Why do patients like chiros more than PTs?

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TheTruckGuy

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And how do I convince them PT will probably be better for them long term?

So I'm a military GMO(basically an intern trained primary care MD), see a lot of young active people with various aches and pains and injuries. Back pain and shoulder pain is very common, and most have poor posture, rounded shoulders, forward neck, etc. You know, your typical 18-30 year old these days. I usually give them some basic stretch and exercises to do, tell them to give that a go for a month or two, and come back and we'll refer to PT if they don't show improvement. But just about all of them come in asking for a referral to the chiropractor, or when I suggest PT they say they'd prefer a chiro.

I've got nothing against chiros, and I think if they couldn't provide pain relief they'd have gone out of business a long time ago. But they tend to not provide good (or any) home exercise routines. They also keep telling my patients they need MRIs because they have "slip discs" or something else that doesn't match the clinic picture I see. And of course the patient thinks I'm the idiot that won't give them the MRI they need. Though to be fair, it's more the off base chiros that do this more than the on base ones.

So, tl;dr, what language/wording do I use to professionally say that PT would likey be better for them than chiros?

Thanks

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And how do I convince them PT will probably be better for them long term?

So I'm a military GMO(basically an intern trained primary care MD), see a lot of young active people with various aches and pains and injuries. Back pain and shoulder pain is very common, and most have poor posture, rounded shoulders, forward neck, etc. You know, your typical 18-30 year old these days. I usually give them some basic stretch and exercises to do, tell them to give that a go for a month or two, and come back and we'll refer to PT if they don't show improvement. But just about all of them come in asking for a referral to the chiropractor, or when I suggest PT they say they'd prefer a chiro.

I've got nothing against chiros, and I think if they couldn't provide pain relief they'd have gone out of business a long time ago. But they tend to not provide good (or any) home exercise routines. They also keep telling my patients they need MRIs because they have "slip discs" or something else that doesn't match the clinic picture I see. And of course the patient thinks I'm the idiot that won't give them the MRI they need. Though to be fair, it's more the off base chiros that do this more than the on base ones.

So, tl;dr, what language/wording do I use to professionally say that PT would likey be better for them than chiros?

Thanks

I'd make sure they know that chiros aren't MDs, first, because a lot of people actually think that chiros are full MDs and that is why they think they are better than PTs. I'd say something like "in my professional experience, PT is more effective than chiropractic care, so if we try that first and you do the exercises and that doesn't work, then we can certainly give chiropractic care a try."
 
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lots of patients like chiros because they provide passive treatment. patients want someone to "fix" them. When people ask me what is the difference between PT and DC I sometimes snarkily say "what PTs do is based on science"
Most of the time, when something hurts for no apparent reason, that body part is not at fault, it is the body part that got dumped on.

I love to use analogies, one of them is this:

Your great grandfather and his brother built canoes out of strips of wood and varnish. they beat the crap out of each other on the river, throwing rocks, shooting buckshot, ramming each other etc . . . They got older and had to shelve the boats. Your grandfather and his cousin found the boats, did the same, and the cycle repeated with your dad and his cousin. Now you have the boat and you want to do the same but your boat is old and beat up and its taking on water.

You have three options: 1. bail the boat - this will allow you to use your boat, provided you can bail faster than the water is coming in but it doesn't solve anything. 2. dump the boat out- you start over with zero water in your boat, but again, it doesn't solve the problem. or 3. fix the boat, obviously that solves the problem.

Chiropractic, ibuprofen, massage, ice are more like bailing the boat. it rarely solves anything. Steroid injections are like dumping the boat out and starting over. (if the water in your boat is due to a rainstorm, and your boat isn't really leaking, the steroid might fix the problem i.e. if you fell down and developed trochanteric bursitis, the injection might fix it because it was a one time incident that caused the inflammation.) but a PT is more likely to identify where the patient is not moving where they are supposed to, which requires them to move differently in a different place (think crappy posture causing poor scapular upward rotation and subsequent impingement syndrome). You can treat the shoulder and sub acromial space all you want but if you don't change the way their scapula moves, it will NEVER really go away.


 
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I've worked with PTs, Chiros, ATCs, etc. Chiros definitely have a role and they do help. I think the reason why people like going to them is because of how they explain things. The biomechanical model is very appealing to people. We all use it but it's their main selling point. They can picture it in their head but its abstract enough that they have to trust someone to explain it. Chiros are also I think in the not-a-physician-point-of view camp. It's a refreshing take for some.
 
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Just tell them there isn’t an indication for chiro for that condition and don’t refer
 
People like quick fixes and when chiros create those popping sounds, people think it means something.
 
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And how do I convince them PT will probably be better for them long term?

So I'm a military GMO(basically an intern trained primary care MD), see a lot of young active people with various aches and pains and injuries. Back pain and shoulder pain is very common, and most have poor posture, rounded shoulders, forward neck, etc. You know, your typical 18-30 year old these days. I usually give them some basic stretch and exercises to do, tell them to give that a go for a month or two, and come back and we'll refer to PT if they don't show improvement. But just about all of them come in asking for a referral to the chiropractor, or when I suggest PT they say they'd prefer a chiro.

I've got nothing against chiros, and I think if they couldn't provide pain relief they'd have gone out of business a long time ago. But they tend to not provide good (or any) home exercise routines. They also keep telling my patients they need MRIs because they have "slip discs" or something else that doesn't match the clinic picture I see. And of course the patient thinks I'm the idiot that won't give them the MRI they need. Though to be fair, it's more the off base chiros that do this more than the on base ones.

So, tl;dr, what language/wording do I use to professionally say that PT would likey be better for them than chiros?

Thanks
It's hard to reason with people who are prone to magic thinking.
 
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No idea its a hard topic since people love instant gratification. Most PT's can perform grade 5 mobilizations if this is what the patient is into and PT's are also trained in multiple ways to decrease pain. The big difference is PT goals involve making the patient more functional AND more independent using research based approaches. This compared to dependence on adjustments and other interventions not supported by research or ones which make the patient dependent on their provider. Maybe finding a simple way to explain this as being the reason you prefer referral to PT might help.
 
Because besides back pain Chiros can also cure their Diabetes, ear infections and autism all with the same back pop. That's a heck of a deal.
 
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Heard from someone yesterday about how they like their new PT because he does dry needling and he was saying that the problem with PT is that it's "always the same thing, take these bands, take this handout, and go do these exercises... at least this guy is actually staying up with new treatments and doing something for us."

So, yeah, I guess people think an exercise handout isn't good enough. Or I guess they want personalized attention and plan. Also, like what y'all said, about the instant gratification of the popping sound, the way chiros explain things, etc.

Because besides back pain Chiros can also cure their Diabetes, ear infections and autism all with the same back pop. That's a heck of a deal.
Forgot about this. I think I heard that there's a way to do certain manipulations to mobilize white blood cells to help fight off infection. I think one involves pushing on the spleen or something. And I know not all chiropractors believe manipulation can cure all this stuff, and many are probably very good musculoskeletal pain specialists with a good finite treatment plan and HEP. What really scares me is when people take their infants in for chiropractic manipulation.
 
Im a current medical student and a licensed chiropractor. PT alone or chiro alone is less effective than both PT and chiro co-management. These kinds of patients need both-you need to address the biomechanical compensations with PT/rehab to manage the chronic component and HVLA to treat the myofascial/soft tissue and articular components. The chronic mechanical back pain cases with upper and lower crossed syndromes in the 18-30 year olds to which youre referring is multifactorial and requires a comprehensive approach. The chiro will also get them out of pain quicker but the PT will keep them out of pain for much longer periods. Def exhaust the conservative options first before the muscle relaxers etc
 
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Im a current medical student and a licensed chiropractor. PT alone or chiro alone is less effective than both PT and chiro co-management. These kinds of patients need both-you need to address the biomechanical compensations with PT/rehab to manage the chronic component and HVLA to treat the myofascial/soft tissue and articular components. The chronic mechanical back pain cases with upper and lower crossed syndromes in the 18-30 year olds to which youre referring is multifactorial and requires a comprehensive approach. The chiro will also get them out of pain quicker but the PT will keep them out of pain for much longer periods. Def exhaust the conservative options first before the muscle relaxers etc

This is where I leave the site
 
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what does that even mean? Ahhh youre a PT student Makes sense lol

Please explain to me what a HVLA does biomechanically and neurologically so I can better understand.
 
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Please explain to me what a HVLA does biomechanically and neurologically so I can better understand.
From a Chiros website after a quick google search ( I didn't know what HVLA meant)

"HVLA spinal manipulation has been linked to the quick and efficient curing of problems such as lower back pain, neck pain, migraines, and headaches that are related to the neurological and musculoskeletal interaction in the neck."

This is why Chiros are quacks. It doesn't say it treats these symptoms. But says they "cure" them.
 
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Please explain to me what a HVLA does biomechanically and neurologically so I can better understand.
A HVLA?
Please explain to me what a HVLA does biomechanically and neurologically so I can better understand.
Mobilization and HVLA influences articular mechanotransduction which affects chondrocyte expression, mechanorective mediated nociceptive inhibition, release of antiinflammatory cytokines like IL10 which inhibits Th1 cell differentiation as well as NFkb mediated regulation of other inflammatory cytokines like TNF, and disruption of capsular and intraarticular adhesions which contribute to a self perpetuating nflammatory cascade that further exacerbates somatic pain. I said that PT and chiro both will contribute to the best results. The patient wants to be out of pain quickly which chiro typically does quicker than PT but without the PT you are not fixing the underlying biomechanical deficits which are essential.
 
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From a Chiros website after a quick google search ( I didn't know what HVLA meant)

"HVLA spinal manipulation has been linked to the quick and efficient curing of problems such as lower back pain, neck pain, migraines, and headaches that are related to the neurological and musculoskeletal interaction in the neck."

This is why Chiros are quacks. It doesn't say it treats these symptoms. But says they "cure" them.
A lot of chiros are quacks, yes.
 
what does that even mean? Ahhh youre a PT student Makes sense lol

Well you're a chiro so touche then? I don't know what my position as a PT student has to do with objectively following evidence.

Do you have research showing those physiological effects occurring post HVLA? Or that those same effects only occur with a chiro and HVLA but do not occur with G1-G5 mobilizations from a PT? Because I can't. You mention patient's perform better seeing both a PT and Chiro, is this just because they are getting an increase in frequency treatment when seeing both instead of the effects of combined treatment? Did the interventions of the PT in this study not include any manual or mobilization? Because this would be a huge flaw. Can you link the study?

 
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Well you're a chiro so touche then? I don't know what my position as a PT student has to do with objectively following evidence.

Do you have research showing those physiological effects occurring post HVLA? Or that those same effects only occur with a chiro and HVLA but do not occur with G1-G5 mobilizations from a PT? Because I can't. You mention patient's perform better seeing both a PT and Chiro, is this just because they are getting an increase in frequency treatment when seeing both instead of the effects of combined treatment? Did the interventions of the PT in this study not include any manual or mobilization? Because this would be a huge flaw. Can you link the study?

Was a chiro but thank God im out of that profession. Research? Yeah no problem. Here is a systematic review. I have more if youd like but this is about as good evidence as youll get. Also, the literature you cited was a single crossover RCT with only 29 individuals (extremely small sample size) so I am not sure I am convinced with such a poor study.
 

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Im a current medical student and a licensed chiropractor. PT alone or chiro alone is less effective than both PT and chiro co-management. These kinds of patients need both-you need to address the biomechanical compensations with PT/rehab to manage the chronic component and HVLA to treat the myofascial/soft tissue and articular components. The chronic mechanical back pain cases with upper and lower crossed syndromes in the 18-30 year olds to which youre referring is multifactorial and requires a comprehensive approach. The chiro will also get them out of pain quicker but the PT will keep them out of pain for much longer periods. Def exhaust the conservative options first before the muscle relaxers etc

Frankly I feel the "co management" or "team" mantra is a bunch of baloney. Save yourself time and money. Make your own decision who you're going to see but then follow what they say to do and then report back to them. It's about personal responsibility. We don't need people seeing wannabee teams wasting immense money and resources.
 
Frankly I feel the "co management" or "team" mantra is a bunch of baloney. Save yourself time and money. Make your own decision who you're going to see but then follow what they say to do and then report back to them. It's about personal responsibility. We don't need people seeing wannabee teams wasting immense money and resources.
Not really. The best management here is to hit a multidisciplinary practice where you can get spinal manipulation and PT under the same roof. You are saving money in the long run (with less driving around/hassle) because it is proven to be more effective for conservative care of back pain management.
 
Because besides back pain Chiros can also cure their Diabetes, ear infections and autism all with the same back pop. That's a heck of a deal.

Went to a chiro once (wanted to try it out and groupon gave me a free consultation). He told me that my acid reflux and period cramps were bc I was misaligned.
 
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Was a chiro but thank God im out of that profession. Research? Yeah no problem. Here is a systematic review. I have more if youd like but this is about as good evidence as youll get. Also, the literature you cited was a single crossover RCT with only 29 individuals (extremely small sample size) so I am not sure I am convinced with such a poor study.

Says its poor evidence? You do know systematic reviews have a lower evidence rating than the actual study itself despite sample size. Also sample size was deemed appropriate through power analysis so what is the statistical problem? You also still failed to provide research showing mobs provided by a PT G1-G5 were less effective and did NOT have the same effects as a Chiro manip. Because that evidence doesn't exist. PT's do more than exercise prescription. Not to mention studies have show low back pain resolves on it's own within 3 months w/o intervention, so using the resolution of that symptom to prove the effectiveness of an intervention is contradictory to other research.

Why a multi-disciplinary approach with chiropractics tho? when a PT can provide a G5 mob if necessary and provide avenues for independence and not reliance.
 
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Not really. The best management here is to hit a multidisciplinary practice where you can get spinal manipulation and PT under the same roof. You are saving money in the long run (with less driving around/hassle) because it is proven to be more effective for conservative care of back pain management.
I have less than zero trust in a "multi" practice regardless of who the "team" is, so that would be a no for me.
 
Grade I through Grade V mobilizations, Grade I is very gentle, through Grade V which moves the joint past where it currently can move similar to a chiropractic or osteopathic manipulation without all of the subluxation, neural flow, innate intelligence woo.
 
I have less than zero trust in a "multi" practice regardless of who the "team" is, so that would be a no for me.

One of the best PT offices I've been in was a multi-disciplinary Orthopedic/PMR/PT Office. But that was MD/DO/PT, not PT / DC.
 
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I have less than zero trust in a "multi" practice regardless of who the "team" is, so that would be a no for me.
Not to mention PTs can specialize in the spine, so chiros are redundant. It just baffles me.
 
I think the only thing that pisses me off about chiros is the fact that their education is no better than PTs in terms of MSK treatment and not nearly as good as a PA or NP in terms of actual medical diagnosis. Yet, they're out here calling themselves Doctors and their leadership states they can act as a full-fledged primary care provider.

Other than that, as an Osteopath I can't really fault the techniques they do as I learn all those techniques and I do find them to be helpful.

The difference is, and all my OMM professors say this: You are a ________ (Emergency/primary/ENT etc) physician BEFORE you are an Osteopath. Therefore, you must have ruled out all other visceral/pathologic causes before you even think about any manipulations. Chiros can't do this despite them saying they can. You don't know what you don't know. When you're a hammer, everything MUST be a nail, and Chiros are definitely hammers and treat everything as nails.

I do like the level headed chiro however that doesn't tout "My manipulations will heal ear aches!" and rather say "So, go to your PCP, get antibiotics, and come back and we can do some lymphatic techniques to help drain the infection and heal it quicker!" -- There is such a vast difference between these two things. And I know at the end of the day their actions are doing the same thing - But if they stopped being so "businessman-like" and more medical like, they could say that and people wouldn't think they're crazy for trying to treat a sore throat or ear infection.
 
I think the only thing that pisses me off about chiros is the fact that their education is no better than PTs in terms of MSK treatment and not nearly as good as a PA or NP in terms of actual medical diagnosis. Yet, they're out here calling themselves Doctors and their leadership states they can act as a full-fledged primary care provider.

Other than that, as an Osteopath I can't really fault the techniques they do as I learn all those techniques and I do find them to be helpful.

The difference is, and all my OMM professors say this: You are a ________ (Emergency/primary/ENT etc) physician BEFORE you are an Osteopath. Therefore, you must have ruled out all other visceral/pathologic causes before you even think about any manipulations. Chiros can't do this despite them saying they can. You don't know what you don't know. When you're a hammer, everything MUST be a nail, and Chiros are definitely hammers and treat everything as nails.

I do like the level headed chiro however that doesn't tout "My manipulations will heal ear aches!" and rather say "So, go to your PCP, get antibiotics, and come back and we can do some lymphatic techniques to help drain the infection and heal it quicker!" -- There is such a vast difference between these two things. And I know at the end of the day their actions are doing the same thing - But if they stopped being so "businessman-like" and more medical like, they could say that and people wouldn't think they're crazy for trying to treat a sore throat or ear infection.
MSK wise chiro school is superior to PT school. Rads and MSK/neuro dx in chiro school is very very comprehensive despite what many may think. Having gone to both i can tell you chiro school anatomy is more challenging than medical school anatomy and neuro in chiro school puts up a decent fight when compared to med school but aside from those two subjects medical school blows chiro school out of the water in everything else (and I mean NO comparison-night and day in terms of volume and complexity). Everything else you are saying i completely agree with
 
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MSK wise chiro school is superior to PT school. Rads and MSK/neuro dx in chiro school is very very comprehensive despite what many may think. Having gone to both i can tell you chiro school anatomy is more challenging than medical school anatomy and neuro in chiro school puts up a decent fight when compared to med school but aside from those two subjects medical school blows chiro school out of the water in everything else (and I mean NO comparison-night and day in terms of volume and complexity). Everything else you are saying i completely agree with

Let me clarify, I think that Chiros definitely have great diagnostic skills in MSK/Neuro (But to be honest, despite learning more intensive anatomy and MSK physiology, I don't think necessarily it expands your DDx). But, for that reason I get frustrated when they consider themselves generalists when they're most definitely specialists.

Just because a therapist treats you appropriately for anxiety and subsequently your GI symptoms dissipate, doesn't mean the therapist is a Gastroenterologist. I think Chiros over-generalize what they do because it has a "tiny little connection" to this other system in the body. "I can be your PCP because if you have high blood pressure, I can lower the sympathetic outflow from T1-5 and decrease your heart rate and BP" - Therefore I'm not just treating your back, I'm basically your PCP too. It doesn't work like that.
 
Let me clarify, I think that Chiros definitely have great diagnostic skills in MSK/Neuro (But to be honest, despite learning more intensive anatomy and MSK physiology, I don't think necessarily it expands your DDx). But, for that reason I get frustrated when they consider themselves generalists when they're most definitely specialists.

Just because a therapist treats you appropriately for anxiety and subsequently your GI symptoms dissipate, doesn't mean the therapist is a Gastroenterologist. I think Chiros over-generalize what they do because it has a "tiny little connection" to this other system in the body. "I can be your PCP because if you have high blood pressure, I can lower the sympathetic outflow from T1-5 and decrease your heart rate and BP" - Therefore I'm not just treating your back, I'm basically your PCP too. It doesn't work like that.
I agree with everything except that when i said more intensive MSK i meant both MSK basic science and clinical ddx in chiro school. Non-surgical ortho/sports med/MSK is taught minimally in medical school. However yes chiros think they know WAYYY more than they do and they over exaggerate their knowledge. they know nothing of what an MD/DO knows and other than MSK we get so much more training in med school its silly to even compare
 
I would dispute your claim that DC ed in MSK or neuro for that matter is superior to PT school. This is a pissing match that can never be resolved, but I think maybe you are mistaken.
 
One of the best PT offices I've been in was a multi-disciplinary Orthopedic/PMR/PT Office. But that was MD/DO/PT, not PT / DC.
And why was it better? Because you say so?
 
MSK wise chiro school is superior to PT school. Rads and MSK/neuro dx in chiro school is very very comprehensive despite what many may think. Having gone to both i can tell you chiro school anatomy is more challenging than medical school anatomy and neuro in chiro school puts up a decent fight when compared to med school but aside from those two subjects medical school blows chiro school out of the water in everything else (and I mean NO comparison-night and day in terms of volume and complexity). Everything else you are saying i completely agree with
Did you go to PT school bud? We don't have C students in PT school just so you know
 
I agree with everything except that when i said more intensive MSK i meant both MSK basic science and clinical ddx in chiro school. Non-surgical ortho/sports med/MSK is taught minimally in medical school. However yes chiros think they know WAYYY more than they do and they over exaggerate their knowledge. they know nothing of what an MD/DO knows and other than MSK we get so much more training in med school its silly to even compare
Who doesn't think they know way more than they actually do? We have two MD/DO's in here waxing away. Shut up and go study and come in here and talk about PT vs this or that when you actually went thru the training and actually have > 5 years of experience.
 
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Who doesn't think they know way more than they actually do? We have two MD/DO's in here waxing away. Shut up and go study and come in here and talk about PT vs this or that when you actually went thru the training and actually have > 5 years of experience.
haha
 
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Who doesn't think they know way more than they actually do? We have two MD/DO's in here waxing away. Shut up and go study and come in here and talk about PT vs this or that when you actually went thru the training and actually have > 5 years of experience.
lol didnt realize how sensitive PT students are
 
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And why was it better? Because you say so?

It was great because the patients who received surgery for anything (Rotator Cuff/Wrist/Knee) were going back to the same office for therapy where the Dr's were who did their surgery. Anytime a PT had a question or if the patient had a concern, they could pull the Doc aside and quickly have them evaluate a patient.

If the hand surgeon thought bracing was the best course of action, they'd walk their patient over to OT and have the head guy make them a personalized mold before the patient even left the office.

It was a one-stop-MSK-shop.

Very convenient for everyone: The PT/OTs, Docs, and especially the patients.
 
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five-O you embarrass our profession with your lack of professionalism, civility, and temper
 
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It was great because the patients who received surgery for anything (Rotator Cuff/Wrist/Knee) were going back to the same office for therapy where the Dr's were who did their surgery. Anytime a PT had a question or if the patient had a concern, they could pull the Doc aside and quickly have them evaluate a patient.

If the hand surgeon thought bracing was the best course of action, they'd walk their patient over to OT and have the head guy make them a personalized mold before the patient even left the office.

It was a one-stop-MSK-shop.

Very convenient for everyone: The PT/OTs, Docs, and especially the patients.
Maybe convenient from your point of view but that doesn't extrapolate to anyone you see in the clinic. I worked in a POPT practice a long time ago and the surgeons (right across the hall) never came into the clinic so I believe you should probably see more than 1 before you can make such claims.
 
lol C students? what do you mean?
I mean Chiropractic school allows nearly anyone in who applies with a C average. Surely that's what NASA does too. There must be some treehouse group of stargazers that meets up every weekend. We should compare the two.
 
I mean Chiropractic school allows nearly anyone in who applies with a C average. Surely that's what NASA does too. There must be some treehouse group of stargazers that meets up every weekend. We should compare the two.
I hate chiropractic and I agree with you in this instance. Just because I was stating facts about chiro training doesnt mean im standing up for the profession. I think the profession itself is a horrible investment and a waste of money
 
Maybe convenient from your point of view but that doesn't extrapolate to anyone you see in the clinic. I worked in a POPT practice a long time ago and the surgeons (right across the hall) never came into the clinic so I believe you should probably see more than 1 before you can make such claims.

I didn't say it was the only great model - just that it was a good set up. Culture and work ethic of each professional in the office is what is going to make or break such a system.

I can give a pig a diamond but they're just gonna roll around in the mud with it and dirty it up. The right culture with the right set-up, in my opinion, will make or break a multi-disciplinary approach. But in the right hands, can be beneficial.
 
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