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USC Medicine Interns to Learn Chiropractic

Discussion in 'Clinicians [ RN / NP / PA ]' started by PublicHealth, Dec 16, 2005.

  1. PublicHealth

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  3. emedpa

    emedpa GlobalDoc
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  4. PublicHealth

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    Are you referring to MDs or DCs in this program? ;)
     
  5. PublicHealth

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  6. emedpa

    emedpa GlobalDoc
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    md's.....
     
  7. chirodoc

    chirodoc Member
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    I have several reactions....

    First, Oh no now they are going to find out if we don't know how to manipulate then we use an activator instrument or crank up a drop table to make the patient think we are moving a joint! :scared:

    Second, Oh crap .... how am I going to 'splain subluxation' to these guys...they'll know I'm lying. :rolleyes:

    Lastly, Whew, I'm glad the smart kids are here so we can actually figure out whats wrong with this patient. :laugh:

    There is a reason why medical doctors have little to no interest in chiropractic. ;)
     
  8. FoughtFyr

    FoughtFyr SDN Lifetime Donor
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    I have several reactions too...

    1. It will be interesting to see how this plays out for USC grads on the residency application trail...

    2. It will be interesting to see how many students actually take the rotation...

    3. It will be VERY interesting to see if the rotation survives USC's next LCME audit, I do not see how they can justify learning objectives that do not have an accepted scientific basis in the medical community. (Medical students are not taught experimental therapies as part of any cirricula - if there is no accepted basis, it is not taught.) Believe what you want about chiropractic but you can not debate the simple fact that it is not accepted by the medical community as a whole.

    - H
     
  9. awdc

    awdc Senior Member
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    It's not so strange since there are some medical schools that have electives in alternative medicine therapies. (UCI comes to mind. I think Mt. Sinai students also have an alternative medicine elective open to them as well.) Anyways, the article states that the medical students/interns will only be observing patient care in the chiropractic clinic. BTW, chiropractic manipulation is an accepted part of back pain and various methods used by chiropractors are part of accepted care of certain musculoskeletal problems.
     
  10. FoughtFyr

    FoughtFyr SDN Lifetime Donor
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    It is somewhat accepted, but not as a medical methodology nor as a medical procedure (that is one performed by MDs). My medical school had alternative medicine as a course (and yes, PH, before you ask, I did well in it) but it wasn't to this level.

    It will be interesting to follow this...

    - H
     
  11. chirodoc

    chirodoc Member
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    FoughtFyr...I'm puzzled why are you so accepting of acupuncture but so skeptical about chiropractic? :confused:
     
  12. FoughtFyr

    FoughtFyr SDN Lifetime Donor
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    A few reasons.

    First (and foremost), there are extremely good data in support of acupuncture. There has never been a sound paper that demonstrates that chiropractic is better than traditional medicine (to be fair there have been good papers that show chiropractic is as effective - but not more so than traditional medicine for LBP)

    Which brings me to my second issue - I have never seen an iatrogenic injury from acupuncture and I see about one a week from chiropractic. These fall into three categories - first, a direct injury from the chiropractor, these are rare, but catastrophic - usually CVAs. The second, but well described in both the literature and my personal experience, is a delay in seeking appropriate care because the patient has been convinced that the chiropractor can treat their cancer, etc. A third, and also common in both my experience and the literature, injury "caused" by chiropractors is the failure to recognize significant pathology while treating LBP (or some other presumed NMS complaint). The worst of this was the 25 yo M being treated for LBP by a chiro for 6 months before hematuria set in and he came to the ED. Renal cell carcinoma sucks.

    Third, acupuncturists, in my experience, are not looking to supplant medical treatment, but rather to complement it. At the Mayo Clinic, acupuncture has been great to stimulate appetites of chemotherapy patients. None have suggested (as have chiropractors) that the chemo be foregone in favor of acupuncture. Nor do acupuncturists have national organizations that advocate against immunizations, floride, and other public health measures.

    Lastly, acupuncture, like medicine, is the culmination of the experiences of generations of practitioners. Whereas D.D. Palmer is the "fountainhead" of all knowledge of chiropractic. The basis behind chiropractic has been soundly rebuked time and again. It is not some ancient art (as is acupuncture), it is the creation of a single snake oil salesman (and his son). I have great respect for the methods that have proven themselves over time in non-western cultures (especially when the results are reproducible in scientific trials). But that is NOT chiropractic!

    - H
     
  13. guetzow

    guetzow Senior Member
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    ........................................
     
  14. chirodoc

    chirodoc Member
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    "Lastly, acupuncture, like medicine, is the culmination of the experiences of generations of practitioners. Whereas D.D. Palmer is the "fountainhead" of all knowledge of chiropractic. The basis behind chiropractic has been soundly rebuked time and again. It is not some ancient art (as is acupuncture), it is the creation of a single snake oil salesman (and his son). I have great respect for the methods that have proven themselves over time in non-western cultures (especially when the results are reproducible in scientific trials). But that is NOT chiropractic!"

    Man, are you seriously saying b/c it's been done a thousand years means it works? Now are you seriously saying DD Palmer invented putting your hands on someone and moving a joint? Bone setting is thousands of years old, too. I think (as an asian) that some people fall in love with our culture just b/c it's attractive, not b/c it's valid. Just like that Feng Shui stuff. Give me a break.
    If that's the case then I need to bind some feet and get me a hotty...woo hoo. That's after I kill me a Giant Panda Bear and eat his liver so I can have 'stamina'.

    As a chiropractor, I'm no fan of chiropractic. But I think there should be a separation from talking about joint manipulation (what chiropractors do) and chiropractic (how chiropractors sell what they do). I think there is good evidence for the conservative, efficacious use of joint manipulation, however, I don't see any plausible reason to market it as a separate and distinct profession. I guess I would apply the same distinction needle therapy and accupuncture. One admits there is some evidence it has a beneficial effect as a therapy and the other addresses a healing art based on non-sense 'meridian' and chi energy in my gut. That is not chi...that is last nights burrito. :laugh:

    Just having fun with you FoughtFyr...I heard you've got relative D.C.'s and can't stand them so if that's the case I can understand the hostility. But this is like kissing a twin and telling her, "man, I'm glad you're not as ugly as your sister". One profession full of BS is as bad as another full of BS.
     
  15. FoughtFyr

    FoughtFyr SDN Lifetime Donor
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    No, what I am saying is that if multiple, double blind, placebo controlled trials shows that it works in limited settings, then it probably does. And, if it has been done for thousands of years with efficacy, then yes, it probably works.

    No, DD "invented" chiropractic, the idea that all dis-ease in the human body was the result of disruptions of nerve flow through the spinal cord. Chiropractic's problem lies not in its use of manipulation, but in its theoretical reason for doing so. I agree that manipulation can be a valid modality of PT. But that setting is far more limited than chiropractic.

    Well, I don't advocate Feng Shui for healthcare, but in limited settings (e.g., headache, antiemesis, appetite stimulation) acupunture is well validated and proven. For instance see:

    http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11105182&query_hl=7&itool=pubmed_docsum

    http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16055451&query_hl=2&itool=pubmed_docsum

    http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16192603&query_hl=5&itool=pubmed_docsum

    But in the end it boils down to this - most acupuncturists in the U.S. are providing adjunctive therapy to medically managed patients. They do not seek to supplant or change medicine, but rather to provide limited symptom relief.

    Reductio ad absurdum - Ah, the logical fallacies, the tools of every good chiropractor.

    http://en.wikipedia.org/wiki/Reductio_ad_absurdum

    The reason to "market it as a separate and distinct profession" is the simple fact that chropractic, as it is practiced today, is dangerous - pure and simple. Face it, even the chiropractic literature bemoans the risks of CVA from high cervical manipulation: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12466778 and the risks of iatrogenic injury during chiropractic school: http://www.jcca-online.org/client/cca/JCCA.nsf/objects/V49-1-46/$file/jcca-v49-1-046.pdf and the low quality of chiropractic education: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15965408&query_hl=10.

    And here is a great example of the dangers of relying on chiropractic "diagnoses": http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9158451&query_hl=11

    Umm, no. Yes, I have a brother-in-law who is a "straight" chiropractor, but no, I don't hate him at all. Actually, prior to meeting him, I had little idea of what chiropractic truly was. In his efforts to explain it to me I became simply aghast. I couldn't believe what a crock it was. I even went to Palmer with him because I was so convinced that he misunderstood things - he doesn't. Now, as an emergency physician, I frequently see the damage chiropractors do. From the little boy dead of Hib meningitis because Daddy's chiropractor told his family to refuse immunizations, to the 30 year old with now intractable renal cell carcinoma whose chiropractor had been treating his LBP for 6 months until the hematuria set in, to the elderly gentleman with massive, true subluxation of L3 on L4 that occured on the chiropractor's table as evidenced by the loss of urinary continence and saddle anesthesia that developed after a "very painful" adjustment, or the 55 year old wth the VAD who had been undergoing chiropractic "treatment" for her headaches, I am simply convinced that chiropractors know just enough to be truly dangerous. And the fact that these patients were all seen by me personally over the past 18 months (and the fact that research posted above shows a high rate of iatrogenic injury during chiropractic training) suggests to me that the problem is very big indeed.

    - H
     
  16. 611

    611 Senior Member
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    Just to be fair, there are many allopathic, osteopathic, etc. screw-ups that end up in our emergency room also. But that is a different issue.
     
  17. FoughtFyr

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    Absolutely correct, they do. The difference is in risk versus beenfit. There are well documented benefits to allopathic / osteopathic care, so some measure of risk is often acceptable. There is NO proven benefit to chiropractic, except in the setting of LBP where it is only "as effective" but not more effective than traditional medicine. No benefit and any risk (even if that risk is low) doesn't make sense.

    And let's be fair, allopaths and osteopaths are the first to state that medical errors are problematic. We monitor them, track them, and design entire systems around preventing them. Chiropractors, on the other hand, insist their methods are completely safe (despite their own research showing they aren't), and have made no cohesive attempts to describe the problem of chiropractic iatrogenic injury, yet alone prevent it.

    - H
     
  18. 611

    611 Senior Member
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    Just curious, other than Palmer, what other Chiropractic colleges have you visited?
     
  19. jesse14

    jesse14 Senior Member
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    The USC students doing rotations is just another example of increased integration of chiropractic into "traditional" academia.

    I also just found out yesterday that my biomechanics TA is a 2005 graduate of the CMCC (which has degree granted status) who is doing additional work to get a fellowship in sports science in partnership with York University and the CMCC. Therefore, a chiropractic college, in partnership with an accredited University, is providing post-doctural studies.

    ---- just another case of chiropractic gaining integration. I know it's a small step, but it's a step many believed wouldn't happen (MD students at USC doing rotations in chiropractic)

    Also, if chiro is so "useless" then why would a good med school such as USC ellect to tarnish its reputation in hopes of giving its students training in chiropractic?
    What's the process a school must go through to add a new rotation? I would think a lot of work/study would be involved...
     
  20. PublicHealth

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    What is the general perception of chiropractic in Canada?
     
  21. chirodoc

    chirodoc Member
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    I can't say I don't agree with a lot of what your're saying. Actually, you were nice enough to email me a while back and it was one of the factors for me to make a decision to leave chiropractic. However, I'm not leaving b/c I am a chirobasher. Mainly b/c it just doesn't fit me, personally.

    It does trouble me though to hear that you, one physician out of 600,000, has seen so many cases of chiropractic malpractice and yet there is no pulic outcry or scrutiny. You have to understand that if there are that many cases then it's either exaggeritis (which I do treat :laugh: ) or the biggest cover up in medicine (which defeats the purpose of bashing chiropractic). :confused:

    I have never heard, seen, know anyone who has been accused of malpractice or know of any local physicians who are accusing D.C.'s of these abuses/incompentencies. I'm not saying it is not true but it just doesn't seem plausible for the way most do joint manipulation. I would hope that the surgeons, neurologists and our own physician would have said something to me if it was a prevalent as you say, otherwise these members of your own profession are culprits, too, for knowingly allowing it . :( Right?

    OBTW...sorry for the crack on your family member (D.C.). I forgot where I heard/read that but nevertheless I shouldn't bust on your family. I love my B-I-L too but disagree with everything he thinks so it's wrong to mischarecterize that as hate....more like loathe. :D

    Anyway, FoughtFYr, you're one smart cookie and I enjoy reading your posts. It's had an effect on me and that's usually really hard to do. I'm better off looking at the common sense of things and that's where my profession has left me speechless. If I were to see you prescribe aspirin for every case that walks in your door I'd think you were a quack...we'll if you don't buy into the subluxation theory then that is what chiropractors do. If you do buy into the theory then it makes sense but that is like creating your own religion to suit your fallacies....ooops I made a correlation from chiropractic to cult. I guess there are similarities. :rolleyes:
     
  22. chirodoc

    chirodoc Member
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    I still think you medics love it b/c it's still needles and you guys love needles. :laugh:
     
  23. FoughtFyr

    FoughtFyr SDN Lifetime Donor
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    None, is there a need? The theory behind chiropractic is the theory behind chiropractic. I realize that practices vary, but if you vary too far from what the base is then you are just making $hit up (and are even less verifiable).

    - H
     
  24. FoughtFyr

    FoughtFyr SDN Lifetime Donor
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    That and I has a toy porcupine as a kid!

    :laugh:

    - H
     
  25. FoughtFyr

    FoughtFyr SDN Lifetime Donor
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    A fourth year (or intern-year, it is really hard to tell from the press release) elective rotation is hardly "increased integration". CAM rotations are common.

    Umm, yeah, not so much. You said yourself he "is doing additional work to get a fellowship in sports science", so the DC alone was not sufficent. I would be VERY surprised to hear that the DC is considered acceptable for "post doctoral" work. More likely the school is considering this as routine graduate level study (in pursuit of a degree or certificate). In any event, at the graduate level self designed cirricula are common - I wouldn't credit that as a partnership any more than if chirodoc gains admission to medical school will his education be a partnership between his chiropractic college and his medical school. Your TA is getting graduate training beyond the DC, big deal.

    Keep the dream alive! :thumbup:

    :laugh: :laugh: :laugh:

    Actually, while I do believe the press release, it is interesting that USC has not advertised this at all. It is difficult to tell, due to "mixed" terminology (the participants are referred to both as "interns" which would be first post graduate year MDs and as "medical students" which generally describes pre-graduates) who is actually doing the rotations, but in either event, it is certainly elective and USC is keeping it on the "down low". And lets be clear (from the OP):
    "While completing chiropractic rotations, the medical interns will be allowed to observe, but not participate in, the discussion, palpation, assessment and adjustment of patients." {emphasis added}.​
    Creating an observational experience for either group (interns or medical students) is very easy. In fact, I know of several schools that electively send students or interns to foriegn countries to observe medical practices that would not be acceptable in the U.S. This is no different.

    BTW - I think USC is concerned about their reputation with this program. Here is a challenge - see if you can find any press release originating from USC regarding this program or find any mention of it on a USC website. I couldn't. I think we both know the reason why...

    Just keep drinking the kool-aid Jesse!

    - H
     
  26. FoughtFyr

    FoughtFyr SDN Lifetime Donor
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    Actually there is extensive literature on the subject. But the lack of public outcry does continue to amaze me. There are a few grassroots efforts (chirobase, quackfiles, chiro911) but nothing has really taken off. The reason (IMNSHO) is that chiropractors are fantastic marketers and no one group stands to make much money from their discrediting. They do not enjoy that big a piece of medicine to be a threat and no large group of other practitioners would stand to gain large patient bases if chiropractic dissappeared. Or it could be that whole "DD Palmer was a Master Freemason" thing! :laugh:

    - H
     
  27. 611

    611 Senior Member
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    The Chiropractic schools do vary greatly especially in their treatment of basic and clinical sciences, as do medical and osteopathic schools domestically and internationally.
     
  28. jesse14

    jesse14 Senior Member
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    simple question: If USC is so worried about their rep then why,as the press realese states, would USC come to the CCCLA to ask them to do rotations in chiropractic? USC MUST see some benifit and importance in it's med students doing rotations in chiro or they simply wouldn't have sighned on for it. I also e-mailed the school (USC) to see if they would provide me with more information on this development. As soon as i hear anything, i'll be sure to let you know.
     
  29. FoughtFyr

    FoughtFyr SDN Lifetime Donor
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    So why no USC press release or web information?

    - H
     
  30. chirodoc

    chirodoc Member
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    It's like kissing your redneck sister. You've got to get the experience somewhere but you don't want everyone to know about it. :laugh:

    .....Just a joke...I don't mean literally your sister since now I know you have a brother in law. I guess I should say kissing "a" erythematic sister. There now it's politically correct. :thumbup:
     
  31. FoughtFyr

    FoughtFyr SDN Lifetime Donor
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    I agree, which proves that it is not the grand step that Jesse seems to believe it to be. I highly doubt that this is as big a deal to USC as the press release makes it out to be. USC has long held a chair within their Pharmacy School for CAM. That program has expanded into the medical school (initially with classes on pharmaco-herbal interactions, now with full courses on CAM). I have no doubt that a Professor within that program approached Cleveland to se if some medical students could observe, but I do not think it is a formal stand-alone rotation, nor do I think it actually lends any validity to chiropractic. I think USC wanted its students to se what alternative "care" their patients may be receiving, which is not an endorsement.

    - H
     
  32. FoughtFyr

    FoughtFyr SDN Lifetime Donor
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    Yeah, my problem is with the entire theory of chiropractic. A theory which the CCE requires be taught to all chiropractic students. Basic sciences are nice but we do not hand out prescription pads to all MS of biology holders even though they have completed a great deal of basic science work. and truthfully, we don't hand them out to MD/DOs without a great deal more training than a chiropractor has - 3 years to 7 years minimum.

    - H
     
  33. 611

    611 Senior Member
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    I don't think most Chiropractors want to write presciptions. The Chiropractic colleges I am familiar with ( National in Chicago) and others have a 10 semester (=5 academic years) program. As with any professional, there are good and bad. It's how you apply your educational background when you get out into the field of practice. I have met healthcare providers in every discipline who had to have cheated their way through school because their clinical decisions were not to be believed. Thankfully, that is the minority.
     
  34. FoughtFyr

    FoughtFyr SDN Lifetime Donor
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    O.k., the prescription pad thing was the turn of a phrase, not meant to imply chiropractors write 'scripts. They don't. And I so love how, in chiropractorland, 8 months equals a year. O.k., let's do the math again for the cheap seats, chiropractic education = 10 "semesters" (where at best a 40 hour clinical work week is done over 1 calendar year) and a few hundred, mainly recruited patients are seen; MD/DO education = 20 "semesters" = seven calendar years but, in fairness, most schools give the summer between M1 and M2 off (minimum, where an 88 hour clinical work week is the norm for at least 4 calendar years) and nearly 10,000 real patients are seen (again, at minimum).

    And if you think an MD/DO can "cheat" their way through school AND residency, you are really deluded.

    - H
     
  35. 611

    611 Senior Member
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  36. 611

    611 Senior Member
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    Again, atleast the schools I am familiar with go 12 months a year. Some of the clinical decisions I have seen over the years would knock your socks off. It makes you "wonder" how they ever got through school. You will see this over the many upcoming years of your practice. I wish all professionals had the dedicated you seem to have. I would certainly hope if I ended up in an ER you or someone with your dedication would be there to help me.
     
  37. FoughtFyr

    FoughtFyr SDN Lifetime Donor
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    I'm not debating that chiropractic education is three calendar years plus one semester for a total of (by USDOE financial aid rules) 5 academic years. The difference is that MD/DO education, by the same standards, is 10 academic years at the minimum. Additionally, the number and composition of the patients seen are completely different. The MD/DO will see many more patients in training (by factors of 10) and the patients will actually be sick, as opposed to recruited.

    - H
     
  38. 611

    611 Senior Member
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    Again, maybe some schools recruit patients(as many dental schools do for their clinics) if there is not a big patient base, but not the schools I am familiar with. Maybe the schools in rural areas need to do that to get their patients. I can't speak for the schools I am unfamiliar with, I can only speak of the ones I know of first hand.
     
  39. FoughtFyr

    FoughtFyr SDN Lifetime Donor
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    Sorry for thee chirobase reference but here:
    http://www.chirobase.org/08Legal/clevelandsuit.html

    Also, the CCE requires training in patient recruitment and most use this to justify mandating their residents to recruit some (if not a majority) of the patients they see.

    Almost no patients are "recruited" into MD/DO training sites.

    And even if we leave the issue of recruitment aside, an MD/DO will see vastly more patients prior to completing their training. This makes a HUGE difference in safety.

    - H
     
  40. 611

    611 Senior Member
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    Again, I can only comment on that with which I am familiar. Unfortuanately, the quality of education varies greatly from institution to institution. No patient recruitment went on with the institution with which I am familiar. Would a greater variety of exposure to clinical conditions help to make chiropractors better diagnosticians?...definately. The school in Chicago has a program with Rush that allows it's students access to rounds which is a start toward improvement of the clinical chiropractic education.
     
  41. FoughtFyr

    FoughtFyr SDN Lifetime Donor
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    Fine, but even with no recruitment (a point which I am not willing to concede since I am personally close with graduates of both Palmer and Logan who freely admit this goes on and the CCE lists it as an educational objective, but I'll set it aside for the sake of the argument), how is it that you feel, in 10 semesters, a chiropractor can learn all of chiropractic theory and treatment sufficent to safely practice independantly AND learn enough "medicine" to safely screen their patients for significant pathology when it takes an MD/DO 20 semesters at the minimum (e.g., 20 semester for emergency medicine and family practice but 32 semesters for cardiology, 35 for general surgery and 23 for PM&R) to do the same. And how, with only two years of clinical exposure (I'm being generous) and only "normal business hours" can a chiropractic student hope to see enough pathology to be competant? Again, an MD/DO will have at least 5 years of near 80 hour work weeks to accomplish the same end.

    BTW - rounding on patients without primary responsibility for care nor physical presence to see effects of care changes is worthless. Again, there are any number of paraprofessionals who round with us each morning. That doesn't make them physicians.

    Unfortunately 611, any DC who has also completed medical school will attest to the fact that while in DC school they were told how equivalent the DC was to the MD/DO and then they discovered the reality. Medical school and residency are so experience intensive that it is nearly impossible to eek out any additional training in the same timeframe. As a testament to this, it has taken significant regulation to adjust the working hours down to a more human level. There is nothing in the DC program that even comes close. And also keep in mind that through all of this, patients die on your watch. Some die in front of you. Almost all who die do so despite your best efforts. So yes, most of us are pretty dedicated to it. And there are very few who don't bristle at the suggestion that DC training is even REMOTELY equivalent.

    - H
     
  42. FoughtFyr

    FoughtFyr SDN Lifetime Donor
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    How's that USC update coming Jesse? Finding out that USC isn't really all that excited (or involved) with the program? I called a friend of mine over there, he said that this has been "way blown out of proportion" by Cleveland and may even be dropped due to their assailing the press with this. It was, as I suspected, a professor in a CAM class who asked if (or arranged for) his students could observe chiropractic teaching with the hopes that the students would understand what other forms of healthcare their patients might be recieveing. It is an informal part of a single course - limited in time and scope, not a full "rotation" as described in the press release, nor is ANYONE at USC supporting or validating chiropractic - they are just merely noting that chiropractors are out there...

    :laugh:

    - H
     

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