Doctorate

[FoughtFyr]

I had a year of microbiology. Does medical school have several different courses in microbiology?

I don't see the point of arguing with you about chiropractic education. It seems that no matter what I say, you dwell on the chiropractic principles and philosophy which is for the most part, old school chiropractic.

Most general practitioners lack diagnostic skill in the NMS department. You say we have a problem differentiating between mechanical or pathological back pain or NMS complaints, look at your own doctors. I'm sure being a ER doctor you see plenty of doctors (MD/DO) missing things.

Yes, at my school microbiology was a two year course. And microbio permeates most of our other coursework as well. Path, clinical rotations etc. all have large microbio components.

The reason I dwell on "old school" chiropractic is that it forms the basis for your education. You learned to do a physical exam based in large measure on how Palmer wanted it done! The profession does NOT interface with medicine as a whole, because it is not based in medicine. Now, individuals can, and do, "see the light" and attempt to work with the medical systems in their area. I'm glad, but on a wide scale basis this would require chiropractic education to change radically, something that we agree is not going to happen.

And yes, I see plenty of missed diagnoses from all variety of providers. And I am sure that I miss some myself. But, when I miss a diagnosis, or when another MD/DO does, it generally is not because we were unaware of a disease/disorder but rather because we failed to detect it. Chiropractors do not have an adequate enough background in pathology to serve as primary care providers.

A good way to demonstrate this is by looking at chiropractic education. You are, primarily, taught by other chiropractors. MD/DOs are taught by microbiologists, pathologists (both clinical and PhD), pharmacists, immunologists, and other research faculty. We are, at least initially, as "up-to-date" as possible in known disorders/disease. You expect a reasonable person to believe that in three years (one year less schooling) and no residency (three years minimum less training) you not only have achieved the same mastry of diagnosis, but also learned all of chiropractic treatment and therapy? When did you sleep? Face facts, you are simply not trained anywhere near the MD/DO level in basic diagnosis of medical conditions. As such, you will miss some diagnoses they would not. Missing diagnoses can have VERY bad outcomes.

Do we "miss" NMS diagnoses. Yep! In fact, after I eliminate more systemic pathology, I routinely refer to PTs with orders to "evaluate and treat" based on their own findings. Why? Because I know that they are far better trained than I in NMS. It is much the same to me as referring to any other medical specialty. The key step? Eliminating systemic pathology! A great case in point is a patient I am treating now. She has a insufficiency fracture at the edge of her SI joint. Not detectable by x-ray or CT but clear as day on a nuclear scan. Had been going to a chiropractor for 3 visits. Each had made her "feel worse" - (pts words, not mine). Now, armed with the correct diagnosis, OT and PT are very helpful in her care. Did her primary care doc "miss it" too? Sort of I guess, but he sent her to the hospital for evaluation after a negative x-ray (which kept her from her next chiropractic appointment. The chiropractor had told her that some pain after manipulation was "normal". We will NOT be referring her back to his care).

I could give you at least half a dozen cases off the top of my head where chiropractors delayed care in high morbidity or mortality settings. In each case MD/DOs correctly diagnosed and treated the patient to resolution. I challenge you to find ONE documented case where a chiropractor evaluated a patient with significant morbidity or high risk for mortality, found a condition missed by an MD/DO, and treated the patient to resolution for that condition. Until then, you won't convince me.

- H

---

Members don't see this ad.

 

[FoughtFyr]

BTW - I thought of one more issue no one has raised yet regarding chiropractic. As a physician, I am overseen not only by a state board (as are chiropractors) but also by individual hospital departments of quality and medical staff boards.

If I have privileges in a healthcare facility or hospital (and almost all physicians do), that hospital's quality staff (itself overseen by JCAHO) monitors various outcomes measures against those of my peers. Things like length of stay, return visits within 30 days of discharge, and significant poor outcomes are monitored. Should I be found to have significantly different outcomes than my peers, an automatic review (read: investigation) is started. And before you scream "doctors protect their own" realize that nurses and public health professionals whose job it is to protect the hospital from lawsuits usually staff quality departments. They leap at any variance from accepted norms and will pull privileges quickly at any sign of trouble.

Should, during my interactions with my peers at a hospital, my skill be called into question, either by virtue of a single event, or an overall pattern, the Medical Staff Board will take notice. This may take the form of an M&M, which is dissecting an individual case to determine ?what went wrong?, or a more structured peer review. In either case, others who can ask that my privileges be restricted or pulled entirely will oversee my work. They can, and do, also file reports with the state medical board.

All of that says nothing about the proficiency and training I had to demonstrate to get the privileges in the first place.

Now, it is true that a physician could see patients without having hospital privileges, but such folks are very rare. And how many work without at least a nurse - yet another professional looking out for the patient. If there were a physician, working alone, without privileges or a nurse, their "missed diagnoses" would be quickly relayed to the state board by ED personnel.

Of course, when we are ?stumped? we admit a patient to the hospital. Why? Because, almost no patient in the hospital is seen by only one doctor. In the case I described earlier (the woman with the SI insufficiency fracture), four MDs saw her pre-diagnosis, and two more afterward (Before - her PCP, the ED doc, the Hospitalist and the Radiologist; After - an anesthesiologist for pain control and a physiatrist overseeing PT/OT). If malfeasance had occurred by a physician, working alone, disconnected to any other oversight methods, any of us would call the state board - assuming the PTs, OTs, or nurses didn't beat us to it.

If she had continued to be treated by her chiropractor, who else would have seen her? How would his work be checked? Is there a method to insure that a chiropractor doesn't take longer than his/her peers to treat a given condition? Are more than one chiropractor routinely involved in a single patient's care? Is there any quality control not regulated by the treating chiropractor?

So, less training, less oversight, less available resources and no cohesive integration with other providers equals better care?

- H

 

[BackTalk]

I have read many posts by you Backtalk, and I am certain that you are a chiropractor that I would refer to. You are a sensible person, and are a credit to your profession. If only all DCs were like you. I definitely acknowledge that there are PT "quack jobs". There are many that I would not want to rely upon to evaluate me or my mother in my absence. There are always failures in every profession. Question: what do you call the person who finishes last in their medical school class? Answer: Doctor.
That said, I truly believe that it is the lack of a consistent standard of practice in chiropractic that is your undoing. When sensible people like yourself say that DCs don't treat medical problems, you are ignoring a significant part of your professional population. There is a DC in my town who makes outrageous claims all the time and on the radio and in his advertisements in the newspaper. I actually had to report him for claiming to do physical therapy. He denied it and was absolved of all wrong doing by the state DC board. He claimed that it was an oversight and that the firm that he had hired for marketing assistance had done it without his knowledge. I thought it was interesting that it happened in the advertisement in the local high school athletic program, his business cards, and the little advertising blurbs you watch before seeing a movie at the local theater.

I was interviewing a woman for a secretarial position who happened to have worked in his office. She was incredibly well qualified. She had worked in his office as a clerical worker, was a chiropractic assistant, knew medical terminology, was able to take Xrays ( not really of benefit to me) and was a very personable person. In our interview and on her resume she said that she was in charge of the physical therapy done in his office. I asked her if there was a PT in the office and she obviously said no and I informed her that then there was no physical therapy being done. Our interview continued and she asked how is PT different than DC and I responded with question. Did you ever see patients that were diagnosed as having a leg-length discrepancy? She said "Oh yes, all the time." I asked her if people ever got lifts for their shoes and she said, almost never.
It is this kind of caricature of your profession that is ruining it. This guy is everything that traditional medicine doesn't like about DCs. He does not stay within his scope of practice, makes claims that are outlandish (but not disprovable) and is a very good salesman. There is nothing wrong with selling yourself, but this guy preys upon peoples hopes and convinces them that it is critical that they attend weekly sessions for life.

Finally, I am sure that you take classes in non-NMS disorders, its just that some DCs think that they can treat things that no science has ever shown that they can. (e.g. middle ear infections) PTs do not.
I read a post once, it might even have been from you. Palmer based the subluxation theory on the curing of a deaf man's hearing loss. That was a long time ago. The person who wrote the post said that he had asked all of his DC friends if they had ever cured deafness or known someone who had cured deafness and they all said no. If it was truly from the adjustment, wouldn't it have happened again since?
If subluxation theory is true, it should be easy to document its effectiveness in a controlled double blinded study that the entire scientific community could agree was legit. Instead it seems that it is based on anecdotes and theoretical principles that do not make scientific sense.

Regards

Truthseeker, you are a friend. I was trying to set you up but didn?t get the response I was looking for. I?m glad I didn?t, as it would have lead to nothing but fighting. As a chiropractor I?m always on the defensive and sometimes I?m that way without even knowing it until I go back and read my post. I spend my life defending what I do and trying to defend what I feel chiropractic is. I hope people will look at it as a NMS specialty. That puts us in competition but there are plenty of patients that can benefit from both of our services. It?s hard to defend what I do when my profession has such a lousy reputation.

Knowing that you would refer to me is a compliment. I appreciate that. As you probably already know there are DC?s out there that I wouldn?t let examine my dog yet let adjust him. I acknowledge that my profession has a real problem. We have way too many goof balls like the guy you mention that in your town. Unfortunately there are many like him. Sometimes I wonder if they practice the way they do because they truly believe that what they?re doing is real or really works or they are just scumbags out for money. I agree that standardization is a big problem.

I?m assuming that what you are saying as far as ?medical problems? are those that should only be treated with a medical approach. We know that many NMS are also medical problems but you and I can effectively treat them. The only things that I have seen spinal manipulation treat effectively outside of NMS complaints are headaches, allergies and asthma. My little girl had chronic ear infections. I was up at the urgi-care center in town once a week. You know it?s bad when the doctors recognize and call you by first name.

Being a chiropractor I figured chiropractic manipulation would do the trick. I heard so much about how chiropractic worked great for ear infections. Well, it didn?t do a ****! Thinking I was doing something wrong I brought her to a pediatric chiropractor. Again it didn?t work. I tell you the thing that did work were tubes. It worked great and cured her ear infections. Being a chiropractor I had a hard time accepting the medical approach. I didn?t until I had an ear infection that hurt so damn bad I was popping Percocet?s that were left over from a kidney stone. I realized the pain she was going through and we scheduled an appointment to have it done. So whatever the quack is doing in your town with ear infections I would like to know.

Listen, chiropractors are like a gang of wolves. They will protect there own. What the guy was doing in your town was illegal, he got caught and the DC board swept it under the table. It?s a pretty common practice. Many times chiropractors refer to anything they do other than chiropractic manipulation as physical therapy. We use modalities and some of us actually do rehab. I realize the practice of physical therapy is not laying a heat pack on someone or just using modalities. I understand your frustration.

The more I read about the guy in your town the more I want to burn clinic down. We ought go get a 12 pack of beer and then go torch his place....hehe. Listen, that guy is a scumbag using his title of doctor to prey upon people. I offer no defense. He is a dirtbag and needs to be dealt with and is the main reason we have the reputation we do.

The guy does not use heal lifts because he is an idiot. We use them all the time and differentiating between a functional or structural short leg is something we have learned over and over in school. We use a heal lift for functional deficiency as many times with treatment we can eliminate the need for the lift. With a structural deficiency I like to get the patient a nice set of orthotics with a built-in lift as they will be wearing them long term.

I agree with your analysis of subluxation theory. Something that doesn?t exist can?t be duplicated.

H, it?s nice talking with you. I will get back to you soon.

 

[lawguil]

I'm equally sorry that I'm not convinced ATC or PT has the ability to take on a direct access role.

What I meant by lacking the tools was the use of prescription medication. Lacking the ability to use meds doesn't affect the ability to rule out pathology but rather the ability to treat. When someone comes in the office with symptoms beyond what we recognize we refer them to a specialist for a consult. If we recognize it and it's out of our scope of practice we refer them out. Most medical doctors do the same thing.

You can utilize whatever profession you like. Being in England it's my understanding that an osteopath isn't a medical doctor nor trained like one in the states. If you were in the states I would understand your reasoning for using a DO. As for the physical therapists, are you saying they are better trained than a DC and that is why you use them?

I agree with you that ATC/PT should not have direct access and I certainly don't think that DC should have direct access. I have no problem with DC/PT/ACT treating NMS disorders, but there should be a system that makes darn sure that they are treating just that. To answer your question about whether I think PT are better trained than DC? Yes!
I suspect that DC would naturally be concerned about losing direct access because it would probably have a MAJOR affect on there business.

Please enlighten me about the elaborate skills and training you have to identify pathology/disease. Tell me how familiar you are with all the diagnostic tests that you have at your disposal and your experience interpolating the data.

 

[Science_Guy]

I?m assuming that what you are saying as far as ?medical problems? are those that should only be treated with a medical approach. We know that many NMS are also medical problems but you and I can effectively treat them. The only things that I have seen spinal manipulation treat effectively outside of NMS complaints are headaches, allergies and asthma. My little girl had chronic ear infections. I was up at the urgi-care center in town once a week. You know it?s bad when the doctors recognize and call you by first name.

Backtalk, not to jump on the chiro-crushing bandwagon, but I do have a very serious question for you. You claim above to have seen spinal manipulation treat allergies and asthma effectively. In how many cases did you actually see something like this, given the very distinct nature of the immune system from that of the nervous system? Also, are you saying that these patients never again suffered from asthma or allergies, and what information did you use to support the claim that spinal manipulation "effectively treated" these conditions? Has any peer reviewed journal published the results of chiropractic care versus the use of other standards of care for these disorders, such as long acting beta agonists or corticosteroids for asthma, or histamine blockers for allergies? And is this something that you advocate as part of your own chiropractic practice?

 

[BackTalk]

I agree with you that ATC/PT should not have direct access and I certainly don't think that DC should have direct access. I have no problem with DC/PT/ACT treating NMS disorders, but there should be a system that makes darn sure that they are treating just that. To answer your question about whether I think PT are better trained than DC? Yes!
I suspect that DC would naturally be concerned about losing direct access because it would probably have a MAJOR affect on there business.

Please enlighten me about the elaborate skills and training you have to identify pathology/disease. Tell me how familiar you are with all the diagnostic tests that you have at your disposal and your experience interpolating the data.

DC's will never lose their direct access. It's never going to happen. There are some that shouldn't have direct access privileges.

You know who your biggest opponent is with concern to direct access? It's not us, it's the MD's. When it comes to chiropractic it's not the PT's, it's the osteopaths who are our biggest opponents. They love to try to block everything.

What training does a PT have in differential diagnosis or laboratory diagnosis? What about diagnostic imaging? What about physical diagnosis? Do PT's do school, sports, employment or DOT physicals? If not then why not? Do PT's draw blood or order and interpret diagnostic studies or labs? Do PT's learn prostate exams, breast exams or how do a hernia exams? H, yes we had to do them on live people when I was at school. No pelvic's though.

What about the MPT who takes online courses to get their tDPT? What is that all about? I have a DPT that works for a diagnostic company that does my NCV's. He is not very happy with his education and mentioned it's not worth the further cost of education as there is no difference in pay or scope of practice. He says that most companies would hire an experienced PT over a DPT. From what I understand there is not much difference between a DPT and a MPT and that's why you can take a few filler courses online to meet the DPT requirements if you already have the MPT.

We may not be equivalent to a MD or DO in medical diagnosis but we certainly have a lot more training than a PT.

I don't have time to go through my training and explain to you how to interpret diagnostic imaging or labs or whatever. Go here and you can read all about the education where I went to school. Courses start around page 72.

http://www.logan.edu/pdf/logan_catalog.pdf

 

[BackTalk]

Backtalk, not to jump on the chiro-crushing bandwagon, but I do have a very serious question for you. You claim above to have seen spinal manipulation treat allergies and asthma effectively. In how many cases did you actually see something like this, given the very distinct nature of the immune system from that of the nervous system? Also, are you saying that these patients never again suffered from asthma or allergies, and what information did you use to support the claim that spinal manipulation "effectively treated" these conditions? Has any peer reviewed journal published the results of chiropractic care versus the use of other standards of care for these disorders, such as long acting beta agonists or corticosteroids for asthma, or histamine blockers for allergies? And is this something that you advocate as part of your own chiropractic practice?

You wouldn't happen to be chico the pharmtech who is doing graduate studies would you? Why did you change your name? Oh well maybe I'm wrong but it's quite a coincidence.

First off let me start by saying I do not directly treat allergies or asthma. It's indirectly. Secondly, it's not a cure. What I have noticed is symptomatic relief. I have no hard evidence to back this up. I do believe there has been some research done through chiropractic intuitions and we know how that goes. Perhaps there are a few osteopathic studies. Anyway, my evidence is anecdotal. All I can say is I have treated enough patients over the years for midback pain and neck complaints that have mentioned a reduction in symptoms related to allergies and asthma that there has to be some connection. I never said that chiropractic was the cure-all for these complaints. You can call it what you want, I'm just saying I've seen it too often for it to be coincidental with the waxing and waning related to both conditions. You can take that and crush it or do whatever you want with it. It won't change what I've observed over the years.

 

[FoughtFyr]

I don't have time to go through my training and explain to you how to interpret diagnostic imaging or labs or whatever. Go here and you can read all about the education where I went to school. Courses start around page 72.

http://www.logan.edu/pdf/logan_catalog.pdf

Yes, but admittedly, they were taught by other Chiropractors. Given that, one could call into question the quality and validity of the instruction.

- H

 

[FoughtFyr]

DC's will never lose their direct access. It's never going to happen. There are some that shouldn't have direct access privileges.

Agreed.

You know who your biggest opponent is with concern to direct access? It's not us, it's the MD's. When it comes to chiropractic it's not the PT's, it's the osteopaths who are our biggest opponents. They love to try to block everything.

Well, that is probably a reaction to the many "straights" that are still out there practicing, and worse, teaching.

What training does a PT have in differential diagnosis or laboratory diagnosis? What about diagnostic imaging? What about physical diagnosis? Do PT's do school, sports, employment or DOT physicals? If not then why not? Do PT's draw blood or order and interpret diagnostic studies or labs? Do PT's learn prostate exams, breast exams or how do a hernia exams? H, yes we had to do them on live people when I was at school. No pelvic's though.

We may not be equivalent to a MD or DO in medical diagnosis but we certainly have a lot more training than a PT.

The problem is that most chiropractors who do "complete" physical exams (e.g., DOT and school physicals), including you up until this post, do not let their patients know that they "are not equivalent to an MD or DO". In fact, many folks believe that chiropractors ARE MD/DOs. It is this misconception, coupled with that inequity that concerns me.

Look, I agree that chiropractors represent an alternative to "medicine" in NMS complaints (although I'm sure we disagree with regard to its effectiveness). I agree that PTs are also not adequately prepared to do primary care. BUT, I realize that the lack of direct access puts them at a disadvantage in a business sense. I do believe a PT is at least as well trained as a chiropractor (and their schools are certainly more difficult to enter). And while I don't like it, I think that allowing PTs direct access will help to differentiate chiropractors from physicians in the public's eye. Right now, they believe chiropractors are MD/DOs in large measure because of the title "doctor" and the direct access.

- H

 

[Science_Guy]

You wouldn't happen to be chico the pharmtech who is doing graduate studies would you? Why did you change your name? Oh well maybe I'm wrong but it's quite a coincidence.

First off let me start by saying I do not directly treat allergies or asthma. It's indirectly. Secondly, it's not a cure. What I have noticed is symptomatic relief. I have no hard evidence to back this up. I do believe there has been some research done through chiropractic intuitions and we know how that goes. Perhaps there are a few osteopathic studies. Anyway, my evidence is anecdotal. All I can say is I have treated enough patients over the years for midback pain and neck complaints that have mentioned a reduction in symptoms related to allergies and asthma that there has to be some connection. I never said that chiropractic was the cure-all for these complaints. You can call it what you want, I'm just saying I've seen it too often for it to be coincidental with the waxing and waning related to both conditions. You can take that and crush it or do whatever you want with it. It won't change what I've observed over the years.

LOL...no, I assure you I am not "chico"...in fact, have only been on the boards for a very short time. Also, I completed my PhD several years ago....I am THANKFULLY not still living the 24-hour life of a graduate student.

Given the natural history of many allergies and other immune system problems, I am not at all surprised that you have seen some changes in allergies for many patients. My concern with Chiropractic has been the claims of many in your profession to cure conditions such as asthma and allergies with spinal manipulation. My contention is that this is best managed by a specialist, with appropriate standards of treatment since asthma can obviously be a very serious condition in children and adolescents. In order to make a "cause and effect" analysis of spinal manipulation, one would need a very well designed study, such as the one published in the NEJM in 1998 in which chiropractic manipulation was added to common allopathic methods of treatment (which showed no statistical difference between the cohorts with vs the cohorts without spinal manipulation).

By the way...I have a good friend who is a DC, and his own philosophy may be very close to yours.

 

[OzDDS]

What do you guys think about this..

http://forums.studentdoctor.net/showpost.php?p=2034572&postcount=73

interesting..

 

[BackTalk]

Yes, at my school microbiology was a two year course. And microbio permeates most of our other coursework as well. Path, clinical rotations etc. all have large microbio components.

Well you have an extra year on me. That?s OK because you need it for what you do.

The reason I dwell on "old school" chiropractic is that it forms the basis for your education. You learned to do a physical exam based in large measure on how Palmer wanted it done!

Nope. I learned it from multiple instructors from EENT to GI and UI. We used Bates in school not mysterious books written by the pot smoker BJ palmer.

The profession does NOT interface with medicine as a whole, because it is not based in medicine. Now, individuals can, and do, "see the light" and attempt to work with the medical systems in their area.

That?s right it is not based in medicine. It is a unique and separate profession. Most all of them "see the light". Most schools do not preach the BJ philosophy.

I'm glad, but on a wide scale basis this would require chiropractic education to change radically, something that we agree is not going to happen.

Chiropractic school has changed for the better and will continue to change with time.

And yes, I see plenty of missed diagnoses from all variety of providers. And I am sure that I miss some myself. But, when I miss a diagnosis, or when another MD/DO does, it generally is not because we were unaware of a disease/disorder but rather because we failed to detect it. Chiropractors do not have an adequate enough background in pathology to serve as primary care providers.

It?s hard to admit when we miss a DX. I?ve done it too. Practice is a learning experience. At least you have the balls to admit it.

A good way to demonstrate this is by looking at chiropractic education. You are, primarily, taught by other chiropractors. MD/DOs are taught by microbiologists, pathologists (both clinical and PhD), pharmacists, immunologists, and other research faculty.

Not entirely true, we were taught pharmacology and toxicology by a PharmD who also taught at St. Louis College of Pharmacy. MD?s taught our pathology courses, physiology and OBGYN courses. Our physiology professor was also a Ph.D. Micro was a Ph.D. who also taught at St. Louis College of Medicine, same for Biochem instructor. Most professors in school were not DC's. If they were a DC most had other professional degrees and some had Ph.D. It is true that we did have some courses that were taught DC?s just like you have course taught by MD's. We even had instructors who were PT's. Why would we learn things from an MD when a DC is more qualified to teach them?

We are, at least initially, as "up-to-date" as possible in known disorders/disease. You expect a reasonable person to believe that in three years (one year less schooling) and no residency (three years minimum less training) you not only have achieved the same mastry of diagnosis, but also learned all of chiropractic treatment and therapy? When did you sleep? Face facts, you are simply not trained anywhere near the MD/DO level in basic diagnosis of medical conditions. As such, you will miss some diagnoses they would not. Missing diagnoses can have VERY bad outcomes.

You got a residency, which apparently is the key to your medical education. I lack that. Therefore you are qualified to be a Primary Care Physician and I am not. I know that.

You are an ER doctor. You are very smart. I would expect you to know just about everything because most of the time you have too. You are one of the best at making a ruling on systemic pathology. Not all MD's are as talented as you. In fact, the skills of many family practitioners are not that great when it comes to NMS diagnosis.

A great case in point is a patient I am treating now. She has a insufficiency fracture at the edge of her SI joint. Not detectable by x-ray or CT but clear as day on a nuclear scan. Had been going to a chiropractor for 3 visits. Each had made her "feel worse" - (pts words, not mine). Now, armed with the correct diagnosis, OT and PT are very helpful in her care. Did her primary care doc "miss it" too? Sort of I guess, but he sent her to the hospital for evaluation after a negative x-ray (which kept her from her next chiropractic appointment. The chiropractor had told her that some pain after manipulation was "normal". We will NOT be referring her back to his care).

The chiropractor practiced within his standard of care. Now if he was treating for 3-4 weeks then I could see where we have a problem. If he didn't order an x-ray (even though the FX was undetectable) we would have a problem. I agree it probably made it worse. Also, it is not uncommon to have some increased pain after manipulation. Usually it is only temporary. I tell people many times that they will probably notice some increased soreness and to ice it. The DC took films and it was undetectable with plain film, he did three treatments and probably didn't have the opportunity to see here again to re-evaluate. I feel if she continued to go to the DC, he would have noticed that the treatment was just not working and probably would have order further testing. I'm not sure if he would have opted for the bone scan right off the bat. If she had a history of a fall or injury or perhaps cancer he probably would have. Listen, this is a tough case and anyone could have had the same outcome. My brother had a patient with shoulder complaints that ended up being heart related. Her MD didn't catch it and she was referred to a DC (My brother) for shoulder treatment. He referred her back to the PCP who sent her to a cardiologist who found an 87% blockage. Patient wouldn't listen to his advice and ended up having a deadly heart attack the following week. So hey, sometimes these conditions can fool anyone. I've been fooled before and have become better as a result of it. Remember I had that patient that had a spinal tumor that was undetectable on my films. I think we talked about him already.

I could give you at least half a dozen cases off the top of my head where chiropractors delayed care in high morbidity or mortality settings. In each case MD/DOs correctly diagnosed and treated the patient to resolution.

You probably could also give 6 more off the top of your head where a MD or DO delayed care due to improper DX and the patient wondered into your ER.

I challenge you to find ONE documented case where a chiropractor evaluated a patient with significant morbidity or high risk for mortality, found a condition missed by an MD/DO, and treated the patient to resolution for that condition.

I will see what I can find. If we catch something that has a high mortality than it probably falls outside the realm of NMS and we have no means to treat it. We would then have no alternative but to refer to the PCP or to a specialist.

 

[FoughtFyr]

The reason I dwell on "old school" chiropractic is that it forms the basis for your education. You learned to do a physical exam based in large measure on how Palmer wanted it done!

Nope. I learned it from multiple instructors from EENT to GI and UI. We used Bates in school not mysterious books written by the pot smoker BJ palmer.

O.k., but we can agree that the administrations of most Chiropractic Colleges lean more towards "old school" than new...right?

The profession does NOT interface with medicine as a whole, because it is not based in medicine. Now, individuals can, and do, "see the light" and attempt to work with the medical systems in their area.

That's right it is not based in medicine. It is a unique and separate profession. Most all of them "see the light". Most schools do not preach the BJ philosophy.

"It is a unique and separate profession", one that has not been demonstrated to be more effective than medical treatment for any condition. There are good RCTs that demonstrate that Chiropractic is as effective as medicine in treating idiopathic low back pain, but it has never been demonstrated, in a quality controlled RCT to be better than medicine.

Again less training and the risk of "straights" misleading patients in return for what benefit? Keeping you in practice?

I'm glad, but on a wide scale basis this would require chiropractic education to change radically, something that we agree is not going to happen.

Chiropractic school has changed for the better and will continue to change with time.

Come on, you have admitted on other threads that it is extremely easy to enter most chiropractic colleges. I have posted a study by chiropractors about the lies and misrepresentations used to recruit students. How has it gotten better? And the "mecca", Palmer College, continues to spew out "straights" at an amazing rate!

And yes, I see plenty of missed diagnoses from all variety of providers. And I am sure that I miss some myself. But, when I miss a diagnosis, or when another MD/DO does, it generally is not because we were unaware of a disease/disorder but rather because we failed to detect it. Chiropractors do not have an adequate enough background in pathology to serve as primary care providers.

It's hard to admit when we miss a DX. I've done it too. Practice is a learning experience. At least you have the balls to admit it.

Actually almost all docs have to admit it. Why? Because as described in my other post, we are constantly reviewed by other physicians, nurses, and public health professionals. Are you?

A good way to demonstrate this is by looking at chiropractic education. You are, primarily, taught by other chiropractors. MD/DOs are taught by microbiologists, pathologists (both clinical and PhD), pharmacists, immunologists, and other research faculty.

Not entirely true, we were taught pharmacology and toxicology by a PharmD who also taught at St. Louis College of Pharmacy. MD's taught our pathology courses, physiology and OBGYN courses. Our physiology professor was also a Ph.D. Micro was a Ph.D. who also taught at St. Louis College of Medicine, same for Biochem instructor. Most professors in school were not DC's. If they were a DC most had other professional degrees and some had Ph.D. It is true that we did have some courses that were taught DC's just like you have course taught by MD's. We even had instructors who were PT's. Why would we learn things from an MD when a DC is more qualified to teach them?

Now I am really confused. What forms the basis for your profession? If, as you say above, chiropractic is a "separate and unique profession" but has largely discarded Palmer's theories, then what is it? Let's see, you are taught by physicians, PhDs and PharmDs. You acknowledge that Palmer's subluxation theory is bunk (although you were still taught it - you said yourself you tried it when your daughter had an ear infection). Yet you still see yourself as separate and unique. How? With Palmer's theory gone, what is Chiropractic? Why should it even be accepted? How is it different than a cross betwen PTs and MD/DOs? If it isn't, then I challenge you; first, to prove the need for such a hybrid, and second, to advocate for the removal of the "primary care" designation for chiropractors.

We are, at least initially, as "up-to-date" as possible in known disorders/disease. You expect a reasonable person to believe that in three years (one year less schooling) and no residency (three years minimum less training) you not only have achieved the same mastry of diagnosis, but also learned all of chiropractic treatment and therapy? When did you sleep? Face facts, you are simply not trained anywhere near the MD/DO level in basic diagnosis of medical conditions. As such, you will miss some diagnoses they would not. Missing diagnoses can have VERY bad outcomes.

You got a residency, which apparently is the key to your medical education. I lack that. Therefore you are qualified to be a Primary Care Physician and I am not. I know that.

But in Illinois you can legally tell the public you are. And many in your profession do. And many in your profession have argued, and continue to argue, for the "right" to do school physicals, DOT exams, etc.

- H

 

[FoughtFyr]

You are an ER doctor. You are very smart.

Nope. We are the "knuckle draggers" of the medical profession. Ask any internist!

I would expect you to know just about everything because most of the time you have too. You are one of the best at making a ruling on systemic pathology. Not all MD's are as talented as you. In fact, the skills of many family practitioners are not that great when it comes to NMS diagnosis.

First of all, I am not that good. But thank you. And I have said time and time again that we (MD/DOs) are not that good at making NMS diagnoses. That is what PT "evaluate and treat" orders are for!

A great case in point is a patient I am treating now. She has a insufficiency fracture at the edge of her SI joint. Not detectable by x-ray or CT but clear as day on a nuclear scan. Had been going to a chiropractor for 3 visits. Each had made her "feel worse" - (pts words, not mine). Now, armed with the correct diagnosis, OT and PT are very helpful in her care. Did her primary care doc "miss it" too? Sort of I guess, but he sent her to the hospital for evaluation after a negative x-ray (which kept her from her next chiropractic appointment. The chiropractor had told her that some pain after manipulation was "normal". We will NOT be referring her back to his care).

The chiropractor practiced within his standard of care. Now if he was treating for 3-4 weeks then I could see where we have a problem. If he didn't order an x-ray (even though the FX was undetectable) we would have a problem. I agree it probably made it worse. Also, it is not uncommon to have some increased pain after manipulation. Usually it is only temporary. I tell people many times that they will probably notice some increased soreness and to ice it. The DC took films and it was undetectable with plain film, he did three treatments and probably didn't have the opportunity to see here again to re-evaluate. I feel if she continued to go to the DC, he would have noticed that the treatment was just not working and probably would have order further testing. I'm not sure if he would have opted for the bone scan right off the bat. If she had a history of a fall or injury or perhaps cancer he probably would have. Listen, this is a tough case and anyone could have had the same outcome.

I disagree. The problem here is that the Chiropractor proceeded without a diagnosis. Way bad move! And there is no one to "catch" his mistake, now or then. If I did the same, I would be facing a peer review or an M&M.

My brother had a patient with shoulder complaints that ended up being heart related. Her MD didn't catch it and she was referred to a DC (My brother) for shoulder treatment. He referred her back to the PCP who sent her to a cardiologist who found an 87% blockage. Patient wouldn't listen to his advice and ended up having a deadly heart attack the following week. So hey, sometimes these conditions can fool anyone. I've been fooled before and have become better as a result of it. Remember I had that patient that had a spinal tumor that was undetectable on my films. I think we talked about him already.

And I am willing to bet that the patient's MD was brought before an M&M after the patient's death. I am also sure that the cardiologist had a few words with the PCP. BUT - what role did the patient's beliefs in a "separate and unique profession's" abilities to heal her play into her decision to blow off the cardiologist?

I could give you at least half a dozen cases off the top of my head where chiropractors delayed care in high morbidity or mortality settings. In each case MD/DOs correctly diagnosed and treated the patient to resolution.

You probably could also give 6 more off the top of your head where a MD or DO delayed care due to improper DX and the patient wondered into your ER.

Happens daily. But the fact that MD/DOs miss diagnoses doesn't mean that we should have chiropractors missing them too. The difference here is in how the "miss" occurs. Generally, an MD/DO misses a diagnosis because that fail to detect the symptoms or fail to recognize them. They are, almost always, trained in the existence of the disorder. Chiropractors miss because they are generally not even aware of the disorder. There are studies (that I have previously posted) that demonstrate chiropractors can not even identify basic emergencies such as neonatal fever.

I challenge you to find ONE documented case where a chiropractor evaluated a patient with significant morbidity or high risk for mortality, found a condition missed by an MD/DO, and treated the patient to resolution for that condition.

I will see what I can find. If we catch something that has a high mortality than it probably falls outside the realm of NMS and we have no means to treat it. We would then have no alternative but to refer to the PCP or to a specialist.

EXACTLY! If you can not treat the disorder, why should a patient risk being assessed for it by you? Even if you (in the generic sense - not personally) find the problem, there will be a serious discontinuity in care as you "turn the patient over" and lose all ability to follow the case. And yes, PCPs who refer to specialists almost always follow their cases directly, most often acting to coordinate the care.

- H

 

[Febrifuge]

I don't want to interrupt, but BT mentioned something that caught my attention --

...As you probably already know there are DC?s out there that I wouldn?t let examine my dog yet let adjust him. I acknowledge that my profession has a real problem...

Speaking as a sideline observer (I'm a pre-med and work in an ED as a tech), one of the things that is helping to form my still-evolving opinion about a lot of these issues is the way the Chiro profession presents itself to the world.

I have someone in my family who is a DC, and this person's spouse was complaining about how our state had a law saying DC's could work on humans, or animals, but not both. See, the DC in question has been trained in veterinary chiropractic, and would love to be able to make it part of their practice. A practice, by the way, located in their home, and which does not have a separate entrance...

Anyway. I'm sure the point is, there are people out there "practicing" under a definition of the word that is, to say the least, not very well standardized. I'm sure this person is smart, talented, and only wants the best for their patients. I don't think there's a cynical money-grubbing thing going on at all. But still; anyone who suggests DC to me as a possible career path gets some resistance, due to stories like this.

 

[Science_Guy]

I don't want to interrupt, but BT mentioned something that caught my attention --
Speaking as a sideline observer (I'm a pre-med and work in an ED as a tech), one of the things that is helping to form my still-evolving opinion about a lot of these issues is the way the Chiro profession presents itself to the world.

I have someone in my family who is a DC, and this person's spouse was complaining about how our state had a law saying DC's could work on humans, or animals, but not both. See, the DC in question has been trained in veterinary chiropractic, and would love to be able to make it part of their practice. A practice, by the way, located in their home, and which does not have a separate entrance...

Anyway. I'm sure the point is, there are people out there "practicing" under a definition of the word that is, to say the least, not very well standardized. I'm sure this person is smart, talented, and only wants the best for their patients. I don't think there's a cynical money-grubbing thing going on at all. But still; anyone who suggests DC to me as a possible career path gets some resistance, due to stories like this.

I think it is more fundamental, and something that has been said between the lines on several posts on this issue. If many (I assume) modern chiropractors do not subscribe to the unproven and unscientific philosophy of Palmer (or Sid Williams), where is the "unique selling point" for a chiropractor? What makes this profession more desirable compared to either the PT, DO, or MD career path? The same for treatment options.....why would a patient choose 12-24 visits with a DC, when several sessions with a PT may prove just as beneficial, if not more so?

As far as an animal chiropractor, how do you assess success or failure? Animals, as far as I know, cannot give testimonials. Also, what kind of neurological scoring system do such veterinary chiropractors use?

 

[BackTalk]

O.k., but we can agree that the administrations of most Chiropractic Colleges lean more towards "old school" than new...right?

I wouldn?t use the word "most" but there are still large parts of the administration in chiropractic colleges that have been around for a long time. They still haven?t seen the light. With time as new positions are filled and the old timers are phased out it, it should get better.


"It is a unique and separate profession", one that has not been demonstrated to be more effective than medical treatment for any condition. There are good RCTs that demonstrate that Chiropractic is as effective as medicine in treating idiopathic low back pain, but it has never been demonstrated, in a quality controlled RCT to be better than medicine.

Again less training and the risk of "straights" misleading patients in return for what benefit? Keeping you in practice?

I never said chiropractic care was "more effective than medical treatment for any condition". With time hopefully more quality research will be produced. I agree there are risks with "straight" chiropractors misleading patients.

Come on, you have admitted on other threads that it is extremely easy to enter most chiropractic colleges. I have posted a study by chiropractors about the lies and misrepresentations used to recruit students. How has it gotten better? And the "mecca", Palmer College, continues to spew out "straights" at an amazing rate!

I?m not disagreeing with you. What I was leading to was the development of chiropractic colleges within the university system like they are attempting to accomplish at FSU. This is where chiropractic students and medical students will be taking many of their courses together like many dental students and medical students do. It is sleazy the way many chiropractic colleges recruit students. Again, many are private and need a continuous flow of new students to stay in operation. That doesn?t make it right, but is the main reason it is easier to get accepted.

Actually almost all docs have to admit it. Why? Because as described in my other post, we are constantly reviewed by other physicians, nurses, and public health professionals. Are you?

I?m in private practice, so no, I am not constantly reviewed by other physicians, nurses, and public health professionals.

Now I am really confused. What forms the basis for your profession? If, as you say above, chiropractic is a "separate and unique profession" but has largely discarded Palmer's theories, then what is it? Let's see, you are taught by physicians, PhDs and PharmDs. You acknowledge that Palmer's subluxation theory is bunk (although you were still taught it - you said yourself you tried it when your daughter had an ear infection). Yet you still see yourself as separate and unique. How? With Palmer's theory gone, what is Chiropractic? Why should it even be accepted? How is it different than a cross betwen PTs and MD/DOs? If it isn't, then I challenge you; first, to prove the need for such a hybrid, and second, to advocate for the removal of the "primary care" designation for chiropractors.

What I meant was the chiropractic profession is a drugless non-surgical profession. That is part of the separate and unique part of the profession. The rest is the philosophical part, which I have problems with. With Palmer?s theories gone, chiropractic is a NMS specialty without the use of drugs or surgery. The cross between the professions of MD/PT is that many PT techniques are learned in chiropractic school and we utilize many of those techniques. We perform manipulations/adjustments, which is our stock of the trade. This sets us apart from the PT profession. Many PT?s use manual therapy techniques but do not perform manipulations. Don?t get me wrong, as there are a few PT?s that have additional training in manipulation. For the most part, there are not a lot of them and in most states it is not part of their scope of practice. As a whole, there is no other profession that has the training that a chiropractor does in manipulation and that includes osteopaths. This sets us apart from MD/PT and osteopaths. As far as MD?s training we learn the same things you do with regard to physiology, pathology and diagnosis. The human body is the human body and each profession having its own name doesn?t change that. Many medical doctors have accepted chiropractic, some for its unique ability to treat complaints without surgery and medication and some because they have tried everything and nothing has worked. In that sense chiropractic is worth a shot to them. Also, chiropractors have more training in diagnosis than PT, we have training in each area of the human body when most of their training is NMS and PT techniques for treatment. The diagnosis part is left to the referring doctor so it?s not a major part of their education. This may upset many physical therapists. I?m not here to do that. Give me an idea of the training you have. I?m here to listen and learn.

I have acknowledged learning chiropractic philosophy but didn?t use subluxation theory to treat my daughter. I wasn?t looking for a mysterious subluxation that was the cause of the problem and neither was the doctor I took her to. The purpose of the treatment was to facilitate drainage. There have been studies on manipulation and ear infections, I believe the osteopaths did a study not too long ago that had some good findings. Either way it didn?t work so it was time to take the medical route. Shouldn?t doctors utilize conservative approaches before jumping to over utilization of antibiotics or the risk surgery?

Chiropractic has been around a long time. We have already proved to public the need for such a profession. I don?t need your approval, all I need is theirs and I already have it. The title or PCP wasn?t intended for us to really function in that capacity but rather to level the playing field when it came to insurance reimbursement.



But in Illinois you can legally tell the public you are. And many in your profession do. And many in your profession have argued, and continue to argue, for the "right" to do school physicals, DOT exams, etc.

I am in within my right to do the above mentioned exams. I do them all the time and am reimbursed by the insurance companies. I can still do a school physical and be reimbursed by the insurance company. The school code in Illinois is what the problem is. Some schools will honor a school physical performed by a DC and some do not. We recently attempted to have the school code changed but ran out of time this year. It will be introduced next year so you can present your case. Don?t worry about the straight chiropractors doing these exams, as they won?t. They wouldn?t want to waste their time getting $25 when they can attempt to sell a year of care to correct subluxations. Personally, I do not want to do a lot of school physicals. I would at least want to do one for a patient if their parent requests it, instead of having to explain the bureaucracy and send them down the road.

I disagree. The problem here is that the Chiropractor proceeded without a diagnosis. Way bad move! And there is no one to "catch" his mistake, now or then. If I did the same, I would be facing a peer review or an M&M.

I understand your concern. I don?t know all of what went on in the chiropractors office. I don?t know the mechanism of injury. I?m assuming she fell. This would warrant a film to rule out FX. The chiropractor did that and the FX was undetectable. There are not a lot of doctors out there that would have ordered a nuclear scan right off the bat. Most would have treated and if the patient failed to respond would then have opted for further diagnostics. The doctor probably diagnosed a sprain strain of the SI joint and proceeded to treat. He was not outside the standard of care and you wouldn?t have been either. Again, if the chiropractor kept treating without changing the plan (diagnostic work-up) or simply didn?t refer the patient to a specialist, then he possibly would have some malpractice issues to deal with.

If the patient wondered into the ER without seeing anyone first, films would have been ordered and would have come back negative. Treatment : Motrin and Skelaxin, released and follow up with PCP. Or meds and your favorite script to the PT for "evaluate and treat". Actually I expect more from you, but in most other ER?s thats probably what would have happened.

It a bad situation and is unfortunate for the patient. It happens on both sides of the fence. With the type of treatment we perform we have to be extra careful. We have to take a great history and do a great examination, We have to order diagnostics and have to know how to interpret them. We have to also work with allopathic medicine. I rely on medical doctors all the time for their opinions. Even with all of that we still will have situations such as this. The best thing you could do is call the chiropractor and let him know what has happened. He can definitely learn from this and may think twice about treating when the next SI joint patient comes through the door. I know I will.


I would love to have an ER doctor like you that I can send patients to when I?m unsure of the diagnosis. I wouldn?t even be offended if you suggested sending the patient to a PT. They are better treating this sort of problem then I am.

 

[BackTalk]

And I am willing to bet that the patient's MD was brought before an M&M after the patient's death. I am also sure that the cardiologist had a few words with the PCP. BUT - what role did the patient's beliefs in a "separate and unique profession's" abilities to heal her play into her decision to blow off the cardiologist?

She didn?t blow off the cardiologist. She went and he told her to quit smoking immediately and they needed to do angioplasty. She blew off his recommendations and had a massive heart attack the next week. I doubt the cardiologist called the PCP as it probably wouldn?t have changed the outcome. Possibly he called to go over pain patterns related to heart conditions. The patient?s beliefs in the chiropractic played no role. The DC called the PCP and said he felt the patients shoulder problem was heart related. The PCP then sent her to the cardiologist.

Happens daily. But the fact that MD/DOs miss diagnoses doesn't mean that we should have chiropractors missing them too.

I agree.

The difference here is in how the "miss" occurs. Generally, an MD/DO misses a diagnosis because that fail to detect the symptoms or fail to recognize them.

So there is a difference on how it is missed. Not sure what your point is as it doesn?t change the fact that it still was missed.

They are, almost always, trained in the existence of the disorder. Chiropractors miss because they are generally not even aware of the disorder.

So they are trained in the existence of the disorder yet still miss the diagnosis. What is your point?

There are studies (that I have previously posted) that demonstrate chiropractors can not even identify basic emergencies such as neonatal fever.

I do remember some of that post. Doesn?t look very good on our part and I admit that. Most neonates aren?t brought to a chiropractic office with a fever. Usually they present to the ER. Hey I bet you brother in law with his diplomate in chiropractic pediatrics would have got that one....hehe


EXACTLY! If you can not treat the disorder, why should a patient risk being assessed for it by you?

To rule it out. I can?t treat cancer but I need to know if it is in the spine before I start treating, I can?t treat a fracture but I need to know its there before I start adjusting, I can?t treat avascular necrosis but I need to know it before I adjust a hip or whatever.....and....on.....and....on.....

Even if you (in the generic sense - not personally) find the problem, there will be a serious discontinuity in care as you "turn the patient over" and lose all ability to follow the case. And yes, PCPs who refer to specialists almost always follow their cases directly, most often acting to coordinate the care

Most doctors, but not all, will send an initial report with my patient?s findings and treatment plan. Then they will continually send updates to me on my patient?s progress and carbon copy to PCP or vice versa. I do the same when a patient is referred to me. Depending on the condition I would also coordinate care. If I send a patient to an orthopedist for a back problem they may do surgery and then coordinate care with me concerning rehab. If it is something that I cannot treat or beyond my skill then there is no need to coordinate care with me.

 

[BackTalk]

I think it is more fundamental, and something that has been said between the lines on several posts on this issue. If many (I assume) modern chiropractors do not subscribe to the unproven and unscientific philosophy of Palmer (or Sid Williams), where is the "unique selling point" for a chiropractor? What makes this profession more desirable compared to either the PT, DO, or MD career path? The same for treatment options.....why would a patient choose 12-24 visits with a DC, when several sessions with a PT may prove just as beneficial, if not more so?

As far as an animal chiropractor, how do you assess success or failure? Animals, as far as I know, cannot give testimonials. Also, what kind of neurological scoring system do such veterinary chiropractors use?

I?m beginning to wonder. You would have to be crazy to choose the path of a chiropractor. I guess that makes me crazy.

Going to the PT may be beneficial and maybe it won?t be. Same for chiropractic. I?ve had patients who failed under chiropractic care yet did great under the care of a physical therapist. I?ve also had patients who have gone to physical therapist and got no response and did great under chiropractic care.

Most people seek chiropractic care for back and neck complaints. When most people think back pain they think chiropractic, when people think about the spine they think chiropractic, when people think about manipulation or adjustments they think chiropractic, when patients think posture they think chiropractic. Do a survey asking patients who a back doctor is and I bet most of them say ?a chiropractor?.

The public identifies chiropractic as a back doctor just as they identify a podiatrist as foot doctor or a dentist as tooth or mouth doctor. If they have a back complaint maybe they feel that 12-24 visits to a chiropractor is the answer.

Some vets take additional training in chiropractic and treat animals. Some chiropractors get certified through vet programs to also work on animals. Personally, I have no interest in working on animals. The way I look at it is if it works, then why not. From what I understand if you are a chiropractor and want to work on animals the certification program is no picnic.

 

[FoughtFyr]

I?m in private practice, so no, I am not constantly reviewed by other physicians, nurses, and public health professionals.

Even in private practice almost all doctors are. See my posts above for details.

The cross between the professions of MD/PT is that many PT techniques are learned in chiropractic school and we utilize many of those techniques. We perform manipulations/adjustments, which is our stock of the trade. This sets us apart from the PT profession. Many PT?s use manual therapy techniques but do not perform manipulations. Don?t get me wrong, as there are a few PT?s that have additional training in manipulation. For the most part, there are not a lot of them and in most states it is not part of their scope of practice. As a whole, there is no other profession that has the training that a chiropractor does in manipulation and that includes osteopaths. This sets us apart from MD/PT and osteopaths. As far as MD?s training we learn the same things you do with regard to physiology, pathology and diagnosis. The human body is the human body and each profession having its own name doesn?t change that.

{SNIP}

Chiropractic has been around a long time. We have already proved to public the need for such a profession. I don?t need your approval, all I need is theirs and I already have it. The title or PCP wasn?t intended for us to really function in that capacity but rather to level the playing field when it came to insurance reimbursement.

First of all, you and I both know there are a good number of "pseudo-mixers" who believe they can work in that capacity. They advertise that way and attempt to fill that role. Second, you are right, all you need is the public's approval. But if you want me to support the profession, refer you patients, or recommend chiropractic to my patients, you will need to prove it to me as well. Just the same as any other treatment, specialist, or test. I use PTs to "evaluate and treat" because there are fantastic studies that back me up and I have had largely positive experiences doing so.

But in Illinois you can legally tell the public you are. And many in your profession do. And many in your profession have argued, and continue to argue, for the "right" to do school physicals, DOT exams, etc.

I am in within my right to do the above mentioned exams. I do them all the time and am reimbursed by the insurance companies. I can still do a school physical and be reimbursed by the insurance company. The school code in Illinois is what the problem is. Some schools will honor a school physical performed by a DC and some do not. We recently attempted to have the school code changed but ran out of time this year. It will be introduced next year so you can present your case. Don?t worry about the straight chiropractors doing these exams, as they won?t. They wouldn?t want to waste their time getting $25 when they can attempt to sell a year of care to correct subluxations. Personally, I do not want to do a lot of school physicals. I would at least want to do one for a patient if their parent requests it, instead of having to explain the bureaucracy and send them down the road.

But will you tell them, as you acknowledged above, that "(I) may not be equivalent to a MD or DO in medical diagnosis"?

I understand your concern. I don?t know all of what went on in the chiropractors office. I don?t know the mechanism of injury. I?m assuming she fell.

Thank you for once again unintentionally proving my point. "Insufficiency fracture is a subgroup of stress fracture. Unlike the other subtype (ie, fatigue fracture), insufficiency fracture is caused by the effect of normal or physiologic stress upon weakened bone. Loss of bone trabeculae decreases the bone's elastic resistance. Awareness is increasing concerning the occurrence of these fractures among older persons. Sites frequently affected by insufficiency fractures are the thoracic vertebra, tibia, fibula, and calcaneus." (from: http://www.emedicine.com/radio/topic545.htm ). By definition, there was no mechanism of injury beyond normal, physiologic stress. She came in to her PCPs office stating that her right hip "hurt worse than when she broke her left one". With that level of pain, neither her PCP, nor the hospital team, was willing to proceed until the source was identified. The chiropractor was. Ooops. Once again, you can't find something if you don't know it exists. And this is an NMS problem!

This would warrant a film to rule out FX. The chiropractor did that and the FX was undetectable. There are not a lot of doctors out there that would have ordered a nuclear scan right off the bat. Most would have treated and if the patient failed to respond would then have opted for further diagnostics.

Actually not. She was sent to us from a community PCP for further diagnostics.

The doctor probably diagnosed a sprain strain of the SI joint and proceeded to treat. He was not outside the standard of care and you wouldn?t have been either. Again, if the chiropractor kept treating without changing the plan (diagnostic work-up) or simply didn?t refer the patient to a specialist, then he possibly would have some malpractice issues to deal with.

Actually, I would have been outside the standard of care. The chiropractor wasn't because as we discussed there really aren't standards.

If the patient wondered into the ER without seeing anyone first, films would have been ordered and would have come back negative. Treatment : Motrin and Skelaxin, released and follow up with PCP. Or meds and your favorite script to the PT for "evaluate and treat". Actually I expect more from you, but in most other ER?s thats probably what would have happened.

Absolutely not! But, if it did, there would be hell to pay later. Modern EDs do follow-up with their patients. And hospital administrator hate to see missed dianoses.

It a bad situation and is unfortunate for the patient. It happens on both sides of the fence. With the type of treatment we perform we have to be extra careful. We have to take a great history and do a great examination, We have to order diagnostics and have to know how to interpret them. We have to also work with allopathic medicine. I rely on medical doctors all the time for their opinions. Even with all of that we still will have situations such as this. The best thing you could do is call the chiropractor and let him know what has happened. He can definitely learn from this and may think twice about treating when the next SI joint patient comes through the door. I know I will.

I have no desire to call him. I am not out to support or improve chiropractic. If he wants to follow-up he can do so with the patient. BTW - as an aside, I asked one of our legal team here if an MD to chiropractor communication without specific written consent of the patient would violate HIPAA. We believed it would. His opinion was that unless we were referring the patient to you, or had directly accepted patient care from you (as a physician to physician handoff - ain't gonna happen) we could not discuss patient care with a chiropractor. This was, he said, because nowhere does the standard of care include chiropractic treatment, therefore chiropractors are outside the treatment team.

I would love to have an ER doctor like you that I can send patients to when I?m unsure of the diagnosis. I wouldn?t even be offended if you suggested sending the patient to a PT. They are better treating this sort of problem then I am.

While I appriciate the compliment, I hope you realize that I would feel obligated to send them to a PT. I believe that to be the standard of care. However, if I had a patient who insisted upon chiropractic treatment despite my protests, I would hope they would find one with your philosophy and level-headedness.

- H

 

[FoughtFyr]

The difference here is in how the "miss" occurs. Generally, an MD/DO misses a diagnosis because that fail to detect the symptoms or fail to recognize them.

So there is a difference on how it is missed. Not sure what your point is as it doesn?t change the fact that it still was missed.

They are, almost always, trained in the existence of the disorder. Chiropractors miss because they are generally not even aware of the disorder.

So they are trained in the existence of the disorder yet still miss the diagnosis. What is your point?

Because the chiropractor had 0% chance to find it in the first place. The MD/DO missed the signs. So, if we take 100 patients with a given condition, the chiropractor will miss it in all 100. The MD/DO will miss it in some small percentage. Big difference!

There are studies (that I have previously posted) that demonstrate chiropractors can not even identify basic emergencies such as neonatal fever.

I do remember some of that post. Doesn?t look very good on our part and I admit that. Most neonates aren?t brought to a chiropractic office with a fever. Usually they present to the ER. Hey I bet you brother in law with his diplomate in chiropractic pediatrics would have got that one....hehe

But this is a basic emergency, and if a patient sees their chiropractor as the PCP, they might present to their office. And truthfully, I think my brother-in-law would adjust the child and send them home. When the baby died, no one would be able to touch him. Why? Because he would have done what the "standard" treatment was for a pediatric chiropractor.

Even if you (in the generic sense - not personally) find the problem, there will be a serious discontinuity in care as you "turn the patient over" and lose all ability to follow the case. And yes, PCPs who refer to specialists almost always follow their cases directly, most often acting to coordinate the care

Most doctors, but not all, will send an initial report with my patient?s findings and treatment plan. Then they will continually send updates to me on my patient?s progress and carbon copy to PCP or vice versa. I do the same when a patient is referred to me. Depending on the condition I would also coordinate care. If I send a patient to an orthopedist for a back problem they may do surgery and then coordinate care with me concerning rehab. If it is something that I cannot treat or beyond my skill then there is no need to coordinate care with me.

Yes but the MD PCP actually goes to the hospital, orders tests, confers with specialists etc. Continuity of care is good for patients. You don't coordinate care, you track it. An MD PCP would help with decisions about co-morbid conditions, on-going therapies and follow-up care after discharge. You do not participate in this way on any patient in the hospital, nor can you. And as a profession, you won't ever. Why? Not because of the "protectionism" of the medical profession, but rather a reluctance/refusal by chiropractors to subject themselves to the same practice reviews in place for MD/DOs.

- H

 

[BackTalk]

Thank you for once again unintentionally proving my point. "Insufficiency fracture is a subgroup of stress fracture. Unlike the other subtype (ie, fatigue fracture), insufficiency fracture is caused by the effect of normal or physiologic stress upon weakened bone. Loss of bone trabeculae decreases the bone's elastic resistance. Awareness is increasing concerning the occurrence of these fractures among older persons. Sites frequently affected by insufficiency fractures are the thoracic vertebra, tibia, fibula, and calcaneus." (from: http://www.emedicine.com/radio/topic545.htm ). By definition, there was no mechanism of injury beyond normal, physiologic stress. She came in to her PCPs office stating that her right hip "hurt worse than when she broke her left one". With that level of pain, neither her PCP, nor the hospital team, was willing to proceed until the source was identified. The chiropractor was. Ooops. Once again, you can't find something if you don't know it exists. And this is an NMS problem!

I know what an Insufficiency fracture is; you don?t have to give me a lecture on it. It was an overlook on my part. Was it the hip or the SI joint? I thought earlier you said it was her SI joint, now it's the hip or are you making this up as we go along? PCP missed it too and you admitted that.

But will you tell them, as you acknowledged above, that "(I) may not be equivalent to a MD or DO in medical diagnosis"?

I don?t know, when your in the ER do you tell patients that you are not equivalent to a therapist or DC in NMS diagnosis?

I have no desire to call him. I am not out to support or improve chiropractic. If he wants to follow-up he can do so with the patient. BTW - as an aside, I asked one of our legal team here if an MD to chiropractor communication without specific written consent of the patient would violate HIPAA. We believed it would. His opinion was that unless we were referring the patient to you, or had directly accepted patient care from you (as a physician to physician handoff - ain't gonna happen) we could not discuss patient care with a chiropractor. This was, he said, because nowhere does the standard of care include chiropractic treatment, therefore chiropractors are outside the treatment team.

So you would rather rant and rave bitch and complain as to how bad chiropractors are and feel no desire to help them? Now ask yourself ?why do chiropractors F?N hate MD?s?? Now ya know.

HIPAA violation! OMG the HIPAA police are gunna getcha....Whatever, you are such *****.

While I appriciate the compliment, I hope you realize that I would feel obligated to send them to a PT. I believe that to be the standard of care. However, if I had a patient who insisted upon chiropractic treatment despite my protests, I would hope they would find one with your philosophy and level-headedness.

Yeah, well you can stop strokin yourself now as I retract my compliment. Obligated?hehe?you *****. I change my mind, I wouldn?t refer to you. I?ve lost all respect for you. Thank GOD there are other MD?s and DO?s out there that don?t have some type of mental problem due to personal reasons towards chiropractic.

I?ll have to get back to the rest of this when I have more time to waste.

 

[CVPA]

For Gods sake, will somebody please shut this embarrassment of a thread down?!

 

[rdennisjr]

This thread has clearly degenerated far enough down the evolutionary change and is being closed. Please feel free to open a new thread and continue to have profesional, non-inflamitory, civil discusion on the topic.

Dennis