Back x-rays in the ER

[FoughtFyr]

{Continued from previous post}...

As far as you analysis of research and chiropractic, stick to diabetic comas and MI's. . .I have frankly heard evidence-based chiropractors make better analyses of the literature and criticisms.

O.k., once again, you take me out of context. I was discussing things with people I've already had these debates with. As you have proven yourself incapable of a search here, I will post an overview below. But if you think you have a paper that "proves" chiropractic for anything feel free to post it. I'll be happy to analyze and discuss it with you.

Since you have so much time on your hands, why don't you find each of the peer-reviewed research papers I have posted?

No, guess you don't want that many data in one place. O.k., I will do it. Have a good laugh at how "FF uses WCA/Rondberg for most of his 'data'."

By my count I have cited four WCA articles (albeit multiple times each) and 23 peer reviewed journals (also multiple times each). Good to see that "most" of my data is from the WCA!

BTW - I went back to 12-28-04; there were no additional WCA citations in that time frame although there were repeats of the ones you posted.

- H
_____

OP: http://forums.studentdoctor.net/showpost.php?p=2687469&postcount=49

"Archives of Pediatrics & Adolescent Medicine

----------------------------------------------
Volume 151(5) May 1997 pp 527-528"

OP: http://forums.studentdoctor.net/showpost.php?p=2687469&postcount=48

"For example, there is a study which I have posted many times that suggested that 17% of chiropractors who identified themselves as treating children would treat a case of neonatal fever without referral to an MD/DO or more appropriately to an ED. (see: http://www.ncbi.nlm.nih.gov/entrez/...d&dopt=Abstract&list_uids=10768681&query_hl=8 ) Neonatal fever is a defacto emergency. No attempt should be made to treat as an outpatient – yet 17% of chiropractors who treat children would try."

OP: http://forums.studentdoctor.net/showpost.php?p=2561300&postcount=1

"Even SCARIER..."

http://www.jcca-online.org/client/cca/JCCA.nsf/objects/V49-1-46/$file/jcca-v49-1-046.pdf" - A chiropractic journal no less!

OP: http://forums.studentdoctor.net/showpost.php?p=2573803&postcount=19

"Now chiropractic and stroke."

from:http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=12743225

from:http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=12692699

from:http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=15513007

from:http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=12466778 - Your favorite journal; JMPT (that fun lovin' group of chiro-bashers!)

"I thought there were "no side effects" to chiropractic? Yep it never happens, but the chiropractic journals describe when and how. I guess they are used to reporting on fictional things (like subluxations) anyway..."

from:http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=14586598

"To be fair, there is an article describing why there is such a different opinion of the level of risk chiropractic manipulation represents."

from:http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=14589464

OP: http://forums.studentdoctor.net/showpost.php?p=2605708&postcount=59

"Great, now we are paying for "unproven" methods to be available to all. You know, given the amount of the population that screams "I can't afford health care" this program seems to me to be a step backward. Especially when you consider the following:

Trends in Alternative Medicine Use in the United States, 1990-1997
Eisenberg GM, Davis RB, Ettner SL, etal
From: Journal of the American Medical Association
Volume/Edition: 280 (18)
Pages/Time: 1569-1575
Source/Year: November 1998"

OP: http://forums.studentdoctor.net/showpost.php?p=2318810&postcount=16

"In that study (see: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9761802), the findings were 'In children with mild or moderate asthma, the addition of chiropractic spinal manipulation to usual medical care provided no benefit.'"

"From my favorite (Cochrane reviews) on 'Manual Therapy for Asthma':
'From 393 unique citations, 59 full text articles were retrieved and evaluated, which resulted in nine citations to five RCTs (290 patients) suitable for inclusion. Trials could not be pooled statistically because studies that addressed similar interventions used disparate patient groups or outcomes. The methodological quality of one of two trials examining chiropractic manipulation was good and neither trial found significant differences between chiropractic spinal manipulation and a sham manoeuvre on any of the outcomes measured. Quality of the remaining three trials was poor. One small trial compared massage therapy with a relaxation control group and found significant differences in many of the lung function measures obtained. However, this trial had poor reporting characteristics and the data have yet to be confirmed. One small trial compared chest physiotherapy to placebo and one small trial compared footzone therapy to a no treatment control. Neither trial found differences in lung function between groups.'"

OP: http://forums.studentdoctor.net/showpost.php?p=2268005&postcount=8

Here are links to the abstracts: http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=12221360 and http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7638657.

OP: http://forums.studentdoctor.net/showpost.php?p=2183403&postcount=46

"Chiropractors were included in two types of these studies, those of low back pain, and those looking at workingmans' compensation costs. see: http://www.annals.org/cgi/content-nw/full/127/1/52/T2 Their findings were hardly supportive of chiropractic."

"The study abstract is here: http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=15477432. While the study is interesting for it's size, there are serious design problems. I quote from the journal editor's comments in the same issue.

'The study design does not permit the definite determination of a cause-effect relationship between access to chiropractic and a more budget-effective approach to musculoskeletal care, pointing rather to the coexistence of the 2 phenomena in a managed-care population. Furthermore, the lack of a random element in defining the populations with and without access to chiropractic care may have partly compromised the validity of the results. The favorable health profile of the 'chiropractically insured' is of particular concern. They comprise a younger and healthier population and, thus, are likely to have better outcomes and fewer health expenses. Even though the authors attempt to correct for this discrepancy, it is worrisome to assume the generalizability of the perceived cost-savings to a sicker, older cohort. In addition, the study portrays a population specific to a particular health care plan and within a particular state and, perhaps, not typically representative of other states or of patients who are insured by Medicaid or Medicare. Another generalizability issue arises from the lack of information regarding patient ethnicity, making the extrapolation of the authors' conclusions to minority populations problematic.'"​

OP: http://forums.studentdoctor.net/showpost.php?p=2183516&postcount=47

"The study is here: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9801210 with a follow-up study here: http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=11940622. Now there are two problems with this as far as your argument is concerned. First, this test was not given to first year out chiropractic graduates, so it doesn't say that chiropractors would do any better. Second, it was administered to interns, who still had an average of three to five years of training remaining. The test itself was validated by administration to eight senior orthopedic surgery residents, all of whom passed. So what have we proven? MD/DOs do a residency for a reason. It is an integral part of our training. Big deal. I'd have granted you that without a study."

OP: http://forums.studentdoctor.net/showpost.php?p=2135577&postcount=95

"Now as an (I assume) educated person, what is your opinion/reaction to these studies?"

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7884327&dopt=Abstract

http://www.cmaj.ca/cgi/content/full/166/12/1531

http://www.cmaj.ca/cgi/content/full/166/12/1544

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=11340209

OP: http://forums.studentdoctor.net/showpost.php?p=2139393&postcount=120

"No, what I am referring to is summarized here: http://nccam.nih.gov/health/chiropractic/index.htm#app2

Three systematic reviews that concluded "Overall, the evidence was seen as weak and less than convincing for the effectiveness of chiropractic for back pain. Specifically, the 1996 systematic review reported that there were major quality problems in the studies analyzed; for example, statistics could not be effectively combined because of missing and poor-quality data. The review concludes that the data 'did not provide convincing evidence for the effectiveness of chiropractic.' The 2003 general review states that since the 1996 systematic review, emerging trial data 'have not tended to be encouraging…. The effectiveness of chiropractic spinal manipulation for back pain is thus at best uncertain.' The 2003 meta-analysis found spinal manipulation to be more effective than sham therapy but no more or no less effective than other treatments."

Chiropractic remains and will remain an effective form of pain and mobility management for chronic and permanent degenerative spinal conditions.

Show me the evidence…

That's why a DC served as past president of the American Academy of Pain Management (I think a MD is now president).

The "American Academy of Pain Management" is not a medically recognized board certifying organization. Only the American Board of Anesthesiology Subspecialty Certification in Pain Management is recognized by the American Board of Medical Specialties. The "other" organization commonly accepted is "The American Board of Pain Medicine", to my knowledge neither has had a DC as their president. A DC as the president of a DC organization – no great shakes.

Acute conditions? Whiplash, yes. LBP - probably better with some NSAID's for awhile and then come to me if it doesn't resolve.

Well, "some NSAID's for awhile and then come to me if it doesn't resolve" is hardly the standard of care. And again, show me quality, peer-reviewed literature to prove these statements and maybe you will convince me.

But then again, I may be talking out my lower orafice here.

I expect no less.

Pain management is not something that you hospital practicioners take seriously, now, is it? You had to have your accrediting agencies actually post posters around the hospital that the "patient has a right to pain control." What seems intuitive to DC's and most of the public, you actually had to have mandated and be reminded.

Well, actually we take it VERY seriously (hence those accrediting agency's emphasis on it. Who do you think runs those agencies?). I address every patient's pain.

Frankly, if you sit back and actually examine yourself, you'll discover the reason we exist isn't because we are so hot or because DD thought up subluxation; it's the fact you do such a crappy job sometimes.

Ahh, yes, we mess up, so go to the less trained providers who have no QI/QA oversight and no standards of care with no scientific basis behind them and get "better" care…



- H

---

Members don't see this ad.

 

[FoughtFyr]

There is a standard of care within chiropractic and that standard is enforced by the state chiropractic board or in other states the medical board. In Illinois, it is overseen by the Department of Professional Regulation. The board is comprised of mostly medical doctors; I believe a DO and one chiropractor. The scope of practice for chiropractic is loosely defined and falls under the medical practice act of 1987, which governs MD/DO and DC. The only difference between scope of practice is that chiropractors treat human ailments without the use of surgery or prescriptive drugs. The human ailments treated “as learned in Chiropractic College”. As far as I know, there is not one Chiropractic College I am aware of that involves courses for treating “cancer or heart disease” through chiropractic methods. So, if a chiropractor were using chiropractic methods to treat these diseases the board would reprimand him. I have suggested to patients with heart disease the importance of omega 3’s, the effects of homocysteine levels, triglycerides etc. That doesn’t mean I would ever persuade them to discontinue their medications or quit seeing their PCP. The PCP should be letting these patients know this as well. This is important information.

First of all you know that a State Chiropractic Board (even in Illinois), much like a State Medical Board, a not a QI/QA organization. They are a regulatory body. And by the logic of your argument, a chiropractor can attend births and deliver babies because Palmer CC clearly has a course in OB/GYN.

As far as “what does a chiropractic adjustment do” there is a lot of information out there that covers the subject from a neurological perspective involving mechanorecptors, nociceptors, muscle spindles, spinal reflexes etc. I could go on and on about the neurological mechanisms involved in a chiropractic adjustment. Too much information to post here and decipher. If any chiropractors out their care to go through the whole mechanism of the chiropractic adjustment feel free do so. I just don’t have the time.

Actually, it was a serious question - not a bait to an argument. I used to "buy" SMT as performed by PTs. Except that when I asked an instructor from a PT training program to explain to me the science behind it, I got similar "pseudo-science" and "take it on faith" answer I've seen in chiro textbooks. So I'm really looking for the "hard science" answer. I used to "accept" the modality. Now I'm less sure (the chiro versus medical models aside).

- H

 

[BackTalk]

At worse (the psychoactive drugs) we understand the molecular effects but do not always understand why they effect the body in the physiologic manner they do.

Hmmm...are you taking it on faith?

 

[CFS]

FoughtFyr,

What are you babbling about?

Something about you have talked about chiropractic before, that you work for Mayo, that the AAPM isn't allopathically recognized (didn't claim it was) as a certifying board and you take your patient's pain seriously (well good for you! good on ya!). Oh, yeah, something about the ER's using chiropractic is not standard.

Well, thank you, Dr. Obvious on that. (from Dr. Sarcastic to you) I didn't know that.

Listen, focus on your ER residency and take some medication if you need some focus. I hear Ritalin works well.

I may want to take a trip to the Midwest and I'd like to think the healthcare there equals Philadelphia's in case I get a kidney stone with intractable colicky pain or something.

As far as your first comment:

Wow. Are you arrogant.

Yeah, well, when you win debates and the hearts and minds of readers all of the time, you tend to get that way.

Think of me like Terrell Owens. I'm arrogant because I'm that good.

How I got that good, I don't know. I guess I was just born with it. I worked at it too a bit.

It will all be in my book "CFS" available in paperback in Spring 2007. I am trying to think whether Letterman or Larry King would be my best venue.

But then again, winning debates on the internet is like winning the Special Olympics.

I may win all the time but I'm still ******ed.

 

[FoughtFyr]

Hmmm...are you talking it on faith?

No, I'm not really a fan, but at least the basic science is done. We know that an SSRI inhibits serotonin reuptake. We know why. What we don't know is why that changes the symptoms of depression.

- H

 

[FoughtFyr]

I'm still ******ed.

So we agree!

- H

 

[FoughtFyr]

How much damage she did (in PR terms and terms of pt. care), I don't know.

Here is one that killed a child, is that enough?

http://deseretnews.com/dn/view/0,1249,640187634,00.html

- H

 

[FoughtFyr]

There is a standard of care within chiropractic and that standard is enforced by the state chiropractic board or in other states the medical board. In Illinois, it is overseen by the Department of Professional Regulation. The board is comprised of mostly medical doctors; I believe a DO and one chiropractor. The scope of practice for chiropractic is loosely defined and falls under the medical practice act of 1987, which governs MD/DO and DC. The only difference between scope of practice is that chiropractors treat human ailments without the use of surgery or prescriptive drugs. The human ailments treated “as learned in Chiropractic College”. As far as I know, there is not one Chiropractic College I am aware of that involves courses for treating “cancer or heart disease” through chiropractic methods.

I finally found it. I have referred many times to the 2 cases oft quoted as case law that essentially state that chiropractors have no standards.

Kerkman v. Hintz (142 Wis.2d 404, 4178 N.W.2d 795, (1988). This case pointed out the distinct differences between chiropractic and medical practice. The Court very clearly defined the extent of a chiropractor's duty to diagnose: "In summary, we hold that a chiropractor has a duty to (1) determine whether the patient presents a problem which is treatable through chiropractic means; (2) refrain from further chiropractic treatment when a reasonable chiropractor should be aware that the patient's condition will not be responsive to further treatment; and (3) if the ailment presented is outside the scope of chiropractic care, inform the patient that the ailment is not treatable through chiropractic means."

Goldstein v. Janusz (582 N.W.2d 78, 218 Wis.2d 683). The Court of Appeals of Wisconsin relied on Kerkman when it ruled, "Chiropractors have no duty to recognize medical problems." It added that "to do so would require chiropractors to make medical determinations which, under Wisconsin law, they are not licensed to make." The Court further noted, "Although chiropractors may take and analyze x-rays, they only do so for diagnostic or analytical purposes in the practice of chiropractic."​

So here we sit. The state boards can say what they want but as long as case law goes the other way, chiropractors will continue to get away with murder (see the post above).

- H

 

[ptguy]

Just a quick note on spinal manipulation, not interested in getting in to an us vs. them debate. There is actually good evidence that spinal manipulation is effective for low back pain. FW, you comment on some systematic reviews which are generally flawed based on the fact that they treat non specific low back pain as a heterogeneous group, thus decreasing the effectiveness of the treatment. Childs published a clinical prediction rule on those patients who demonstrate dramatic success with manipulation in the Annals of Internal Medicine in 2004 and found that they could identify with 92% accuracy patients who would have a 50% reduction in Oswestery Disability scores in one week with spinal manipulation performed by a PHYSICAL THERAPIST. patients who were positive on 4 of the following 5 criteria:

1) pain < 16 days
2) pain not below the knees
3) Fear Avoidance Beliefs Questionnaire score < 19 on work subscale
4) Hypomobility at any one lumbar segment determined by PA palpation on spinous process
5) Hip internal rotation > 35 degrees

Significant decreases remained at 6 month follow-up with respect to disability scores, health care utilization and medication use. In this multicentred trial about 30% of patients attending acute therapy were positive on the rule.
Treatment consisted of two manipulations and three sessions of stabilization exercises.

With respect for why manipulation is effective, I agree with you FW that we really haven't figured that one up and most of the explanations to date have been quite non scientific although I dont believe that this precludes the use of manipulation in appropriate patients as identified by the CPR.The best research I have seen as of late is a neurophysiological effect immediately following manipulation as identified by Walter Herzog. He found consistant changes in muscle tone (Both inhibition and facilitation) with manipulation. Tony Wright has also found consistant changes in pain sensitivity following manual therapy in both treated joints and distal joints.

 

[f_w]

FW, you comment on some systematic reviews which are generally flawed based on the fact that they treat non specific low back pain as a heterogeneous group, thus decreasing the effectiveness of the treatment.

Never quoted a single study in this thread. ( In general, I don't find it helpful to discuss the merits of chiropractic. I made some comments on how I see my professional relationship with chiropractors and what obligations to the patient I have, thats all.)

 

[wayttk]

Fought posts:
>>>"Dentists are medical doctors"<<<

Oh really?

Please support this--------What "medical"
schools do dentists graduate from? Please cite what medical school dentists attend.

 

[wayttk]

>>>"A.T. Still served as a civil war doctor. He was a physician, trained to the standards of the day."<<<

The "standards of the day"??? Pretty pathetic to build a case upon. You obviously have no idea of what the "standards of the day" were back then.

 

[BackTalk]

Dentists aren't medical doctors. They are doctors but only the first two years of training is similar. An oral surgeon is probably closer to being a MD than a DDS or DMD is. My brother is a dentist and from him I was told anatomy was concentrated on the head, the rest of the body was a superficial overview. Physical diagnosis was geared to the area of specialty (month). Dentists have minimal training in full body diagnosis yet have the full gamut of pharmaceutical use.

 

[CFS]

That's it?

You are citing that case?

That's about the most ******ed reference I have ever heard. I thought I was the Special Olympian here but that really takes the case.

I don't deny this DC misdiagnosed but that's hardly a testimony to made against chiropractic. The girl had a stiff neck and the DC is denying she had flu-like symptoms.

*GASSSSSSSSSPPPPPP!" A CHIROPRACTIC DOCTOR MISSED SOMETHING!!!!!!

Call the Papers! Call the Law! Call the President!

We got some hot news here!!!

You know, it has been known to happen that MD's treat a patient and a diagnosis escapes them for awhile (until the worst happens).

What this is a case of, and I hope the attorney hands somebody their lunch on it, is a case of harrassing a grieving mother when the worst happened. She was taking care of her daughter the best she thought and now some gun-ho District Attorney wants to make a case for himself to get elected is my suspicion.

Of course, the knuckleheads here are only too eager to jump on the bandwagon.

This case will be dismissed/won on patient rights/negligence. Whether the DC committed malpractice or not remains to be seen. Did he take vitals? How many times did he/she see her over 2 months? Was this one of my cases that I have that I call a "one visit wonder?" Was follow-up instruction issued if the girl didn't respond? What testing was done? Is there even a suit against him/her?

Apparently you geniuses have some kind of Vulcan mind meld that you are able to ascertain this.

BTW, how are those malpractice rates there, FoughtFyr?

Maybe you should take a gander at this, while you are smoking your pipe in your glass house:

http://www.nytimes.com/2006/02/22/b...d9f1d654850c17&ei=5088&partner=rssnyt&emc=rss

 

[CFS]

Under the current medical system, doctors, nurses, lab technicians and hospital executives are not actually paid to come up with the right diagnosis. They are paid to perform tests and to do surgery and to dispense drugs.

No truer words have ever been spoken.

 

[ptguy]

Sorry FW, I meant FoughtFyr and some of the comments he made regarding the efficacy of spinal manipulation. That stated, this is not an endorsement of chiropractic - This research was done by physical therapists. It is rather a comment that although there may be significant difficulties with some chiropractic practices, spinal manipulation actually does have some evidence for dramatic effectiveness in a subgroup of patients with low back pain and can actually influence long term disability.

 

[CFS]

PTguy,

The Quebec Task Force on Whiplash also concluded the only worthwhile intervention in uncomplicated whiplash was manipulation followed by the quick introduction of therapeutic exercises. Passive modalities were of little use and medication did not offer significant pain relief, although it was not certainly discouraged by the panel.

I also beleive that a British Journal, I beleive the Journal of Orthopaedic Surgery did a study on whiplash and manipulation and found that for "coathanger distribution" neck pain from whiplash, manipulation of the c-spine had the best outcomes. I beleive the sample size was fairly small on that study so the study needs to be repeated with a larger sample size.

I believe in both studies, the manipulations were provided or the studeis referenced were by DC's but I'll have to admit in the same breath, a manipulation is a manipulation, whether a DC or a PT or a DO or a MD does it.

I should retrieve the references but really, what's the use? It's the Special Olympics here - no one's mind is going to be changed by evidence.

 

[FoughtFyr]

This case will be dismissed/won on patient rights/negligence. Whether the DC committed malpractice or not remains to be seen.

The case will be dismissed (if it is even ever filed against the chiropractor). By case law, he committed no malpractice. As cited in appealate court (Goldstein v. Janusz (582 N.W.2d 78, 218 Wis.2d 683)) the chiropractor is under no obligation to discover medical disease. And that is the problem. You can hold yourselves out as primary care physicians, but, when the rubber meets the road, you hide behind your lack of training and simply declare "That wasn't a chiropractic dis-ease. We didn't know about it." And I'm not just relying on this case. I've seen two fatal and two major disability cases from chiropractic negligence in the past two years in my own practice.

What this is a case of, and I hope the attorney hands somebody their lunch on it, is a case of harrassing a grieving mother when the worst happened. She was taking care of her daughter the best she thought and now some gun-ho District Attorney wants to make a case for himself to get elected is my suspicion.

Of course, the knuckleheads here are only too eager to jump on the bandwagon.

While I agree with you, that this is a tragedy, it does need to prosecuted. Our legal system has held, time and time again, that Christian Scientists can be held liable for the deaths of their children if all that is done is prayer to treat them. The mother in this case was an RN. No reasonable RN should think, any more than a reasonable person would believe that prayer alone could heal a severely ill child, that a chiropractor could cure a severely ill child. As even you have said, chiropractic is an outpatient business. And I am not "jumping on the bandwagon". Had this mother been a layperson, I wouldn't agree with the prosecution at all. But that is not the case. And I do not blame the chiropractor. He or she was woefully unprepared to recognize the serious nature of the illness. In one study (see: http://www.ncbi.nlm.nih.gov/entrez/...uids=10768681&query_hl=2&itool=pubmed_docsum), 17% of chiropractors whose practice included pediatrics on a regular basis failed to recognize that a 2 week old neonate with a fever represented a medical emergency. This case is just a "real world" example of that documented ignorance.

BTW, how are those malpractice rates there, FoughtFyr?

Well, given that I actually treat sick people for terminal conditions and take all comers, including those your profession has worked hard to kill, they are much higher than yours. But not for long - it seems the lawyers have discovered chiropractic! (And BTW, that is the weakest argument comparing apples and oranges that I've ever heard. What are your malpractice rates compared to a PTs?)

See: http://www.worldchiropracticalliance.org/tcj/2006/sep/h.htm

And BTW, you can claim "special olympics" all you want and thus refuse to actually engage in scientifically based debate by refusing to list references, sources, etc. But if you bothered to read any of the previous posts here, there have been decent discussions of the merits of the literature. Of course, you are probably right, few minds will be fully changed from an internet forum discussion, but I believe that open, intelligent discussion is a good thing. You've just failed to provide any to date.

- H

 

[wayttk]

Fought argues CFS:

>>>scientifically based debate by refusing to list references, sources, etc.<<<

Yet Fought uses WCA to support his arguments........What a joke!!!!

 

[FoughtFyr]

Fought argues CFS:

>>>scientifically based debate by refusing to list references, sources, etc.<<<

Yet Fought uses WCA to support his arguments........What a joke!!!!

Wayttk,

I realize that you are a chiropractor, but you do understand the difference between social issues (malpractice, accreditation of educational institutions, etc.) and scientific issues (the in vitro or in vivo validity of treatments or therapies, etc.) don't you? Are you suggesting the the WCA, a group of chiropractors, is not in a reasonable position to comment on social issues? They are probably the most rabid "pro-chiropractic" group out there! Are you saying that there has not been a recent spike in malpractice suits against chiropractors? Are you suggesting that lawyers groups are not targeting your profession (usually, I would grant, unfairly, but hey, welcome to the party)? Perhaps the "Master's Circle" lawsuit wasn't really filed? Come on, you know darn well that I realize that the WCA is a fringe group of straight chiropractors. That said, their "pro-chiropractic" editorials on the outside forces acting on the profession are as valid as any other editorial piece.

- H

 

[FoughtFyr]

The "standards of the day"??? Pretty pathetic to build a case upon. You obviously have no idea of what the "standards of the day" were back then.

Actually, I do. I've actually read the Flexner Report. Have you? The bottom line is that A.T. Still was a medical doctor. Palmer wasn't. These are facts, not opinion. Now, you could, rightfully, impugn the medical education of the time, but that doesn't change the simple fact that osteopathy, through Still's training, has always allowed for traditional medicine. Early on, that allowance was quite small, in modern times it is quite large, almost to the point of overshadowing its base, but it has always been there. Palmer, and thus chiropractic, has always shunned traditional medicine. There is no place in medicine for chiropractic. As for SMT, I'm not sure. I'd really love to see the scientific base. PTGuy, do you have a text you could name (I've got access to an extensive library) that describes the basic science behind SMT? Thanks!

- H

 

[611]

I don't see how you can say that a curriculum like this http://www.nuhs.edu/show.asp?durki=507 completely shuns medical science.

 

[wayttk]

I don't see how you can say that a curriculum like this http://www.nuhs.edu/show.asp?durki=507 completely shuns medical science.

or likewise this:

Wolfe-Harris Center for Clinical Studies Submits Grant Proposal with Mayo Clinic College of Medicine
BLOOMINGTON, Minn. - The Wolfe-Harris Center for Clinical Studies at Northwestern Health Sciences University recently submitted a grant proposal to the National Institutes of Health's National Center for Complementary and Alternative Medicine (NCCAM). The grant proposal was submitted in collaboration with the internationally recognized Mayo Clinic College of Medicine's biomechanics laboratory in Rochester, Minn.

The proposal asks for $275,000 to fund a two-year pilot project with three aims: to develop automated software for tracking and quantification of segmental motion in the lumbar spine; to establish the accuracy and limitations of automated motion analysis within a spine model; and assess the reliability of the process in humans.

"This proposal is a part of an ongoing collaboration with Mayo Clinic," says Craig Schulz, DC, assistant professor. "Currently motion assessment can be done by hand, but it is an intensive process."

http://www.nwhealth.edu/nwtoday/press/mayo.html

Fought has difficulty separating his personal predjudicial blather from reality, eg. like WCA-----reality is: it exists, but membership is .05(one half of one percent!!) of the DC profession. YUP!

 

[FoughtFyr]

I don't see how you can say that a curriculum like this http://www.nuhs.edu/show.asp?durki=507 completely shuns medical science.

Who cares what you title a class? I can stand in front of a class, tell you to "pray to the Otter God" to effect your patient's heart rate and title the course "physiology 506". That doesn't make it valid. There are two MDs on staff at National, neither are licensed in Illinois according to the DPR. On their main faculty page, they list more instructors in "massage" than anything else. We had this argument before 611. This is "old hat".

Even if I accepted the argument (which I don't), that National is a completely "science based" institution, that still doesn't address the fact that the majority of chiropractors did not train at National, legal standards do not hold chiropractors (trained at National or not) to a reasonable standard for primary care physicians (which is how many sell themselves), and the public has no protection against any chiropractor (National trained or not) who oversteps what they can handle.

Leaving those arguments aside; what is the need for chiropractic. Even if we grant (which again, I don't), that chiropractic is a valid modality, where is the research to demonstrate that it is better than the current modalities available? If there isn't any, than why have chiropractors?

- H

 

[wayttk]

>>>"There are two MDs on staff at National....."<<<

Yet Fought neglects to mention the ten(10) full-time PhDs on faculty at National. Just an unintentional oversight I'm sure.............


http://www.nuhs.edu/show.asp?durki=519

 

[611]

Time for a chill pill.

 

[FoughtFyr]

>>>"There are two MDs on staff at National....."<<<

Yet Fought neglects to mention the ten(10) full-time PhDs on faculty at National. Just an unintentional oversight I'm sure.............


http://www.nuhs.edu/show.asp?durki=519

Nope, no oversight at all. I've acknowledged that fact before. The question at hand was if the curriculum "shunned medical science". The proportion of faculty holding degrees in "medical science" is the germane point. Come on Wayttk, even you can do better than this...

- H

 

[FoughtFyr]

or likewise this:

Wolfe-Harris Center for Clinical Studies Submits Grant Proposal with Mayo Clinic College of Medicine
BLOOMINGTON, Minn. - The Wolfe-Harris Center for Clinical Studies at Northwestern Health Sciences University recently submitted a grant proposal to the National Institutes of Health’s National Center for Complementary and Alternative Medicine (NCCAM). The grant proposal was submitted in collaboration with the internationally recognized Mayo Clinic College of Medicine’s biomechanics laboratory in Rochester, Minn.

The proposal asks for $275,000 to fund a two-year pilot project with three aims: to develop automated software for tracking and quantification of segmental motion in the lumbar spine; to establish the accuracy and limitations of automated motion analysis within a spine model; and assess the reliability of the process in humans.

“This proposal is a part of an ongoing collaboration with Mayo Clinic,” says Craig Schulz, DC, assistant professor. “Currently motion assessment can be done by hand, but it is an intensive process.”

http://www.nwhealth.edu/nwtoday/press/mayo.html

Now this is interesting. I'll look up the IRB filing on this and get back to you.

Fought has difficulty separating his personal predjudicial blather from reality, eg. like WCA-----reality is: it exists, but membership is .05(one half of one percent!!) of the DC profession. YUP!

And again, I've never said that the WCA is all chiropractors. The Washington Post is only read by a very small percentage of the adult population in the U.S. However, if they write an editorial, that is fair game for discussion. Likewise with the WCA. I'm not claiming they represent all chiropractors or even a majority. What I am saying is that, like the editors of the Washington Post, they do provide a publicly accessible commentary on the state of affairs in their realm of interest. What you've failed to do is show where ANY of the editorials I've quoted are factually incorrect...

But, then again, I really don't expect coherent debate from a chiropractor (BT and 611 excluded).

- H

 

[awdc]

The question at hand was if the curriculum "shunned medical science". The proportion of faculty holding degrees in "medical science" is the germane point.

If the question at hand is "if the [chiropractic] curriculum shunned medical science," I'd have to say a big NO. However, I'd have to qualify that my answer would only apply to the more scientifically aligned schools of chiropractic such as National, Southern California, Western States, etc. And given the fact that all chiropractic students must take the same board exams, no chiropractic college can really shun medical science as it is a heavily tested area (but not to the level of the USMLE). The problem is the pervasive (poorly constructed) one-sided criticisms of medical science that is allowed to flourish at certain chiropractic schools.

FoughtFyr, believe it or not some chiropractors are with you in that they would sure like to rid the profession of the pseudo-science. The question becomes (like you posed) why have another profession like PT? Similarly why a DO profession (now that they are so similar to MD's)? Chiropractic, like osteopathic medicine, does not have to be defined by antiquated philosophies of its founders but rather to use the spirit of those philosophies such as holism to drive how its practitioners interact with patients and to address particular research questions like manipulative therapy.

One more point, Palmer does not equal chiropractic. And just because Palmer shunned medical science, doesn't mean that chiropractic today shuns medical science. As a profession, it evolves and to say it hasn't evolved since Palmer is a misunderstanding. In fact, it's offensive to some DC's to suggest that they are adherent to Palmer's views.

Bottom line: the chiropractic profession really needs to clean house. And until they do, it's tough to advise and justify "blind" referrals to chiropractors from physicians.

 

[ptguy]

F-W

Sorry, I agree with your statement about pseudo science predominating the explanation of the effectiveness of manipulation and as such cant reccomend a text. If you PM me I can supply you with a couple of articles by walter herzog and Tony Wright that summarize their work in this area. Although this neurophysiological effect is the most plausible to date, it is far from proven.

This lack of explanation for why manipulation is effective certainly does not preclude its short term use in specific patient population and John Childs, Tim Flynn, Audrey Long and a few others have gone a long way in sub grouping low back pain populations and finding that treatments (Manipulation, stabilization, fear avoidance therapy) can be much more effective in specific identifiable populations.

With respect to cervical manipulation CFS, I agree it can be an effective treatment but has not shown efficacy superior to mobilization (Non high velocity manual therapy) and carry an unknown grave risk (Anywhere from 1 in 20,000 to 5 million) so I choose not to employ them in practice.

I do, however, agree that a manip is a manip and there is little need for "Guru expertise" in their application. In the quoted Childs study, novice practicioners had equal outcomes to expert clinicians in manual therapy when applying the clinical prediction rule for manipulation. This was after 15 minutes of instruction in technique provided to novice clinicians. Certainly education/theory that a practicioner gives clients to why manipulation is effective would influence outcome can have a huge impact - Ie. "Your back is subluxed and requires ongoing maitenance care" goes a long way in creating patient fear avoidance beliefs and percieved disability.

PTguy

 

[f_w]

F-W

Sorry, I agree with your statement about pseudo science predominating the explanation of the effectiveness of manipulation and as such cant reccomend a text.

Again, I am not arguing the merits of manipulation or chiropractic with you.

 

[ptguy]

Sorry! Fought-fyr. mental block.

 

[CFS]

FoughtFyr,

I am not entirely certain a DC can mount a defense to malpractice of "I am not responsible for diagnosing disease" and be excused in a court of law. I guess it varies from state to state. In my state of NJ, a judge ruled against that specific defense a lawyer forwarded. Now, it is certainly possible to define the parameters of the doctor/patient relationship, much as I am certain an optometrist is not responsible for detecting high blood pressure, a DC could say, "Why am I responsible for detecting DM in this patient?." A chiropractor can certainly position himself to a certain extent this way his patient population.

But when the problem is right there in front of them (in this case - spinal meningitis), there is a duty to be diligent.

As far as the RN being criminal, I disagree with you. We have no idea if this child's problems was masking as cervicogenic headache or if she was spiking fevers and showing signs of infection.

You'll excuse me if I simply don't beleive you. You are so far out of your area of expertise, you simply look foolish commenting on the finer aspects of chirolegality and practice.

PTguy,

I suppose it's debatable whether a Grade 5 mob would acheive the same results as a manipulation in whiplash. My suspicion is not but I'll have to admit in the same breath I have no evidence to support my suspicion.

I think acheiving movement into the paraphysiological joint space is the key to inhibiting fibroblast production and of course, all the anti-nociceptive effects that go with it. My observations may be biased b/c I have seen pt.s where PT has failed so the selection criteria in my emprical observations are going to different.

But you are right to be careful in not manipulating the c-spine if you are uncomfortable. Manipulating necks is tricky business and probably best left to a DC.

As just a side story, I have spoken to my kid's pediatrician on immunization rxn's (my sons are fully vaccinated) - he has noted that he has never seen one in his career. He takes precautions to not administer if there are any signs of infection or immunocompromise.

I personally have never even had a patient get dizzy getting off my table following a c-spine manipulation, let alone an adverse event other than temporary soreness in my entire career. And for the most part, I am acheiving cavitation on 90%+ manipulations to the c-spine.

I think the establishment of a Board of Manual Medicine (Health Care, lol) with DC's, DO's, PT's, and MD's and having every DC and optionally PT's et al become board certified could institute some quality control and practically eliminate the risk associated with the procedure.

 

[CFS]

Folks,

I said I wouldn't hang around here long and I'll be a man of my word. (FoughtFyr can breath a sigh of relief).

I just want to say to the other DC's here who may be new to just not beleive everything you hear.

I guess I especially have the newbies here in mind for my audience.

FoughtFyr and other MD's would have you beleive that chiropractic patients are walking out of our offices, injured in droves, making their way to the ER to be patched up from the actions of our irresponsbility. They will have you beleive that diagnoses are escaping us to be finally caught by the MD later on and we are a bunch of "rabid dogs" that are in need of euthanasia.

It simply isn't true. In fact, it's almost a ridiculous implication.

I've been in practice 9 years and that's not the way it has gone down at all. I'll admit when I graduated, I had a bit of the "MD-admiration" psychology. I would refer to them expecting some great clinical insight that I must not had (because I lacked training after all, according their constructed arguments). Much to my surprise, the patients would come back with no greater or better clinical insight or diagnosis clinched than I was able to provide.

IF you don't beleive me, go ahead and refer 10 patients around just as an experiment. My conclusion will be confirmed by you and your confidence boosted.

I was "disappointed" to say the least but it was a boost for my confidence (arrogance as someone put it). Over the years, I have just learned to accept the provincial roles the specialties serve and just dutifully refer when necessary but mostly, the pt. just goes back to their family doctor when discharged, at MMI, or not helped.

And, over the years I have missed pathology - an astrocytoma (along with pediatrician missing it), AVN of the left hip, one case of mets, among other I am sure but I have caught pathology the MD has missed, from vanilla Diabetes Mellitus to an eroded and enlarged sella turcica on x-ray that I brogught to the attn. of the radiologist who didn't note it.

All this from simple vanilla chiropractic training and graduating somewhere like 28 out of 68 in my class, a very non-impressive class rank.

Just remember - chiropractic school's jobs are to make chiropractors, not medical doctors. If I am average, I think they do a pretty good job for the most part.

I am certain after 9 years. . . my career has not been misspent. I have helped people where I am absolutely certain they could have not been helped by a PT or DO or MD (because they had been to all of them). We just have a different perspective on the human body than those allopathic professions and we aren't afraid to touch the patient and "get our hands dirty." In the end, it may sound corny, I am amazed what a pair of hands, some confidence and a good heart can accomplish in health care when surrounded by marvelous technology such as 3D MRI and ventilators that do our respiration for us. It's hard for American's to comprehend but sometimes technology isn't always the answer.

That's not to take away from those professions. I am certain their careers are not misspent either. It's just to serve as a comparison.

Just don't let Mayo-Boy start convincing you of arguments from his position of non-reality. Don't let unsubstantiated arguments like his give you any inferiority complex; I can see a theme or "motif" if you will running through his posts that just doesn't match with what the reality of most chiropractic practice out there is.

The fact lawyers are trolling for lawsuits from DC's won't last long when they figure out there's nothing there in the way of evidence supporting harm. Frivolous lawsuits may still be a concern.

Overall, I am convinced that the training is better for MD's (if that makes Mayo Boy feel any better); but after 9 years of perspective, what I am not convinced of is that the care (the ultimate outcome of any training) is better than what we give for the patient population we care for.

 

[f_w]

Folks,
FoughtFyr and other MD's would have you beleive that chiropractic patients are walking out of our offices, injured in droves, making their way to the ER to be patched up from the actions of our irresponsbility.

Well, the problem is that you will never see these patients or hear their stories.

They will have you beleive that diagnoses are escaping us to be finally caught by the MD later on

At times yes.

and we are a bunch of "rabid dogs" that are in need of euthanasia.

Not quite, but is is certainly a craft in need of external regulation, either through the civil courts or state regulatory authority.

IF you don't beleive me, go ahead and refer 10 patients around just as an experiment. My conclusion will be confirmed by you and your confidence boosted.

I might suggest that nobody conduct experiments on their patients.

Just remember - chiropractic school's jobs are to make chiropractors, not medical doctors. If I am average, I think they do a pretty good job for the most part.

As long as you limit your practice to chiropractic and the disease entities treatable by it, only few people will have a problem with you. If you hold yourself out to be a 'physician' and exceed your area of expertise, that is where 'we MD's' get pissy.

It's hard for American's to comprehend but sometimes technology isn't always the answer.

No doubt about that. Quite often simple attention and applying a label to the patients symptoms will do.

Don't let unsubstantiated arguments like his give you any inferiority complex; I can see a theme or "motif" if you will running through his posts that just doesn't match with what the reality of most chiropractic practice out there is.

Then why is there so little scientific evidence to support chiropractic ? PTboy quotes studies to show the benefits of manipulation, where in this discussion are the well founded arguments to support chiropractic and refute foughfyrs arguments ?

 

[CFS]

F-W,

Fine, I'll stay a bit longer if you have questions.

Well, the problem is that you will never see these patients or hear their stories.

Might I suggest you take "stories" with a grain of salt. I take an appropriate dose of NaCl when my patients tell me MD "stories."

Not quite, but is is certainly a craft in need of external regulation, either through the civil courts or state regulatory authority.

But F-W, we are regulated as thus (BTW, I like your descriptor of "craft"; like surgery I think chiropractic is a craft and don't take offense; I happen to think I excel at my craft).

Anyway, if a pt. has a complaint against me, it's as easy as going online to file one against me. If you have a complaint against me, it's also that easy.

And of course, this is America. Anyone can sue anybody for anything.

There are civil and criminal remedies just as there are for you.

I think what you mean to say is that we need more internal quality control. I have proposed a Board of Manual Medicine but I am open to other suggestions. Perhaps board cert. could = ins. participation in my suggestion?

No doubt about that. Quite often simple attention and applying a label to the patients symptoms will do.

But more than that. I mean, a radiologist can give someone attention and apply a label to something. I am not sure how much that and a cup of coffee will get you. It's more about getting in there with your hands to effect a physiological change (yes, even if it is only temporary).

Then why is there so little scientific evidence to support chiropractic ? PTboy quotes studies to show the benefits of manipulation, where in this discussion are the well founded arguments to support chiropractic and refute foughfyrs arguments ?

There are a lot of studies, mixed, to support and refute spinal manipulation.

I'll even help you sort them. Generally the ones in JAMA and NEJM show a negative outcome for manipulation. The ones in JMPT (our journal) show a positive outcome.

Spine, my favorite, shows a more editorially balanced selection of studies of both positive and negative.

Studies on "chiropractic" per se (the profession, not manipulation) are very few at best. A recent pilot study done indicated that going to a chiropractor resulted in less diagnostic testing, less pharmaceutical usage, and less hospitalization. But admittedly, it could be because the less serious diagnoses present to us and that explained the results of the study. In fact, I suspect that is the reason.

However, it's still valuable from an actuarial standpoint to have this information. If actuaries know that people who go to DC's are healthier, then perhaps either premium breaks can be applied to this group or people directed to the DC. And people consuming medical care pay more. It's just an idea.

What we have now is people going to an orthopedist (network engineer) when all that's wrong is a broken wire and an electrician (chiropractor) could fix, if you can bear with me on the analogy. It's a poor use of resources.

Manipulation, on the other hand, has been very studied in the literature. One researcher remarked it was the most studied procedure out there.

Personally, I think we have been barking up the wrong tree - studying acute, uncomplicated pain. For that, I'd be the first to admit that probably the aspirin/NSAID's make more sense. It's cheaper, it's more available, probably equal safety (taken as directed - still lotsa GI bleeds out there). To use chiropractic as an "expensive aspirin" doesn't make sense. Even from a business perspective, it hardly makes sense for me to do a half-hour work-up, administer treatment, and follow-up and discharge. I lose money on "acute cases."

Where we should be focusing, IMO, is on chronic pain and mobility management, esp. as the population ages. Quite simply for the pt. with chronic degenerative pain and disability, chiropractic often (but not always) makes the most sense, given the low risk to moderate return ratio.

Do you have another proposal? Vioxx 2x/day the rest of their life? Celebrex 2x/day the rest of their life? Better living through chemistry? Ohhh!!! I know. . .they can exercise their pain away at the PT, no? Is there something to operate on that maybe we are missing? Oh, wait, I know. . ."You are just going to have live with it, Mary. Here's a $1 pamphlet."

You see, it is difficult to study chronic pain. It's more difficult to set-up the research parameters to prove the hypothesis (or null hypothesis) of "chiropractic care/manipulation provides (or doesn't provide) effective pain and mobility management for painful degenerative conditions." An expenseive and lengthy prospective study with controls is the only way I can think of doing it although perhaps a more creative researcher could design something.

However, if in the meantime you have any alternative suggestions for my patient population dealing with this, as Ross Perot would say, "I'm all ears."

I'll even refer them to you and watch you perform an amazing healing on them.

In fact, I challenge you to.

 

[FoughtFyr]

FoughtFyr,

I am not entirely certain a DC can mount a defense to malpractice of "I am not responsible for diagnosing disease" and be excused in a court of law. I guess it varies from state to state. In my state of NJ, a judge ruled against that specific defense a lawyer forwarded.

Please, cite the case. WestLaw is a great service. It should be easy. From my own experience searching, I can tell you that the cases I provided have been cited extensively in many states, and I have yet to find a ruling countering them. If you have one, please post it.

Now, it is certainly possible to define the parameters of the doctor/patient relationship, much as I am certain an optometrist is not responsible for detecting high blood pressure, a DC could say, "Why am I responsible for detecting DM in this patient?." A chiropractor can certainly position himself to a certain extent this way his patient population.

The question is not what they hold out to their patient, but rather what they hold out in court when their livelihood is on the line. It seems much of the bravado fades away in a deposition.

But when the problem is right there in front of them (in this case - spinal meningitis), there is a duty to be diligent.

Actually, although you failed to comment on it, I posted an article (http://www.ncbi.nlm.nih.gov/entrez/..._uids=10768681&query_hl=2&itool=pubmed_docsum) which suggests that, when dealing with children, chiropractors do not necessarily recognize simple medical emergencies when faced with them.

As far as the RN being criminal, I disagree with you. We have no idea if this child's problems was masking as cervicogenic headache or if she was spiking fevers and showing signs of infection.

Thank you for proving my point. In this case you "are so far out of your area of expertise, you simply look foolish". I am an emergency physician. There are a limited number of serious pathologies which must be ruled out when treating a child with a new onset headache. Meningitis is one of them. And yes, we get negative taps (after negative CTs, f_w) on a fair number of kids. But we generally don't miss the meningitis calling it instead, what is it, oh yeah "cervicogenic headache".

You'll excuse me if I simply don't beleive you. You are so far out of your area of expertise, you simply look foolish commenting on the finer aspects of chirolegality and practice.

Really. So, is it the cases I cited you don't believe or the papers? Look CFS, you are under a common delusion, that the plural of anecdote is fact. It isn't. You are also convinced that I am "after" chiropractors. I'm not. I only ask that they validate themselves and set up systems of QI/QA that go beyond their current boards, you know, something more in line with the rest of the medical profession, before holding themselves out as equals. And this type of debate (at least the scientifically based side) goes on between physicians all of the time. In fact, if you read back in the thread, f_w was giving EPs the business on the evidence basis of spinal imaging in the ED. If you can't take the heat, get out of the healthcare business...

As just a side story, I have spoken to my kid's pediatrician on immunization rxn's (my sons are fully vaccinated) - he has noted that he has never seen one in his career. He takes precautions to not administer if there are any signs of infection or immunocompromise.

Just as a side story, in my intern year a 10 year old boy died of Hib meningitis. He had not been vaccinated on the advice of daddy's chiropractor. The malpractice case against that chiropractor was thrown out, as was the civil case, because the State Chiropractic Board found that the chiropractor acted within the scope of chiropractic when advising against the immunization.

I personally have never even had a patient get dizzy getting off my table following a c-spine manipulation, let alone an adverse event other than temporary soreness in my entire career. And for the most part, I am acheiving cavitation on 90%+ manipulations to the c-spine.

Cool, if you want to keep just throwing around worthless anecdotes, we can do that. Or we can again go to the science. Here is a paper (in "Spine", your favorite: http://www.ncbi.nlm.nih.gov/entrez/...uids=14589464&query_hl=3&itool=pubmed_docsum), written using the files of a chiropractic malpractice insurance company that offers an explanation as to why the experience of chiropractors varies from that of physicians with regard to chiropractic iatrogenic injuries. The answer is fairly simple. One injured person sees one chiropractor (the one who injures them). They are then seen by, an emergency physician, their primary medical physician, a radiologist who interprets the study, several neurologists, a hospitalist or two (if inpatient), perhaps an orthopod and / or a neurosurgeon.

I think the establishment of a Board of Manual Medicine (Health Care, lol) with DC's, DO's, PT's, and MD's and having every DC and optionally PT's et al become board certified could institute some quality control and practically eliminate the risk associated with the procedure.

Well see, more oversight is needed. We agree there.

- H

 

[FoughtFyr]

Folks,

I said I wouldn't hang around here long and I'll be a man of my word. (FoughtFyr can breath a sigh of relief).

A sigh of relief?!? Like SDN actually means something in the real world? Heck, I love having guys like you around. It helps me hone my arguments and stay up on the literature. When I make my run for a PhD in a few years (health policy hopefully), this stuff will actually come in handy!

I just want to say to the other DC's here who may be new to just not beleive everything you hear.

Sure, believe CFS. Why, because he is simply "that good". Please pay no attention to the research behind the curtain...

I guess I especially have the newbies here in mind for my audience.

Cause they are the only ones willing to blindly follow anecdotes.

FoughtFyr and other MD's would have you beleive that chiropractic patients are walking out of our offices, injured in droves, making their way to the ER to be patched up from the actions of our irresponsbility. They will have you beleive that diagnoses are escaping us to be finally caught by the MD later on and we are a bunch of "rabid dogs" that are in need of euthanasia.

Nope, not in droves, but there are certainly differences in perception (as noted here: http://www.ncbi.nlm.nih.gov/entrez/..._uids=14589464&query_hl=3&itool=pubmed_docsum) and documented risks (as noted here: http://www.jcca-online.org/client/cca/JCCA.nsf/objects/V49-1-46/$file/jcca-v49-1-046.pdf and here: http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=12743225 and here: http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=12692699 and here: http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=15513007 and here (in JMPT no less): http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=12466778 and here: http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=14586598 and here: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7884327&dopt=Abstract and here: http://www.cmaj.ca/cgi/content/full/166/12/1531 and here: http://www.cmaj.ca/cgi/content/full/166/12/1544 and here: http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=11340209) among many others I'm sure. What is strangely missing is the benefits. From: http://nccam.nih.gov/health/chiropractic/index.htm#app2

"Three systematic reviews that concluded "Overall, the evidence was seen as weak and less than convincing for the effectiveness of chiropractic for back pain. Specifically, the 1996 systematic review reported that there were major quality problems in the studies analyzed; for example, statistics could not be effectively combined because of missing and poor-quality data. The review concludes that the data 'did not provide convincing evidence for the effectiveness of chiropractic.' The 2003 general review states that since the 1996 systematic review, emerging trial data 'have not tended to be encouraging&#8230;. The effectiveness of chiropractic spinal manipulation for back pain is thus at best uncertain.' The 2003 meta-analysis found spinal manipulation to be more effective than sham therapy but no more or no less effective than other treatments."​

It simply isn't true. In fact, it's almost a ridiculous implication.

You are right. It simply isn't true. That is because you've put words in my mouth, then said "look how ridiculous what he said is". I am not claiming that patients are "injured in droves". But some are injured. And in medicine, we do everything as a "risk versus benefit" decision. Heck, earlier in this thread f_w and I tossed down about radiation levels in CT. Now, I think even you are willing to stipulate that more people are seriously injured by chiropractic than by CT radiation each year (I'm talking direct acute injury). The point is that there are risks to chiropractic. They are well documented. What isn't so well documented are the benefits. If you have that documentation, please provide it...

I've been in practice 9 years and that's not the way it has gone down at all. I'll admit when I graduated, I had a bit of the "MD-admiration" psychology. I would refer to them expecting some great clinical insight that I must not had (because I lacked training after all, according their constructed arguments). Much to my surprise, the patients would come back with no greater or better clinical insight or diagnosis clinched than I was able to provide.

Yep, in fact, here is a great paper speaking to how low of a percentage of ED patients are ever diagnosed with a condition that explains their pain. See: http://www.ncbi.nlm.nih.gov/entrez/..._uids=16858088&query_hl=7&itool=pubmed_docsum. MD/DOs are not omnipotent - and I would strongly advise avoiding any who believe they are.

IF you don't beleive me, go ahead and refer 10 patients around just as an experiment. My conclusion will be confirmed by you and your confidence boosted.

So you suggest what would be, in your experience, unwarranted referrals?

I was "disappointed" to say the least but it was a boost for my confidence (arrogance as someone put it). Over the years, I have just learned to accept the provincial roles the specialties serve and just dutifully refer when necessary but mostly, the pt. just goes back to their family doctor when discharged, at MMI, or not helped.

And, over the years I have missed pathology - an astrocytoma (along with pediatrician missing it), AVN of the left hip, one case of mets, among other I am sure but I have caught pathology the MD has missed, from vanilla Diabetes Mellitus to an eroded and enlarged sella turcica on x-ray that I brogught to the attn. of the radiologist who didn't note it.

Wow, if you know about those misses, how many are there you don't know about? Oh yeah, no QI/QA system. You have no idea.

All this from simple vanilla chiropractic training and graduating somewhere like 28 out of 68 in my class, a very non-impressive class rank.

IMNSHO it'd be unimpressive if you were first of sixty-eight.

Just remember - chiropractic school's jobs are to make chiropractors, not medical doctors. If I am average, I think they do a pretty good job for the most part.

Yes, but what is the role of the chiropractor and is he/she 1. needed and 2. safe?

I am certain after 9 years. . . my career has not been misspent. I have helped people where I am absolutely certain they could have not been helped by a PT or DO or MD (because they had been to all of them). We just have a different perspective on the human body than those allopathic professions and we aren't afraid to touch the patient and "get our hands dirty." In the end, it may sound corny, I am amazed what a pair of hands, some confidence and a good heart can accomplish in health care when surrounded by marvelous technology such as 3D MRI and ventilators that do our respiration for us. It's hard for American's to comprehend but sometimes technology isn't always the answer.

Wow, I'm glad I "never get my hands dirty". Yep, emergency physicians, we never touch our patients... {SARCASM}

Just don't let Mayo-Boy start convincing you of arguments from his position of non-reality. Don't let unsubstantiated arguments like his give you any inferiority complex; I can see a theme or "motif" if you will running through his posts that just doesn't match with what the reality of most chiropractic practice out there is.

Umm, my arguments are "unsubstantiated"? I have cited case law and rulings, you respond with "I don't think so", I cite papers and you refuse to acknowledge their findings, and you refuse to cite papers because you once ran in the special olympics. I'm unsubstantiated? All your posts boil down to "This one time, at band camp..."

The fact lawyers are trolling for lawsuits from DC's won't last long when they figure out there's nothing there in the way of evidence supporting harm. Frivolous lawsuits may still be a concern.

Horsepucky. They will come after you tooth and nail. What you have to remember is that "evidence" doesn't matter to the trial lawyer. Money does. Here is another unsubstantiated paper that suggests "For 3 percent of the claims, there were no verifiable medical injuries, and 37 percent did not involve errors". See: http://www.ncbi.nlm.nih.gov/entrez/...uids=16687715&query_hl=10&itool=pubmed_DocSum. If the lawyers have now set their sights on chiropractic, fairness, causality, and logic go out the window. Soon, you'll know what double-digit percentage malpractice insurance rate increases feel like.

Overall, I am convinced that the training is better for MD's (if that makes Mayo Boy feel any better); but after 9 years of perspective, what I am not convinced of is that the care (the ultimate outcome of any training) is better than what we give for the patient population we care for.

How can you know? What are your outcome measures? Where is the science?

- H

 

[CFS]

http://72.14.209.104/search?q=cache...492+A.2d+371+(1985).&hl=en&gl=us&ct=clnk&cd=5

The imposition of a duty on chiropractors to at least recognize whether a condition is treatable through chiropractic, or is really a medical condition, is the clear rule throughout the United States. (See Polin, Proof of Malpractice by Chiropractor 55 Am.Jur. (2004) Proof of Facts 3d, § 15, 125: “It is generally held that a physician has the duty to advise a patient to consult a specialist or one qualified in a method of treatment which the physician is not qualified to give, where she knows, or ought to that she does not have the requisite skill, knowledge, or facilities to treat the patient’s ailment properly, or that the method employed has been ineffective. The same principle has been applied in the few cases dealing with a chiropractor’s failure to refer a patient to a medical doctor. Thus, it has been held that chiropractors owe a duty to exercise reasonable care in analysis and treatment of their patients which includes duty to inform them when nonmedical treatment has become useless or harmful and medical treatment should be sought. This standard of care requires a chiropractor to (1) recognize a medical problem as contrasted with a chiropractic problem; (2) refrain from further chiropractic treatment when a reasonable chiropractor should be aware that the patient’s condition is not amenable to chiropractic treatment . . . and (3) if the ailment presented is outside the scope of chiropractic care, inform the patient that the ailment is not treatable through chiropractic means.” (Emphasis added.) See also Penofsky, Chiropractic Malpractice Litigation 78 Am.Jur. (2004) Trials § 116, 327-328: “A chiropractor is under a legal duty to employ proper skill, care, learning and experience in correctly diagnosing the chiropractic patient’s condition. Where the chiropractor fails to employ such due diagnostic care and the patient is proximately injured, the failure -- which is generally referred to as misdiagnosis -- may constitute a malpractice act, for which the chiropractor can be liable in damages. Misdiagnosis may occur where the chiropractor: Diagnoses a chiropractic condition when a medical condition actually exists . . . .” (Emphasis added.))

FoughtFyr,

I had better leave. You are somehow threatened by my presence and that's fine - you are allowed to have your little club here. This will be my last post and I will let you have the last word and return to your little world.

I am not your penpal, FoughtFyr. I don't have the inclination to respond to you point by point as you seem to have the need to do so with me.

The above reference refutes your absurd claim that somehow we are excused from diagnosis. And from that, your entire arguement falls apart as it is based on this assumption. I think where you are confused is that yes, in Michigan, where the practice scope is very confined, if the DC cannot order the test to establish the diagnosis, the judge reasoned that there was no duty to diagnose. This was played out throught case law.

For instance, academically and theorectically, if a pt. had pyelonephritis and cannot order a UA and CBC by law, then he is, in effect, excused from being obligated to differentially diagnose that.

However, Michigan is more the exception than the rule. In NJ, we have "physician" status and part of the responsiblity that goes with that is a duty to diagnose. Most states give a DC broad abillity to order tests.

Finally, again, you don't know what this child and RN mother was going through and the details of the case. The child could have had musculoskeletal H/A's (cervicogenic - that's neuro-talk there FoughtFyr) and then developed spinal menigitis in the course of treatment.

In fact, that's a very possible scenario given the mother's apparent confusion on how to treat the daughter and delayed proper treatment. She may have responded to chiropractic, then developed spinal mengititis. The patient is entitled to more than one condition.

Or the DC could have blatantly missed it.

We just don't know.

It's all speculation.

And part of being a professional, FoughtFyr, is KNOWING WHAT YOU DON"T KNOW, apparently something you struggle with or else you wouldn't be making comments on an area that's clearly not within your expertise.

Just say, "I don't know" and I think most here, including me, will have a greater respect for what comes out of your mouth.

 

[FoughtFyr]

http://72.14.209.104/search?q=cache...492+A.2d+371+(1985).&hl=en&gl=us&ct=clnk&cd=5



FoughtFyr,

I had better leave. You are somehow threatened by my presence and that's fine - you are allowed to have your little club here. This will be my last post and I will let you have the last word and return to your little world.

Wow. You finally post something substanative then leave. That's o.k. This ruling is in sharp contrast to the WI superior court findings, and interesting neither quotes the other in assessment of other state's rulings. Which seems a bit of neglect on the part of the clerk toward whichever is the latter ruling.

Another quote form the ruling you posted is actually quite provacative and should spur some good discussion even in your absence.

" One comment from the Rosenberg court bears quotation here: "Chiropractic licensure also contemplates considerable education and knowledge on the part of the chiropractic practitioner with respect to the general field of diagnosis, presumably covering conditions that fall within the field of chiropractic as well as those more properly attributed to other licensed healing professions." (Rosenberg, supra, 492 A.2d at pp. 377-378, emphasis added.)

Let's compare Rosenberg with the situation in California. Interestingly enough, Rosenberg noted that in New Jersey at least, chiropractors must devote at least 300 class hours to diagnosis and symptomatolgy. (Id. at p. 378, fn. 3.) And that was in addition to even more time devoted to what one might think as the non-chiropractic subjects of bacteriology, pathology and laboratory techniques. If chiropractic were only about bone cracking, its practitioners presumably would never have to darken the door of the lab, or pay any attention at all to bacteria (like, as in the case before us, staph germs).​

O.k. BalkTalk, it looks like you win our previous discussion. I stand corrected. It appears that courts have held that the education is more similar than most allopaths might assert. But another quote fromthe same ruling declared that "in the universe of healing arts, chiropractic is a subset of medicine." So I have to believe there exist parts of the ruling that would upset both professions.

I am not your penpal, FoughtFyr. I don't have the inclination to respond to you point by point as you seem to have the need to do so with me.

Sorry, that's how I keep my thoughts organized.

The above reference refutes your absurd claim that somehow we are excused from diagnosis. And from that, your entire arguement falls apart as it is based on this assumption.

No, it suggests another court found differently. Given the fluid nature of law, I have to imagine the defense might still be atempted. Especially in WI where the case law is en pointe.

I think where you are confused is that yes, in Michigan, where the practice scope is very confined, if the DC cannot order the test to establish the diagnosis, the judge reasoned that there was no duty to diagnose. This was played out throught case law.

Seems reasonable. It is too bad you've left. I would be interested in your opinion on the discussion of the duty to refer to a specialist versus merely diagnosing in the cite you posted.

For instance, academically and theorectically, if a pt. had pyelonephritis and cannot order a UA and CBC by law, then he is, in effect, excused from being obligated to differentially diagnose that.

Again, seems reasonable. One question (for anyone), what is the obligation of the DC to test. In other words, what is the standard applied to see that the proper tests for medical conditions are ordered?

[However, Michigan is more the exception than the rule. In NJ, we have "physician" status and part of the responsiblity that goes with that is a duty to diagnose. Most states give a DC broad abillity to order tests.

Finally, again, you don't know what this child and RN mother was going through and the details of the case. The child could have had musculoskeletal H/A's (cervicogenic - that's neuro-talk there FoughtFyr) and then developed spinal menigitis in the course of treatment.

You are correct. I have no idea. I was providing my opinion, based on the article as provided. Something went on. There is no way a DA goes after a grieving mother without cause.

In fact, that's a very possible scenario given the mother's apparent confusion on how to treat the daughter and delayed proper treatment. She may have responded to chiropractic, then developed spinal mengititis. The patient is entitled to more than one condition.

Or the DC could have blatantly missed it.

Again, I was not stating fact, but my opinion. Your explanation is as plausible, but it wouldn't explain why a DA would risk the public wrath from charging a grieving mother.

We just don't know.

It's all speculation.

And part of being a professional, FoughtFyr, is KNOWING WHAT YOU DON"T KNOW, apparently something you struggle with or else you wouldn't be making comments on an area that's clearly not within your expertise.

Yeah, see, unlike you up until this post, I acutually cite my sources as I am not an expert. But the case you cited clearly stated that an allopath could provide expert testimony on the actions of a chiropractor...

Just say, "I don't know" and I think most here, including me, will have a greater respect for what comes out of your mouth.

I truly do not care what you think. I will continue to question the safety and efficacy of chiropractic. If it is one day proven - great. If not...

- H

 

[CFS]

Wow, FoughtFyr,

Do I detect a tone of aquiescence in your post? It's the one thing that could convince me to continue to talk, if we are really going to talk.

Thank you for changing your tone and I will change mine.

You write:

I will continue to question the safety and efficacy of chiropractic. If it is one day proven - great. If not...

If you would amend your statement to "question the safety and efficacy of certain chiropractic practices", I think many DC's, if not the majority could come on board, including me.

There is always a discrepancy between academia and practice. Many "practices", are put into chiropractic because of business reasons, not academic ones. They always deserve to be questioned.

Let me use your specialty as a comparison.

This is what goes on at a typical ER, everyday, but probably not advocated in medical school.

A person comes in with X complaint, let's say chest pain. They see a community college educated triage nurse RN, who's under pressure just as much as anyone else there, maybe more so given the shortage of RN's. She takes a history and some vitals. The nurse orders tests (a violation of scope of practice) because the attending ER physician has said, "All people with chest pain get chest x-rays and Chemistries/CBC" or whatever your standard is.

Later, let's say, an x-ray tech comes into perform x-rays, let's say portable and take a history. The pt. points to lower flank as site of pain, not really the chest.

Tech asks, "Have you seen a doctor yet?"

The pt. replies, "No, I haven't as a matter of fact. It seems busy here."

"You haven't seen a doctor?"

"No."

Either tech. notifies doctor of error in history and test is altered or tech. just does the chest x-ray and phlebotomist takes blood.

What's a few hundred extra dollars among friends, right?

Doctor comes in later and examines pt. and discovers abdominal pain and now thinks a KUB, preg. test, and UA should be done.

Now, forget the obvious violation that a nurse should not be ordering diagnostic tests. . .is this what medical school teaches you?

No, 10 to 1 bet MD school teaches you:

1. Take a history
2. Examine the pt.
3. Order tests
4. Form a DDX
5. Treat

But in practice, you have to move pts. along and you rely on your "extenders." How much this results in misdiagnosis or needless tests being charged to the healthcare system, I don't know. You at the mercy of the hospital sometimes. Let's get the testing in and do the exam later. . .

I am not pointing this out to embarrass you or any ER across the country. I am pointing this out to describe a fact that practicioners don't always do what they were taught and that goes for chiropractic as much as medicine.

If you want to point those out and be critical of any practices, I, and I think most DC's will have an open ear for the most part. Yes, some practices will meet stubborn resistance.

And yes, some practices by DC's are potentially dangerous, as dangerous as the ER practices.

One thing I admire about medicine is that you do take quality control more seriously than chiropractors do, although, in defense of DC's, I do think most DC's deep down know there's a QC problem. They are just probably poltically frightened of quality control and see it as a potentially damaging process vs. an enabling one.

 

[fab4fan]

With all due respect, CFS, your scenario is flat out stupid. Have you actually worked in an ED? Do you know any RNs who do triage? Do you understand what "clinical pathways" and "standing orders" are?

I can tell you that if I triaged a pt. with chest pain and just put him in a room to wait to be seen by the doc, I would have my head on a pike, and rightly so. Nurses working in the ED have a different working relationship with docs than nurses on a general medical unit. The docs I work with depend on me to get the ball rolling. If I don't at a minimum get labs and a 12-lead on a pt. with chest pain, for example, it makes the doc's job a lot harder and delays crucial treatment. BTW, how do you know what is/is not within a nurse's scope of practice? Have you looked at what the scope of practice is from state to state? Does "standard of care" mean anything to you?

It's just about laughable to say the triage nurse said the pt. had chest pain when in fact the pt. had flank pain. Do you honestly think we don't know how to do a basic assessment?

You don't like having your skills and education questioned. Neither do we. It is obvious you have no clue about what nurses do and in particular the level of skill ED nurses have.

I could go on a huge tirade about the chiros in my area. The bad ones far outnumber the good ones. I won't, out of respect for you. It would be nice if you could do the same, or at the very least, be minimally informed about nursing before you chose to portray nurses as ignorant and incompetent.

 

[fab4fan]

What's a few hundred extra dollars among friends, right?

Wrong. Maybe that's how you chiros think, but in my world, the pt. gets credited, and I get written up.

 

[fab4fan]

A couple other thngs:

It does not take an experienced triage nurse/ED nurse to know that a woman of childbearing age would need a preg. test with any c/o of chest pain/flank pain/abd. pain, and that radiology would need a heads up.

It doesn't take an experienced triage nurse /ED nurse to know that a pt c/o chest pain, then flank pain, then abd. pain is a huge red flag.

It's taking all of my self-control not to say what I really think about chiro.

 

[lawguil]

Wow, FoughtFyr,

Do I detect a tone of aquiescence in your post? It's the one thing that could convince me to continue to talk, if we are really going to talk.

Thank you for changing your tone and I will change mine.

You write:



If you would amend your statement to "question the safety and efficacy of certain chiropractic practices", I think many DC's, if not the majority could come on board, including me.

There is always a discrepancy between academia and practice. Many "practices", are put into chiropractic because of business reasons, not academic ones. They always deserve to be questioned.

Let me use your specialty as a comparison.

This is what goes on at a typical ER, everyday, but probably not advocated in medical school.

A person comes in with X complaint, let's say chest pain. They see a community college educated triage nurse RN, who's under pressure just as much as anyone else there, maybe more so given the shortage of RN's. She takes a history and some vitals. The nurse orders tests (a violation of scope of practice) because the attending ER physician has said, "All people with chest pain get chest x-rays and Chemistries/CBC" or whatever your standard is.

Later, let's say, an x-ray tech comes into perform x-rays, let's say portable and take a history. The pt. points to lower flank as site of pain, not really the chest.

Tech asks, "Have you seen a doctor yet?"

The pt. replies, "No, I haven't as a matter of fact. It seems busy here."

"You haven't seen a doctor?"

"No."

Either tech. notifies doctor of error in history and test is altered or tech. just does the chest x-ray and phlebotomist takes blood.

What's a few hundred extra dollars among friends, right?

Doctor comes in later and examines pt. and discovers abdominal pain and now thinks a KUB, preg. test, and UA should be done.

Now, forget the obvious violation that a nurse should not be ordering diagnostic tests. . .is this what medical school teaches you?

No, 10 to 1 bet MD school teaches you:

1. Take a history
2. Examine the pt.
3. Order tests
4. Form a DDX
5. Treat

But in practice, you have to move pts. along and you rely on your "extenders." How much this results in misdiagnosis or needless tests being charged to the healthcare system, I don't know. You at the mercy of the hospital sometimes. Let's get the testing in and do the exam later. . .

I am not pointing this out to embarrass you or any ER across the country. I am pointing this out to describe a fact that practicioners don't always do what they were taught and that goes for chiropractic as much as medicine.

If you want to point those out and be critical of any practices, I, and I think most DC's will have an open ear for the most part. Yes, some practices will meet stubborn resistance.

And yes, some practices by DC's are potentially dangerous, as dangerous as the ER practices.

One thing I admire about medicine is that you do take quality control more seriously than chiropractors do, although, in defense of DC's, I do think most DC's deep down know there's a QC problem. They are just probably poltically frightened of quality control and see it as a potentially damaging process vs. an enabling one.

Could you define what it is that chiropractors are? Are you alternative health care providers? Are you the typical eastern medicine providers? Or does it really depend on how you really care or decide to practice ....like, i guess I'll practice like an MD/DO because that's really what I wanted to do with my life, but didn't work out....or.....eastern medicine is a big scam and all your problems are a result of subluxations and it's interfering with you bodies nervious system and ability to function properly.....or......I only treat NMS conditions and I can also function as your primary care provider.

I'm so confused....it doesn't sound like there is training tailored for each particular style.....and how can a 3 or 4 year degree be so all-encompassing? (from primary care provider to NMS to extreme alternative "practitioner")

........and without hospital privilages or clinical education within a hospital setting or within the basic clinical rotations during your 3-4 year degree, how can you really learn how to diff. dx: or tx: patients if indeed you would like to act as a patients primary care provider?

Primary care physicians have a broad education across many disiplines sometimes refered to as a generalist.....further, specialist are trained as generalist before they specialize. So, are you a generalist or a specialist or is it simply undefined? Talking the language doesn't make you qualified to act as a PCP.....I think any nurse on the planet could talk in a language a chiropractor would be hard pressed to understand at times, but they don't go around acting like a doctor either. They practice within their own scope which if reflected in their education and experience......Do all chiropractors practice within their educational scope? I know all nurses do and all MD/DO/PT/PA/NP's do, but do chiropractors? What you practice as far as scope should be based on the content of the education and the experiences you will have as a result. The degree you are awarded (Dr, masters, BS, certificate) tells little about your education. the courses and the content of the courses that you study, clinical education and it's content, along with any standardized tests that a person must pass tell more of the story!

I know what john doe, MD -Family practice physician does and I know what Doe John, MD orthopedic sugeon does, or Pete the physical therapist...but I don't know what the hell I'm getting when I go to the 10 chiropractors in town who have a shingle outside their office that says Tom Smith, DC - Chiropractic physician. Granted, I know all of them will perfrom will ajustments everytime I see them, but what else? who knows! One bad one out of ten isn't a good ratio and I suspect that there could be two in town that would attempt to corrent subluxations all day long! L.

 

[wayttk]

Lawquil queries:
">>>
Do all chiropractors practice within their educational scope? "<<<

There is an immense amount of misinformation, declared as fact, on this board. Your confusion, as a result, can be appreciated. Perusing "This site" may help you to have a clearer. more accurate answer to your questions, than what is posted on this board(particularly by those that have never been to DC school, or others that have a personal axe to grind, or both). I think this will be very helpful to you.

http://www.spinedocsonline.com/

 

[611]

Lawquil queries:
">>>
Do all chiropractors practice within their educational scope? "<<<

There is an immense amount of misinformation, declared as fact, on this board. Your confusion, as a result, can be appreciated. Perusing "This site" may help you to have a clearer. more accurate answer to your questions, than what is posted on this board(particularly by those that have never been to DC school, or others that have a personal axe to grind, or both). I think this will be very helpful to you.

http://www.spinedocsonline.com/

Nice, but you can't help those who do not want to be helped or are not open to it.

 

[FoughtFyr]

Lawquil queries:
">>>
Do all chiropractors practice within their educational scope? "<<<

There is an immense amount of misinformation, declared as fact, on this board. Your confusion, as a result, can be appreciated. Perusing "This site" may help you to have a clearer. more accurate answer to your questions, than what is posted on this board(particularly by those that have never been to DC school, or others that have a personal axe to grind, or both). I think this will be very helpful to you.

http://www.spinedocsonline.com/

So, no chiropractors follow practices like the WCA? What about the "Gonstad" method? This website www.hartchirocenter.com says the Gonstad method is best. Hmm, what about accupuncture - some chiro say it works, others don't. The question was not what do "those who would like to practice evidence-based conservative care for non-surgical neuromusculoskeletal conditions" but rather what can the public expect when they walk into the average chiropractor's office. The standards in medicine are fairly uniform, are you suggesting that they are in chiropractic as well?

- H

 

[FoughtFyr]

Lawquil queries:
">>>
Do all chiropractors practice within their educational scope? "<<<

There is an immense amount of misinformation, declared as fact, on this board. Your confusion, as a result, can be appreciated. Perusing "This site" may help you to have a clearer. more accurate answer to your questions, than what is posted on this board(particularly by those that have never been to DC school, or others that have a personal axe to grind, or both). I think this will be very helpful to you.

http://www.spinedocsonline.com/

BTW - this seemingly conservative and rational site you offer has a link to a chiropractic forensics conference - sponsored by National. In it is a course

"8:45 - 9:30 Clayton Hopkins, DC, DABFP - .75 hours
Meeting by Accident...Developing Attorney Referrals
A diverse practice is a healthy practice. Each subset of your "patient population" has its own particular set of headaches and rewards. "Personal injury" patients require more detailed documentation and supervision (headache) than a wellness patient but the reimbursement is usually substantially greater (reward). Marketing your practice to the attorney referral sources can be easy and inexpensive (no headache) and result in significant income growth (big reward). I would like to share with you my
successes in marketing to this referral resource."​

How can your profession expect to be taken seriously when even those offered up as your most rational abide this type of course?

- H

 

[CFS]

Fab,

Yes, I have worked in an ER, in my past life. I could call any "tech" in here (as unbiased testimony) and have "war stories" shared. Another common mispractice is failure to place an ID tag on the ER patient, some estimates being as high as 1 in 20 patients. The last time I saw that happen was when the Director of Medical Education was a patient and bawled the nurse out (embarrassing for all) in front of everybody. Where the breakdown occurs on that, I don't know (on intake I guess) but we all know the dangers of that mispractice.

My diagnostic scenario may have not been well thought-out (I should try to think of very specific examples) but patients are often ("routinely" may be too strong of a word) funneled to testing prior to seeing the ER doctor.

It happens every day.

Don't deny it.

Don't try to excuse it.

It's not ideal practice and shouldn't be defended.

I'll admit I don't know the scope of practice for RN's but it is my understanding they don't have diagnostic privledges. If I am wrong, please correct me. I want legal references, not "Mary in XYZ Dept. at Mayo Hospital said it's okay I do this and it's my head on a platter if I don't."

Here is one reference: http://64.233.161.104/search?q=cach...ng+Scope+of+Practice&hl=en&gl=us&ct=clnk&cd=3

I don't see diagnostic prescriptive powers mentioned although a "nursing diagnosis" seems to be allowed.

I don't think a community college educated nurse should be ordering x-rays, lab work, etc. on my mother. I'll venture an opinion that most of the public feels this way. Now, if a PA or a CNP were doing the initial eval. and ordering tests, I would have no problem with that practice at all. But I don't think it is commonplace having those mid-level providers serving in that role as of yet.

Again, I am not saying this to embarrass you or one-up you or distract from the subject at hand - chiropractic. I truthfully wished you had just let it lie. It's to point out that there is discrepancy between ideal medicine/nursing (which functions under the medical license) and practice and also a discrepancy of ideal chiropractic and the practice of chiropractic.

Ideally, a DC will make an appropriate referral every time it is warranted. In reality, it won't happen and mostly because of business practices and procedures within the chiropractic practice.

Now. . .lest you think I am picking on you, let me turn the tables on my own profession to give you another bad practice. All chiro. schools teach taking of vitals, at least on the first visit. Often, that falls by the wayside in business and the "chronic back and neck pain practice" develops over the years. Then one day, a HTN H/A comes in or spinal mengititis case comes in and bam! it's over.

You at this forum and other forums are having a chiro-bashing party.

It's not a testimony against chiropractic as much as it's just practicioner laziness and complacency. Stuff we all did when we first graduated but then over the years, one takes short cuts for business reasons.

I guess the spinal meningitis case kind of got to me. There before the Grace of God goeth I. Despite having caught pathology on exam and x-ray that MD's have missed, I can fathom missing this and that's why I am quick to defend the automatic crucifixtion of this chiropractor by the forum.

I can recall another chiropractic malpractice case where nerve damage developed b/c the 22 year old had syringomyelia. Sometimes, there is nothing that could have been done. You can't go around MRI'ing everyone to r/out anything and everything.

That would be practicing Defensive Medicine and nobody here does that, right?

Right? Riiiiiiiigggggght.

You develop the best diagnostic impression you can and you go from there.

Finally, I don't really care what you think of chiropractors. Some nurses are so caught up in the medical system, it's practically impossible to get them to think outside the pharmaceutical box. Some are such a bunch of pill popping addicts, I just don't see hardly any point in talking to them. 9 years ago when I was new, I would have had the patience for it. Now, I don't. Other nurses love their chiropractor and chiropractic care given the nature of their occupation. It's a very bipolar opinion they have - they either hate or love chiropractic. Makes for fun party conversation. Truthfully, I found MD's more balanced nowadays, esp. if the MD is a non-white, non-male, non-older MD. It's the white, male, older MD that continues to struggle with chiropractic.

But let's ask the public opinion of the competence (let's not even go with service) at the average local ER.

I would say, "Most of them are "bad" would be the rule. The nurses are ill-experienced, newbies not often having the benefit of much clinical time, the doctor's distracted, and the compassion non-existent because the staff is "hardened."

I can recall one 13 year assault victim where the parent came back to see her and stood in their daughter's blood. The nurses didn't even clean her up (and they had the time). Truth is, they were just "kids" and didn't probably know/understand compassion.

Is that a fair assessment?

Am I being fair?

Or am I just handing some of what you hand chiropractic back to you?

I would sincerely wonder - who has the bigger "reputation problem?" The average DC or the average ER? My wife works PR for a hospital and let's just say she's on damage control a lot of the time (as well as pre-damage control, knowing that a screw-up is only around the corner, which I guess that's what PR is).

Empirically, I could fill up this thread with stories of "incompetence" at the local ER from my patients, all unsolicited. Why they feel compelled to tell me what happened 2 nights ago at the ER is beyond me.

I don't really care to know, but I do. I don't have an axe to grind as apparently many here do.

All in all, I sleep well at night with how I practice. I have made a difference, a small difference in my community and won't let anyone make me embarrassed of my degree/license or minimize or take away or minimize my contribution to their families.

I have learned a thing or two in dealing with medical professionals over the years - make them respect you, not like you. Too many DC's act as "If I am nice and make reasonable assertions and arguements, then they will see the error of their ways, they will like me and refer to me." It doesn't work.

You make them respect you, by taking what they have (NMS cases). Then you have what they want (pain management or radiology referrals), and then they like you.

"Gee, I love that CFS guy. . .he sends us 15 cases/month."

See how that works? You see? Even FoughtFyr respects me now, even if he doesn't like me.

I just don't know why I don't have more friends. I win all arguments all of time with my friends. . .I'm practically undefeated and yet cointinue to not have many friends.

I don't why this is. . .