but I will be evidenced based and practice accordingly- I know I am proficient in ms problems and limited in other areas bc even in internship DC's do not see a wide enough variety of cases to be 100 percent in diagnosis, making it imperative to refer- opinion of DC shouldn't be an assumption but a judgement based on clinical interaction- I do trust in the MD/DO because you do your residency have many more hours and experience-my point is identification of problems via tests to limit costs for tx on the patients end in the longrun- to get healthcare and be american is expensive and a lot of ppl struggle
Click to expand...

Yes, but the point I'm making is that simply referring is going to be much cheaper than someone blindly doing tests and then referring. I'd wager that 9/10, the PCP will be much more efficient and cost-effective in the selection of tests to order, not to mention interpretation. Someone who hasn't been in a medical setting doing medical workups will not have the refined ability to make sufficient diagnosis or have medical reasoning for which tests to order and why. That's what I'm really getting at. You can screen away and cost the patient money. You also wouldn't lose catching the pathology that you're worried about by referring, either. So, referring makes good medical and economic sense. Do we not agree?
 
I see what you mean, I do agree with you on that- referral would, in the end, provide the patient with a tighter, more concise evaluation for the problem rather than 'blindly' testing.
 
Why does vanbamm always high-jack the osteopathic threads and make it about DCs.

The last thing I want when I am looking for information from DO/DO students is the input from a DC student.

No one cares about DCs here, get your own forum
 
vanbamm said:
I see what you mean, I do agree with you on that- referral would, in the end, provide the patient with a tighter, more concise evaluation for the problem rather than 'blindly' testing.
Click to expand...

So then I guess the question becomes whether or not alternative practitioners can provide a better cost/benefit ratio by screening vs. the cost/benefit ratio of referring. I could be wrong, but I'm guessing that by the way you worded your post you're saying 'blindly' testing and not testing in general, which is obvious. My definition for blind testing was ordering tests for something someone is not trained to workup or diagnose, thus making it very difficult to really "screen". If this is what you mean, which I sense it is, I'd be interested in knowing more specifics about what kinds of tests and not just speaking in general terms. What tests could the chiropractic world implement that would provide a better cost/benefit ratio for the patient than would referring? We may or may not agree, I just want to make sure we're talking about the same thing.
 
jl13 said:
Why does vanbamm always high-jack the osteopathic threads and make it about DCs.

The last thing I want when I am looking for information from DO/DO students is the input from a DC student.

No one cares about DCs here, get your own forum
Click to expand...

No DC forums on SDN.
 
I know:laugh: Its perfect
 
HAHA yea, baby steps.

1) forum on SDN
2) better education that isn't centered on quackery
3-197)......
198) equal practice rights
 
I merely contribute but the focus shifts immediately. I'll go to the allo. Side then they don't mind discussion and input...mmm better education? Practice rights? But I only have time to research and prove this subluxation thinger once and for all! Haha. Bon voyage!
 
vanbamm said:
I merely contribute but the focus shifts immediately. I'll go to the allo. Side then they don't mind discussion and input...mmm better education? Practice rights? But I only have time to research and prove this subluxation thinger once and for all! Haha. Bon voyage!
Click to expand...

I'd appreciate if you could give the added clarification first.
 
st2205 said:
So then I guess the question becomes whether or not alternative practitioners can provide a better cost/benefit ratio by screening vs. the cost/benefit ratio of referring. I could be wrong, but I'm guessing that by the way you worded your post you're saying 'blindly' testing and not testing in general, which is obvious. My definition for blind testing was ordering tests for something someone is not trained to workup or diagnose, thus making it very difficult to really "screen". If this is what you mean, which I sense it is, I'd be interested in knowing more specifics about what kinds of tests and not just speaking in general terms. What tests could the chiropractic world implement that would provide a better cost/benefit ratio for the patient than would referring? We may or may not agree, I just want to make sure we're talking about the same thing.
Click to expand...

Here is a scenario he might be thinking of (of course I can't read his mind): Patient presents to chiropractic office that is not necessarily "sick." They are interested in making some lifestyle modifications to "just be healthier." They are 29 years old and haven't really been to the PCP lately. DC is interested in establishing some baselines prior to exercise program initiation and to plot progress, orders lipid profile.

In this scenario of an asymptomatic patient, requesting the patient to make an appointment with a PCP simply to order a lipid profile would add costs to the patient (PCP office visit).

I don't think he's referencing cases where patients present to DC office with a non-NMS complaint and the DC wants to order blood tests to diagnose and treat the non-NMS complaint.
 
taylormade2006 said:
Here is a scenario he might be thinking of (of course I can't read his mind): Patient presents to chiropractic office that is not necessarily "sick." They are interested in making some lifestyle modifications to "just be healthier." They are 29 years old and haven't really been to the PCP lately. DC is interested in establishing some baselines prior to exercise program initiation and to plot progress, orders lipid profile.

In this scenario of an asymptomatic patient, requesting the patient to make an appointment with a PCP simply to order a lipid profile would add costs to the patient (PCP office visit).

I don't think he's referencing cases where patients present to DC office with a non-NMS complaint and the DC wants to order blood tests to diagnose and treat the non-NMS complaint.
Click to expand...

But to my understanding chiropractors can (and do) order lipid panels.
 
Ok here is the rationale and some examples for test ordering:
1. Urinanlysis
-Patient presents with low back pain and the H&P suggests that in addition to mechanical dysfunction treatable by chiropractic, there may be non0mechanical dysfunction associated with; urinary tract infection,signs of renal disease,hx of diabetes, proteinuria,bacteriuria,pyuria,microhematuria

2. Pregnancy Test
-female patient of child-bearing age presents with acute lower back problem- radiograph would like to be taken, but is contrainindicated. Levels of hCG need to be measured, but at the same time, this test may be positive in ectopic pregnancy and carcinomas (i.e. breast cancer)

3.CBC and Differential
-patient presents with neck, back, joint pain- findings indicate other non-mechanical dysfunction and possible infection and/or anemia...

(I dont feel like I need to explain why the tests are being ordered and I dont have enought time at the moment, except for the fact that the patient presents with non-mechanical dysfunction in conjunction to mechanical dysfunction treatable by a DC. Other tests include-)

ESR, Gram Stain and Culture,Serum/Plasma Glucose,Serum Urea and Creatinine,Serum Calcium, Serum Inorganic Phosphorus,PTH,Serum Total Protein and Albumin, Bence-Jones Protein,Protein Electrophoresis,Cholesterol,Serum Alkaline Phosphatase, Serum PAP,Serum PSA,total bilirubin, serum aspartate aminotransferase,Serum creatinine kinase,TSH,uric acid,RH factor,anti-nuclear antibody, HLA-B27,potassium, sodium, iron, ferritin, b12 and RBC folate, pro time, fetal occult blood....all in the end, to get a better picture of what is going on within the patient so that the proper referral to a specialist can be made, rather than send them to the PCP, who will just refer them to the said specialist anyways- all of these tests cost 30.00 or under (except for parathyroid hormone and bence-jones protein which are more expensive).

The question that comes up, and reasonably so, is the clinical impression that is warranting the ordering of these tests and whether or not the DC is proficient enough to make that call- that is going to be on an individual basis- the problem also is whether or not that patient needs to be referred directly or just sent to the PCP with suspicion of said pathology- saving time and saving money if the test is not needed. On that note, DC would also need to implement a residency in internal medicine as they do in radiology/orthopedics/neurology/sports med. in order to make more informed decisions and have the skills and ability neccesary- this whole issue arises from the crisis that there are a number of underserved areas where a PCP is not available (mostly out west- montana, dakotas) and someone needs to be able to help the patient- the approach can be to allow the DC to have the rights, with extended training, to order tests- or the MD/DO world to provide more of an incentive to doctors to get into primary care again and serve these areas that need them. I don't know what is said within the walls of DO school, but right now, lack of PCP is a big problem... If there is not a DO/MD to refer to as the PCP, I am sure as hell not leaving them in the hands of a NP/PA unless they have a ton of clinical experience.
 
vanbamm, like I said before, the restricted scope is only in a few eastern states, the laws in NY are not universal, nor do they represent a significant portion of scope laws across the country. In ND the scope of practice allows for any test a DC could ever ask for. The only difference being medicare/medicaid allowing for spinal manipulation only.

st2205, in NY insurance will not cover any blood tests ordered by DC. I actually think it might be law that DC can not order any blood tests.
 
vanbamm said:
ESR, Gram Stain and Culture,Serum/Plasma Glucose,Serum Urea and Creatinine,Serum Calcium, Serum Inorganic Phosphorus,PTH,Serum Total Protein and Albumin, Bence-Jones Protein,Protein Electrophoresis,Cholesterol,Serum Alkaline Phosphatase, Serum PAP,Serum PSA,total bilirubin, serum aspartate aminotransferase,Serum creatinine kinase,TSH,uric acid,RH factor,anti-nuclear antibody, HLA-B27,potassium, sodium, iron, ferritin, b12 and RBC folate, pro time, fetal occult blood....all in the end, to get a better picture of what is going on within the patient so that the proper referral to a specialist can be made, rather than send them to the PCP, who will just refer them to the said specialist anyways- all of these tests cost 30.00 or under (except for parathyroid hormone and bence-jones protein which are more expensive).
Click to expand...

First HLA-B27, ANA panel, protein electrophoresis probably aren't going to be under 30 bucks, even before the cost of venipuncture is figured in.

Lastly, I'm not sure your bolded part holds a whole lot of anything. So if a PCP orders a UA and the Nitrite and Leukocyte Esterase are positve the PCP is going to refer the patient to a urologist? Or would you prescribe antibiotics at that point, furthering your scope of practice? The problem comes up that, just because a solid chiropracter doesn't know how to treat the problem you're assuming a solid PCP doesn't know how to treat the problem and that is a HUGE assumption.

Additionally who regulates whether the chiro is then allowed to order just a Serum Electrolyte panel or a full blown Karyotype? Where exactly would the buck stop?
 
I just don't see the point in a provider ordering tests to diagnose things he/she doesn't treat.
 
To give the next guy a head start
 
I would just refer the patient to their PCP so he/she can order the tests they want based on their exam/opinion.
 
vanbamm said:
To give the next guy a head start
Click to expand...

But you're assuming that "the next guy" is going to order those tests anyway.

Honestly, I don't see the point, and frankly don't think you should be ordering tests to rule in/out diseases that you have not been trained to handle or manage. And to say that saves costs may not be true, especially if a lot of unneeded tests are ordered.
 
vanbamm said:
To give the next guy a head start
Click to expand...

The first thing the next guy is going to do is redo the tests (if he/she does agree). Legally, it's foolish not to do so.
 
The rate of chiropractic manipulations causing strokes is exceedingly rare.
 
FutureDr8429033 said:
Chiropractic manipulation can cause strokes.

http://www.sciencebasedmedicine.org/?p=94
Click to expand...

One of our OMM professors gave a lecture on cervical spine manipulation and the rate of vertebral artery dissection (as he called it), and unless he had some reason to show bias (which I doubt from knowing him), the chances of impinging/damaging the vert artery during reasonable cervical manipulation is very, very low.

Again, he could have been showing some sort of bias, and I'm not 100% familiar with the way DCs manipulate the c-spine, but the way it's taught in OMM (after getting over the initial jitters about it) seems safe.
 
http://chiromt.com/content/18/1/22

An article from what was formerly Chiro and Osteo journal (now chiropractic and manual therapies) that discusses the factors contributing to CVA from cervical manipulation (HVLA), which pertains to those chiro's that do c-spine, and those D.O.'s that utilize it in the context of osteopathic manipulation-

Interesting point: cervical manipulation will not cause a stroke to occur in a healthy patient because the force utilized in this type of manipulation is not enough to cause vascular disturbances that would cause the vertebral artery and its associated pathways to dissect- BUT in patients that are susceptible to stroke or present with signs and symptoms indicitive of stroke or vascular compromise, this technique should not be used because it can instigate stroke...this brings emphasis to a thorough exam and orthopedics (i.e. hautants, underburgers, barre lieu, halsteads etc.) and evaluation of vitals amd neurological responses in the patient...I am glad this paper was published to identify that the problem is not in the technique or the practitioner themself, but in the screening process which needs to be complete.
 
vanbamm said:
http://chiromt.com/content/18/1/22

An article from what was formerly Chiro and Osteo journal (now chiropractic and manual therapies) that discusses the factors contributing to CVA from cervical manipulation (HVLA), which pertains to those chiro's that do c-spine, and those D.O.'s that utilize it in the context of osteopathic manipulation-

Interesting point: cervical manipulation will not cause a stroke to occur in a healthy patient because the force utilized in this type of manipulation is not enough to cause vascular disturbances that would cause the vertebral artery and its associated pathways to dissect- BUT in patients that are susceptible to stroke or present with signs and symptoms indicitive of stroke or vascular compromise, this technique should not be used because it can instigate stroke...this brings emphasis to a thorough exam and orthopedics (i.e. hautants, underburgers, barre lieu, halsteads etc.) and evaluation of vitals amd neurological responses in the patient...I am glad this paper was published to identify that the problem is not in the technique or the practitioner themself, but in the screening process which needs to be complete.
Click to expand...

Yup. This was essentially what I was told as well. The perception has shifted from testing everyone for some sort of vertebral artery issue beforehand/not performing cervical because of the very small chance of VA issue, to essentially screening for those who already have compression issues (reports of dizziness, vision problems, etc) and using this as a contraindication for treatment.
 
DannyDeRosa said:
Cranial is a Joke and so is anyone who uses it! I defy you to provide legit research proving me wrong. I think it should be tossed out of medical education period. There is nothing worse than being in a rotation with a cranio-sacral therapy quack and having to go along with his/her enthusiasm about it to get an A in OPP. I dont feel the CRI becuase it isnt there...If it isnt HVLA or ME I simply dont believe its worth a dollar to medicare or my education.
btw.....has anyone else looked up osteopathic manipulative therapy on "uptodate.com"......its sad just how little real evidence osteopathy has acrued in 118 years.
Click to expand...

Cranial Joke!

So I am studying the other night for an OMM test, and my father, who is a Family Practice DO walks by and says: "What is it tonight"? I say "Craniosacral technique". Dad: "Is that the one with the chicken??………. or is that voodoo? I still get the two confused". Score one for science!
 
OkieStateof16 said:
Cranial Joke!

So I am studying the other night for an OMM test, and my father, who is a Family Practice DO walks by and says: "What is it tonight"? I say "Craniosacral technique". Dad: "Is that the one with the chicken??………. or is that voodoo? I still get the two confused". Score one for science!
Click to expand...
I like your dad.
 
You must log in or register to reply here.

Similar threads

U
NYT: So Your Doctor Is a D.O. Does That Matter?
Replies
2
Views
2K
amoxicillin_resistant
amoxicillin_resistant
pigsinacloth
How bad is a generic letter of rec?
Replies
4
Views
2K
pigsinacloth
pigsinacloth
magician7772222
How big of a deal is P/F vs no graded
Replies
17
Views
3K
Goro
Goro
pigsinacloth
Is it too late to get a LOR for this cycle?
Replies
4
Views
1K
wysdoc
wysdoc
Mr.Smile12
Reminder: How is your school using AI?
Replies
1
Views
910
turtleai
T
Top Bottom