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Physicians please help this chiropractic student.

Discussion in 'Clinical Rotations' started by DCStudent, Aug 17, 2001.

  1. DCStudent

    DCStudent Junior Member
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    My name is Adam Alexander. I am beginning my 3rd year of chiropractic school and I am very excited with my profession and my future career, with some minor exceptions. That is why I am posting here.

    It has taken me 2 years to realize that I want to get more out of my education than what I am getting in chiropractic school. Don't get me wrong, the classes are challenging but I want more. I have personal and family reasons why I can't change schools or professions at this stage of the game, but I have decided that I am going to hold myself to a higher standard and learn everything I possibly can, while I have the opportunity. I would love the opportunity to continue and expand my education by attending medical school at a later date but for now I have committed my time and resources to chiropractic.

    This is where I ask for advice. I am attending Life University in Georgia just north of Atlanta, and currently they have yet to implent a clerkship program through different medical and surgical services, unlike other chiropractic schools. I would like the opportunity nevertheless to spend some significant time with different M.D.'s in their practices and even during grand rounds for a number of reasons. 1) I would like to see the clinical manifestations of different pathologies 1st hand. 2) I would like a better and more accurate understanding of the medical management of different medical cases. 3) I would like to increase my over all knowledge and experince with the human body, health and disease.

    Does anyone have any recommendations on how to obtain such opportunites for additional clinical exposure?

    You can email or post responses.

    Thank you in advance,


    Adam Alexander
    [email protected]
     
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  3. I'm sure some physicians might be open to the idea of having you shadow them in their practice. In terms of grand rounds and actually rotating through the hospital, I think you will encounter many barriers.
     
  4. Djanaba

    Djanaba Senior Member
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    It sounds like you want the benefit of a medical education without the entirety of medical school. This is a pretty difficult position for potential teachers/preceptors to deal with, methinks, which is another reason you'll find barriers. Consider, instead, petitioning to take some clinical medicine or pathology courses at a medical school instead, so the knowledge you amass will be complete and formal rather than superficial, incidental, and incomplete.
     
  5. DCStudent

    DCStudent Junior Member
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    1st of all, thank you for the replies. Djanaba, is it possible to take individual medical courses, like cliical medicine or pathology? How do I go about petitioning to do that? Any suggestions?

    Thanks,

    Adam Alexander
     
  6. Freeeedom!

    Freeeedom! Senior Member
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    DCStudent,
    You must realize, for you to take these couses you must BE a medical student, of which you are not. It would do a dis-service to those medical students who worked to be there, for you to simply "show up". Now, I am not bashing you at all, but medical training is earned by getting into medical school...not chiropractic school.
    I applaud you for your desire, but there are NO SHORTCUTS to a medical degree. You must decide what you want.

    PS, I have worked with a chiropractic student on a medical rotation ( I thought it was perhaps the weirdest thing ever), and he wasn't allowed to do anything. And, I don't blame the attendings or residents for not letting him. He was a 4th year I guess, but clinically like a 2nd year medical student.
    Unfortunately, that is the way it goes.
    If you don't want to be there, for Gods sake, leave that program now.

    Plus, ya know...if I paid big bucks for that class, I might get a bit upset someone is learning for FREE, taking up space, and didn't earn it.
    my 2cents.
     
  7. Billie

    Billie An Oldie but a Goodie...
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    Hi DCStudent!

    When I was in anatomy class during my first year, we had a guy who was a massage therapist sit in on our lectures AND attend our anatomy labs. He was not a medical student, so it IS do-able. How he came to be though I don't know. I don't know if he called the anatomy dept, the dean of the school...or what.

    Good luck!

    Billie, MS-IV
     
  8. platinumdoc

    platinumdoc Member
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    Dear DCStudent,

    It is good that you have an interest in the Allopathic field of treatment. Why not apply for medical school, or better yet, osteopathic school, to learn 1st hand what it is like to understand pathology. Although sitting in lectures will help, there is a lot of basic science and clinical experience that is required to 'truly understand' what topics are covered. Osteopathic medicine is an excellent choice by reading your introduction to us. They cover a holistic approach to the patient.

    Why not set up a lecture, yourself, regarding the type of treatment and general philisophical training that is learned through chiropractic school? A lot of us (Allopaths) have little understanding of your field. As a practitioner, I sometimes get the impression that chiropractors are trying to make patients think that this type of treatment is the only way.

    Why would you want better understanding of the management of medical cases? You won't be practicing 'medicine', per se.

    If you want 1st hand knowlege of pathology, you can pursue a PhD in pathology or go through medical/osteopathic school and pursue a residency in pathology.

    However, if you want superficial knowledge but don't want to go through another 8 years of training then just talk and listen to 'your own' patients (I think the HMOs call them clients or customers, now)....
     
  9. Djanaba

    Djanaba Senior Member
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    DCstudent, while I think pursuing a medical education in entirety would be optimal for you, some medical schools do permit attendence at courses despite not being accepted to the school. Often these are not for credit, but you may be able to even sit for exams and get feedback without an official grade or transcript. Check with a dean of students at a medical school in your area to find out. Some will be more receptive than others; you may be able to find a place sympathetic to your desires if you couch them in the right jargon.
     
  10. Mr. happy clown guy

    Mr. happy clown guy Senior Member
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    I agree with platinumdoc's statement and Freeeedoms statement.
    I personally think it would be unfair to allow a chiropractic student take a medical school course primarily, because he/she did not earn the right to sit in the seat. And personally, I know that labs can be crowded as it is.
    Secondly, I really don't think it is wise to attempt to "piece" together a medical education by picking and choosing selected courses of your liking. A little knowledge can be a dangerous thing!

    My advice, Get out of chiropractic ASAP and apply to medical school...there are no shortcuts to learning real medicine.

    take care
     
  11. DCStudent

    DCStudent Junior Member
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    I want to thank everyone for their comments and perspectives. I would like to clarify some things if I may. To begin with I asked for recommendations on how to go about taking individual medical classes on the recommendation of a medical student in this forum, he felt it may be the best way to accomplish what I asked about. Second, I appreciate everyone's stance on whether or not I would belong in a medical class because I haven't earned it, and you may be correct, but remember IF that was something that I did, it wouldn't be in pursuit of a short cut to a medical degree, just information. I filly agree, a little information is usually very dangerous. Nevertheless, the point was well taken. While I admit I am giving some consideration to attending medical school at a later date to enhance my knowledge of care I am quite enthusiastic about what I am learning in chiropractic school. I do not however, see the need to exclude myself from my medical counter parts, for I think there is a lot I can learn from the medical profession and I feel I have something to offer as well. As far as wanting to observe during rounds or even observing during a clerkship, there are a couple of reasons for this. One of the benefits of attending medical school is the clinical clerkships through the different medical services that you are exposed to. In chiropractic school we do not usually have the benefit of seeing the clinical manifestations of the disease processes we "read" about and are expected to recognize., with the exception of a few chiropractic schools that have integrated such clinical exposure through local medical schools and hospital systems. Even, simple things such as auscultating the lungs and actually hearing different abnormal breathe sounds or abnormal heart sounds. I also think it is important to understand and have a working knowledge of general medical protocols of treatment, because I think more times than not I will be co-treating a patient with an M.D., meaning that my patients may be patients of M.D.'s as well, especially those with established disease processes. I also think having this knowledge and experience would help me build the bridge between the two professions when I am practicing by having an understanding of the other care my patients are under.
     
  12. Mr. happy clown guy

    Mr. happy clown guy Senior Member
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    IT sounds like you should have chosen Osteopathic Medicine, so that you could achieve the best of both worlds.

    Just remember, it takes a LONG time to develope a "good ear", and I mean years. A single clerkship as a potential "outsider", may do little. But, I admire your desire.

    It is all about the subtle signs of disease, and that takes many, many rotations to get a handle on...even many years in residency.
     
  13. Oliver Lang

    Oliver Lang Member
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    I think it is interesting that DCstudent wants to sit in on medical courses. I once transferred into a class in mid semester and the Professor was a tenured one. He told me that I couldn't transfer in when I asked him. I told him I wanted to learn and asked if I could sit in on his class and he eventually took me in. He said that he can not turn down someone who wants to learn. Knowledge should never be witheald.
     
  14. Morgus

    Morgus Junior Member
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    Hi DCStudent,

    I just finished the MD degree and am glad to see your interest. I have complained for a long time that there is not enough hybridization amongst various health oriented fields. As I took all of the graduate courses in biochem and physiology for a PhD, without bothering to spend a couple of years pursuing doing research that I wasn't really interested in (to write the mandatory dissertation), I'm a big believer in knowledge for the sake of knowledge. It gives me a depth that I couldn't have gotten just from straight medical school. Yes, I know, a lot of people will say, "why would you do all that course work without wanting the degree?" and my answer is that my MD is degree enough in terms of employment, and that the grad school knowledge was just that--knowledge. I enjoyed every minute of it. I see a lot of animosity between some of the PhD's and MD's, and it strikes me as pointless. We should all be on the same team. To me, than includes DC's as well.

    The days of DC's claiming that a spinal adjustment can cure cancer and other such ridiculous claims are long past. All of the DC's I know understand when a neuromusculoskeletal condition is within their realm of practice, and when to refer to an MD. Some of the orthopods I know get 1/3 of their referrals from DC's, and although those orthopods don't like to admit it publicly, a lot of those MD's and their patients are also treated by chiropractors.

    I was very fortunate to date a girl who was already a DC through several years of medical school. I'd give her our hospital scrubs and lab coat, and sneak her with me into everything from anatomy lab, microbiology lab, pathology lab, and even my 3rd year rotations, sometimes in the OR--of course, all at night, and with the support of my friends. She taught me more about neurology and kinesiology and surface anatomy than I ever would have learned from just MD school, and I taught her biochem, physiology, microbiology, pathology, and many other things. We learned heart/lung sounds and advanced physical diagnosis together. She taught me how to deal with patients before I ever dealt with a patient. Although we aren't still involved romantically, I refer her patients when I think chiropractic might be the way to go, and when I start practicing will get referrals from her. It was one of the best learning experiences of our lives, seeing everything through two different sets of lenses.

    Of course, all of the above was on the QT, nothing official. But there was never any trouble--after all, I didn't delegate any responsibility to her--she was just observing and teaching me while I was teaching her. My MD friends loved her. It's interesting that she was able to officially arrange for me to visit some workshops at her DC alma mater with no sweat--they loved cross-training with me. I wish I could say that it would be easy to get an MD school to do this with you--I suppose it would depend heavily on how progressive the school was. Perhaps a DO school might be more cooperative, although since they might fear a "turf war" over spinal adjustment, they could be worse. I think it can't hurt to network like this and find a backdoor entrance.

    Also, remember this--the grass is always greener on the other side. My former girlfriend wanted to be an MD until she saw the ****ty long call and hours and abusive treatment of 3rd year, and I even fancied being a DC until I heard her horror stories.

    She still adjusts my spine for me, and we still trade out on massage even though we're only friends now. . .or are we? It's a good thing that this forum is anonymous!

    So start looking for a cute MD female student, and who knows what will happen?

    Best of fortune in your pursuits,
    Dr. Morgus
     
  15. Morgus

    Morgus Junior Member
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    I just realized that my admissions about my "QT interval" above may well start a "torsade de pointes". . . LOL!
     
  16. Djanaba

    Djanaba Senior Member
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    I think the pursuit of knowledge is noble, but I wonder to what end, in your case.

    Understanding breath and heart sounds is all well and good, but why are they important to you as a chiropractor? Will you expect to be able to diagnose a bronchitis or atrial fibrillation? Or, more importantly, will you try to treat them? Hopefully, all your patients will have a primary care physician, under whose care non-chiro issues can be addressed. While I agree that more folks involved in patient care who can pick up red flags and appropriately refer is excellent, I am unsure that you could gain enough of the sorts of info you want to really do you or your patients a lot of good -- since most things you seem to want to pick up are things most patients experience and seek attention for on their own. If pathological processes of a certain type will change YOUR care of a patient, of course that sort of knowledge is beneficial. And should be part of your DC curriculum. If it's just for overall knowledge, and you forsee co-treatment as you stated earlier, I'd recommend learning your field exquisitely well and leaving the medical knowledge beyond the basics of first aid and a few red flag symptoms to the med folks -- or learning it in its entirety. The lines get too blurry without a clear deliniation of knowledge and expectations of caregivers otherwise.
     
  17. DCStudent

    DCStudent Junior Member
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    Once again I want to thank everyone for their insight and advice. Without getting into a passionate debate over the "proper" scope of practice of chiropractic I would like to try and answer some of the questions posed.

    I don't think that any additional clinical experience can do anything but benefit my education. Will my treatment change if I detect abnormalities? Possibly, but my primary concern would be the need for medical co-treatment. I used the examples of heart and lung sounds as examples only, but I would hope to be exposed to much more than this. I realize that these clinical skills take time to develop, and I plan on spending the time to do that in my practice with my patients, but the original problem still exists; I haven't been exposed to abnormal, just normal. As far as my patients have a primary care physician that would manage anything other than musculoskeletal I see it a little differently. But I would not expect anything different given we are coming from two or three different schools of thought. Dr. Morgus is right, chiropractic has come along way since claiming that chiropractic cures cancer and other type of diseases. The chiropractic profession for the most part understands the need for peer-reviewed scientific research and is working to increase the resources available for such research. Nevertheless, while I would not go as far as saying that chiropractic cures anything, including LBP, I feel very confident in knowing that chiropractic extends beyond the borders of musculoskeletal disorders, and has positive effects on general physiology and the restoration of homeostasis. Chiropractic is NOT a replacement for Allopathic/Osteopathic Medicine or Surgery but may be a less invasive alternative prior to the need for Medicine or Surgery. Please don't attack me for saying that. I AM NOT trying to be offensive towards anyone.

    I guess the bottom line to my desire for enhancing my education is because I want to take care of sick people. Not to replace the efforts by my counter-parts in the allopathic community but because I know what chiropractic has to offer. Enhancing my clinical skills and understanding of medical protocols will only enhance education and ability to care for my patients. I am married with a 13 year old and a 10 year old, I have moved my family several hundred miles to attend the school I am attending. I have been in college for 6 years and have two remaining. I could not, and would not move my family to change my career at this point. We have been "poor" long enough ;) and they have been very supportive of me. I appreciate all of the support I have received in this forum, both positive feedback and criticism.

    I have come to the conclusion that perhaps this idea of mine was not thought out very well or realistic. I know a number of M.D.'s where we moved from that you not hesitate in helping me learn, but I don't know many here and the ones I do know I am not sure how they would view my desire to learn.

    Any other suggestions are appreciated.

    Best regards,

    Adam Alexander
     
  18. Djanaba

    Djanaba Senior Member
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    Another thing to remember: you will, in practice, likely be exposed to a lot of "abnormal" findings, and your patients will teach YOU. Sure, this doesn't help right away in picking up other problems with new patients, but it's a start.

    I feel bad that you might perceive all this as a big brick wall to your education. However, scope of practice is a big issue. And many believe that expanding skills is only valuable if it results in real ability to use them, which in your case, might only be referral. My only other suggestion is that you commit yourself, in practice, to fantastic whole-patient care in partnership with med professionals of all types (be them MDs, DOs, NPs, PAs, home health aides, alt med types, youname it) to thereby provide best patient care. Being able to talk to a primary doc of an MS patient you've adjusted and say "Hey, she's doing great, but I noticed more ataxia today and I think it's worth checking in on" would be great, and likely as you build your practice, you'll learn how to do exactly that. I understand that you want, early on, a way to learn about the ataxia of MS and a lot of other related things, but I don't know of a good way of picking that up without simply being an observer in your own practice, or narrowing your desired field of knowledge (i.e., specifically a few of the more common neurological diseases, specifically diabetics, specifically arthritides). In those cases, I think you'd have an easier time being able to find a specialist who'd be willing to let you shadow for a bit, because your desired knowledge base is smaller and by example only. Does that make any sense?
     
  19. Morgus

    Morgus Junior Member
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    Hi Adam,

    Now that I know that your married, please 'xcuse the comment about "finding a cute female MD student". ;)

    I think the principle of "underground infiltration" still works, however. I meet and mingle with atypical MD's, DO's, DC's, massage therapists, etc., in 3 different places--health clubs, since I train with weights and aerobics, health food stores, and integrated medicine conferences (held in major cities several times per year), like those run by Andrew Weil MD (Harvard MD at that) at the Univ of Ariz Med Sch and Ronald Klatz DO from Chicago (both of whom are making a ****load of money and getting some fantastic results from their combined modality approaches). I'll bet that if you could find the time to so mingle, that you'd get to know MD's and DO's who would be glad to learn from you and to teach you as well. I think that going the official route is going to be very frustrating, as part of the feedback here has indicated. If you were in Dallas, I'd be glad to network with you.

    By the way, my ex, Tina, taught me to do what DC's tell me is an excellent adjustment on non-pathological spines. As an MD, and with her additional training, I know how to rule out the pathological spines. Now, I don't plan to do that with my patients, but I do trade out with Tina, and she tells me she can't tell the difference between her colleagues and me, except that I'm more fun. It's not that I need to be able to do it, but I do enjoy it under safe circumstances, and between that and having it done to me, I have an insight into chiropractic that I couldn't possibly have any other way. And I'm the guy who did grad school in biochem and physiology, which some people think should make me even less interested in chiro. In fact, every school of valid knowledge that I encounter makes me all the hungrier for yet more diversity. I'll bet I could teach you heart sounds and their physiological and anatomical correlates, and a few other things, at least just for broadening the pallette and for fun.

    Keep in touch, and keep the faith.
    Dr. Morgus :cool:
     
  20. roo

    roo Voice From The Wilderness
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    Hi Adam,

    If I was finished my medschool and in practice, I doubt I would turn you down, if there was room available and the following things were able to be sorted out. The things that would be requred:

    -You come in when there are no medical students/fellows/nursing students around in my care to be trained. Their education comes first, they paid to be here, and education for them is the priority of this hospital. If there is always medstudents, consider asking in a more rural-community hospital.
    -You come in when we need a hand because there aren't many others available (such as a Sunday morning, a holiday, late-night, etc). This will automatically assess your actual level of committment to learning, as well. If you don't want to come on a tough night, then I can give the opportunity to someone who is more dedicated to learning.
    -You aren't going to do anything that requires medical skill/knowledge. For example if it was an ER rotation and we are setting a leg, you can hold the leg, and you, I, and the patient can all talk about the procedure being done, and its care.
    -You will be introduced to the patient (with your title) and asked if they mind if you are there. If they say no, then you wait outside until the next case. There will also be some cases (a traumatic patient, or very bad news, in which case I will drop the hint that I want you to wait outside, or do something else until this one is done). The patient's wishes come first, before your learning.
    -You are my responsibility. If something goes wrong in a procedure, it is my name on the sheet, not yours or anyone elses (this is actually going to be one of the things that will be one of your barriers when asking for a shadow, not that people don't want to teach you).
    -It will more likely be a clinic than ward rounds.
    -Be mindful and tactful if you are asking questions, especially when a patient is present.

    In actual practice, you will find that asking for a shadow in a clinic has a good self-limiting factor built into it: Those who like teaching/sharing their knowledge the most are the ones most likely to let you shadow, and these are the ones that are the best from whom to learn. It is a hobby that they enjoy, so they have lots of practice at it to strengthen their teaching ability making them an excellent teacher, and since they enjoy having interested students, they will be the ones most likely to provide an enjoyable learning experience.

    -Best wishes, roo
     
  21. UHS2002

    UHS2002 Senior Member
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    Although I admire your interest and your motivation, I personally object to the idea of DC students shadowing physicians. The rationale behind my objection is that, if a physician introduces a DC student to a patient, the patient might erroneously assume that DCs receive the same medical training/education physicians-in-training receive. We all know this not to be the case but the general public is often confused on this matter, particularly because there are plenty of DCs who refer to themselves as primary care "physicians".

    By the same token, the DC student might end up believing himself that he is receiving the same training and thus qualified to practice medicine.

    What we currently need is better ways to inform the general public that DCs ARE NOT physicians, so that we stop seeing people in clinic that report having x or y disease, which they actually don't have, that was "diagnosed" by their chiropractor. I don't know how many times I have heard patients saying "I have chronic mono/anemia/hypoglycemia/low blood pressure/ chronic fatigue syndrome/MVP/diabetes/etc" and they actually believe that their chiropractor 1.knew what he was talking about
    2.was trained/licensed in making medical diagnoses.
    I particularly like all the "diabetics" diagnosed by chiropractors...Then you ask them: are you on any medications for your diabetes? Invariably they reply: "my chiropractor gave me some "insert favorite herbal supplement"" or "no, my chiropractor just said to watch my diet". It just makes me want to scream...

    Another example of why people end up assuming that DCs are doctors. I have seen plenty of residents that could not tell one murmur from the next, and they had years or practice ascultating heart sounds, starting in the pre-clinical years of med school, not to mention all the "book learning" and testing. And yet, I have seen DCs with stethoscopes slung across their necks. To me, watching a DC listening to his patient's heart is like watching a bad practical joke. The unsuspecting patient thinks that "the doctor" knows what he is listening to. The DC probably can basically tell that his patient has a heartbeat.

    I don't see much good coming to you from being allowed to shadow a physician. It is not going to change your scope of practice nor it is going to increase your "diagnosis acumen" first because DCs cannot legally give medical diagnoses and, second, because it is just not enough time or training.
     
  22. bustinbooty

    bustinbooty Senior Member
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    DC Student
    I have to applaud your motives here. THere are so few people out there that seek out knowledge for the sake of knowledge itself. OF course, all of us in med school seek knowledge; however, equally important to us is seeking DEGREE. To hear that someone wants to go through what I am going through, for the sake of the knowledge alone, is a very noble motive to me. YOu would be a welcome addition to my PATH lab, GROSS lab, etc., because your sole quest for knowledge could only help the the rest of us learn as well.
     
  23. Morgus

    Morgus Junior Member
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    Hello all,

    In the 6 different medical schools that I'm familiar with through my friends, along with my own, things just aren't that uptight in terms of bringing in serious and interested "noncombatants" for some informal, non-credit experience and learning. I'm surprised to find any opposition at all to your "yearning for learning".

    My friends and I have taken on tour our opposite numbers in dating and marriage, law students, MBA students, yes chiropractors, massage therapists, pre-med students, graduate students, and the like. In fact, when I was a grad student in biochem before med school, I was invited to observe many surgeries on an informal basis, as long as I kept my mouth shut, observed sterile precautions, and stayed out of the workflow, just observing. I learned a hell of a lot. I dated a law student who wanted to see what it was like to be on call for a few nights. She decided to stay in law, but came away forever joining me in my campaign to lower working hours to sane levels--and a lawyer is a handy ally in this matter.

    In return, my friends and I have learned from law school debate and moot court, negotiation seminars, chiropractic clinics, and many aspects of biomedical and biotechnology industries. It's all a nice big tradeout on fund of knowledge and experiential expansion.

    The fact that you have patient contact and know the importance of participating when you should and avoiding improper involvement when you shouldn't certainly qualifies you, a DC student, to a higher level than law and MBA and engineering students. And yet no one is afraid of these others with respect to them stopping the show.

    Yes, all of this kind of stuff has been unofficial and off the record, but that doesn't mean that it wasn't generally known. We'd get informal heads ups from someone high up enough to say OK.

    I am glad to see that there are a few other MDs here that would welcome your company. There are so many med students that I know that HATE to learn and are just going through the motions at a minimum level to pass just to get the IV bolus of money at the end of the voyage of the slave galley of medical training. I really welcome those who want to expand their minds just for the sake of it.

    Best to all,
    Dr. Morgus
    :cool:
     
  24. DCStudent

    DCStudent Junior Member
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    Well, once again I must say thank you for everyone's input, whether I agree with it or not. UHS2002, your perspective is one that is shared by many, but much less than just a few years ago. I won't preach at you or anyone else about chiropractic care, practice, etc., but I will say that I disagree on some of your points. However, I can agree to just disagree and leave it at that. Like I have said before, this is "medical" turf and I am a guest here, not here to start fights.

    My original questions come from what I perceive of my clinical education. I am starting my 3rd year and have 5 weeks until my clinical internship begins; from the time I have spent in our outpatient clinics thus far I have not seen the same degree of "sick" people that I am assuming my medical and osteopathic counter-parts have seen to this point. And this is where my questions stem from. It is understandable that medical students or doctors would not know about scope of practice or qualifications of chiropractors because you have a LOT to deal with in your own training. So if I may shed some light on a topic that may not be familiar. To begin with it is not within the scope of practice of a chiropractor to diagnose a patient with diseases not related to musculoskeletal disorders, in most states. I say in most states, because scope of practice varies state to state. It is however, within the scope of practice of a D.C. to identify pathology related abnormalities throughout the human body. In fact, with the exception of Michigan, to the best of my knowledge, if a D.C. fails to recognize abnormal function during an exam, laboratory studies, x-ray, etc. they are held accountable and liable. To the best of my knowledge every state allows a D.C. to order any lab study or radiographic study. Some allow the D.C. to use venipuncture. Some D.C.'s have hospital privileges, and I know of one that is on call at the local ER, for cases which chiropractic may be indicated for. I have read that there is a hospital in Rochester, N.Y. that is building a chiropractic wing. Here are some additional examples different variances in scope of practice you may not expect:
    Florida – is planning to pass legislation that would allow D.C.'s to prescribe non-legend drugs.
    Oregon – requires additional training in obstetrics and minor surgery and are authorized to deliver babies and perform minor surgery.
    California – requires additional training in gynecologic and proctologic exams.
    Illinois – Blue Cross/Blue Shield is using D.C.'s as primary care doctors in their HMO, making them the gatekeepers with co-management from medical directors and is having significant results. For more info go to www.alternativemedicineinc.com
    There are some states that have severe shortages of "medical" care and are considering passing legislation that would extend the scope of practice of D.C.'s and authorize them to use pharmaceuticals, after additional training of course.
    The United Kingdom – This past year authorizing D.C.'s and D.O. to prescribe pharmaceuticals.
    I don't necessarily agree or disagree with the above but I just wanted to point out there is more to the chiropractic scope of practice than "popping" or "cracking" spines. ;)

    I guess my point is that the scope of practice of a D.C. is much broader in most cases than the D.C. practices. Let's be realistic, taking care of back aches and neck pains is a lot easier and less time consuming than co-managing someone's care that is more serious and complicated. It also doesn't require the same level of communication with the medical community, as does the more complicated care, perhaps that is why a lot of D.C.'s don't focus on that. There are D.C.'s out there that make me sick. Any doctor that recognizes a patient may have a disorder like diabetes, etc. and does not refer to an M.D. that specializes in that care is an idiot. Any D.C. that sells, insert herb of the month here, in response to abnormal findings is unethical. However, if a D.C. has taken significant additional education, not provided by the company producing product X, in such matters and makes recommendations in addition to getting an expert opinion, than more power to them.

    So my search for knowledge and clinical experience is not only for personal fulfillment, but it is to enhance my ability to practice at a level of competency above what is legally expected of me. I spent 3 years when I was younger as an Army Ranger. One thing I learned was the importance of training at a level above and beyond what was expected of you, and that there is no such thing as over kill. I hope that one day my training will save someone's life, and that surpasses boundaries of paradigm and turf wars. Chiropractic is not allopathic medical, but it is caring for people and their health. I know that everyone will not agree with me on everything, but it is not about us, it is about taking care of and serving others. For now, chiropractic is how I have decided to do that.

    Thank you so much everyone, even UHS2002, for letting me stay and hear your different perspectives.


    Best regards,


    Adam Alexander
     
  25. please give me a break. chiros are not physicians. the idea of a chiro prescribing a drug or performing minor surgery scares me to death. how many hours of pharmacology do you take? and isn't a big part of chiro preaching the evils of drugs that are proven to do what they claim? and chiro (beyond neuromusculoskeletal problems) has never been held to that standard. if it has, i would love to read the study...something that shows that chiro beats placebo in treatment of asthma or diabetes or depression or cancer...the list goes on.

    it offends me to no end that a chiro would attempt to sit in on a medical school class. i can just see the advertisement now..."free spinal exam by chiro trained at harvard med! let me examine you and recieve a coupon for a free jiffy-lube!"

    chiros have a niche that they are good at. treating back problems. period. but, by preaching the evils of drugs (sure they have side effects...that is considered it the decision to give a drug.) which you have no training in, by preaching the unproven "scope" of chiro, you have alienated much of the legit medical profession.

    you can be sure that when i complete my training, i will be concerned for the health of my patients. i will treat them as best possible, with drugs, surgery, excercise, diet, physical therapy or any referral that may benefit them. but that will only include a chiro that respects the limits of his knowledge and trainig. which you clearly have no intention of doing.

    be more responsible. do not expose your patients to what you "believe" chiro can do. that is like medicien hundreds of years ago, bleeding patients. thankfully, we have the science in allopathic medicine. and now chiros are trying to take us back...

    i really do believe chiros have an important place. but, it is a much smaller place than you want to accept. the only way to increase your role in patient care is to letr science do the talking and complete a study, or to expand on what you already do and do it better. not by making ridiculous claims, or by attending a class or two to round out your education/brainwashing.
     
  26. DCStudent

    DCStudent Junior Member
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    Neil do you feel better now?

    Look Neil, I really do not understand your animosity. I do not have a problem if you disagree with me on the issue of scope of practice, or the potential of chiropractic care, although I never said that I felt the individual scopes of practice mentioned above were appropriate or not. I don't have anything to defend, especially to some that knows so little about chiropractic. If you feel these examples are inappropriate than when you get back to the US why don't you address it with the state legislature's that passed these laws. If you really are interested in research than send me your email address. I am in the process of compiling the research you are referring to. I agree with it's importance and as I compile it I will make sure you are the first one I send it to and I welcome dialogue with you concerning the research I find if you can conduct yourself with professionalism.

    In regards to your personal comments about me: With all do respect, you know nothing about me and it is wrong for you to imply anything about me that could be interpreted as unethical. Especially in a public forum. What I don't understand is who you think you are? You are a 2nd year med student, not a seasoned, let alone trained physician. And the only experience you have with chiropractic is hearsay; I will not get drawn into your pettiness.

    My email address will be listed below and if you are interested in discussion than email me and let me know.

    Otherwise, best to you in your endeavors.


    Adam Alexander
    [email protected]
     
  27. i do feel better. you mention that i have only experienced the chiro profession through heresay and that is not true. i have worked for chiropractors, some of my freinds are chiropractors, several members of my family see chiropractors and some fellow students of mine have left chiropractic. sure, i am a second year med student, with an undergrad degree in anatomy and physiology. i also have over 10 years of experience as an EMT, in emergency rooms, ambulances and several private clincs including many medical specialties. so, yes, i think i have good background for this discussion. and just a little thought...how many DC's move on to medicine after starting as a chiro? do many MD's do the same? that makes me question whether the reality of practice shows many chiros a little too late the error of their ways. and your experience with chiropractic is completely objective as a student of chiropractic, right?

    i do not have anything against you personally, but i do have a large problem with Life chiropractic and its attacking of proven medical therapies, and attempts to treat patients "subluxations' to cure disease. please, do send me the research that shows subluxation causes disease and that chiropractic fixes it.

    i do see a valid place in healthcare for chiropractic. but it just irks me to no end that chiropractors are so unwilling to limit the practice to what has been proved beneficial. doctors of medicine do not try new things before evaluating them scientifically. a large part of chiropractic is "well, this seems to work" or "my patients feel soooooo good..." which is absolute nonsense scientifically.

    i do favor professional dialog, and i will gladly discuss and review any research that you provide. but, i hope you can see how this is offensive to me. it just appears that you are trying to give chiro such a huge place in health care, a place that it franky does not occupy or deserve.

    so, feel free to email me anything, and i would actually quite enjoy a lively dialog. i hope my tone does not reflect animosity toward you, but concern toward what i consider non-scientific thought. and when you post publicly, i will respond publicly as i see fit. the beauty of america, eh!

    best of luck to you as well, and i really would not mind if i were wrong about chiro.
     
  28. daveshnave

    daveshnave Senior Member
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    NeilC-
    What's your problem? It's people like you that start the whole MD vs DO controversy. You should see my reply to the thread about fraternities in the lounge (or everyone) chatroom (can't remember which one it was). Anyway, talk about generalizations. There is a valid role for DC's in health care... as you admit. But for you to discourage DC from wanting to learn more is ludicrous. He even said earlier that he was considering med school later on. Give him a break. Too many future MD's such as yourself are narrow-minded and fail to recognize the benefits that these alternative therapies provide. Personally speaking, my mother has had back problems for years, and MD's haven't been able to help her worth a damn... yet it's been a chiropractor (and I'm sure an OMT-practicing DO would be able to do the same) that's been able to help her walk after she's been bed-ridden with back pain. To her, her DC was 10X better than any allopathic orthopedist, who could only prescribe her pain medication, or suggested risky surgery. Realize that MD's ARE NOT in fact gods... I've worked in research for years before starting allopathic med school, and I understand the importance of research. However, an experiment is only as good as the person asking a specific question, and too many allopaths fail to "think outside the box." Don't shut yourself off to new ideas because they don't fall within your accepted dogma... and even more so don't insult a peer who is interested in learning. You only discourage the discovery of truth by doing so.
     
  29. i have never said chiros do not have a place in medicine...please reread my post. they clearly have a role, and they are very good at treating nueromusculoskeletal problems. my problem with chiro is the fact that the vast majority of them carry the practice beyond this to treating asthma, diabetes and cancer. all i am saying is prove that the theory is sound, that subluxation causes disease and that chiro fixes subluxation before telling patients you can treat this.

    if you read the previous posts, it mentions several things that some states may allow chiros to do, and i find it appalling. granted, adam may not agree with these, but in my previous encounters with him, he spouted life chiro as the gospel. i strongly disagree with that aspect of chiro.

    as to adam enhancing his education by attending allopathic classes, i just have some doubts. education for the pursuit of education is noble, but a little knowledge is a dangerous thing. medical school is a series of classes, all of them important in the relations to each other. and as for going on clinical rotations and learning about heart sounds or whatever, that is ridiculous. how on earth is that going to help? is he going to start integrating this into his practice based on a few days in a hospital? it may be a great thing, but i have doubts.

    if you want to be a chiro, great. go to chiro school and do what is proven to help people. if you think that chiro has broader indications, than form a study and prove it before you tout it as a valid treatment. in short, i am only asking chiros to be held to the same standards as all legitimate health care.

    and, yeah i read the thread on frats. in fact, i agreed with you there. but, this is so different that i am unable to see how you can compare. i am not looking at medicine and chiro as to opposing clubs. all i ask is that chiros stop saying they can treat things that they have never proven they can treat. simple.

    i am not trying to say that allopathic medicine is perfect or that chiro is useless. i do not even think that my opinions are anything more than that. however, i do think that a forum such is this is a great way to air differences of opinion as a way of obtaining a new perspective and knowledge. so, please do not hassle me for having an opinion and posting it. simply read it, respond to it and if there is something that i am wrong about, accept my apologies.
     
  30. dcdo

    dcdo Senior Member
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    "...vast majority of them carry the practice beyond this to treating asthma, diabetes and cancer."

    Whoa there with the generalizations! I would say a rather sizable majority aren't quite that far off the deep end, but unfortunately they tend to squawk the loudest and get the most publicity.

    On the other hand, I probably agree with at least 75% of the other stuff you said, especially about Life U. You do seem a bit itchy with the trigger though. :eek:
     
  31. guess i was a little eager to jump in on this one. i do not mean disrespect, and if that it how i sound, i apologize.

    i just have this urge to sound off against the Life chiro guys whenever possible, mainly due to my personal experience with them.

    but, like i must admit, there is a place for chiro. it is the definition of what that place is that holds the controversy.

    best of luck to all!
     
  32. guess i was a little eager to jump in on this one. i do not mean disrespect, and if that it how i sound, i apologize.

    i just have this urge to sound off against the Life chiro guys whenever possible, mainly due to my personal experience with them.

    but, like i must admit, there is a place for chiro. it is the definition of what that place is that holds the controversy.

    best of luck to all!
     
  33. B-Flatblues

    B-Flatblues Member
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    Heaven forbid one of us simple prokaryotic non-med students wants to learn. :rolleyes:
    Russ
     
  34. DCStudent

    DCStudent Junior Member
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    Neil,

    How about your email address? I am serious, I want to try and address what you disagree with or don't understand about chiropractic, and I will provide you all of the "data" I can. Just email me with it.... [email protected]

    Neil, to put your mind at ease a bit and maybe to put to rest some of your animosity let me tell you I am NOT a "Sid"ite. I am not against the allopathic or osteopathic professions. I understand that when "drugs and surgery" are used that the medical or osteopathic doctor takes into serious consideration the possible side effects. I do not think medicine is EVIL and I do not stand on a soap box anywhere preaching about how horrible M.D.'s are. But, I do think there are alternatives to "drugs and surgery" that must be considered 1st when treating a patient that is not in a critical stage of care. I would do this regardless of my credentials.

    AS far as scope of practice goes I can't say that I completely disagree with you. These broader scopes of practice allowed in different localities are inherently dangerous if the D.C. is not properly trained. What is properly trained, I can't say. But whether or not you agree you need to realize that these scopes of practice still exist and your patients DO NOT NEED a referral from you or anyone else for that matter. In fact I am willing to bet that a majority of the 30 million plus Americans that visited a D.C. last year did not have a referral.

    Please reread the posts from beginning to end, and you will find that it was one of your peers that recommended sitting in on a medical school class, not my idea.

    Further, I appreciate the time everyone has taken to give their input. I am going to do what I feel is in the best interest of my patients; regardless of the flak I may take. I will practice within the full scope provided me by law and not outside that, or outside of my training. I want everyone to know the clinical skills that I mentioned interest in enhancing are just examples, and these are not skills that I haven't been taught already, and what I am looking for is clinical exposure to develop those skills.

    Best regards,

    Adam Alexander
    [email protected]
     
  35. Ponyboy

    Ponyboy Senior Member
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    Can someone tell me exactly what type of education chiro students get when they are in the hospital? Do they do the whole IPPA exam of the patient with a full history? Do they order all the labs and read all the results? Do they DAVID all the orders? Are they supervised as they write prescriptions for two years (and then another year in residency)? Do they start IV's, perform LP's, run the deliveries (supervised), reduced #'s?

    I would really like to know.
     
  36. DCStudent

    DCStudent Junior Member
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    I have serious doubts that they do any of that unless their training is affliated with a D.C. that is working in the hospitol. Anything concerning drugs or veinapuncture would be outside the scope of practive of a D.C. in most states.

    Your question is valid and it gives me another opportunity to reiterate my goals for such an opportunity.

    My goal would be to "observe" for three reasons. The 1st reason is to observe the physical manifestations of different pathologies that I have learned about in school. The 2nd is for a chance to enhance some of the clinical skills I have learned in school, "examples" being auscultation of heart and/or lungs and being exposed to abnormalities which I may not see in a chiropractic teacing institution. 3rd is so I can get a better understanding of the medical protocol of care my patients are experiencing. The goal is not to perform the duties of a qualified medical student but to enhance what I have already learned.

    If this doesn't answer your question please email me and I will try to communicate my point better.

    Best regards,

    Adam Alexander
    [email protected]
     
  37. Ponyboy

    Ponyboy Senior Member
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    So, I take it that you have learned the pathophysiology of the human body and are familiar with the presentations and pathology of CHF, asthma, nephrotic syndrome, PCOD etc.?

    Have you learned how to conduct an entire chest history & exam or a precordial history & exam?
     
  38. DCStudent

    DCStudent Junior Member
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    I have learned the physical presentations of all of the conditions you have listed with the exception of nephrotic syndrome, had to look that one up, and I am sure there are many more that I have not been taught. I am in fact still learning. To answer your question about pathophysiology of the human body, I have completed a number of physiology courses and am currently taking my first pathology class with another one next quarter, and I realize that there is a difference in the indepthness of pathology that I will study and that which medical students study. But my understanding of normal physiology gives me a strong foundation to understand pathological physiology and it's presentations, if given the opportunity.

    As far as "Have you learned how to conduct an entire chest history & exam or a precordial history & exam?", I believe so. Although, I am not clear on the difference between a chest history and exam and a precordial history and exam, unless you are referring to a heart exam? We are tested with both written and practical examination of a "student" patient to include inspection, palpation, percussion and auscultation. Reading about abnormalities is one thing but actually learning first hand with a patient experiencing this is different. At my school, when we begin our clinical internships we are responsible for finding our own patients, who are typically not people in critical stages of care. While their are chances of our patients having detectable abnormalities besides those related directly to musculoskeletal conditions it is not as likely to happen as if I was in a more critical care setting or a practice that specialized in care of these anatomical regions, or at least I am assuming not. If I gave you the impression that I "have it altogether", than I am sorry, because I don't. I have so much to learn and that is why I asked my original question. As far as making any specific diagnosis from the findings of my exam, with the exception of a chiropractic diagnosis, my goal is to recognize and understand different pathological conditions; so I can make sure my patients get the care they are in need of and to make sure I understand their complete health condition and how it may relate to the care I provide.

    It bothers me to hear someone, especially the rare classmate, say why does a chiropractor need to know this? This is not chiropractic. Chiropractic is not just moving bones, "cracking or popping" backs; It is about taking care of people and their health, and in my opinion I would be negligent in my responsibilities to my patients if I didn't learn everything I could and be proficient at it.


    Adam Alexander
     
  39. JoeDoc

    JoeDoc Member
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    Dude, take my advice and hang it up. I was a DC for 10 years (WSCC, 1987) before moving on to osteopathic school (AZCOM, 2002). It's great that you recognize the shortcomings in chiropractic education, specifically the clinical years, but I sincerely doubt that you'll find the kind of informal training you're looking for. Granted, if you know a DO or MD personally s/he may be willing to allow you to observe some procedures, but you probably won't be allowed to touch any patients due to liability issues. If you really want to sharpen your auscultation skills get a series of taped heart and lung sounds, listen to it for 1 hour per day, and aucsultate every patient, friend, and relative that you can.

    Having been through both schools I can tell you that as far as basic sciences go the training DC's get is equivalent in content to courses taught at allopathic institutions. Yes, MD's and DO's get more training in biochem, physiology, and pharmacology, but DC's get more training in biomechanics, clinical orthopedics, and skeletal radiology. Nobody can be good at everything....not even the DO's (sorry guys). The important thing is to strive for excelence in whatever field you choose to practice. Unfortunately as a DC you're at a disadvantage for several reasons. First, despite what the CCE says the quality of education is not equal at all chiropractic schools. Second, even DO's will tell you that many doc's still don't recognize manual medicine as a specialty, mainly because they have zero training in it an therefore don't know when to refer or what to expect if they do. Lastly, although there are some brilliant chiropractic educators (Cox, Yochum, Croft) the fact remains that the chiropractic degree carries very little academic weight outside the profession. Over the years I found that no matter how much I studied neurology, biomechanics, radiology, and orthopedics, in the eyes of other professionals I was still "just" a chiropractor.

    So, here's my new philosophy: If you can't beat them, join them. Then beat them. I'm planning to do a residency in physiatry and subspecialize in interventional spine medicine. You can bet that I'll continue to use manipulation for musculoskeletal conditions, and I'll make sure my colleagues understand when it's indicated and when it's not. My advice for you is to make sure you're getting the best that chiropractic has to offer. Get a diplomate in neurology or orthopedics and stay away from spinal exam booths in shopping malls, unless you set up next to a proctologist giving free rectal exams, then it's OK. Also, respectfully tell physicians who will listen exactly what you do and why you do it, and don't waste time with docs who give you a hard time. As I've previously discovered on this forum, you can wrestle with a skunk and you'll probably win, but in the end you'll have to wonder if it was all worth it.
     
  40. Mr. happy clown guy

    Mr. happy clown guy Senior Member
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    I think JoeDoc makes some great points here...and I want to add a bit.

    No matter how MANY HOURS you had learning pharmacology in class, it pales in comparison to clinical knowledge learned first hand when prescribing these meds or seeing them work. I remember coming out of class and entering the hospital and feeling like "****, I don't know a thing!"...now imagine a chiropractor in the same scenerio...even more distressed.
    There is a place for everyone, and I think the chiropractor has a VERY limited place, and niche that in being infringed upon my P.T's and expanded by Osteopathic Physicians. That puts chiropractic in a strange role, and a fight for survival and significance.
     
  41. DCStudent

    DCStudent Junior Member
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    I just wanted to thank everyone for all of their input. Even if you chose to "bash" me about my questions. My best to all of you.

    Adam Alexander
    [email protected]
     
  42. pharmer

    pharmer Senior Member
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    Nice plug!!!! This thread was over 4 years old :laugh:
     
  43. humuhumu

    humuhumu nukunuku apua'a
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    This is an entertaining thread, definitely worth resurrecting. I wonder how Dr. Alexander is doing these days.
     
  44. nabeya

    nabeya Senior Member
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    How about somebody email him and get an "update", 4 years later?

     
  45. Daddydoc

    10+ Year Member

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    It always makes me laugh when I read through an entire post only to realize that nearly the entire "conversation" occurred several years ago.
     
  46. efex101

    efex101 attending
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    He he...same here...oh well back to the study grind.
     
  47. davvid2700

    davvid2700 Membership Revoked
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    Typical snobby medical student
     
  48. Krazykritter

    Krazykritter Senior Member
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    Neil,
    As a DO student, I can tell you that there is plenty of research out there to tell you that "subluxations," or what DO's call somatic dysfunctions, can cause disease. In the osteopathic profession we spend a great deal of time dealing with the theory behind our manipulative treatment. It is a well established fact that the body functions as a unit and I do not believe that any physician, DO or MD, would argue that it does not.

    A Somato-Visceral Dysfunction is an established finding that shows that a somatic problem in one area can affect an organ or organ system. For example, a pt. with a severe scoliosis will often develop respiratory problems b/c of the strains placed on the diaphragm. Although I do not necessarily agree with every technique that DC's (and even DO's for matter) practice, your notion that state of the body does not affect pathology is completely off base.
     
  49. BMW19

    BMW19 Senior Member
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    I would indeed be interested to know what happened to Adam in this Saga. Being that I was in his place less than 3 years ago. I am now a first year in DO school, and I would love to tell Adam the vast difference in education. I make it analogous to Snorkeling VS. Scuba Diving (Chiro Vs. Medical). But you cannot understand it until you get there. Oh well, I hope he found his way.

    BMW-
    DCtoDO 2009


     

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