OMT and Chiropractics

Getting into Med School is Hard? Not with BeMo.
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One last inflammatory response to such an ignorant post by Treybird. My previous profession included being a Navy Corpsman, an EMT-P, most recently a PA in the civilian world and Army Reserves, and now a medical student. You can always measure a profession by how much the military utilizes them, which is about none for people like you as you know. Anyone see an chiro's on Band of Brother's running from foxhole to foxhole seeing who needed a combat adjustment?

There is not a single day I wake up wishing I was a chiropractor. Care to trade tax returns and see who did better this year or any other. What kills you is that a PA could get more respect than a chiro, and make more money. I am continuing my journey through medicine because it is what I love, and I don't mind giving up the 6 figure salary to do it. I would take a pay cut to be a physician, because it is my dream. Don't patronize people without knowing anything about them. My original post was not aimed at you personally by the way, and neither will any of my future responses. You will get the last word because I am not going to respond to your ignorance any further. Care to try and get me to resond? You won't be able. I wish you luck getting that foot out of your mouth so you can get the last word. Something tells me you will.
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•••quote:•••Originally posted by PACmatthew:
•

Don't patronize people without knowing anything about them. •••••This seems awfully ironic on this thread....
 
Hey JenMac, welcome back. I noticed they seem to ignore what you have to say. Not very gentlemanly, if you ask me. You speak the truth. Just don't patronize them. It gets them excited.

PACmatthew, hasta, bubba. Sounds like you have a foot fetish. Good luck with that.

Anyone want to get adjusted? The door is always open.
 
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I definately have less respect for chiropractors after reading all of these posts, and surfing around on SDN.
 
I'm sorry you feel that way.
 
JerseyGirl, I'm sorry you feel that way too, esp. since we both hail from the Garden State. I suspect you didn't have much respect for us before this so I highly doubt that this forum changed your mind on that issue. How about respect for your fellow DO students in this forum? You must feel that they've been angels throughout this debate.

I agree, however, that this really has gotten unprofessional. So, let's start over.
Would anybody like to discuss the differences between Chiropractic and Osteopathy. No slamming, or attacking, or condescending...myself included. This is supposed to be a forum for open discussion and my guess is that many of you don't understand Chiropractic, our scope of practice, or our level of education. Some just don't care, and to you I say, fine. You're entitled to your opinion. If you don't want to discuss, go start the DC's vs. DO's forum. For those of you seriously interested in learning something new, let's talk.

Many of you posting seem to find it very easy to put us down or dismiss us. Why is that? This is an honest question, not an attack: Do you feel insecure by the way that MD's treat DO's and that some of you need to slam Chiropractic to feel better? that is a sincere, non-condescending question. I know that some of you DO's out there support us, and detest what has been written by your peers. If so, speak up. Self-police. Some of you think that it is Jen and I who are the aggressors, and the others are just innocent victims in our scathing wake. How can the minority be the aggressors? Do you honestly feel that we've been treated fairly in this forum? That we've been treated with the respect that you would show each other? Is this how you would treat a Chiropractor in the field? I can honestly say that I have a great relationship with the DO's and MD's that I've met in practice. Most have questions about what I do, even skepticism, but they keep an open mind and learn something new. If you feel that we've been unprofessional, then take some of the blame as well. This has not been a one-sided conversation. We've all had the chance to vent, and now it's getting old. So, who would like to discuss?

TB
 
I'm really interested in the difference between chiropractic and OMM. I've yet to even start my first year of DO school (2.5 months to go!) so my knowledge of the subject is very limited, but I've shadowed both DCs and DOs.

It appears as though the HVLA techniques used by both disciplines are identical (to me, anyway), and that DCs who employ muscle work as well as HVLA adjustments are performing something very similar to some of the OMM I've seen. I know DCs and DOs speak about the patient's dysfunction in different ways, but the actual techniques look quite similar.

Can someone please correct me if I'm way off? I'd like to learn more.
 
One of the difficult things about these GOOFY forums is that when 2 people debate there is loss of continuity...the affect of the voice is missing.

If there was anything that I learned from my lengthy debate with Treybird is that he honestly cares about his patients...he is not in chiropractic to push mega vitamins or to manipulate the OA joint to treat hypertension. As we know, he intends on going to medical school.

Ego's get in the way sometimes. PAC Matt, yours is rather large. I like you, I am impressed with the fact that YOU ARE ENTERING MEDICAL SCHOOL...just be prepared to be humbled. Prepare to learn that JUST MAYBE what you had been doing in the past may have been incorrect in theory...and that all of us aren't QUITE as smart as we think we are.
Despite what the Armed Forces lets us do.
 
Hey Solie. First off, congrats for shadowing both professions in trying to make an informed decision. I can't comment on osteopathic manipulation b/c I don't have any experience in that arena. I'll refer you to my counterpart, happy clown.

From what I do understand, you hit the nail on the head. At the heart of the matter, we have the same basic philosophy in that vertebral misalignments can affect the way the body functions. This is strictly philosophy. For Chiros, we believe that it affects the nervous system, for DO'c the circulatory system. We both use manipulations, although we approach it from different angles and call it different things, it's the same thing essentially. The biggest difference is that Chiros don't use medicine or surgery as a treatment. Now, you will find Chiros that run the spectrum in philosophy from those who don't believe in adjusting anything besides the first two vertebrae. They believe that all disease stems from this. They are the Amish of the profession and I think that kind of thinking is dangerous and malpractice. Then you will find some Chiros who will do everything up to dispensing medicine and doing surgery. In their trainging, they did partake in clinical rotations. Check out National U. or Northwestern U. for more specific training requirements. Some Chiros rely heavily on nutritional supplements. Some small percent get into really bizarre, way-out techniques that do not represent the majority in any way, shape or form.

I think I've hit the highlights. If I didn't answer your question, please let me know. If you have any other questions, let 'em rip. Happy clown, care to jump in on this one?

Happy: I agree that trying to debate on this forum is too intermittent to hold any real steam. You can't debate, only discuss. Thanks for the support. We've reached common ground. I can see it now, I'll get into my internship and you'll be my attending or senior resident. :D

I realize the limitations of Chiropractic and the long road ahead, but at least the schools are starting to take some responsibility in initiating the research necessary to lay this debate to rest. Outside of the medicine and surgery, I honestly don't see that much difference in Chiropractic and Osteopathy, at its heart. We both view the patient as a whole, not a disease, and we both use manipulation to help patients get out of pain. Do I think there are some loony Chiros out there? Absolutely. Do they represent the majority? Absolutely not.

Good dialogue today.
 
Treybird, I don't think it's very accurate to say that DC's and DO's are the same except for the medicine and surgery thing. I agree OMM and chiro technique share similar philosophies but on the whole modern Osteopathic Medicine is not very related in philosophy to Chiro practice. If this were true, then DO's would primarilly use manipulation and then drugs and surgery as a supplement to it. With the exception of a few DO's that specialize in OMM, most practice medicine with the reverse philosophy--Drugs and Surgery with OMM as a supplement. They are taught, though, that underlying all of their treatment should be emphasis on the whole patient and not just one body part or symptom. Several decades ago they were, when a lot of DO's still saw OMM as the end all be all of medical treatment. This was Still's initial philosophy and it held up for many years until the field of medicine began to make strides in the 20's and 30's. However, the early DO's and their success as well as modern scientific evidence today does prove the efficacy of OMM. Chiro's are more closely related to the DO's of old, then modern DO's who don't use medicine in accordance with OMM, but rather OMM in accordance with medicine. I personally have no problems with chiropractors, but if it came down to myself needing treatment, I would rather see an OMM specialist. With their medical background, it just seems to me that on the whole, they would have a larger piece of mind. With the exception of OMM specialists, if you are looking at Osteopathic medicine as an extention of chiropractics then you may be disapointed. Good luck in medical school.
 
PAC, I believe your posts are a bit out of line.

"You can always measure a profession by how much the military utilizes them"

Perhaps all of your military background gives you this perspective, but I think you'll find that there are many valued professions in civilian society that have no representation at all in the military.

How would you measure artists? philosophers? what about the vast majority of scientists and teachers? What about doctors that specialize in geriatrics or pediatric diseases?

Maybe you think nothing of these people, but many highly value their contributions to society. Many value chiropractors as well.

"Don't patronize people without knowing anything about them. "

I do think we should all take this one to heart. That goes for everyone reading this board...

You can't always directly control what people have to say, but you CAN control your own responses.

salary? presteige? NOTHING.. once you get beat down in your first year of medical school and realize there is seven more years to go (and either 150grand of debt or a long government service agreement), those will be very distant rewards indeed. If the presteige is all your looking for in a job, you might find there isn't enough of it in medicine to pay you for your lost years and suffering. If you really DO do it because you love it... then why couldn't someone love chiropractics every bit as much? What right have you to try to take that away from them to make yourself feel better?

R&R doc-
Let me see if I undertand: t-bird posts that chiropractors and DO's are similar except for DO's practicing medicine and surgery, and your entire argument is that he's wrong because DO's practice lots of medicine and surgery? hmm...
 
Thanks for answering my questions--I'm learning a lot on this thread. :)
 
Bones,

I think what I stated is pretty clear. It is also not an argument, but rather a perspective. I have studied philosophy for the past 4 years, and I have learned, and experienced first hand, the difference between a constructive discussion and a pissing contest. This is not a question of right and wrong. Things aren't always black and white.. I'm just saying, from my perspective, that a DO is closer to a traditional MD, than a Chiropractor. That is a fact. If Treybird is thinking that it is the other way around, he will be disapointed at Osteopathic Medical School. I don't know why everyone takes everything so personally, it is nothing but immaturity and it takes away from constructive discussion. Now the next step, if you disagree is to tell me a reason why you think DO's are more like DC's than physicians; however, I don't think many would agree with that. That's just a hunch, and I could be wrong.

" Since light travels faster than sound. Some people appear bright until they speak."

--Rock and Roll
 
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•••quote:•••Originally posted by Treybird:
[ They are the Amish of the profession and I think that kind of thinking is dangerous and malpractice.
/QB]••••He he he. I couldn't agree more. BUT, Northwestern and National don't teach surgery or medical intervention. They teach an evidence based approach to chiropractic. Which I think is awesome because we are prepared to interact with MD's and comanage cases, if necessary. I think the only school that teaches minor surgery is Western States in Portland. And Oregon would be the only place you could practice that broad of a scope of practice anyway. Correct me if I'm wrong?
 
Bones!! Welcome to the foray. Good to see ya again.

Chiro's are more closely related to the DO's of old, then modern DO's who don't use medicine in accordance with OMM, but rather OMM in accordance with medicine.

R&Rdoc: I would agree with that statment 100%. But that doesn't take away from what the early DO's did. They've just shifted their paradigm a little to the right...or left, depending on where you're standing, since then. I think what DO's did then and now is just as valid as what chiros do. If you're more comfortable with someone in your own profession, that's understandable. You feel more comfortable with your own. But that doesn't mean that what a DC does is less valuable. I can't quote you research articles on the efficacy of Chiropractic, all I can do is speak from experience, and I have more experience at treating patients with manipulation than any students in DO school. No matter what modern osteopathic medicine's philosophy is, it still springs from the original. You shouldn't lose sight of where your profession came from. It will keep you true to your art. We can't explain all the ways that aspirin works, we just know it does, so we use it.

With the exception of OMM specialists, if you are looking at Osteopathic medicine as an extention of chiropractics then you may be disapointed. Good luck in medical school.

Actually, I'm very confident with my adjusting abilities (aka OMM) after being in practice for 8 years. Now I want to learn about medicine, with a whole person approach. Who knows, I may even go into radiology or surgery. Thanks for the good luck.

Solie: Good luck. If you want any more specific information regarding chiropractic or websites that can lead you to info, send me an e-mail.

JenMac: Keep goin' girl!! No, National and NW don't teach surgery. I'm sorry if I implied that. They just do rotations in hospitals. I've heard about a school that teaches minor surgery but I don't where they could use it.

TB
 
Treybird, I'm sorry I am a little naive about some of this stuff, however my mother was manipulated by a DO (unfortunately for her I'm in MD school)so I know it works. What if you end up at a DO school and out in practice and manipulate your patient with a modality similar to the two fields ie HVLA (again correct me if I'm wrong in their similarity) What do you mark down in the chart? A DC technique or a DO technique? Is it possible to practice both DO and DC manipulation on the same patient or is that a breech in the laws of referring? Personally, I think that it would be good for the patient, but does the law prevent it?
 
Clarification for all, including pacMatthew. Armed forces do utilize chiropractors. There is a staff chiropractor at all Air Force bases I have been stationed at, and a full clinic at most. These are fully funded and staffed by military personel. Do you see them on the front line? (a.k.a. Band of Brothers) What a silly thing to ask.
 
The military utilizes all specialties of medicine because families and retirees are also treated by military doctors. So yes, they have plenty of pediatricians and geriatricians in the military. The military doesn't utilize chiropractors to any significant degree because 30% of the miltary physicians are DO's. And DO's in the military often practice a great deal of manipulation, while a chiropractor could ONLY practice manipulation (hence not a very broad scope of practice in the military's eyes).

As for artists and philosophers; This is a medical discussion and it should have been obvious that I was referring to medical specialties when I was speaking of the military usage of them. And if you have a degree in Art of Philosophy, the military will absolutely commission you as an officer. You will just likely find just find yourself doing things other than your major area of study, just as a chiropractor might have to do if they accepted a commission in the service. And don't get me wrong, there are some chiropractors in the military that are practicing their craft.
 
Ice Man: I honestly don't know how that would work. Are there two seperate codes for a DC manipulation and a DO manipulation? I use the CPT code 98941. What does a DO use? If there are two seperate codes and you used both techniques than you bill using the code that pays more. If anyone can help me on this one that would be great.

I suppose that once I've been trained in OMM I will end up just incoroporating into the techniques I already use. That's what happens in practice anyway. We're taught many different techniques but once you're in practice you end up sort of developing your own style, which combines most of the techniques you've learned. I suppose adding OMM to that bag of tricks would work the same way. Sometimes OMM would work better for a patient, sometimes a Chiro adjustment. Sometimes both. That's where the art of manipulation comes into play. We're taught that Chiropractic is a science, a philosophy and an art. That's true of medicine as well. I'm sure that OMM has some great stuff that would compliment what I already do and vice versa. In the long run you just do what works best for the patient and don't worry about whether or not it was a DO or DC manipulation That's just semantics.

bustinbooty: That's part of a study that's being done by the military, authorized by Congress, to study the efficacy of Chiropractic in the military. It's been going on for years now and I suppose they will never actually finish it.

You will just likely find just find yourself doing things other than your major area of study, just as a chiropractor might have to do if they accepted a commission in the service. And don't get me wrong, there are some chiropractors in the military that are practicing their craft.

That's what I was told was the big hang-up with adding Chiros to the military. I spent many years looking into it b/c that's what I wanted to do. I even thought of applying to that study I mentioned before. One base they were doing that study at was in Illinois, I think. Like PAC said, the big question is, what would we do in times of war? One AF officer told me we could be trained as PA's or something since we already have the basic training down. Whatever works. I can't see adjusting soldiers on the front line. Talk about having to perform with a gun to your head. Too much pressure. I didn't want to go into the military and not be able to pratice as a chiro. I was offered jobs as a warrant officer, healthcare administrator, chopper mechanic, etc. I was like, whatever dude. Can't see myself adjusting a Blackhawk. Do you think this guy was just after the commision?? :confused:

TB
 
Where is the pre-chiropractic or chiropractic forum? It?s seems all the other health professions have a forum except chiropractic. Why is that??
 
R&R,
?I think what I stated is pretty clear. It is also not an argument, but rather a perspective. I have studied philosophy for the past 4 years, and I have learned, and experienced first hand, the difference between a constructive discussion and a pissing contest.?

Impressive- four years of philosophy. If you have studied philosophy, you should appreciate the broad use of the term ?argument?, as in the philosophy I?ve had that?s the way we frame all constructive discussions- your line of reasoning is your ?argument.?

While my post had a passing reference to the circular nature of your argument, it never involved a personal attack.

However the tone of your response to me makes me wonder about your intentions:

"Since light travels faster than sound. Some people appear bright until they speak."

?I don't know why everyone takes everything so personally, it is nothing but immaturity and it takes away from constructive discussion.?

Take it personally? <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" />
Do you assume that anyone disagreeing with you on this board must be a chiropractor? I didn?t give you much information to make that assumption. Actually I?m a DO student like yourself, but I?m not quick to take sides. I evaluate arguments by their merit and not their author.

Your thesis does not match your conclusions, nor does it match with what treybird said. He clearly stated that chriopractors and DO's share philosophical roots, while maintaining different theories of dysfunction and different scopes of practice. I happen to think he's right, and while you say you disagree with him, I see nothing in your post that does so clearly.

I would argue that "OMM philosophy" is no different than "DO philosophy"- after all, thats what they put in all the brochures- (and what they teach us in class). If you disagree with me on that topic, we can debate it.

You state:
"I agree OMM and chiro technique share similar philosophies but on the whole modern Osteopathic Medicine is not very related in philosophy to Chiro practice."

To me that sounds like a contradiction- at least with the premise I listed above. This premise is well accepted in the profession, and you can see it on any of the osteopathic philosophy boards. Sure DO's don't all use OMM, but the philosophy of the body as a unit- and discovering health in the patient rather than targeting diseases- these ARE the basis of modern DO philosophy, if there be such a thing.

If you think I misrepresented your argument- tell me how, or restate it by laying out your premises and how they relate to what Treybird posted. I simply don't see the value of disagreeing for the sake of disagreeing, and that was my impression of your post.

"Now the next step, if you disagree is to tell me a reason why you think DO's are more like DC's than physicians"
<img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" />
Don't be silly, DO's ARE physicians. Chiropractors, (so far as I know) are not. Obviously I never made any such claim, nor did Treybird so far as I know. Who exactly are you trying to pick a fight with and for what purpose?

relax, it's almost summer.
:cool:
bones
 
•••quote:•••Originally posted by PACmatthew:
•
You can always measure a profession by how much the military utilizes them, which is about none for people like you as you know. Anyone see an chiro's on Band of Brother's running from foxhole to foxhole seeing who needed a combat adjustment?

As for artists and philosophers; This is a medical discussion and it should have been obvious that I was referring to medical specialties when I was speaking of the military usage of them. And if you have a degree in Art of Philosophy, the military will absolutely commission you as an officer.•••••PACmatthew

let me just get this straight now...

Are you saying that the only value of HEALTHCARE professions are in what capacity the military utilizes them?

How about individuals? are individuals only as valuable as their capacity to serve in the military? <img border="0" alt="[Wowie]" title="" src="graemlins/wowie.gif" />

These are the natural extrapolations of your logic. If this is what you belive, please say so.

bones :cool:
 
I think we all need an adjustment. I know I do. I just spent two days doing my amcas and aacomas applications, and boy does my neck hurt. Any of you have any problems with amcas changing the characters in your essays? i.e.&gt; question marks where apostrophies should be?
 
okay, I got a few minutes... so who wants cervical HVLA from a guy who does martial arts in his free time? :p
 
I've been wanting to try out a new HVLA wrestling move...courtesy of the WWF.

Hey, how many Chiros does it take to screw in a lightbulb??

One, but it takes 8 visits.

HAHAHAHAHAH...that cracks me up.
 
•••quote:•••Originally posted by Treybird:
•I've been wanting to try out a new HVLA wrestling move...courtesy of the WWF.

Hey, how many Chiros does it take to screw in a lightbulb??

One, but it takes 8 visits.

HAHAHAHAHAH...that cracks me up.•••••LOL

I have great respect for those who can laugh at themselves!
 
How many DO's plan on using OMM in their practice?
 
Although I'm still working on my undergrad and far from the application period, I hope to use OMM with my patients. Of course, this all depend on what type of specialty I choose and how practical it is to use OMM. In any case, I know my family will bennefit from it. Wish everyone luck in their future as DO's.

Student247
 
My Dr uses OMM (somewhat) and has really helped my husband (he has shoulder problems). I don't plan on specializing in OMM, but I can certainly see myself using it if I choose to go into primary care. Outside of that, I'm not sure.

My husband is excited for me to learn it so that he can benefit! :D
 
Thought I would say a word...
The techniques I learned in PT blend with OMM, so I guess I use a fusion of both techniques in clinic. I guess you really come to the point where it no longer distinguishes itself as "OMM-not OMM" in practice, but rather becomes "part of your normal approach to medicine".

I would NEVER have a patient leave the E.D. (say with a dx of 'lumbar strain') without getting postural education and BASIC stretches to ease them back into movement...it takes 60 seconds!
 
Welcome back, Happy. That's exactly my point. Your techniques become an amalgam of everything you've learned. That's where experience comes into play, and confidence. The more tricks you have in your bag, the more confident you are that you can handle 99% of what walks through the door. That's why I feel that learning OMM will make me a better manipulator (of joints, not people).

When you say that a DO specializes in OMM, do you mean that is all he does is OMM? How does one specialize in it? Do you just lay aside the medical aspect of the profession?

DrMom, manipulation is an excellent way to help some people who don't find relief any other way. Definately become proficient in it. It takes a lot of practice so try and get some in on all your patients you think can benefit from it. Your husband and your patients will love you for it. :)
 
OMM specialists are DO's that go through normal training through their undergrad medical school and rotating internship. They then do a residency in OMM, or "neuromuscular medicine" as some places call it. Many OMM specialists still use much of what they learned in medical school the way any other doctor would. Some of the competition between chiropractors and DO's, I think, stems from the fact that superficially OMM specialists and chiropractors look very similar in practice.

OMM specialists have a very sophisticated ability to diagnose diseases and dysfunction, rooted in their medical training. Since I don't know exactly what chiropractors are taught (except what I've heard on this board and via the links here), it would be difficult for me to draw a comparison. Perhaps treybird can get back to us on the matter after a few years of DO school!

OMM specialists make it their goal to treat patients that come in as if OMM is a medical treatment. Treatment attempts to target the cause of the problem, and alleviate that cause on the first visit (rather than ongoing treatments for patients without significant symptoms for the purpose of "wellness"- though I don't know how many chiropractors do this). If the symptoms do not resolve on the first visit, sometimes the patient must come in a few more times. If no improvement is shown, obviously other treatment options are available. Some OMM specialsts operate as primary care providers, though typically it is best to do a Family med/OMM dual residency for this (or do a +1 program-&gt; most OMM residencies take only 1 year if you already have another residency under your belt).

OMM specialists do, however, charge normal doctor wages- which is significantly more than chiropractors.

What is the recommendation? many would say for serious neuromuscular issues it is better to see an OMM specialist, since thier medical background will aid them in determining the best course of action, and perhaps how to most directly treat the presenting symptoms. Whether this is necessarily true- I can't say. I haven't seen outcome studies, and I suspect the effectiveness varies a lot by the individual practicioner as well.

this is a complicated subject, and I'd like to discuss it some more once finals are over...
I'll see if I can find any sources then.

peace,
bones :cool:
KCOM '05
 
The way that I view Chiropractic is that it is similar to PT in that rehabing an injured joint is like rehabing any other injured MS area, which means it's a process. This is why it may take several visits to a Chiro, depending on the activity level of the patient, their age, occupation, sex, injury etc. It can take a while for the body to heal so while it's working through the healing stages, the adjustments keep the spine aligned, more to the point, keep the joints moving, while stressing the ligaments in a way that stimulates proper healing, avoiding the formation of fibrosis and adhesions. Just like you would get an injured football player with a torn ACL back on the exercise equipment as soon as possible, to add stress to those ligaments, causing the healing fibers to realign in the direction of stress, thereby assuring the strongest possible heal, avoiding scar tissue as much as possible and therefore chronic pain.

I keep hearing that people would go to a DO instead of a Chiro b/c of the medical background in case something else is the underlying cause, etc. First of all, we all know that a patient's history will tell you the diagnosis 90% of the time if you listen close enough. If a patient was at work and he went to lift something and felt his back go pop and now has sharp SI joint pain, what is there to medically diagnose?? Come on, seriously.

You read through the history to look for red flags of previous conditions that may have set up this injury (i.e. cancer, etc.); do a patient interview to find out the mode of injury onset, location of pain, description of pain, presence of any radiating pain, what makes it worse, what makes it better, etc.; do the orthos/neuro tests to rule out a disk problem, or other more serious injury; and then do the motion palpation of the SI joint to confirm your diagnosis, but you already know what the problem is. Tests are run to confirm or deny a diagnosis, not to make a diagnosis. No, I don't X-ray/MRI every patient, only when looking for pathology. So what makes you think that chiros are different in this regard. We are very well trained in A & P and have an excellent knowledge of how the body works. Granted, we don't spend as much time in path, pharm, and surgery, but I'm not interested in the organic basis for cholecystitis b/c I'm not going to treat it. All I want to do is recognize what it is and refer that patient out. Most people who have a DC also have a family doc. So we just call the family doc, explain what I think is going on, set up an appt and send the patient on his/her way.

You guys are making this harder than it is. When you hear hoofbeats, think horses, not zebras. If a patient comes in with insidious onset pain and has a history of blood clots or prostatic cancer, then you start to do some investigating. Yes, we have the training to pick out the red flags, investigate, and refer. I don't know why everyone in here feels that we're just not qualified to do this. We don't usually have the life-threatening cases walking in our doors, but if one did I am confident that I know enough to recognize that and send them on to the proper specialist. I have before.

It's not brain surgery, well, unless you're a neurosurgeon of course. I meant Chiropractic is not brain surgery. For those of you in internship or residency, don't overthink everything. Use some common sense, and I'm not saying that to be an ass or directing it at anyone in particular. It's just a reminder to take your knowledge of anatomy and physiology and just use common sense. Sometimes we get too tunnel-visioned and lose sight of the big picture. DO's, I think, are much better at looking at the big picture than any other allopathic professions.

Ok, bring on the onslaught of disagreements...... <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" />

TB
 
Nice post Trey! I just think it's sad that because we, as DC's, have so many loony representatives of our profession, we are all automatically stereotyped to be witch doctors. Not pointing any fingers at anyone but ourselves, of course! :) But the perceptions are slowly changing, and definitely for the better. I was just hoping to spread some awareness to the fact that DC's do have something wonderful and valuble (and valid) to add to medicine. :cool: Trey here, has been my hero in that respect!
 
JenMac <img border="0" alt="[Lovey]" title="" src="graemlins/lovey.gif" /> Well put, Jen.
 
•••quote:•••Originally posted by Treybird:
•I keep hearing that people would go to a DO instead of a Chiro b/c of the medical background in case something else is the underlying cause, etc. First of all, we all know that a patient's history will tell you the diagnosis 90% of the time if you listen close enough. If a patient was at work and he went to lift something and felt his back go pop and now has sharp SI joint pain, what is there to medically diagnose?? Come on, seriously.

You read through the history to look for red flags of previous conditions that may have set up this injury (i.e. cancer, etc.); do a patient interview to find out the mode of injury onset, location of pain, description of pain, presence of any radiating pain, what makes it worse, what makes it better, etc.; do the orthos/neuro tests to rule out a disk problem, or other more serious injury; and then do the motion palpation of the SI joint to confirm your diagnosis, but you already know what the problem is. Tests are run to confirm or deny a diagnosis, not to make a diagnosis. No, I don't X-ray/MRI every patient, only when looking for pathology. So what makes you think that chiros are different in this regard. We are very well trained in A & P and have an excellent knowledge of how the body works. Granted, we don't spend as much time in path, pharm, and surgery, but I'm not interested in the organic basis for cholecystitis b/c I'm not going to treat it. All I want to do is recognize what it is and refer that patient out. Most people who have a DC also have a family doc. So we just call the family doc, explain what I think is going on, set up an appt and send the patient on his/her way.

You guys are making this harder than it is. When you hear hoofbeats, think horses, not zebras. If a patient comes in with insidious onset pain and has a history of blood clots or prostatic cancer, then you start to do some investigating. Yes, we have the training to pick out the red flags, investigate, and refer. I don't know why everyone in here feels that we're just not qualified to do this. We don't usually have the life-threatening cases walking in our doors, but if one did I am confident that I know enough to recognize that and send them on to the proper specialist. I have before.

It's not brain surgery, well, unless you're a neurosurgeon of course. I meant Chiropractic is not brain surgery. For those of you in internship or residency, don't overthink everything. Use some common sense, and I'm not saying that to be an ass or directing it at anyone in particular. It's just a reminder to take your knowledge of anatomy and physiology and just use common sense. Sometimes we get too tunnel-visioned and lose sight of the big picture. DO's, I think, are much better at looking at the big picture than any other allopathic professions.

Ok, bring on the onslaught of disagreements...... <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" />

TB•••••The biggest issue that I have is that I have no knowledge of a chiro's clinical skills. Chiro's simply do not see the pathology that doctors see through out their training. It's one thing to have read about a disease and how it presents. It's a totally different thing to actually see the patient and how they present with that particular disease. By seeing pathology, you hone your clinical skills that are necessary for that group of diseases. If chiro's do not see the volume of pathology that doctors do, how can they develop that clinical skill set? How can I be sure that when you auscultate someone's heart, you can interpret the sounds in an accurate fashion? How can I be sure that you can effectively rule out PE when someone presents with MSK sounding chest pain? As medical students/doctors, we do not look for red flags, we look for a diagnosis. There isn't a specific sign that we look for, we look at the whole picture of the patient as they present to us. If you're not interested in the organic basis of cholecystitis, we are. We are interested in organic disease (by which I assume you mean internal, non-MSK organs) as well as MSK disease. Everything that our patient presents with, from their psyche to their lungs to their elbows, is our concern. That is the big picture.

As for DO's being more concerned with the big picture, DO's are the same as MD's. They will treat the same diseases and the same patients in the exact same way as an MD. Any difference between the two will be entirely based on the individual doctor.
 
The biggest issue that I have is that I have no knowledge of a chiro's clinical skills.

Exactly. Go shadow one for a day and see what we do. You might learn something about a new profession. Just a suggestion, not a dig.

If chiro's do not see the volume of pathology that doctors do, how can they develop that clinical skill set? How can I be sure that when you auscultate someone's heart, you can interpret the sounds in an accurate fashion?

Ponyboy, I know enough to know when something doesn't sound normal. That's all I'm concerned about at this point because I'm not going to treat cardiac tamponade or any other cardiac condition. I'm going to refer them out to their cardiologist or family doc. You keep looking at this from the perspective of a medical student. We're not medical doctors. That's what I've been saying all along.

If you're not interested in the organic basis of cholecystitis, we are. We are interested in organic disease (by which I assume you mean internal, non-MSK organs) as well as MSK disease.

I agree with that. I never said that you guys weren't interested in those things. I just said that we weren't as interested in the pathology of organic, non-MSK diseases, because we don't treat the pathology of those conditions. You do, so naturally you would have an interest in it, I would hope. I just said that we're trained enough to know when something is outside our scope of practice to refer that patient on. Organic, non-MSK diseases are outside our scope of practice. Certainly any MSK conditions that require surgery or medicine are also outside of our scope of practice as well.

Everything that our patient presents with, from their psyche to their lungs to their elbows, is our concern. That is the big picture.

I'm absolutely concerned for my patients. Enough so that I make sure they get the proper medical care when necessary.

As for DO's being more concerned with the big picture, DO's are the same as MD's. They will treat the same diseases and the same patients in the exact same way as an MD. Any difference between the two will be entirely based on the individual doctor.

I stated that as a compliment. I'm sorry if you didn't see it that way.

TB
 
The problem is not whether chiros can recognize typical red flags of serious disease but can if they can recognize atypical presentations of serious disease. Sometimes an MI presents as heartburn. Sometimes pericarditis presents as costochondritis. Even seasoned doctors can miss things like this. Think about how much easier for someone who doesn't have the same training could also make the same mistake.
There is also the minor diseases that must be looked after as well. If chiros admit that they are not medical doctors and that they do not treat diseases outside of a spectrum of MSK ailments, then why do some of them insist they are primary care providers? Even minor illnesses such as a sore throat can be harzardous if they are not given the appropriate investigation and therapy (sore throat that's actually Strep that leads to rheumatic fever).

I've seen chiros in action. But I've never seen them evaluate chest pain, use a stethescope or read a CXR (other than looking at the spine). There isn't really an environment for them to do so.
 
Sometimes pericarditis presents as costochondritis. Even seasoned doctors can miss things like this.

If that's the case then why would you expect more from a Chiro under the same circumstances? Nevertheless, let's use this as an example.

If I had a patient come in with pain in the costal cartilage region, these are the questions I would ask.
1: First thing I would do is ask the patient if it is a specific pain or a diffuse pain, then I would touch the costal cartilage where it hurts and see if pressure on that area increases pain. How would you describe the quality of pain (i.e. sharp or dull - typical of a MSK conditon)
2: Does it hurt when they move that cartilage or at times independent of movement, esp. when using the chest muscles that attach to that region?
3: What was their history? Have they had this pain in the past? If so, what was the diagnosis?
4: Do they have a history of a recent illness or other heart condition (rheumatic fever as a child)?
5: Are they having trouble breathing that feels like it originates from the lungs or a sharp pain in the costal cartilage area?
6: Do they have an abnormal or weak pulse, abnormal breath sounds, bradycardia, etc?
7: Does ice on the costal cartilage make it feel better?
8: Have they recently played any sports or done any new activities that may have caused that patient to strain the costal cartilage (i.e. a new racquet sport, new weightlifting program, weekend warrior-type housework, etc.)?
9:Have they felt very run down lately, esp. when they exert themselves, indicating hypoxia due to cardiac compromise?
10: Have they been running a fever lately?
11: Have they noticed any digital cyanosis, esp. with exertion?
12. Does swallowing make it worse?
13: Is there any radiating or referred pain to the neck or inferior scapula?
14: Is there a change in pain with a change in position, i.e. sitting and leaning forward?

You mean to tell me that with this information you couldn't take a reasonable guess as to whether or not their conditon was life threatening?? Keep in mind, I only have to have enough info to suspect that a referral is warrented, not a diagnosis. If after a few adjustments and directions for the use of ice and massage the pain remains or gets worse (assuming the patient is compliant in following their restrictions), then I start to suspect something beyond a MSK problem.

TB
 
If I had a patient come in with pain in the costal cartilage region, these are the questions I would ask.

1: First thing I would do is ask the patient if it is a specific pain or a diffuse pain, then I would touch the costal cartilage where it hurts and see if pressure on that area increases pain. How would you describe the quality of pain (i.e. sharp or dull - typical of a MSK conditon)
A: Yeah, it hurts when you push on it. It's a little between a sharp pain and an ache. Kinda like a muscle ache.

2: Does it hurt when they move that cartilage or at times independent of movement, esp. when using the chest muscles that attach to that region?
A: It hurts when I stretch my arms out. Otherwise it aches like if I bruised my chest or the muscles.

3: What was their history? Have they had this pain in the past? If so, what was the diagnosis?
A: Was exercising for the first time in a few weeks because I had the flu. It feels very similar to what I've had in the past but it usually goes away after a few days.

4: Do they have a history of a recent illness or other heart condition (rheumatic fever as a child)?
A: Just the flu.

5: Are they having trouble breathing that feels like it originates from the lungs or a sharp pain in the costal cartilage area?
A: Feels like it's in my chest wall. And its sharp whenever I breathe and stretch my arms.

6: Do they have an abnormal or weak pulse, abnormal breath sounds, bradycardia, etc?
A: That depends on your clinical skills. You tell me.

7: Does ice on the costal cartilage make it feel better?
A: A little.

8: Have they recently played any sports or done any new activities that may have caused that patient to strain the costal cartilage (i.e. a new racquet sport, new weightlifting program, weekend warrior-type housework, etc.)?
A: As above.

9:Have they felt very run down lately, esp. when they exert themselves, indicating hypoxia due to cardiac compromise?
A: Just had the flu. Stayed home from work a few days. Better now.

10: Have they been running a fever lately?
A: Nope.

11: Have they noticed any digital cyanosis, esp. with exertion?
A: Nope.

12. Does swallowing make it worse?
A: Nope.

13: Is there any radiating or referred pain to the neck or inferior scapula?
A: Nope.

14: Is there a change in pain with a change in position, i.e. sitting and leaning forward?
A: Sitting feels a little better than lying down. But not much difference. Pretty much the same actually.

From this history (from a previous patient of mine), can you honestly say that you are sure that this isn't MSK related? How long would you wait before referring this patient? I've had diabetic patients with PE's come into the hospital thinking that they were going hypoglycemic. I've had TIA's come in thinking that they've sprained their ankle. I have yet to see a textbook presentation of anything but warts. There will be some patients who will always be an enigma, no matter how many questions you ask. And even after a physical exam, you may still be wondering.

But what I really want to know is my second question: Do chiros truly try to function as primary care providers, even if they assert that they only treat a certain spectrum of MSK illnesses?
 
I'm gonna leave the question to Trey since he has the chiro clincal experience here, but I wanted to interject and mention that with the training I am receiving now, we have a problem based learning class in every term (starting with the very first term) where we are presented with cases, and we must figure out the tests to run to determine the probable diagnosis, method of treatment (referral? comanage? treat? how?), the questions to ask them, info we need, blah , blah, blah. Then we all research it, and come back with what we found, all researching different probable diff dx's, and different variables that may be affecting the pt. Then we discuss. Every case we have gotten has not been textbook, so there is a lot of discussion. It's a very cool way to learn. The longer we are in the program, the more complex the cases get. Of course, we can't cover everything, but it's a really good experience to apply to future clinical experience. Correct me if I'm wrong Trey (or anybody), but I am thinking that most of the time, patients won't come to a chiropractor for these complaints. However, when they do, we can catch them, and even if they are coming to a chiro for a different reason, we are still able to catch things that they need attention for beyond our scope.
 
Sorry i just have to laugh a bit regarding the questions...coming from an Emergency Dept perspective, many of the questions you guys are asking are virtually inconsequential (sp?) and skip over the more dangerous causes of chest pain. Not only have you done that, but your questions automatically attempt to RULE OUT/RULE IN costochondritis.
From a new intern to you guys...rule out the most dangerous causes of chest pain first (ones that cause sudden death)...it may seem like overkill, but I am coming from an ED point of view.
 
Well, it's all a matter of perspective. If you're a neurosurgeon, you're going to recommend surgery for LBP. If your a PT, you recommend exercise. If you're a chiro, you recommend adjustments. Simplistic, but do you see what I mean?

You'll never view the patient in my office the way I will, and I'll never view the patient in the ER the way you do. We are coming at the patient from two completely different views. The chance that a patient is going to come in to my office with near death heart spasms is very remote. Is it a possibility? Of course. But statistically very remote. You guys play the statistics game all the time. You have to for practicality's sake b/c we can't run through every battery of tests for every patient. I'm not going to immediately jump to pericarditis for a patient complaining of specific MSK pain. You know as well as I do that it's just not feasable, or necessary, to run to an EKG machine every time a patient has some soreness in his pectoral region.

Ponyboy was addressing a situation in which a patient was showing atypical symptoms of a serious condition that even experienced docs miss. My point was if that's the case than we can expect that it will happen to everyone at least once throughout the course of a career. So if you can accept that it happens to seasoned medical docs, why would it make you think twice about going to a Chiro, unless you are holding us to a HIGHER standard than your seasoned docs. That is just unrealistic for the situation posed.

I've been to the ER with MSK inguinal pain and the ER doc didn't have the first clue as to how to approach me. He asked very basic MSK questions, was very nervous and unsure, and really didn't know what to do outside of giving me drugs. I ended up telling him what to do, and I'm not saying that egotistically or condescendingly, it just was what it was. I wanted X-rays to rule out a hip fracture or dislocation. I ended up getting adjusted and PT from a PT friend of mine for 3 days in a row (I did take the Demoral shot that night, though, I wasn't stupid). Both PT and CHiropractic worked great together and I was back to normal in 3 - 4 days. My point is that this ER doc probably kicked ass on life-threatening conditions, but was clueless with basic MSK issues, which was my area of expertise. It was all a matter of perspective b/c to me it was a no brainer. As long as I wasn't dying or bleeding or unconcious, he didn't know how to treat me, other than to turf me.

We're like at three different corners of a triangle all looking in at the same patient. I find that both funny and sad, but it's true. Even you two DO's see things differently.

TB
 
Clown, I asked an entirely different set of questions than those posed by TB. I was simply answering all of his, using my patient's history (relatively asymptomatic except for MSK sounding pain). After spending considerable time in the ER as well as the ICU, I find I have a mind set similar to yours (dead or alive or checking out quickly).

TB, the point is, if even seasoned docs can make these mistakes, how easy do you think it'll be for other allied health professionals (who see much less pathology) to also miss treatable diseases, life-threatening or otherwise. Even if chiros function as portals into the healthcare system, they must pick up signs of disease to refer the patient to the doctor. Moreover, I'd still like this answered: how can chiros function as PCP's if they admittedly only treat certain MSK diseases?

PS I'm not a DO or a DO student.
 
TB, the point is, if even seasoned docs can make these mistakes, how easy do you think it'll be for other allied health professionals (who see much less pathology) to also miss treatable diseases, life-threatening or otherwise.

I agree that it would be easier for those in the allied health field to miss those pathologies. We're agreed there. But, you also have to admit that the chances of those patients walking into my office (i.e. serious disease exhibiting atypical symptoms) is much less than them walking into yours. Agreed?

Let's just say that in 8 years in practice this has never been an issue for me. We're talking about what could theoretically happen, but doesn't usually happen. It goes back to what I previously wrote, what conditions am I most likely going to see in my office? You're still using an extreme example to prove a point that statistically isn't as likely. I just don't see those type of patients. If I did, and the patient wasn't exhibiting obvious symptoms that could be drawn out through some Q & A than what could I do differently than you? How many patients have cancer but are given aspirin and sent home? It all goes back to the think horses, not zebras.

Ponyboy, it's like you're trying to drag some big confession out of me that Chiros aren't competent doctors b/c they can't diagnose atypical serious diseases, but you chose to ignore the field docs who do this all the time, so how is that DIFFERENT from me?? How is that different from YOU?? That is just the risk of being in healthcare. We all share that same risk. Many doctors don't even take the time to listen to their patients to find out what is going on. I feel confident b/c I take the time with my patients and ask a lot of questions. If something doesn't sound right to me than I refer them for a second opinion. That's all any of us can do. I can't sit and worry about every potential atypical thing it could be. It's just not practical. I'm not going to run them through an ER protocal in my office. None of you guys seem to address this point, and I don't understand how you can't agree with me on that. Man, getting you guys to give on any issue becomes a total battle of wills. It's like Bones says, sometimes you guys disagree with me just to disagree. If someone is that ill then we lie them down and call the EMS. Fortunately that's never happende to me. Doesn't exactly look good for business (ha ha).

Moreover, I'd still like this answered: how can chiros function as PCP's if they admittedly only treat certain MSK diseases?

I've never held myself out to be a primary care provider, only a Chiropractor.

What is your occupation if not a DO or DO student? I must have missed something or even worse, assumed something.

TB
 
•Even if chiros function as portals into the healthcare system, they must pick up signs of disease to refer the patient to the doctor. •

I'm using an extreme example to support an argument. Yes, pericarditis is something that you might not see, but I'm not only concerned about serious diseases. As I've said before, I'm concerned about even the minor illnesses that are missed as they can have bad outcomes if they are left for too long. For example, asthma is a very common disease and research has shown that if it isn't treated promptly, the outcomes of patients are much worse than if they had been treated right away. Yes, doctors miss things. There's no question about that, but think about how much easier it would be for someone else with not as much training to do the same. I'm not trying to make you say that chiros are not competent doctors. They're not doctors. What I'm trying to say is that I have no evidence to suggest that chiros can effectively screen out patients that need to be seen by a doctor from those that do not.

As for being a PCP, the only reason why I joined this debate was because you remarked that chiros can be PCP's and I disagreed. It's about four pages back.

PS. I'm an MD student, not DO. Not that there's a difference.
 
I'm not trying to make you say that chiros are not competent doctors. They're not doctors.

We're Doctors of Chiropractic, just like podiatrists are Doctors of Podiatry. Do you realize that when you say we're not doctors that it makes you appear insecure. Do you feel threatened somehow by the idea that we are called doctors too? If you want to say thet we're not Doctors of Medicine than I can accept that. But don't insult my education. I don't understand the need for people to be so ego-driven here.

Yes, doctors miss things. There's no question about that, but think about how much easier it would be for someone else with not as much training to do the same.

I think I can recognize and refer an asthma patient, thank you. So you feel that all professions less than MD's and DO's should not see patients b/c of the possibility that something might be missed? Nurse pracitioners? Mid-wives? PA's? Do you know how condescending this is? I mean honestly stand back and think about what you're saying. You're saying that I should not be in practice b/c of the possibility of missing something seriously atypical. If I've misinterpreted this, please tell me where you see Chiropractic fitting in to the healthcare system. Let's start there b/c I want to make sure that I'm not being overly sensitive here. I think if MD's had their way, we would not be in business.
 
When I say doctor, I mean doctor of medicine. No slight intended.

What I'm trying to say is that I have no evidence to suggest that chiros can effectively screen out patients that need to be seen by a doctor from those that do not.

The training for an NP and a PA is much different from that of a chiro. I think chiros provide good care for certain MSK pain. However, I have no evidence to suggest their abilities on any other front.
 
Well, I guess until a study is done, this will all be nothing more than opinion and conjecture. I would venture to say that Chiros don't miss an atypical diagnosis more than medical doctors. Not b/c we're better, we just don't come across those situations as frequently as you do. You're still talking about a theoretical situation. I know that we can pose a million theoretical situations regarding medical doctors and what they miss. Do we want to play that game though?

I've already admitted that we don't have the clinical training on par with medical doctors. I guess I don't know where you want to go with this. I've never run across the situation your proposing, nor have any of my friends or coworkers.

I use my training and instincts to rule out anything I consider questionable and if I find something that doesn't quite sound or feel right, then I refer them on for further study. No matter how the medical profession tries to twist this to make it sound like patients who go to Chiros are at risk for strokes, or missed diagnoses, or fractures, or whatever, the fact is that the chances for any serious injury are statistically way lower than in medicine. That's a fact.

Do we want to talk about all the surgical and drug mishaps that happen every day? I know what happens when interns and residents have been up for 36 hours straight. How can you, in all seriousness, even point a finger at us when you have these serious issues on your plate? It's like that whole misdirection thing, the medical smoke screen. "Look at the Chiros and what they're doing...just don't look over here at what we're doing..." You still have this superiority attitude that the Chiros could just NEVER compete with the medical profession. We're not trying ot compete.

I will be the first to admit that there are many Chiros out there that I can't stand b/c they're nothing but car salesman. That makes my skin crawl b/c Chiropractic works, and it works well. And you're arguement that we could miss something serious is moot b/c so could you. It's all relative. We come in contact with many, many less patients with atypical symptoms than you do. I noticed you still haven't acknowledged the things I asked if we agreed upon. This tells me you have no intention of actually having a give and take discussion. I will never say that we shouldn't be in practice b/c we might miss something serious, b/c I don't believe that for a second. And you know what, let's not play the "Oh, my, those poor patients at risk for a Chiropractic missed diagnosis...will they survive the Chiro visit?" But you just can't have an open mind on this issue at all. So how can we discuss this? We can't. All we do is go in circles.
 
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