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I LOLed hard @ "ozone injection." WOW
What are the legal aspects of letting an ND at your patient?
Pt present with signs of GERD, but ask for his ND, ND says he is having an acid imbalance with citrus fruits and prescribes herbal tea, patient whats to be discharged.
3 months later
Pt has Barretts esophagus.
If this went to court, would the ND be held accountable or would the blame be held of the real doctor?
When the chiropractor, again as an example, sends a patient to a real doctor after having claimed to be able to treat real disease, he is admitting that his profession is worthless...
M.Furfur said:However, my concern is with the boundaries. Like what's next consult with a psychic or a voodoo witch?
Hmmm... I think that is a stretch. I'd counter by saying your "profession" doesn't include many of the invasive procedures, and thus you concede your profession as worthless every time you consult surgery or cardiology (for the trips to the cath lab), GI (for the scopes of upper GI bleeds), etc... I agree in principle that chiropractors, NDs, etc...shouldn't be calling themselves primary care providers, but I'm not so sure Ob/Gyns should, either, as their training doesn't really include the long term management of chronic diseases.
Procedures and specialists are a continuation of an allopathic medical system so your "profession" is not "worthless" every time you call a consult if you are not procedurally based.
You just realize your scope of practice and refer on for care, I'm not sure that's all bad or "worthless" in your words.
... I do think there are certain things naturopaths can bring to the table that I don't know about or that they can simply help to ease the nerves of a patient. As long as I have the final say, I don't see the harm...
Procedures and specialists are a continuation of an allopathic medical system so your "profession" is not "worthless" every time you call a consult if you are not procedurally based.
You just realize your scope of practice and refer on for care, I'm not sure that's all bad or "worthless" in your words.
Because they see themselves as part of the medical community in the role of the primary care provider. They don't see themselves as outside of our profession. It is the same reason you don't see FP hospitals, emergency departments or ICUs.Panda Bear said:If, as many chiropractors believe, they can cure most diseases with manipulation, where are the chiropractic hospitals, chiropractic emergency departments, and chiropractic intensive care units?
I call the chaplain, which, as you know well from our past discussions, I feel is just as effective and is actually providing the same sort of support.Panda Bear said:Are you going to consult with a faith healer just because your patient asks you to?
I don't know that I agree that it is a harm. When Juan Parodi first started doing endoluminal stenting of aortic aneurysms, people thought he was crazy. Look at vascular surgery now. You can't simply say something is wrong because you don't think it will work or can't understand how it will work or hasn't been done before. I don't know there is anything wrong with alternative medicine when used as an adjunct to other medical care. Simply because it doesn't fit with what you believe and because you don't believe there is any evidence to support it simply because there is no real scientific explanation for why they seem to get results doesn't mean it is bad.Panda Bear said:The harm is that...you, as a real physician, legitimize it by either endorsing or tolerating...
Because they see themselves as part of the medical community in the role of the primary care provider. They don't see themselves as outside of our profession. It is the same reason you don't see FP hospitals, emergency departments or ICUs.
I think profession and practice are synonyms. Plus, I was being dramatic to make a point, whether or not I agree with it or not, that by referring to another person in the medical world doesn't mean you are admitting that your profession is worthless. Family practitioners are considered primary care. Apparently, that is what some chiropractors and naturopaths are calling themselves, too. My point was, FPs (as PCPs) send their patients to the hospital/refer them to a specialist when they are dealing with a condition out of their "scope of practice." The chiropractor/ND is doing the same thing.
Because they see themselves as part of the medical community in the role of the primary care provider. They don't see themselves as outside of our profession. It is the same reason you don't see FP hospitals, emergency departments or ICUs.
Monkeyguts, you were the one who said allopathic medical system, not me. While I consider MDs and DOs equal, it doesn't mean everyone else does. I wanted to make sure that, in a discussion about who should be considered a PCP and what training is required, you didn't really mean "allopathic" as in MD as much as "allopathic" or conventional medicine. FPs are physicians who have completed a residency in Family Medicine; they can be either MDs or DOs, but not all FPs are "allopaths." Semantics, I know, but that is what this entire thing is at this point.
LifetimeDoc, I don't think NDs/naturopaths should be considered PCPs anymore than anyone else here and I don't think I ever said I do; I agree that the training is different and there are probably things they wouldn't notice (although, there are probably things they would notice that you, an allopath, wouldn't). I see them as consultants, just like PT, OT, RT or any other xT you want. However, just because I see them that way and you see them that way and Panda Bear sees them that way doesn't mean they see themselves that way. If you examine it from their perspective, they wouldn't see it as admitting their profession is worthless when they send a patient to a hospital anymore than a FP would. They would see it as sending a patient for treatment outside their (to use your words) "scope of practice" and that they are just trying to "refer on for care."
It is important to understand the perspective of the other side in order to better understand how to best relate to and work with them. I think this is something to consider even if you never consult an ND because even in the different specialties of "allopathic" medicine the personalities, priorities and approaches to the patient are vastly different.
I think profession and practice are synonyms. Plus, I was being dramatic to make a point, whether or not I agree with it or not, that by referring to another person in the medical world doesn't mean you are admitting that your profession is worthless. Family practitioners are considered primary care. Apparently, that is what some chiropractors and naturopaths are calling themselves, too. My point was, FPs (as PCPs) send their patients to the hospital/refer them to a specialist when they are dealing with a condition out of their "scope of practice." The chiropractor/ND is doing the same thing. How about the DO PCP who refers his patient to an allopathic hospital? Will you, on this forum initially hosted by a DO student, say he is admitting his profession is "worthless?"
Because they see themselves as part of the medical community in the role of the primary care provider. They don't see themselves as outside of our profession. It is the same reason you don't see FP hospitals, emergency departments or ICUs.
I call the chaplain, which, as you know well from our past discussions, I feel is just as effective and is actually providing the same sort of support.
I don't know that I agree that it is a harm. When Juan Parodi first started doing endoluminal stenting of aortic aneurysms, people thought he was crazy. Look at vascular surgery now. You can't simply say something is wrong because you don't think it will work or can't understand how it will work or hasn't been done before. I don't know there is anything wrong with alternative medicine when used as an adjunct to other medical care. Simply because it doesn't fit with what you believe and because you don't believe there is any evidence to support it simply because there is no real scientific explanation for why they seem to get results doesn't mean it is bad.
Maybe it is because of my take on religion that makes me more open-minded to this because I see it as the same thing; something done to make the patient feel better that may or may not have a clinical benefit that we can't scientifically explain.
It's much more serious than "just semantics", it's about a psuedo-profession that provides largely unproven, possibly substandard and inadequate care to their "patients" under the auspices or the cloak of being "primary care physicians".
That has nothing to do with the original question; would you consult with an ND if your patient requested it. Again, they are being used as consultants, not PCPs, and you as the PCG have the final say as to whether or not to implement their recommendations.
Panda Bear, let me see if I can summarize your position accurately. We should not consult any naturopaths/homeopaths because they don't practice real, evidence-based medicine and any benefit that may be derived isn't worth the cost, and to consult them validates them and puts them in the position to then go on and (a) politic for insurance reimbursement and (b) claim they should be allowed to serve as PCPs. Basically, your two big objections are financial and patient safety.
The financial thing is easy; it's already happening. As you said, in your community, chiropractors are already calling themselves PCPs. Was that a result of (a) their active lobbying for it, (b) conventional medicine referrals, (c) the denouncement of the field by conventional medicine or (d) the practitioners of conventional medicine not listening to their patients' wants and needs? I bet the answer isn't (b).
I think many people go the alternative medicine route because they aren't happy with the treatment they are getting from the conventional medical community. To talk about the alternative practices as "woo" or to discredit them to your patients may only serve to drive them there more, as most patients are more concerned with the way you talk to them than how good you are, and the alternative medicine people are much more likely to spend the extra 10-15 minutes listening to and talking with their patients, and a lot of the time that is all that matters. I think that, if a patient ever asks for a naturopathic consult, they are already leaning that way. If you deny that consult, they are still going to seek it out. If they like what they hear, they may not come back to you. If you give the consult, you are validating your patient. It also puts you in the driver's seat for following the recs given by the ND; you can tell your patient that you don't recommend following their recs for (evidence-based) reasons x, y and z, and they are more likely to listen to you than if you had already discredited the naturopathic field by telling your patient it was a waste of time. You are doing the patient a greater disservice to alienate them than to validate them, even if it means consulting with a service whose practice you believe to be complete b.s.
People are going to be disenfranchised with conventional medicine regardless of what you do (and sometimes because of what you do); the best way to keep them from completely abandoning it is to let them do what they are going to do and serve as their informed guide rather than proclaiming their wishes to be foolish and slam the door on it, as you may be slamming the door on them, too.
I think one thing that is missing here is that many on the forum are confusing the words profession with the word industry. They are not the same.
I profession is a group of people who through there merits, virtues, and qualities have been granted the right to govern themselves in what they do. Thus they determine their standards, their requirements for entry into the profession, their educational standards, procedures for internal punishment of those who fail the standards, etc. It is this group that grants all the rights, privleges, etc. not the state. There are only a few of these Medicine, dentists, accountants, lawyers, engineers, and a few other. Sure the state grants you a license but the requirements for licensure are determined by the individual medical societies, NBME, etc not the state itself.
Industry is something that conducts business or provides services but they are regulated by the laws of the land. So nursing is not a profession it is an industry because they do not regulate themselves based on the definition above, same with business etc these are not professions.
THIS DOES NOT MEAN PEOPLE ARE NOT PROFESSIONALS that is a totally different word. But things that are truth professions are very few.
ND is not a profession it is not granted to rights by the states to govern themselves, etc. It is an industry. (except for Oregon a state that can be convinced to do anything by every outside organization known to man. If someone told them that they would have cleaner air by rubbing cats together they would enact laws making people rub cats while they drive)
....Basically, your two big objections are financial and patient safety....
Thanks. I wouldn't waste my time if I didn't feel the same about you.I don't often say this but I enjoy reading your comments immensely. They are well-thought out and well written.
In other words, the patient will go to a naturopath for treatment and will be loaded with medicinal herbs produced with shoddy quality control when he could get the same effect cheaper and more safely with a conventional, quality-controlled drug...that isn't "natural" of course, but "natural" is a marketing phrase, not a meaningful description.
The patients can do whatever they want. If they're going to see a woo-practitioner, that's their lookout. If they need my blessing they're not going to get it and if they don't like it, they are welcome to find another doctor. We are not slaves to our patients and we do not have to humor them to the point of acting contrary to our own values.
It reminds me a lot of Scientology with its "miasms" and "proving" and other made-up words. Still, they were the ones who gave us the name "allopathy," so they aren't completely worthless...You do know what homeopathy (for example) is, right?
Here's you on the witness stand:
Plaintiff's Attorney: So doctor, would you say that by referring Mrs. Smith to the naturopath, you trusted her medica skills and l judgment and felt safe sending my client to her?
You: Umm....
That has nothing to do with the original question; would you consult with an ND if your patient requested it. Again, they are being used as consultants, not PCPs, and you as the PCG
I'm glad you can see the forest from the trees.
Why should we be open-minded about things that are patently absurd? None of this stuff would fly in any other field:
Me: Yeah, so I can't get this toilet unclogged.
Reiki Plumber: Hmm. It seems like something is interrupting its energy flow. Let me try to fix it. *waves hands over toilet*
Me: Huh? What are you doing?
RP: I'm realigning the toilet's qi.
Me: Get out.
Me: I'll take a gin and tonic.
Homeopathic Bartender: Here you go.
Me: This is just water.
HB: No, it's actually an incredibly potent drink.
Me: There's no alcohol in it.
HB: Yes, but the water remembers the alcohol.
Me: Give me my money back.
Me: It's been making this really awful noise every time I shift into fourth gear.
Chiropractic Mechanic: Yeah, we see this a lot these days. You see, the chassis has a misalignment, or subluxation, as we call it.
Me: What?
CM: Vital energy flows from the chassis into the transmission. Fortunately, this is easy to correct. *smashes car with sledgehammer*
Me: WTF! Get away from my car!
Me: After that storm we had last week, none of the outlets in this room have worked.
Acupuncture Electrician: There's an ancient Chinese technique for fixing problems like this.
Me: Really?
AE: It's quite simple. All I do is take these acupuncture nails and hammer them into the room's meridians.*starts pounding nails into random parts of the wall*
Me: Get out.
It's all the same sort of magical thinking, just dressed up in different outfits, and it's all a scam.
This is pretty funny. Here is an MD version to add to your collection .
Me: Yeah, so I can't get this toilet unclogged.
MD Plumber: Let's take an X-ray, take a stool sample, and run a lead analysis on the water.
Me: I read something on the internet about this. How about trying a plunger or maybe Roto-Rootering it out?
MD Plumber: (Long, loud laughter). I wish I had a dime for every customer who comes up with these crazy things you read on the Internet. I'm sorry, we're going to need to treat this scientifically and plungers are not FDA approved because they carry a high risk of splinters. Also, we don't want to treat it until we know what it is. I could lose my license otherwise.
($200 later, after an X-ray that can't penetrate the ceramic of the toilet and is nowhere near the lesion, a lead analysis that is less than irrelevant, and a stool sample "quick strip" followed by a culture that showed normal gut flora)
MD Plumber: We weren't able to find anything unusual, but I suspect it's something viral that was brought on by a broken handle. People don't wash their hands before operating the handle, and those handles don't seal well. The viruses leak into the tank and next thing you know we have a huge viral load that leads to a clog. Here is a prescription {written with an ACME Toilet Handle, Inc. pen} for a new flush-handle and a prescription for 1 lb of ciprofloxacin to be dumped into the toilet 3 times per day for 10 days. Be sure to finish the entire 30 lb bag.
Me: Huh? The handle looks ok to me. If it's viral, why are you prescribing an antibiotic?
MD: The handle feels loose to me on physical exam. The break is probably internal where you can't see it. Statistics based on 8000 truck stops say it's the handle 80% of the time. If that doesn't work come back and I'll write you a prescription for a new commode; I'm hoping it won't come to that because that would cost a mint.
Me: That's ok. I think I'll see a plumber without an MD.
I'm not saying we get it wrong all the time. However, let's not pretend we have it all figured out; much of what passes for medical diagnosis is little more than educated guessing.
As above, it seems like there's a distinction between letting them be present and asking their advice.
Also I think it's important to distinguish between a Naturopathic Doctor (ND) and a Naturopath. A naturopath can do a certification course and that's it, obviously leading to minimal quality/training control. ND goes through a 4-year school and are licensed in something like 11 states to be primary care providers. I'm not saying everything they do is evidence based in an RCT way, but at least they've got a standardized level of schooling.
So i heard on the radio, from a doctor ( I am assuming an ND), that when a person is having a stroke or heart attack that giving them cayenne pepper would stop it on contact......That seems hard to believe
Is there any truth to this?