Quacks

[facetguy]

Facet-
1. I openly admit that my n=1 study is in no way shape or form scientific, I just wanted to relay a personal experience.

Understood.

2. I am curious as to how you would manage a pt. with a herniated disc without a referral to an orthopedist. Would you try "high velocity" manipulation?

In some cases, yes, high velocity low amplitude manipulation can be helpful to these patients. Many times the treatment will involve other tractional types of mobilization/manipulation, soft tissue treatments, modalities, and the like. I don't refer every disc patient to an ortho, but it's obviously something I consider and do regularly (particularly in cases of lower extremity motor deficits, and it's usually a neurosurgeon that I'll refer to).

3. Panda will not start a blog against me because he really did say those words himself.

Perhaps I should consider having his statement printed and framed for my office! Do you think he would autograph it for me?

4. Show me the research from a respected, peer reviewed journal, with a title that does not contain the words chiropractic, manipulation, or alternative medicine that proves chiropractic is better than placebo for low back pain.
When you do, I'll PM you three articles from NEJM alone that will dispute it. Agree to disagree, I guess. After we do that, do the same thing for manipulation compared to placebo for the treatment of asthma.

Reading my earlier posts (which I just know is high on your to-do list!) reflects my thoughts on the asthma issue. I have to ask, though, what would you recommend to the parent of a teenage kid who hurt his back playing sports, came to see me, received treatment, and felt better BUT who also noted that his asthma symptoms seemed to improve as well. Would you have a problem suggesting that perhaps they seek my care periodically to see what happens? Please note that, in our hypothetical here, I never told the kid his asthma would improve, nor did I ever comment on the medical care for his asthma. Do you suggest to this kid he is lying? That it is all in his head? This wouldn't constitute any kind of scientific study, just one patients hypothetical experience.

5. I will openly admit, here and now, that "orthodox" medicine who you so obviously dislike does not have all of the answers. In fact we have very few answers compared to the amount of information that we do not know. What I do know, however, is that modern chiropractic medicine borders on malpractice when they start treating children for asthma, reject vaccinations, and generally take over primary care for some patients. Other chiros know their purpose, and will only "treat" things that they know will not harm the patient further by not seeking medical attention.

I commented on this earlier today. And assuming that I feel some sort of "anti-medicine", "us vs. them" sentiments perhaps says something about your mindset on the issue. And I really doubt there are very many cases of chiros preventing their patients from seeking medical attention. There are malpractice liability issues, after all.

6. As far as your "high veloctiy" manipulation goes, yes I have read about it, no I havent gone to chiropractic school so I'm sure you will dispute what I say here, but the average human being does not contain the strength to move the spine in any significant way, minus neck rotation.

Are you capable of bending to tie your shoes, for example? I'm not sure where this notion of spinal immobility comes from. You got off-track somewhere.

And neck rotation at high velocity is bad, but you will probably dispute that also. This will be my last post on this subject on here, but as I am certainly open to debating this further with you please see my blog. I would love to trade off articles, info, what you learned vs. what I am learning, etc to get a better idea about what you are up to in that mysterious world of chiropractic.

Perhaps I'll check out your blog. Is your info posted somewhere?

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[Excelsius]

You obviously have not gone to medical school. To honor a class, you must first memorize the book, and then be able to apply that information to a scenario. Very few test questions are just straight memorization of a fact.

That's good that you have a different experience, but a lot of med students here say that for honors you have memorize more and that just knowing the big picture can make you fail.

 

[geogil]

Balance? Not exactly. And any student who has to rely on being spoon-fed by his instructors will never really be anything but your average doctor. The entire point of the educational system is that the apprentice should surpass the master. Students need a better appreciation of the amazing library system that they have available in the US and the information that can be obtained there. And the teachers you need are not the ones who are pessimistic and choose to force their one sided opinions upon you, but rather the type that encourages you to think for yourself and utilize the vast resources available to you to come to your own conclusions. As it is now, med school is a breeding ground for identical, robotic minds. To honor a class you have to memorize a book. Don't you see something wrong with that picture? I don't see how memorizing loads of facts for a test (which you are going to forget after the test) is going to make you a better doctor.

So, by that logic, if you didn't memorize anything in medschool, you would be the finest physician. Medschool learning in the first two years is to give you a framework of vocabulary and principles upon which you can build later in your career when you're reading other texts, journal articles, attending talks, etc. Without that baseline knowledge, you can't continue to learn. Ergo, you have to memorize (or commit to memory, in other words LEARN).

 

[geogil]

That's good that you have a different experience, but a lot of med students here say that for honors you have memorize more and that just knowing the big picture can make you fail.

So, as I understand it, you're not a medstudent, yet you are telling medical students and physicians what you learn and how you learn in medical school, is that correct?

 

[coldweatherblue]

nice posts njbmd and Panda Bear (on the previous page).

 

[facetguy]

I have a pretty fail-safe way to prevent obesity, DM, most of the country's hypertension, CAD, peripheral vascular disease, strokes, MI and a host of other conditions. It is a very revolutionary idea that has just come out and that doctors are just learning about. It is called proper diet and an hour of exercise a day.

Frankly you can say whatever you want to about doctors not doing anything in terms of prevention but the impetus that is lacking comes from the patients. Until we can get patients to actually do some exercise and make better choices, a lot of the lifestyle diseases that are so prevalent today are going to continue to get worse.

Instate, please note that I said "we as a society".

 

[Excelsius]

...

If you (or anyone else) wants to engage in a dialog about any medical practice, you have to learn to ignore opinions and "buzz words" and produce sound clinical evidence for your assertions. To denigrate what others have said doesn't lead credibility to your arguments but achieves quite the opposite.

SDN is a discussion board that is made up of folks who largely post their opinions. This is a good process but at it's best, it's the opinions of folks and as such, should be either accepted or rejected wholly or in some part. I invite you to not attempt to label but to accept or reject based on your experience or lack thereof.

I will post this caveat though for your perusal. Experience is not the best teacher but wisdom is the best teacher. I don't have to experience jumping out of a plane without a parachute to know that things are not going to be good when I hit the ground and that to perform such an action does not show sound judgment on my part. Much the same goes into choosing items to incorporate into my clinical practice. I have to rely on my ability and wisdom to distinguish good research from poor and items that will be good clinical practice from those that are not as such.

Agree to disagree without being disagreeable and continue the dialog. To step back, pull out the points that you wish to respond to with clear and precise rebuttal is far more sound than responding to opinions which like anal openings, are possessed by most people and mean little in the overall scheme of things.

You are right, but here is the issue: you have an entire thread started based on assertions without any proof. All I did is try to insist on any significant proof to back up the assertions. As med students, many of the guys are more experienced in certain areas than I am and it would be far easier for them (in theory) to produce the necessary proof. When you are the one who attacks an entire discipline, the burden of proof is on you. Plus you have premeds coming here and learning respect and disrespect from this thread. I don't think it would have been right to allow this thread to remain so one-sided.

As for the paragraph that you quoted, that wasn't written with any anger or for the purposes of denigration. I have seen Panda use the koolaid example several times before and since I find it amusing, I decided to have fun with words (he certainly is great at it). I guess when you read that paragraph, you can misinterpret it. That's why a personal dialogue is much better. And of course I have already ignored a lot of ridiculous assertions here, but yes, in the end getting down to the same level doesn't help me or my cause (or anyone else's here). Some of the claims are too upsetting and we get overly passionate about them, even though we shouldn't. For example, the thought processes involved in choosing to prescribe ibuprofen instead of chiro or placebo just because of personal reasons is not only upsetting, but unethical. If a placebo or chiro works for a patient and avoids using something that can foment health risks, it is the obligation of the doctor to choose the placebo. This is just logical.


Wisdom... Sometimes the only way you can achieve it is through direct experience, even if it means jumping from a plane. You may disintegrate in the process, but if you survive, you will be sui generis. Risk can be a prerequisite for leaps of knowledge and there are some great examples in the short history of our civilization.

 

[Excelsius]

So, by that logic, if you didn't memorize anything in medschool, you would be the finest physician. Medschool learning in the first two years is to give you a framework of vocabulary and principles upon which you can build later in your career when you're reading other texts, journal articles, attending talks, etc. Without that baseline knowledge, you can't continue to learn. Ergo, you have to memorize (or commit to memory, in other words LEARN).

I am talking about the minutiae of details that many students say they are not going to remember simply because they don't use that.

 

[Excelsius]

So, as I understand it, you're not a medstudent, yet you are telling medical students and physicians what you learn and how you learn in medical school, is that correct?

One of the ways to understand the teaching material at med schools is to talk to med students in person, in forums, and also read some lecture notes and course requirements, all of which I have done. Another way is to evaluate the outcome of the education and make presumption about the education itself. But I don't claim to be an expert here. My views may be skewed due to the small sample size of my data and the students who post here might not be representative of med school in general. So yes, I may be wrong, but all my statements were pretty general and applicable to the educational system as a whole.

 

[45408]

To honor a class you have to memorize a book. Don't you see something wrong with that picture? I don't see how memorizing loads of facts for a test (which you are going to forget after the test) is going to make you a better doctor.

Yeah, don't forget the facts. I go see my physician based on the fact that he knows more than I do. If he didn't, I wouldn't go see him.

 

[Brodiewankenobi]

Facts are meaningless. You could use facts to prove anything that's even remotely true!
-- Homer Simpson

 

[Excelsius]

Facts are meaningless. You could use facts to prove anything that's even remotely true!
-- Homer Simpson

...

"It is not possible to fight beyond your strength, even if you strive.

Do thou restrain the haughty spirit in thy breast, for better far is gentle courtesy."

Homer

 

[cpants]

This is of course true and will continue to be so. However, I think the point is a relative lack of effort going into preventing the need for these lifelong meds in the first place. This is not laying blame at the feet of individual physicians. I think it instead reflects a systemic issue. Let's face it: the healthcare culture today poo-poos anything low tech, inexpensive, non-pharmaceutical, non-surgical and elevates technology, meds and surgery. Much of this is clearly driven by economics and some simply by office logistics (i.e., time constraints).

Until we as a society figure out how to efficiently and effectively combat obesity, Type II diabetes, chronic inflammation and any number of other health-robbing conditions, we will never get ahead of the curve. Again, this is not to say that any one family physician is to blame. It is bigger than that. And, no, it's not as simple as "eat better and exercise more".

There is no choice here, really. It's just a matter of when. Our healtcare system is set to crumble under the financial strain, which will impact other aspects of our lives (if more and more money goes to healthcare, less money goes everywhere else).

Actually it is that simple, but you forgot "stop smoking and drinking, get vaccinated, and wear a condom." Doctors do tell patients all these things, and patients are actually surprisingly aware of what they have to do to get healthy. Everyone knows they shouldn't wash down their McDonald's with a pint of vodka. So to what extend does the blame for our unhealthy society rest on the shoulders of medicine? Where does physician responsibility end and patient responsibility start? We can educate and provide strategies until we are blue in the face, but until that patient decides to make a change, it is useless. I agree that we should research better prevention strategy, but in a lot of ways this is more of a sociological/cultural problem than a medical problem.

 

[8744]

You, as an ER doc, can't do much about prevention. Nor can a surgeon. By the time you see someone, he/she is in need of some drastic intervention rather than prevention. There are only specific fields that can concentrate on prevention, like FP or IM, though there can be exceptions with some surgeons, such as ENTs, who can, in some situations recommend alternatives to surgery. I know you may not understand this. I'll just give you a simple example - when a patient goes to an ENT because he can't breathe through his nose, the ENT should not automatically recommend surgery to remove excess turbinates. He should suggest alternatives like avoiding situations where the person would be exposed to allergens (maybe he works with trees or pets a lot) or at least refer the person to someone who specializes in allergies. Do you know how many ENTs just cut the crap out of your nose only to discover that it grows back? Well, this is not right. And I don't really care that ENTs only specialize in surgery. They should be aware of simple things like allergies. You cannot cut out an allergy, as one internist said. I know of one particular case where we almost wanted to bring a lawsuit against the doctor - he did three freakin rhinoseptoplasties on the same patient without even ONCE questioning why did it not work. So when I talk about alternatives, I am not talking about just drinking chamomile tea or looking in a crystal to see your future health, but rather starting with the least invasive procedure and working up to the most invasive as a last resort. You have nothing to lose by trying to treat someone's depression with omega-3 and exercise before you decide to give him Prozac and ruin his life. Let's not sit here and say that doctors concentrate on prevention, because that's just not the case. It worries me that residents like you think that everything is fine in medicine. You choose to claim prevention for the doctors while AMA itself admits that there is not enough concentration on prevention. You have been force-fed too much soothing information by your school. Not everything is potable, you know. You will have to discard that pacifier some day. Just the like the rest of the population, you are vulnerable to being inculcated ideas that are one sided. That's why for you all CAM is the same.

I never said anything about manipulations= prevention or even being useful. I just don't know and I have not seen any conclusive studies one way or another. You don't know much about this either. My point was that as med students/doctors, you have a far bigger fish to fry than chiros. It's just too insignificant compared to the rest of the problems the doctors are facing. To me, that's very egocentric. I am also really surprised that you are the second resident here who just doesn't get it: Motrin (or ibuprofen, as the Tired resident suggested) has likely side effects, especially for long term use. It is NOT designed for long term use. No drug is. Why can't you understand that it is better for the patient to have a massage, manipulation, or whatever else that can prevent the pain just so that she doesn't have to take that drug? It's like saying "take prozac and risk suicide, even though omega-3 might help you too." Can you explain to me which part of natural pain prevention threatens your integrity that you feel that it's better to prescribe your patient something that can cause kidney failure and an entire list of other terrible diseases, even if uncommon? Are you willing to subject your patient to those threats just because you have egocentric feelings about sending your patient to a chiropractor instead? Can you grasp the absurdity of that? If you did that and your patient developed one of the serious side-effects, I'd testify against you myself. As a doctor, you have no right to subject your patient to a more dangerous treatment just because of your personal or religious beliefs. How can you have a shred of integrity if you are willing to play with your patient's life? And then you wonder why people have no respect for the doctors and want to take away their salary.

Jesus, Dude. The question is whether physicians are interested and involved in preventative medicine and the answer is that they are, to a varying degree of course depending on their specialty. I glean from your post that you agree with this.

Also, preventative medicine is not rocket science. It starts from clean drinking water and good sanitation, extends to vaccinations, and pretty much ends with good diet, exercise, and moderation in one's irregular pleasures. In between we screen for disease that are a) common b) easy to screen for, and c) demonstrate benefit from early detection and treatment (which is why we screen for cholesterol but not for glioblastomas). Lifestyle is 99 percent of the battle and I would say, conservatively, that if nobody smoked, drank to excess, stuffed their faces with fatty foods, or consumed recreational drugs I would be out of a job.

The sum total effect of chiropractic adjustments, natural remedies, and other modern snake oil on the general health of a patient ain't worth a bucket of warm spit which is why I say that the whole dishonest edifice of CAM can be replaced by a couple of motrin (a very safe medication) and a Flinstone vitamin for those who can't find it in their heart to eat some fruits or vegetables every now and then.

Additionally, one of the benefits of education is that it gives us the ability to discriminate what is reasonable and likely from what is ridiculous and highly unlikely. Because I am, like most physicians, well-educated in the physical and biological sciences I don't need to "keep an open mind" about things like Homeopathy, a CAM modality which is beyond idiotic just like I can pretty much dismiss your belief that adjusting non-existent misalignment of vertebrate can cure or prevent diseases. If you make a ridiculous claim along those lines the burden is on you to prove it. One day you will just have to accept that cracking someones back will not prevent asthma. We can keep studying it, of course, hoping for a miracle but it is sometimes required that intelligent people make a decision. The opposite of decisiveness is not "close minded." I considered your theory, examined it, found it ridiculous, and now we can move on.

 

[8744]

Until we as a society figure out how to efficiently and effectively combat obesity, Type II diabetes, chronic inflammation and any number of other health-robbing conditions, we will never get ahead of the curve. Again, this is not to say that any one family physician is to blame. It is bigger than that. And, no, it's not as simple as "eat better and exercise more".

Whoa. It is exactly that simple and there is nothing to figure out. Type II diabetes, hypertension, and hyperlipidemia, three of the biggest killers out there and the cause of the majority of all the money we spend on medical care respond beautifully to diet and exercise. Even a ten-pound weight loss and modest exercise, say a brisk daily walk at the mall, have an incredible effect on these conditions. Anecdotally, every spry, healthy 90 or 100-year-old I see never smoked, never drank to excess, and lead active, non-sedentary lives. Conversely, my stable of regular 40-something patients with ischemic heart disease, congestive heart failure and insulin dependent type II diabetes did nothing but smoke, drink, overeat, lay around the house and otherwise abuse themselves horrifically. The problem is, of course, to motivate the patient which in many cases is impossible.

There is no amount of chiropractic manipulation that will change a thing about these patients and here lies the concept that is difficult for many of you who don't see sick patients for a living to understand: CAM practitioners see mostly well patients who have mostly psychosomatic conditions. You treat imaginary complaints with imaginary therapies until they get sick at which point you dump them on real doctors.

 

[Excelsius]

Jesus, Dude. The question is whether physicians are interested and involved in preventative medicine and the answer is that they are, to a varying degree of course depending on their specialty. I glean from your post that you agree with this.

Also, preventative medicine is not rocket science. It starts from clean drinking water and good sanitation, extends to vaccinations, and pretty much ends with good diet, exercise, and moderation in one's irregular pleasures. In between we screen for disease that are a) common b) easy to screen for, and c) demonstrate benefit from early detection and treatment (which is why we screen for cholesterol but not for glioblastomas). Lifestyle is 99 percent of the battle and I would say, conservatively, that if nobody smoked, drank to excess, stuffed their faces with fatty foods, or consumed recreational drugs I would be out of a job.

The sum total effect of chiropractic adjustments, natural remedies, and other modern snake oil on the general health of a patient ain't worth a bucket of warm spit which is why I say that the whole dishonest edifice of CAM can be replaced by a couple of motrin (a very safe medication) and a Flinstone vitamin for those who can't find it in their heart to eat some fruits or vegetables every now and then.

Additionally, one of the benefits of education is that it gives us the ability to discriminate what is reasonable and likely from what is ridiculous and highly unlikely. Because I am, like most physicians, well-educated in the physical and biological sciences I don't need to "keep an open mind" about things like Homeopathy, a CAM modality which is beyond idiotic just like I can pretty much dismiss your belief that adjusting non-existent misalignment of vertebrate can cure or prevent diseases. If you make a ridiculous claim along those lines the burden is on you to prove it. One day you will just have to accept that cracking someones back will not prevent asthma. We can keep studying it, of course, hoping for a miracle but it is sometimes required that intelligent people make a decision. The opposite of decisiveness is not "close minded." I considered your theory, examined it, found it ridiculous, and now we can move on.

Let's start with definition for CAM: http://nccam.nih.gov/health/whatiscam/

CAM is an approach, not a bunch of dishonest people. I am ok with you attacking specific individuals or perhaps a group, but don't attack an entire approach based on the experience you have had with just few areas of CAM, especially when you admit that vitamins are useful. Guess what? It's CAM. I don't want to derail this thread, but I can make arguments that 1. Taking multivitamins is far less beneficial because certain people need only certain supplements, and 2. Eating all the food you want does not mean that you will get all the necessary nutrition. From the above two rises the discipline of CAM where every specific supplement has a specific function. You are not interested in it so you call it "multivitamin." I prefer to go deep into it and look at enantiomers of vitamin E or the effect of proanthocyanidins...

Motrin is a safe medication? Wow. Here is another reference for you:

Cardiovascular Risk

• NSAIDs may cause an increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal. This risk may increase with duration of use. Patients with cardiovascular disease or risk factors for cardiovascular disease may be at greater risk (see WARNINGS).
• MOTRIN tablets are contraindicated for treatment of peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery (see WARNINGS).

Gastrointestinal Risk

• NSAIDs cause an increased risk of serious gastrointestinal adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients are at greater risk for serious gastrointestinal events (see WARNINGS).

I know these are uncommon side-effects, but you have no way of knowing whether the genetic make up of your particular patient will elicit these side-effects or not. You also don't know what are the ramifications of long term usage of ibuprofen. Long term means a study of ten years or more (continuous). It is unethical to give your patient an Rx instead of choosing CAM which might help. Can't you see that this is ridiculous and very patronizing towards your patients?

Where did I say that I believe in manipulation? You just keep missing what I say. I don't believe in homeopathy, I don't know enough about manipulation to claim that it's useful or useless (though according to residents here, it helps LBP), and I definitely think that it is stupid to claim that bone manipulation can help asthma. I even said something like that in an earlier post and said that DCs should therefore normalize their practice.

I wonder what theory did you consider? I did not propose any theories. If you know what it is, maybe you can let me know.

How come everyone in here is staying away from expressing opinions about hypnotherapy? Do you guys have no opinion or are uncomfortable expressing it?

 

[8744]

And by the way, you mentioned multivitamins helping back pain in your post. Are you saying that multivitamins have SOME effect? Wow. We may be onto something here because multivitamin=CAM. I'd like you to develop your idea more fully as to what is your hypothesis on multivitamins.

No, I said that a multivitamin can take the place of the entire deceptive industry of dietary supplements, natural remedies, and the like for those who cannot accept the fact that you can get everything your body needs from a varied diet with ingredients from the basic food groups.

Motrin can take the place of chiropractic. A six-week course of motrin? Five bucks. Twice weekly chiropractic care for six weeks? A couple of thousand.

One Flinstone vitamin every day: 3 cents. You piss most of it out anyways but it's cheap and harmless.

 

[8744]

Let's start with definition for CAM: http://nccam.nih.gov/health/whatiscam/

CAM is an approach, not a bunch of dishonest people. I am ok with you attacking specific individuals or perhaps a group, but don't attack an entire approach based on the experience you have had with just few areas of CAM, especially when you admit that vitamins are useful. Guess what? It's CAM. I don't want to derail this thread, but I can make arguments that 1. Taking multivitamins is far less beneficial because certain people need only certain supplements, and 2. Eating all the food you want does not mean that you will get all the necessary nutrition. From the above two rises the discipline of CAM where every specific supplement has a specific function. You are not interested in it so you call it "multivitamin." I prefer to go deep into it and look at enantiomers of vitamin E or the effect of proanthocyanidins...

Motrin is a safe medication? Wow. Here is another reference for you:


I know these are uncommon side-effects, but you have no way of knowing whether the genetic make up of your particular patient will elicit these side-effects or not. You also don't know what are the ramifications of long term usage of ibuprofen. Long term means a study of ten years or more (continuous). It is unethical to give your patient an Rx instead of choosing CAM which might help. Can't you see that this is ridiculous and very patronizing towards your patients?

Where did I say that I believe in manipulation? You just keep missing what I say. I don't believe in homeopathy, I don't know enough about manipulation to claim that it's useful or useless (though according to residents here, it helps LBP), and I definitely think that it is stupid to claim that bone manipulation can help asthma. I even said something like that in an earlier post and said that DCs should therefore normalize their practice.

I wonder what theory did you consider? I did not propose any theories. If you know what it is, maybe you can let me know.

How come everyone in here is staying away from expressing opinions about hypnotherapy? Do you guys have no opinion or are uncomfortable expressing it?

Motrin is a very safe medication which is used daily by millions of people, many of whom use it for the treatment of chronic pain. When is came out it was so effective that it was hailed as a wonder drug, something that it truly is, and generally speaking, people who won't try it for their pain or claim it doesn't work are usually drug seekers.

As for supplements and CAM, unless we're talking about the exceedingly small percentage of the population with things like pernicious anemia, short gut syndrome, or various malabsorbtion disorders, everybody, and I mean everybody, can get everything they need for good health from a varied diet which includes meat, vegetables, grains, and fruit. We just sorta' evolved that way. There is no need for anybody who is not part of the small above-mentioned group to obsess or worry about getting the nutrients they need for good health if they eat a good diet. Enantiomers of vitamin E my ass. Just more worthless pills shoveled into the maws of an increasingly ignorant, entitled, and irresponsible public.

Hypnotherapy is bunk. Pure, high grade horse****.

 

[Excelsius]

Motrin is a very safe medication which is used daily by millions of people, many of whom use it for the treatment of chronic pain. When is came out it was so effective that it was hailed as a wonder drug, something that it truly is, and generally speaking, people who won't try it for their pain or claim it doesn't work are usually drug seekers.

As for supplements and CAM, unless we're talking about the exceedingly small percentage of the population with things like pernicious anemia, short gut syndrome, or various malabsorbtion disorders, everybody, and I mean everybody, can get everything they need for good health from a varied diet which includes meat, vegetables, grains, and fruit. We just sorta' evolved that way. There is no need for anybody who is not part of the small above-mentioned group to obsess or worry about getting the nutrients they need for good health if they eat a good diet. Enantiomers of vitamin E my ass. Just more worthless pills shoveled into the maws of an increasingly ignorant, entitled, and irresponsible public.

Hypnotherapy is bunk. Pure, high grade horse****.

Wow!!! Panda, you are something else. I feel for you that you had to bust your ass during residency and school and be exposed to all the negative reinforcement while being an older student. I just hope that you will have some respect left for your patients, for everyone's sake, doctors' and patients'. You are basically treating all your patients as if they are "ignorant, entitled, and irresponsible." Is this any wonder why the public has such a terrible attitude about doctors?

Thank you so much for trashing hypnosis as well. As someone who has studied autogenic training and marvels at the amazing power of the brain to heal itself, I find your comment very ill informed. There have been some programs on the brain on PBS in the past. One of the doctors there, Dr. Daniel Amen, has talked extensively not only about the efficacies of certain supplements for the brain, but also the use of hypnosis to help things like depression and insomnia. He is an older MD and knows far more about the brain and hypnosis than you do with your specialized training in EM. And if you care at all about your patients, read his Magnificent Mind. He has around 400 scientific references there and he scans the brains of all his patients (SPECT). Maybe, just maybe, it will satiate you. I don't think I can tell you anything else, except that you made it much easier for me to understand why doctors are having so many problems. And you know, this may not be necessarily your fault. It seems to be the training that is so taxing and brutal for many residents who lose their humanity by the time it is over. One of the advisers I talked to (an MD) quit her residency because she could not take the pelting anymore and was saying how the most difficult thing in med school is not trying to memorize facts or get enough sleep, but rather to maintain your humanity. It is sad that the very system supposed to create a professional who is supposed to serve the public actually effaces the very students it trains. If you are inside the loop, it is very difficult for you to see what is happening to you.

 

[Ginzo]

There have been some programs on the brain on PBS in the past.

PBS has also featured some notorious quacks in the past, like Gary Null. A guy so insane that he rails against vaccines and still denies the HIV-AIDS connection.

It is sad that the very system supposed to create a professional who is supposed to serve the public actually effaces the very students it trains. If you are inside the loop, it is very difficult for you to see what is happening to you.

You're just embarrassing yourself now. PB is a well-known critic of the medical training system.

 

[8744]

PBS has also featured some notorious quacks in the past, like Gary Null. A guy so insane that he rails against vaccines and still denies the HIV-AIDS connection.



You're just embarrassing yourself now. PB is a well-known critic of the medical training system.

Exactly. And, from futile care to defensive medicine, I am a critic of much of what we do in the world of real medicine. But the key thing to remember is that the abuses and outright insanity of much of the current medical system neither validates nor justifies Complementary and Alternative Medicine. This country is ridiculously over-doctored and the solution to the problem is to stop spending so much money, not to spend it on expensive placebos pushed by the 21st century version of Snake Oil Salesmen.

 

[8744]

.

..(an MD) quit her residency because she could not take the pelting anymore and was saying how the most difficult thing in med school is not trying to memorize facts or get enough sleep, but rather to maintain your humanity...

In other words, the only way to maintain your humanity is to embrace some hippy-dippy, I'm Okay, You're Okay philosophy where right and wrong, effective and ineffective, and real and make-believe are just opinions, the veracity of which depends on the beliefs of the individual.

Cynicism, on the other hand, is the true measure of humanity and is the birthright of every educated person.

"Natural Ways to Unleash Your Brain's Maximum Potential." Oh man. If this subtitle of Dr. Amen's book doesn't set your spider senses tingling and your bull**** radar beeping then maybe I'm giving you too much credit.

 

[Excelsius]

In other words, the only way to maintain your humanity is to embrace some hippy-dippy, I'm Okay, You're Okay philosophy where right and wrong, effective and ineffective, and real and make-believe are just opinions, the veracity of which depends on the beliefs of the individual.

Cynicism, on the other hand, is the true measure of humanity and is the birthright of every educated person.

"Natural Ways to Unleash Your Brain's Maximum Potential." Oh man. If this subtitle of Dr. Amen's book doesn't set your spider senses tingling and your bull**** radar beeping then maybe I'm giving you too much credit.

The book's title is not the best. It also contains a lot of fluff. What I find interesting though is that his research, as well as his references, show how much the brain activity can change by simple, "alternative" changes in lifestyle, supplements, etc. He is someone who is actively involved in research and published research articles. This book, just like most books, was made for the layman with the purpose to make money, besides trying to inform the public. It would be better if you wrote a more technical book, but I am not sure whether he didn't do that because no one in the medical community will pay enough attention to it. At least not enough people to make enough money.

Anyway, just take a look at some of the stuff he says, whether in that book or somewhere else. After you are more familiar with what he is saying and the techniques he is using, you'll be in a better position to dismiss his lifetime of work. I knew you were going to go after the title. Man, it's always something, even though I agree with you on that. It's a bit cheesy.

 

[facetguy]

Ginz, take a look at these then take a guess as to how many patients will still undergo this surgical procedure for this condition over the next month:
http://www.ncbi.nlm.nih.gov/pubmed/...nel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

http://content.nejm.org/cgi/content/full/347/2/81

Will it be this evidence or the lack of reimbursement that will reduce this practice? Evidence schmevidence!

Ginz, no guesses?

 

[Excelsius]

In other words, the only way to maintain your humanity is to embrace some hippy-dippy, I'm Okay, You're Okay philosophy where right and wrong, effective and ineffective, and real and make-believe are just opinions, the veracity of which depends on the beliefs of the individual.
...

Humanity doesn't= belief in CAM. But humanity also doesn't = thinking about your patients as brainless, entitled asses whom you would rather expose to possible side-effects than give them what will achieve the same results without the side-effects. I know you are against the educational system too, but try to understand that some of the bitterness and cynicism that you have today is partly due to the fact that you yourself were mistreated. And just like your attendings abused you, you are may carry on the same tradition onto your own residents. The best you can do for the system is to not be the same way as the people who caused you grief during your own training. No one likes to be called an idiot, snake oil salesman, a quack, or anything else that. Some of these people have the best intentions and your words, besides being hurtful, alienate doctors from the public and dwindle the support. Is it worth it?

 

[Turtle01]

Facet-
My blog is in my signature. Yes, I would tell that hypothetical patient of yours to continue seeing you, if indeed his asthma improved after your treatment. This would be after I took another history to check updates on meds, peak flow, etc. just to make sure it was really you that helped (sorry, its the cynic in me). If you did indeed help, I would send the patient back.

I took the liberty of reading about half of that Spine article you recommended in an earlier post, lucky for me my school has a fully paid account to a bunch of journals and pubmed so I got access. Granted, since it was an entire supplement I did not read every article, but the ones on treatment and future recommendations that I read did not seem to praise chiropractic. In fact, nearly every reference to chiropractic states that there is no difference between manual vs. immobilization therapy. Thats all they say. What does this mean? To me it means that I would rather put a patient in a neck brace then send them for manipulation, especially given the very slightly increased risk for VBA stroke. I know you will dispute this stroke idea, and yes i have seen papers going both ways, but this enormous Spine supplement you recommend has an article in there itself compiling the research, and shows a very slight increase in stroke, especially in people under 40 (or is it 45 i don't have the article in front of me). Again, that was a very interesting set of articles for me to read and I appreciate the recommendation, please keep them coming, preferably on my blog so we don't bog down this forum.

 

[Turtle01]

That's good that you have a different experience, but a lot of med students here say that for honors you have memorize more and that just knowing the big picture can make you fail.

Come on, man. You are really going to medical school? I see all of these posts of yours hating on memorizing facts. You are in for a big surprise when you hit pharmacology. Not only must you memorize a bunch of little facts, but ALL of these facts will be relevant at some point in your career, some alot more than others but still you must know them. Anatomy is ALL memorization, and again you will be a ****ty doctor if you cannot recall the name, location, innervation, and blood supply of every muscle/organ/what have you in the human body. The big picture part of the courses is not that difficult, it's the memorization of all those facts that sets bad doctors apart from good doctors. If you pretend you mind is a tub, and you must use whatever is in your tub to answer a question posed to you, think of facts as the things that fill up your tub. A tub that is running low gives you a worse chance of answering a question correctly. Especially knowing all of these little anatomical facts will separate your ability to diagnose correctly a cause of shoulder pain, of which there are many. With the proper diagnosis, you can then give the proper treatment. If you forgot your brachial plexus because you didnt memorize the facts, then symptoms here or there would throw you off. I don't really know how else to convey this concept to you, sorry for the terrible analogy.

 

[Excelsius]

Come on, man. You are really going to medical school? I see all of these posts of yours hating on memorizing facts. You are in for a big surprise when you hit pharmacology. Not only must you memorize a bunch of little facts, but ALL of these facts will be relevant at some point in your career, some alot more than others but still you must know them. Anatomy is ALL memorization, and again you will be a ****ty doctor if you cannot recall the name, location, innervation, and blood supply of every muscle/organ/what have you in the human body. The big picture part of the courses is not that difficult, it's the memorization of all those facts that sets bad doctors apart from good doctors. If you pretend you mind is a tub, and you must use whatever is in your tub to answer a question posed to you, think of facts as the things that fill up your tub. A tub that is running low gives you a worse chance of answering a question correctly. Especially knowing all of these little anatomical facts will separate your ability to diagnose correctly a cause of shoulder pain, of which there are many. With the proper diagnosis, you can then give the proper treatment. If you forgot your brachial plexus because you didnt memorize the facts, then symptoms here or there would throw you off. I don't really know how else to convey this concept to you, sorry for the terrible analogy.

Facts are fine. I am referring to the minutiae that some people claim they are going to forget anyway since they are not using them. Anyway, thanks for the different point of view.

 

[geogil]

Humanity doesn't= belief in CAM. But humanity also doesn't = thinking about your patients as brainless, entitled asses whom you would rather expose to possible side-effects than give them what will achieve the same results without the side-effects. I know you are against the educational system too, but try to understand that some of the bitterness and cynicism that you have today is partly due to the fact that you yourself were mistreated. And just like your attendings abused you, you are may carry on the same tradition onto your own residents. The best you can do for the system is to not be the same way as the people who caused you grief during your own training. No one likes to be called an idiot, snake oil salesman, a quack, or anything else that. Some of these people have the best intentions and your words, besides being hurtful, alienate doctors from the public and dwindle the support. Is it worth it?

Side effects are dependant on your point of view. You can give aspirin as an anti inflammatory but with the side effect of platelet inactivation, or the other way around. Ergo, if you treat someone, then they will have either an effect, or a side effect, depending on the point of view. I guess Homeopathy is so bogus that you could consider it side effect free, but only because the treatments are themselves without effect.


I have to say, you're just embarassing yourself on this forum.

 

[geogil]

Facts are fine. I am referring to the minutiae that some people claim they are going to forget anyway since they are not using them. Anyway, thanks for the different point of view.

As one of my neuro professor said, the minutiae is what separates you from the nurses. Pattern recognition and on the job training are fine and will cover maybe 60-70% of your cases. The remaining 30% is why you're paid to be a doctor, and is defined by the more obscure things you have been taught but rarely see. If you study to the depth that you're learning minutiae, then you are also picking up the bigger picture things which you will remember long term. I'm not sure why you're trying to get through medical school (when you finally start) by learning the least amount possible. That should work out pretty well down the road.

 

[Excelsius]

As one of my neuro professor said, the minutiae is what separates you from the nurses. Pattern recognition and on the job training are fine and will cover maybe 60-70% of your cases. The remaining 30% is why you're paid to be a doctor, and is defined by the more obscure things you have been taught but rarely see. If you study to the depth that you're learning minutiae, then you are also picking up the bigger picture things which you will remember long term. I'm not sure why you're trying to get through medical school (when you finally start) by learning the least amount possible. That should work out pretty well down the road.

A lot of misrepresentation here. I am not trying to learn as little as possible. I am trying to learn as broadly possible. And if your professor is right, then about 90% of doctors know only as much as the nurses do, because 90% don't get to honor and don't know all the minutiae. That's not the case, of course.

The existence of this thread, at least the title and most of the posts by medical students, and the patronization of the patients, that's what embarrassing. The inability to argue without quarreling and calling names is embarrassing. I don't want to waste any more time on this, especially since it is ruining my mood before even the holidays start. I just wanted to make sure that this thread is not one sided so that the general public or the premeds know that you guys do not necessarily represent all doctors and that there are other points of view. My goal has been more or less achieved. Now we just keep recycling the same arguments and discussing "he said, she said," sprinkled with the occasional, rare scientific study.

The temperature of this thread is directly proportional to the amount of continuous discussion. After a few days, the temperature reaches critical levels and requires a cooling down time. What's far more important than this thread is what's going on out there, in the real world. In the real world, doctors are just not in a good position right now and are losing ground every day. We need novel methods of approach if we are ever going to halt the disrespect. Something obviously is not working for doctors and the status quo over the past decades has driven the entire field deeper into mud. I don't know about you, but when I really don't want that to happen. Seeing how things have been progressively worse, anyone can see that we need new solutions. You don't have to be in medical school to understand that attacking CAM is not going to help our cause. The real enemy is the insurance company. It makes doctors' lives miserable, and it makes patients' lives miserable.

Alright. I wish all of you happy holidays. School will resume soon enough. No hard feelings. We all try to do our best given the way the system is set up.

 

[cpants]

A lot of misrepresentation here. I am not trying to learn as little as possible. I am trying to learn as broadly possible. And if your professor is right, then about 90% of doctors know only as much as the nurses do, because 90% don't get to honor and don't know all the minutiae. That's not the case, of course.

You need to know the minutiae to pass, not to honor.

 

[facetguy]

Actually it is that simple, but you forgot "stop smoking and drinking, get vaccinated, and wear a condom." Doctors do tell patients all these things, and patients are actually surprisingly aware of what they have to do to get healthy. Everyone knows they shouldn't wash down their McDonald's with a pint of vodka. So to what extend does the blame for our unhealthy society rest on the shoulders of medicine? Where does physician responsibility end and patient responsibility start? We can educate and provide strategies until we are blue in the face, but until that patient decides to make a change, it is useless. I agree that we should research better prevention strategy, but in a lot of ways this is more of a sociological/cultural problem than a medical problem.

When I said it is not as simple as 'eat better and exercise more', I was looking at the big picture, not necessarily the immediate role of medicine. To fix our healthcare system, we AS A SOCIETY will need to consider such diverse issues as agricultural subsidies, socioeconomics, food marketing practices, and environmental exposures to things in our food, water, etc. Walk through any supermarket. Most of the store is full of processed, instant junk, laden with bad fats, bad carbs and devoid of nutrients. Yet this is what we eat today. Obesity is not as simple as a bad diet. Why is our diet so poor today? These are big, difficult issues and won't be easy to solve. However, since your future livelihood depends on the stability of the healthcare system, and our healthcare system is facing some major financial difficulties due in large part to these 'lifestyle diseases', I thought it would be worth mentioning.

I do, however, feel as though more importance could be placed on prevention by building more incentive into the system (improving reimbursements, perhaps). Nobody makes much money by pushing prevention. If this were to somehow change, the likely overall impact would be healthcare savings.

To your point about doctors telling their patients all about prevention, yes, I agree they do. But you have to admit, when it comes to diet/nutrtition and exercise at least, the message isn't getting through. We need to ask ourselves why. That is where the age-old advice of eating better and exercising more, stated more or less just like that to patients, clearly doesn't work. Perhaps doctors need to be more invested in this advice, which is where the idea of improving incentives for doctors who actually take the time to get into details comes in. While some have said this is all common-sense stuff, I regularly have patients who have no idea how to tell a healthy fat or carb from an unhealthy one, or who think that drinking diet soda all day is healthy, or that believe the Filet-o-Fish at McDs is good for their heart. When patients routinely see doctors act as though diet advice is below them or is unimportant, that sends a bad message. As an aside, when organizations such as the American Heart Association sell the use of their seal of approval for sugary breakfast cereals, its a joke and also sends a bad message and confuses patients.

 

[J1515]

Facts are fine. I am referring to the minutiae that some people claim they are going to forget anyway since they are not using them. Anyway, thanks for the different point of view.

You would be surprised how much is actually remembered. All of medicine is minutiae. Remembering that Ampicillin is an antibiotic is not good enough.

 

[quiltlady]

.

 

[geogil]

A lot of misrepresentation here. I am not trying to learn as little as possible. I am trying to learn as broadly possible. And if your professor is right, then about 90% of doctors know only as much as the nurses do, because 90% don't get to honor and don't know all the minutiae. That's not the case, of course.

you misunderstood. The details I'm talking about are the things all physicians should know. I'm not talking about the 1% of the information that is there to separate a class into H/NH/P/F categories. Unless you understand, profoundly, both big picture and details, you are going to be limited to being a protocol driven drone. I'm really curious still, why you are anxious to avoid learning things. This is the whole point of going to school and getting 250K into debt, so that you will have a body of knowledge at your disposal. It seems like you would be happy minimizing that investment and learning as little as possible. Best of luck with that.

Meanwhile, back to the argument in progress.

 

[8744]

Humanity doesn't= belief in CAM. But humanity also doesn't = thinking about your patients as brainless, entitled asses whom you would rather expose to possible side-effects than give them what will achieve the same results without the side-effects. I know you are against the educational system too, but try to understand that some of the bitterness and cynicism that you have today is partly due to the fact that you yourself were mistreated. And just like your attendings abused you, you are may carry on the same tradition onto your own residents. The best you can do for the system is to not be the same way as the people who caused you grief during your own training. No one likes to be called an idiot, snake oil salesman, a quack, or anything else that. Some of these people have the best intentions and your words, besides being hurtful, alienate doctors from the public and dwindle the support. Is it worth it?

I'm sorry but you will find many of your patients are exactly how I describe them, that is, fat, lazy, stupid, and entitled. These are independent character traits. In other words, when you in the full flower of your love for your patients assess them, you will have to conclude that they are fat, lazy, stupid, and entitled.

If you can't identify the problem you can't fix it. This is why any social program or system of free medical care is doomed to bankruptcy unless it assumes from the outset that a large subset of its recipients are freeloaders and takes aggressive action to weed them out. Do not make the mistake of projecting your values on others.

 

[masterofmonkeys]

This is utterly ridiculous. Any medical student will tell you that anatomy is one of the principal subjects and an important focus of of their pre-clinical training. This is why we dissect cadavers, sweat through anatomy "practicals" and memorize the name and function of every muscle in the body (including those that stabilize and move the spine) and the nerves that make 'em go.

This may be one of the most naive things I've seen yet in this thread. While we all have to learn the names of parts and the names of muscles and where they attach, it is a total joke to claim that we focus on functional musculoskeletal anatomy.

Here's some relatively common problems that a strength and conditioning specialist or exercise physiologist spends their day taking care of:
1. Young athlete comes in complaining of lower rib pain. In your examination of the athlete you realize that his oblique on the painful side is much tighter than on the contralateral side.

Name the probable muscle weakness.

2a. What muscles are crucial in the prevention and rehabilitation of shoulder impingement syndrome?

(Hint it's not the 'external rotators')

2b. What are the two crucial anatomic motions that prevent impingement from taking place to begin with?

3. Which set/rep schemes are best for rehabilitating a muscle with

3a. poor maximal strength?

3b. poor endurance?

4. What benefits to tendon health accrue with lower vs higher rep schemes?

5. Given that the pyriformis is a very common element in hip pain, what stretch would be anatomically ideal?

6. Here's a real basic one, give me the three basic rep ranges and what each one emphasizes in terms of muscular development.

As a long-time nerve damage and spine patient I can fairly safely say that medical knowledge on the subject of functional anatomy is pretty poor, given how little I learned from reading the sports med, physical med, and spine texts and primary literature myself.

I learned a lot more from kinesiology and exercise science literature, and that might be why I've successfully (mostly) rehabilitated, using the knowledge I gained from the REAL basic science on this subject, when the doctors didn't know where to start, except with offers of surgery and narcotics, and the PTs tossed me little pink dumbbells that didn't do a darn thing beyond a certain (relatively low) point.

 

[8744]

The existence of this thread, at least the title and most of the posts by medical students, and the patronization of the patients, that's what embarrassing.

To "patronize" means to treat in a condescending manner, as if you are dealing with a child. To observe that many patients are fat, lazy, stupid, and entitled is not the same as patronizing them unless we were to ignore reality and treat them like babies who are completely helpless and not in any way responsible for their own lives or health. I do not patronize my patients but give them the courtesy of believing them to be sentient actors in their own lives.

 

[Turtle01]

6. Here's a real basic one, give me the three basic rep ranges and what each one emphasizes in terms of muscular development.

Careful making claims that may not be entirely true. While I agree with you that exercise functionality is not well taught during medical school, some of us (myself) come in with a background in exercise science. Also, depending on the specialty, I guarantee you the ones who need to know about this, a majority of them will from their residency training (Ortho, ER, Family sports med). Are you looking for ranges such as 2-6, 7-10, and 12-15, going from strength gains to endurance? I know they may not be exact but you would be surprised at what some of us know.

 

[masterofmonkeys]

It is a very revolutionary idea that has just come out and that doctors are just learning about. It is called proper diet and an hour of exercise a day.

Frankly you can say whatever you want to about doctors not doing anything in terms of prevention but the impetus that is lacking comes from the patients. Until we can get patients to actually do some exercise and make better choices, a lot of the lifestyle diseases that are so prevalent today are going to continue to get worse.

I'm pretty sure you were being sarcastic but it's kinda true. Doctors don't really know all that much about the best nutrition and which forms of exercise do the best in terms of weight loss.

If a patient walked in and said 'Doc, what's the best form of exercise to do for weight loss?' I would be very surprised if even 1/3 got the answer right. Likewise if they asked what's the best way to lift weights, machine or free. Or whether steady state cardio versus a targeted regimen for increasing muscle mass (within reason) would be better for longevity and health. Or which form of exercise resulted in the greatest increase in aerobic capacity (VO2 Max). Or which exercise was best at relieving arthritis.

 

[masterofmonkeys]

facetguy, I'm willing to keep an open mind on manipulations on back/neck problems.

As an MS4 and a chronic back/neck pain sufferer, thank you.

 

[masterofmonkeys]

Careful making claims that may not be entirely true. While I agree with you that exercise functionality is not well taught during medical school, some of us (myself) come in with a background in exercise science. Also, depending on the specialty, I guarantee you the ones who need to know about this, a majority of them will from their residency training (Ortho, ER, Family sports med). Are you looking for ranges such as 2-6, 7-10, and 12-15, going from strength gains to endurance? I know they may not be exact but you would be surprised at what some of us know.

That's awesome that you come in with a background in exercise phys; it, kinesiology, and nutrition are the subjects that more than any other need to be pushed harder in medical school.

But as you know, that's one of the most basic things in exercise phys. Are you satisfied with the knowledge of exercise phys and kinesiology of the majority of medical practitioners?

I seriously doubt I'm the only med student ever to have a strong interest in the above subjects, but I'm also reasonably sure I'm in an insubstantial minority. And while I'm sure I sound like a pompous ass, I'm glad I at least had the self-doubt to say 'hey maybe knowing all the vessels of the anastomosis of the knee doesn't mean I know how a knee actually functions'

 

[Turtle01]

I agree with you on that one, my entire anatomy course I wished we discussed more things related to what goes wrong and why in functional anatomy instead of just learning the basic structure. I nearly cried when the only thing discussed related to injuries of the knee joint was the unhappy triad. However, it was quite a bit of material as it was. I think what I'm trying to say is that most likely those relevant things are learned in the residencies of specialists who are most likely to deal with those problems (at least I hope). I agree that it would be a crying shame if an ortho or family sports med doc couldn't discuss the proper rehab/prevention exercises competently with the PT's. However, I'm not too concerned if my ophthalmologist can do it or not. If they can, more power to them.

 

[masterofmonkeys]

I agree with you on that one, my entire anatomy course I wished we discussed more things related to what goes wrong and why in functional anatomy instead of just learning the basic structure. I nearly cried when the only thing discussed related to injuries of the knee joint was the unhappy triad. However, it was quite a bit of material as it was. I think what I'm trying to say is that most likely those relevant things are learned in the residencies of specialists who are most likely to deal with those problems (at least I hope). I agree that it would be a crying shame if an ortho or family sports med doc couldn't discuss the proper rehab/prevention exercises competently with the PT's. However, I'm not too concerned if my ophthalmologist can do it or not. If they can, more power to them.

Well, even though I'm going psych, I think everyone should have at least a limited foundation in the scientific principles of the stuff. You know, the basics. HIIT>steady state cardio. The importance of moderate resistance training and maintenance of muscle mass for overall health, diabetes prevention, and especially in prevention and management of osteoarthritis. And the absolute basics of being able to assess posture and ROM (properly) and at the very least look for some of the more common muscle imbalances. Just think about how many spinal problems could be prevented if it even occurred to doctors to look for exaggerated kypholordosis, flattened lumbar curve, and cervical flattening/exaggerated lordosis.

Given the huge overall health, quality of life, and economic consequences of issues directly related to (lack of) fitness and functional anatomic dysfunction in our patient population, I would think that every doctor should know the basics of prevention and surveillance, just as we check FBG and blood pressure.

At the very least, every doctor needs to know what they don't know, so they can put their patient in touch with someone who DOES know. I mean it's ludicrous that we learn the citrulline-malate cycle and all sorts of anatomy that never ever gets used again by almost anyone, but we can't even identify the basic differences between a healthy individual who exercises regularly and someone who's a couch potato but doesn't actually have medical problems...yet. The hubris in this thread and what I've experienced as a patient and a med student have convinced me that most medical professionals don't realize how little they know about these things.

At any rate, I just want to say that I love you, and if I weren't a) straight and b) very taken, i would probably hit on you.

 

[facetguy]

Since we are on the topic of musculoskeletal knowledge/education among medical students, I thought these might be of interest:
(Remember to not shoot the messenger!)

http://www.ncbi.nlm.nih.gov/pubmed/...nel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
Gave a standardized MSK quiz to recent med school grads.
82% failed.
Published in J Bone Joint Surg.

http://www.ncbi.nlm.nih.gov/pubmed/...nel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
Same authors did follow-up a few years later.
78% failed. (A trend toward improvement, no doubt.)
Published in J Bone Joint Surg.

http://www.ncbi.nlm.nih.gov/pubmed/...nel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
Gave MSK quiz to med students, residents and staff physicians.
79% failed.
Published in J Bone Joint Surg.

http://www.ncbi.nlm.nih.gov/pubmed/...nel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
Modified version of MSK quiz given to students at Univ of Washington (not a bad school, if I'm not mistaken).
4th year students did better than 'younger' students.
Still, less than 50% of 4th years "showed competency" (I'm guessing that means failed).
Published in Clin Ortho Relat Res.

(I won't mention the study of what happened when chiro students were given the same test. Oh, heck, why not...)
http://www.ncbi.nlm.nih.gov/pubmed/...nel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
Not perfect, but way better.

 

[Instatewaiter]

Whoever is inferring that motrin is dangerous is an imbecile.

 

[grandslam521]

Since we are on the topic of musculoskeletal knowledge/education among medical students, I thought these might be of interest:
(Remember to not shoot the messenger!)

http://www.ncbi.nlm.nih.gov/pubmed/...nel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
Gave a standardized MSK quiz to recent med school grads.
82% failed.
Published in J Bone Joint Surg.

http://www.ncbi.nlm.nih.gov/pubmed/...nel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
Same authors did follow-up a few years later.
78% failed. (A trend toward improvement, no doubt.)
Published in J Bone Joint Surg.

http://www.ncbi.nlm.nih.gov/pubmed/...nel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
Gave MSK quiz to med students, residents and staff physicians.
79% failed.
Published in J Bone Joint Surg.

http://www.ncbi.nlm.nih.gov/pubmed/...nel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
Modified version of MSK quiz given to students at Univ of Washington (not a bad school, if I'm not mistaken).
4th year students did better than 'younger' students.
Still, less than 50% of 4th years "showed competency" (I'm guessing that means failed).
Published in Clin Ortho Relat Res.

(I won't mention the study of what happened when chiro students were given the same test. Oh, heck, why not...)
http://www.ncbi.nlm.nih.gov/pubmed/...nel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
Not perfect, but way better.

I only read the abstracts, but I don't believe these were the same tests.

 

[facetguy]

I only read the abstracts, but I don't believe these were the same tests.

You are sort of right. 5 questions were removed because they dealt with things out of the scope of chiro practice (like joint aspiration and whatnot). Otherwise, same test. And, really, how chiro students did is not the issue here at all, is it?

 

[facetguy]

Whoever is inferring that motrin is dangerous is an imbecile.

I guess 'dangerous' is a relative term. But I think we can say that NSAIDs are not without risk, particularly to the GI tract. This is well-documented and was the whole point of COX-2s, which themselves went on to generate all sorts of problems (I don't think we need to revisit the Vioxx debacle). There are estimates out there that say conservatively 100,000 hospitalizations and over 16,000 deaths per year are directly attributable to NSAIDs (and this may just be in those being treated for arthritis).

With regard to the notion that Motrin can replace the chiropractic profession (I realize this wasn't your statement, Instate), this is of course silly and again shows poor understanding of neck and back pain treatment. At the very least, even if NSAIDs help with pain, they do nothing to address function, and without correcting function you are only increasing the risk of chronicity. And what do you tell the guy who already has a GI ulcer..."suck it up, Buddy, and quit complaining"?

It's kind of funny how if one mentions that NSAIDs carry real risk of very serious side-effects (dying is pretty severe, I'd say), that person is an imbecile. Yet, we've heard over and over how chiropractors are so dangerous that they are stroking patients out left and right at a rate of maybe 1 in a million (literally). I think we need to remain more objective about these things.