wayttk said:
Once again, Prozac and Mike demonstrate their complete and utter ignorance and dishonesty on the subject, and wouldn't recognize a reality check if it poked them in the eye.
Here's a little reality
I am legally able to draw blood, order labs, and diagnose any medical condition, within, OR outside my scope of practice. And I have. There is a big difference, however, between eg. Diagnosing a osteosarcoma, and treating an osteosarcoma. I am obligated to question the credibility of someone "claiming" to be an MD that does not know the difference. While it is considered out my scope to prescribe(tx) chemotherapy, it is NOT outside of my scope to diagnose it.
I also, regularly advise my patients on pharmcological treatment. Why? Many have many specialty docs, each giving them drugs separately. I advise them to maintain a personal medical file, that contains copies of all their test results, docs names and phone #, drugs prescribed etc. Whenever I suspect a possible drug induced symptom/problem, I advise them to appoint with the rx'ing doc, take their personal file to the appointment, and get it checked out.
Why would a cardiologist or opthomologist "have any training in GYN"?
First, I am an MD with an MS in biomedical sciences. My MD is from Michigan State University College of Human Medicine. In order to get into medical school, I needed a BS/BA degree from a four-year accredited institution, not an associate's degree or 60 credits of college from any school. To even be considered for admission, MSU CHM requires a 3.5+ GPA (usually 3.75-4.00) in all undergraduate coursework, not just science courses. Acceptable scores on the MCAT, usually around 10+, are also required.
Second, I am a licensed physician in Michigan with board certification in internal medicine and psychiatry. I also successfully passed (on the first try) my USMLEX I and II. After I completed my MD degree, I underwent five years of residency training at the University of Michigan Medical Center and William Beaumont Hospital in Internal Medicine and Psychiatry. After residency, I successfully completed board certification in IM and PSYCH.
Typically, IM is 4 years and PSYCH is 4 years post graduate, but I combined the two to maximize my career options after residency. As a physician, I am able to (although I restrict myself to practicing within the scope of my speciality training) practice medicine on an unlimited basis in Michigan. I can Rx from all drug schedules. I, however, stay within the scope of my knowledge and skill level, although based on my intense training, I am able to treat and diagnose a wide range of medical conditions safely and effectively.
That is to say, even though I practice exclusively as a psychiatrist, my training equips me to treat a full range of general medical conditions. As an intern and later as a resident, I rotated through IM, Peds, FM/FP, path, OB-GYN, ophth, emergency, uro, and even radiology. I've treated patients for such diverse things as epididymitis, conjunctivitis, MS, macular degeneration, IRDM, MVR, lymphoma, comminuted fxs, DDD, DJD, radiculopathy, HTN, UTIs, URIs, COPD, paranoid schiz, DID, MDD, BAD, and constipation.
Unlike you, I've had my hands inside a living human being. I've ordered labs and interpreted them. I understand what SGPT and SGOT are. I know how to read a BUN. I know what FBS is. I've examined MRIs, IVPs, CTs, and XRs and can spot more than just fractures, misalignments, and malunions -- I can spot renal calculi, cholelithiasis, ureteral stents, stents from PTCAs in the CAs, and can differentiate between types of tumors. Can you?
Unlike chiropractors, to enter the profession of medicine, students have to prove themselves to be intellectually, morally, and academically superior to other students. It takes a great deal of academic achievement to enter medical school, and it requires a great deal of academic achievement to graduate from medical school. It requires a great deal of work and effort to match into and then complete a residency and then pass separate boards in a speciality. To get into DC school, you need to be living and have attended community college or trade school. You need Cs in your science classes, but you can have an overall GPA of 2.0. You need no admission tests.
Each state regulates the practice of specific professions. Here, in MI, the broadest scope of practice in health care is found within allo and osteo med. Chiropractors are restricted to specific treatments. A chiro cannot perform any invasive procedures, such as drawing blood. A DC cannot order labs because they are neither trained to read them, nor are they able to perform any procedure that would require bloodwork. Why would a DC order labs anyway? You neither have the training or need for such things? You adjust and possibly do some quasi-OMT type stuff, maybe therapeutic massage, but why would you need to draw blood? You don't Rx meds. You have no reason. That's why DCs have no authority to order labs in MI and in most states. If you're in Canada, this may be diff, but in the US, the practice of medicine is highly regulated. No DC has any business ordering labs.
X-rays are NOT labs. You are qualified to take x-rays and possibly read them, but then again, so is an x-ray tech.
Now, having said that, you are right, there is a differece between being able to diagnose a condition and being able to treat a condition. You mentioned an osteosarcoma. Since this type of cancer effects the musculoskeletal system, it might be something a DC would encounter and be able to detect per MRI or XR. Would you be able to actually make a definitive dx, however? NO! Why? You could make a speculative dx, but you'd need bloodwork and a bx and cytopath report to make a complete and definitive dx. You're not qualified to do this. Even I am legally able to do this, I'm not qualified to do this and would never dream of doing so.
So, if you, while doing a routine XR to bilk your patient out of more money while treating his recalcitrant LBP secondary to HNP/DDD/spinal stenosis with radiculopathy (which you can't effectively treat since he'd probably need a lami with fusion) spot a suspicious mass that may possibly be an osteosarc, all you can do is speculate, you would not be diagnosing. So, who lacks credibility now? Would you really tell your patient he has bone cancer because you spotted something looking like an osteosarc on scan or film without having a path report or bx in front of you? Would you be able to recognize mets to the nodes, brain, lungs, kidneys? Most competent DCs would say "you have a mass, get it checked SOON!" This is not a dx, but speculation. Surely, you know the difference.
A DC might be able to dx stenosis, DDD, disc herniation, nerve impingement, post traumatic DJD, an ACL tear, medial meniscus tear, rotator cuff tear, etc. Those things are within your diagnostic training, but can you treat them? I guess that would be left up to your state boards to determine whether you can do such things. However, it's unlikely that a DC who is not a PA, NP, or MD/DO can draw blood or even order labs. Why would you need to? It's not part of your training nor is it part of your tx protocols.
Advising patients "to maintain a personal medical file, that contains copies of all their test results, docs names and phone #, drugs prescribed etc." is not advising them ABOUT their medications. That is general advice that anyone would give a patient who may not be organized about such things. Since you have no training in pharmacology, what the hell business do you have advising patients ABOUT their medications? You have about as much training in pharm as your average x-ray tech, lawyer, or school teacher. Would any of those folks tell someone to stop taking their ACE inhibitor or SSRI? A DC would.
I won't even "touch" the GYN comment. Let me just say this, go ahead, use a speculum, do a PAP or vag swab, and see how long you'll be retaining your license and/or staying out of jail. That would be sexual battery in MI. Sorry to tell you that, buddy. I don't care if you took a crash course called "this is a vagina, that is a penis" in chiro school, you put a gloved or ungloved hand on anyone's genital region for "tx purposes", and you will be in some hot water! If you have done this, what state permits you to do this? Why would a cardio or PSYCH have any training in GYN? You see, UNLIKE you quacks, we went to med school. We did an internship. We did clerkships and rotations. We rotated in residency. Like I said above, I may be a psychiatrist, but I've had experience in other areas of med. Would a backcracker have any rotations in peds or GYN? NO!
As for the DC who works at Brown, I don't have an answer for you. Some people talk a good talk and use their charm to move up. He may also know someone. He's not treating patients and he's not teaching any real classes. If you look at what he's actually doing, it's almost PT type research. You do not find DCs teaching at real schools. That DC is an isolated anomoly. These things happen.
