OMM vs Chiropractic

[facetguy]

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How is that allowed? I would think that as a regulated field, there would be some consequences for someone advertising themselves as a physician when they're clearly not...
Also, how is Chiropractic Physician different from Engineering Physician for an engineer, or a political physician for a politician, or a Managing Physician for a general manager.
I'm sorry because I don't mean to be rude but:

You're preaching to the choir here. We have a really big problem with everybody wanting to be a physician, practice medicine, etc, and it affects patients. Technically, some states allow/classify DCs as 'Chiropractic Physicians,' but they don't practice medicine ... so I agree with you.

It's been this way for a long time. It's not some new run at undermining medical physicians' status. There are many more important things you could be thinking about as pre-meds, so don't let this consume you. It's such a non-issue.

 

[JaggerPlate]

It's been this way for a long time. It's not some new run at undermining medical physicians' status. There are many more important things you could be thinking about as pre-meds, so don't let this consume you. It's such a non-issue.

It only becomes a big deal if DCs advertise themselves as primary care PHYSICIANS or encourage individuals not to see MD/DOs because of it.

 

[JaggerPlate]

MDs, DOs, DPMs, DCs, and NDs all call themselves physicians (other than the surgeons).

Not too long ago, MDs didn't like it when DOs called themselves doctor/physician/surgeon. How the tides have shifted. Who knows, maybe in 100 years, NDs won't like it when LMAOMD's call themselves doctor/physician.

Yes, yes, there's currently a substantial difference in osteopathic education and training from DCs, NDs, etc. Just food for thought.

How is this food for thought? MDs didn't like it when DOs called themselves doctors 60 years ago when DO education wasn't on par with standardized medical education in the US. They were right. Now that it is ... they are both physicians. If DCs, NDs, what the hell else want to go through the process of being accredited by the LCME/AOA, complete 4 years of medical education, pass steps I - III, and compete for and complete AOA/ACGME accredited residencies ... they can call themselves physicians. Until then ... these little tid-bits are pointless.

 

[cbrons]

Not too long ago, MDs didn't like it when DOs called themselves doctor/physician/surgeon. How the tides have shifted. Who knows, maybe in 100 years, NDs won't like it when LMAOMD's call themselves doctor/physician.

I read this on my blackberry in bed and laughed so hard I woke the whole house up. I wanna get a Doctor of Lmao Practice.

Sent on the Sprint® Now Network from my BlackBerry®

 

[facetguy]

It only becomes a big deal if DCs advertise themselves as primary care PHYSICIANS or encourage individuals not to see MD/DOs because of it.

This doesn't happen. First, state laws don't allow it, nor should they. A chiropractor always has to identify himself as such. Second, encouraging a patient to not see an MD/DO is asking for a malpractice suit. I'll say again, it's a non-issue.

 

[Bacchus]

This doesn't happen. First, state laws don't allow it, nor should they. A chiropractor always has to identify himself as such. Second, encouraging a patient to not see an MD/DO is asking for a malpractice suit. I'll say again, it's a non-issue.

What is the prevalence of those cases in the DC community? We've been told its a much more bearable premium for DCs than it is DOs in terms of malpractice coverage. Would you mind elaborating?

 

[facetguy]

What is the prevalence of those cases in the DC community? We've been told its a much more bearable premium for DCs than it is DOs in terms of malpractice coverage. Would you mind elaborating?

Do you mean malpractice cases in general? DCs have a very low malpractice risk, although I don't know the exact numbers. Malpractice premiums are quite low for DCs across the country, reflecting this low risk.

If you mean malpractice cases involving a DC intentionally refusing to refer a patient to an MD/DO when such a referral would have been appropriate, this would be even more rare, probably approaching zero. First, DCs aren't trained to advocate against medical care. Secondly, DCs aren't so dumb as to open themselves to such risk (perhaps an argument could be made for such attitudes amongs DCs many decades ago, but not today).

How's everything at PCOM?

 

[st2205]

This doesn't happen. First, state laws don't allow it, nor should they. A chiropractor always has to identify himself as such. Second, encouraging a patient to not see an MD/DO is asking for a malpractice suit. I'll say again, it's a non-issue.

I'm not sure but I just find this hard to swallow. I know there are plenty of good chiropractors out there, but there are also quite a few that fit that criteria that I think you are downplaying (my brother being one of them). Either these people are a larger population than thought or their minority voice has hijacked chiropractic, both possibilities which are grossly denied by chiropractic apologists. Can't say I blame them. I wouldn't want to be associated with them, either.

 

[facetguy]

I'm not sure but I just find this hard to swallow. I know there are plenty of good chiropractors out there, but there are also quite a few that fit that criteria that I think you are downplaying (my brother being one of them). Either these people are a larger population than thought or their minority voice has hijacked chiropractic, both possibilities which are grossly denied by chiropractic apologists. Can't say I blame them. I wouldn't want to be associated with them, either.

Are you saying that your brother and other DCs are out there telling cancer patients to forget their cancer treatments and instead pursue chiropractic care exclusively? C'mon. Your brother may be a fringe extremist, but that in no way indicts the entire profession.

 

[st2205]

No, I'm saying precisely what jagger implied -- that the problem is when they proport to be a PCP for any and all general medical issues. And as a side note, my brother does believe it can treat cancer (not spinal adjustment solely, but chiropractic care) and states that it is chemotherapy that kills cancer patients. I understand this is extreme and doesn't represent the whole field. Overall I'm pretty I'm pretty positive regarding chiropractic. My point was that however small this minority is (chiropractors as medical specialists [I understand this isn't the phrase you'd choose but you get what I mean]), they are hijacking chiropractic and becoming its voice.

 

[taylormade2006]

No, I'm saying precisely what jagger implied -- that the problem is when they proport to be a PCP for any and all general medical issues. And as a side note, my brother does believe it can treat cancer (not spinal adjustment solely, but chiropractic care) and states that it is chemotherapy that kills cancer patients. I understand this is extreme and doesn't represent the whole field. Overall I'm pretty I'm pretty positive regarding chiropractic. My point was that however small this minority is (chiropractors as medical specialists [I understand this isn't the phrase you'd choose but you get what I mean]), they are hijacking chiropractic and becoming its voice.

I would say that this statement is absolutely accurate.

 

[facetguy]

No, I'm saying precisely what jagger implied -- that the problem is when they proport to be a PCP for any and all general medical issues. And as a side note, my brother does believe it can treat cancer (not spinal adjustment solely, but chiropractic care) and states that it is chemotherapy that kills cancer patients. I understand this is extreme and doesn't represent the whole field. Overall I'm pretty I'm pretty positive regarding chiropractic. My point was that however small this minority is (chiropractors as medical specialists [I understand this isn't the phrase you'd choose but you get what I mean]), they are hijacking chiropractic and becoming its voice.

Any and all general medical issues? I think that's a bit of an overstatement. I don't know many chiropractors interested in treating "any and all general medical issues". And even if they did, I find it hard to believe that they would refuse to refer to an MD if warranted (e.g., need for antibiotics or surgery).

If you want to be objective about this PCP issue, you should consider what is probably the only study to look at this:
http://www.ncbi.nlm.nih.gov/pubmed/15195041
In this study, DCs were permitted to be PCPs for patients in the Chicago area as part of a study for Blue Cross Blue Shield. Of course, patients were dropping dead left and right, so the study had to be stopped. Just kidding, the findings were pretty positive for DCs serving as PCPs, as you can see from the abstract. The studies conclusions: "In the limited population studied, PCPs utilizing an integrative medical approach emphasizing a variety of CAM therapies had substantially improved clinical outcomes and cost offsets compared with PCPs utilizing conventional medicine alone." Uh-oh.

A few years later, a similar study was published looking at other licensed healthcare practitioners acting as PCPs. http://www.ncbi.nlm.nih.gov/pubmed/17509435
Again, the results were just horrible. From the abstract: "CONCLUSION: During the past 7 years, and with a larger population than originally reported, the CAM-oriented PCPs using a nonsurgical/nonpharmaceutical approach demonstrated reductions in both clinical and cost utilization when compared with PCPs using conventional medicine alone. Decreased utilization was uniformly achieved by all CAM-oriented PCPs, regardless of their licensure." A scathing indictment for sure.

Look, this is a tempest in a teapot because as I said, the vast majority of DCs have no interest in diarrhea and pulmonary infections. Those few who might are most certainly not hijacking the profession and they are not becoming its voice. To be honest, I never even hear about this stuff.

As to your brother's skepticism toward cancer care, I don't think it's a stretch to say he's not alone. Patients do die from cancer treatments. That doesn't mean their oncologists aren't doing their best, or that they are evil people. That doesn't even mean there haven't been improvements (modest as they may be) in cancer care. But to say that cancer care is without major problems would be naive. We've got a long way to go in the cancer department.

 

[taylormade2006]

I should clarify my last post. I agree with facetguy that those fringe practitioners are not hijacking chiropractic, however, they are most definitely the loudest voice out there.

Anytime you see chiropractic in the news, it is an extreme practice doing applied kinesiology on infants.

 

[Bacchus]

Do you mean malpractice cases in general? DCs have a very low malpractice risk, although I don't know the exact numbers. Malpractice premiums are quite low for DCs across the country, reflecting this low risk.

If you mean malpractice cases involving a DC intentionally refusing to refer a patient to an MD/DO when such a referral would have been appropriate, this would be even more rare, probably approaching zero. First, DCs aren't trained to advocate against medical care. Secondly, DCs aren't so dumb as to open themselves to such risk (perhaps an argument could be made for such attitudes amongs DCs many decades ago, but not today).

How's everything at PCOM?

Cases brought against DCs, in normal practice.

 

[ArmyDoc2010]

As I am pretty sure that I'm the only guy on this thread who holds both degrees (D.O., D.C., perhaps I can set a few things straight.

1. Difference between styles of manipulation, CMT vs. OMT. Quick answer is there is no physical difference between the two. Manipulation didn't start here in the US, it's roots lie in Europe where it was originally practiced by Barbers (haircut, shave, and some neck work) The differences lie in two particular areas, OMT is both osseous (bone/joint) manipulation and soft tissue work (massage) grouped together while Chiropractic separates the two.

2. Philosophical Differences/Health Care Scandals - It's really complicated, this seems to be what most people focus on while usually involving a few individuals. Chiropractic has an amazingly strong minority voice that has a great deal of money, enabling them to promote their insane viewpoints. Are there crackpots out there? Sure, the MD down the street from my house is Harvard trained, dresses like Moses (long hair, beard, robes, and staff) and practices "energy medicine". Conversely we had a D.O. family doc in the community that billed the state insurance $5,000 for performing OMT on a mentally handicapped woman when in reality he was having intercourse with her twice a week in his office to treat her lower back pain. You can find it in every profession, my experience having been that Dental is the worst.

3. Physician Status - More of a legal definition than anything else, the original meaning meant some one skilled in healing, or managing the "physis" or life force. Allows the ability to diagnose, as opposed to a DPT (doctor of physical therapy) who cannot in most instances. MD's, DC's, DO's, DPM's and ND's compose the physician group of healthcare providers. Dentists are not, although they share many of the same rights and privileges. OD's call themselves "Optometric Physicians", I do not believe they meet the legal definition, but I could be wrong about that. Of interest, in the UK physician only applies to someone who practices general medicine (family/internal) Surgeons are also referred to as Mr. not Dr., which is a custom left over from when medicine and surgery were separate professions.

4. Malpractice - The average Chiropractor is never sued during their career, the average medical physician is sued 5-20 times depending upon specialty with the surgical specialties and OBGYN being the highest. My malpractice as a DC was 1/20th of what it would be now in civilian practice. Malpractice for DC's is much lower than medical providers for a number of reasons. First reason is the manipulation in any form is largely safe and effective, notwithstanding any contraindications to treatment in the first place. Secondly, Chiropractors do not perform lab (Blood/Urine/Sputum analysis) work in their offices as commonly as medical offices do, so the chances of an acquired infection are far lower. Failure to diagnose is a common reason for all providers to be sued, but Chiropractors usually only fall into this area when dealing with things outside the musculoskeletal arena such as heart disease and such.

I'd be happy to clear up any other misunderstandings, it is often hard to see past all the B.S. out there.

 

[facetguy]

Excellent.👍 I would only differ with the notion that there is any group within chiropractic that has enough money to begin to even get in the same room with the likes of Pharma, medical device companies, and the like from a lobbying standpoint.

 

[JaggerPlate]

MD's, DC's, DO's, DPM's and ND's compose the physician group of healthcare providers. Dentists are not

Uhhhh WTF??? You're going to lump NDs into a group with MD/DOs and leave out dentists??? What???

 

[FutureCTDoc]

The problem with chiropractors are several fold. A lack of emphasis on diagnosis while in training is one. Minimal standards for entry into chiropractic school is another. Poor quality of education is a third issue for chiropractors. Chiros have embraced bizarre philosophies with no real grounding in science. They just keep on looking for subluxations which cause all illness according to DD Palmer, their patron saint. Medicine has advanced since 1900, the chiros haven't.

 

[docdoc121]

What, this again? I'm going to echo my sentiments that I shared in another thread. According to the US government:
Physician

(r) The term “physician”, when used in connection with the performance of any function or action, means (1) a doctor of medicine or osteopathy legally authorized to practice medicine and surgery by the State in which he performs such function or action (including a physician within the meaning of section 1101(a)(7)), (2) a doctor of dental surgery or of dental medicine who is legally authorized to practice dentistry by the State in which he performs such function and who is acting within the scope of his license when he performs such functions, (3) a doctor of podiatric medicine for the purposes of subsections (k), (m), (p)(1), and (s) of this section and sections 1814(a), 1832(a)(2)(F)(ii), and 1835 but only with respect to functions which he is legally authorized to perform as such by the State in which he performs them, (4) a doctor of optometry, but only for purposes of subsection (p)(1) with respect to the provision of items or services described in subsection (s) which he is legally authorized to perform as a doctor of optometry by the State in which he performs them, or (5) a chiropractor who is licensed as such by the State (or in a State which does not license chiropractors as such, is legally authorized to perform the services of a chiropractor in the jurisdiction in which he performs such services), and who meets uniform minimum standards promulgated by the Secretary, but only for the purpose of sections 1861(s)(1) and 1861(s)(2)(A) and only with respect to treatment by means of manual manipulation of the spine (to correct a subluxation) which he is legally authorized to perform by the State or jurisdiction in which such treatment is provided. For the purposes of section 1862(a)(4) and subject to the limitations and conditions provided in the previous sentence, such term includes a doctor of one of the arts, specified in such previous sentence, legally authorized to practice such art in the country in which the inpatient hospital services (referred to in such section 1862(a)(4)) are furnished.

Also, once again, I'm not saying that I agree or disagree, but that is just how it is. Moreover, the definition of physician, according to government, will not change any time soon. If you want any portion of the above changed, do something about it. Get involved. Until then, arguing and putting in your two cents on this site or other avenues will most likely simply raise your blood pressure.

Audiologists (AuD) and Clinical Psychologists (PsyD, PhD) are not considered physicians, but are generally referred to as "doctor" in the healthcare setting. Not sure about Speech Pathologists (PhD).

Physical and Occupational therapists (DPT, OTD), Doctors of Nursing Practice (DNP), and Pharmacists (PharmD) are typically not referred to as "doctor" or "physician" in the healthcare setting, but with the push for doctorate-level degrees in these fields, a minority of practitioners seem to be introducing themselves as "doctor" nowadays.

Naturopathic (ND), Naprapathic (DN), Doctors of Acupuncture and Oriental Medicine and its variants (DAOM, DOM, OMD, etc), and other CAM providers are definitely another story.

(That reminds me, future and current DOs that want a degree change to DOM or OMD; the degree isn't changing to one of those two designations anytime soon because as you can see, TCM practitioners already use the two acronyms. Be proud of your DO degree and accomplishments.)

 

[facetguy]

The problem with chiropractors are several fold. A lack of emphasis on diagnosis while in training is one. Minimal standards for entry into chiropractic school is another. Poor quality of education is a third issue for chiropractors. Chiros have embraced bizarre philosophies with no real grounding in science. They just keep on looking for subluxations which cause all illness according to DD Palmer, their patron saint. Medicine has advanced since 1900, the chiros haven't.

A true expert opinion, no doubt.

 

[FutureCTDoc]

A true expert opinion, no doubt.

Well, let's think about this for a second. No chiropractic school is integrated within a major research university. Chiro schools are run like businesses. There is an old saying As and Bs=MD; Ds and Cs equal DCs. There is a reason for this, the academic standards are significantly lower for chiropractic schools. There is a resistance to the use of pharmacologic interventions even in cases where they would be the appropriate and prudent way to go about things. DCs don't have the same level of research as do allopathic/osteopathic medicine. Manipulation is utilized inappropriately. DCs have massive default rates on loans coupled with massive amounts of fraud. This doesn't suggest a wonderful field.

 

[facetguy]

Well, let's think about this for a second. No chiropractic school is integrated within a major research university.

This has much to do with the recent (ongoing?) efforts on the part of 'mainstream medicine' to marginalize and destroy the chiropractic profession. Review some of the history and you'll see what I mean.

Chiro schools are run like businesses.

Chiro schools are private institutions. Private institutions are, in many respects, run like businesses. I'll assume that you equally denounce all private DO schools, of which there are plenty.

There is an old saying As and Bs=MD; Ds and Cs equal DCs. There is a reason for this, the academic standards are significantly lower for chiropractic schools.

No argument here. However, if you are honest, you'll agree that chiropractic education has advanced light years in the last 3 decades or so. How about if we were to peer into the osteopathic profession's early educational efforts. It wouldn't be pretty. (And, depending who you listen to, some would say the DO eduation is still not on par with that of MDs).

There is a resistance to the use of pharmacologic interventions even in cases where they would be the appropriate and prudent way to go about things.

DCs don't use pharmacologic interventions at all; not in our scope. That doesn't equate to being 'anti-pharmacologic' however. Don't confuse the 2.

DCs don't have the same level of research as do allopathic/osteopathic medicine.

Research is largely money driven, and it is certainly true that the chiro profession has nowhere near the funding of allopathic, or even osteopathic, researchers. That said, there is a lot of research going on in the chiro community, much more than in decades past. Of course, you don't know about this research because you don't read it; that was my main point when I said you have zero expertise in the field and therefore have no idea what you're even talking about. As a pre-med, you are entitiled to not know about these things; you're not entitled to pretend you do while making disparaging remarks about an entire profession.

Manipulation is utilized inappropriately.

OK, if you say so.

DCs have massive default rates on loans

That may be true; I'm not sure. It is true that entering the chiro profession is riskier career-wise than entering the medical profession.

coupled with massive amounts of fraud. This doesn't suggest a wonderful field.

"Massive amounts of fraud"? I'll chalk that whacky statement up to your depth of knowledge of the profession.

 

[salazaar]

From what I understand one of the primary things that sets OMM apart from Chiro is HVLA (high velocity low amplitude). If I remember right HVLA was developed at CCOM and has since been implemented as a safer way to make Chiropractic-like adjustments. I am no expert, but from what I understand, Chiropractors utilize more HVHA (high amplitude) treatments. Chiropractors tend to make larger corrective movements in some cases than their Osteopathic counter-parts. Such extreme movement can cause serious damage in the wrong hands. I guess an example would be that neck snap move from James Bond, where he sneaks behind a guard grabs his head and twists forcefully to the side. Fast and extreme - HVHA. Another key distinction is that OMM addresses a much wider physiological scope than chiropractic treatments.

On the other hand, Chiropractors train and practice their form of manipulation far more frequently than your run of the mill DO might practice OMM. It follows that the Chiropractors given their experience are better than most DOs at manipulation, even though DO methodology may be more sound.

I would go to a DO who has extensive training in OMM for manipulative therapy before I would go to a Chiropractor, but I would go to a Chiropractor before going to a regular fm DO.

An interesting note from Norman Gevitz in his book The DOs is that Chiropractors came after Osteopathy was established. Before HVLA there was very little distinction between the two fields and I believe the AOA of the time sued the Chiropractors more or less for copying.

 

[facetguy]

From what I understand one of the primary things that sets OMM apart from Chiro is HVLA (high velocity low amplitude). If I remember right HVLA was developed at CCOM and has since been implemented as a safer way to make Chiropractic-like adjustments. I am no expert, but from what I understand, Chiropractors utilize more HVHA (high amplitude) treatments. Chiropractors tend to make larger corrective movements in some cases than their Osteopathic counter-parts. Such extreme movement can cause serious damage in the wrong hands. I guess an example would be that neck snap move from James Bond, where he sneaks behind a guard grabs his head and twists forcefully to the side. Fast and extreme - HVHA. Another key distinction is that OMM addresses a much wider physiological scope than chiropractic treatments.

On the other hand, Chiropractors train and practice their form of manipulation far more frequently than your run of the mill DO might practice OMM. It follows that the Chiropractors given their experience are better than most DOs at manipulation, even though DO methodology may be more sound.

I would go to a DO who has extensive training in OMM for manipulative therapy before I would go to a Chiropractor, but I would go to a Chiropractor before going to a regular fm DO.

An interesting note from Norman Gevitz in his book The DOs is that Chiropractors came after Osteopathy was established. Before HVLA there was very little distinction between the two fields and I believe the AOA of the time sued the Chiropractors more or less for copying.

HVLA is HVLA. There is no HVHA; nothing "extreme".

 

[salazaar]

I am sure that they don't call it HVHA.

 

[facetguy]

I am sure that they don't call it HVHA.

They, or I should say we, call it HVLA. HVHA is when your buddy at the gym thinks he's good at cracking your neck. No thanks.

 

[st2205]

Do people at the gym really crack necks? On a side note, facetguy, I've been meaning to get around to responding to your post from last week but have been on vacation (posting from a phone) and just didn't want to appear that I ducked out and dodged the questions.

 

[facetguy]

Do people at the gym really crack necks? On a side note, facetguy, I've been meaning to get around to responding to your post from last week but have been on vacation (posting from a phone) and just didn't want to appear that I ducked out and dodged the questions.

Vacation away! I'm not sure which post you mean, but we'll see you when you get back. Are you somewhere exotic I hope?

 

[st2205]

If you consider Utah, Montana and South Dakota exotic...

 

[taylormade2006]

If you consider Utah, Montana and South Dakota exotic...

Not the beach, but certainly scenic in parts.

 

[RetinaTazer]

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