Chiropractic

[FoughtFyr]

I'll agree with most of your statement. What you're describing is "straight chiropractic". There are only a few schools left that teach chiropractic that way.

It's not a suggestion, it's the truth. Chiropractic care is based upon theory and that is true. In fact, many professions have started with a theory. The thing is, when they found that the theory didn't work they changed. Our problem is we haven't changed. I have, or least I think I have, but the profession as a whole hasn't. I feel that with time chiropractic theories will cease to exist and schools will change the way they teach chiropractic. I don't think much of the philosophical hoopla will fly at FSU.

O.k. so we agree here. The theory of chiropractic is bunk. But listen to yourself. "I have (changed), or at least I think I have." So you are basing your practice on what? Self-study? Best guess? The problem is that while you may well be a very cautious and careful practitiioner, well learned in health care, there is NO reasonable "check" to insure this. The profession, which, by your own admission has not changed, has not standardized what the profession will be. There are no limits on what some some chiropractors feel, or are taught, they can treat. I strongly encourage you to continue your education in healhcare, if for no other reason than to insure you are not harming patients with gaps in your knowledge or training.

DCP (Doctor of Chiropractic Programs) says the curriculum required for the DCP must include gynecology and obstetrics. That is true. In fact; our courses in OBGYN were in depth but not to the extent that we learned how to deliver babies, at least not as a career. So yes, it is true we do not attend births. The reason we train in OBGYN is because we have patients who will present with female problems. We don't learn in order to treat but rather to recognize and refer. You should know that many female conditions can produce back pain that in itself is enough for a DC to learn OBGYN. Did you learn any thing about teeth in medical school? What the hell for? You're no Dentist! But if someone comes to your office with nasty tooth disease at least you have the training to recognize it and enough common sense to refer the patient to a specialist (aka Dentist). So you see the point?

Actually no, I don't see the point. I learned about teeth in medical school because, at that time, I had yet to specialize. I might well have become an maxofacial surgeon. As it stands, I am an emergency physician. So, I am called upon, from time to time, to be "a dentist", and at least stabilize oral illnesses and injuries. So, I guess it is good that I learned about teeth. It is also good that I learned many things I will not use, because I am part of an integrated profession that shares a basic theory, a common lexicon, and the authority to treat and transfer care between practitioners. I am held to that standard as set forth both by law and the prevailing "standards of care" regardless of my specialty. State and national boards have certified that I sucessfully complete a set course of training and that I passed examinations on the content of that training. There is no question between "straights" and "mixers", nor are there competing theories between schools. And I believe in what I was taught.

On the other hand, it takes no training to say, "ma'am it appears you are pregnant, go see an OB". The problem is that your training does not integrate with that of MD/DOs. You use different terminology, have different approaches, and are not part of the system.

I see you memorize Barrett's routine list of answers given by chiropractors . Maybe chiropractors use those phrases because most, if not all of the time, they're true.

"I never heard of this procedure" Well most of the information in the chirobase is outdated so this would qualify as a good response.

Except that I am talking about the cce-usa.org standards. Are they outdated as well?

"This certainly is not mainstream practice." I can think of many idiotic chiropractic procedures and techniques that would demand this response.

"Nobody I know does this" Well if it's not mainstream then it is very unlikely I know someone who does it.

"This is not taught in chiropractic colleges" which is basically the same as "It was not taught in my school" Most of the quackery that chiropractors practice, demand this response because most of the time it's true. Example: They do not teach us to cure cancer in chiropractic school yet many people claim chiropractors say they can cure cancer. The quack schools aren't even crazy enough to teach that.

Really, then why are they taught and practiced? Where are your standards? Who protects the public against these "idiots" (your word, not mine)?

"Every barrel has a few rotten apples. So does every profession." This statement is true no matter who says it.

O.k., I'll give you thaat.

"On the other hand, they might adress this with their second favorite tactic - attack the medical profession:" Well, we usually attack those who are attacking us. 95% of all attacks are from the medical profession so logically we attack them back.

See, that is where you are wrong. This is not an attack. It is pointing out that chiropractic does not meet the standards that the rest of health care does in terms of proof of efficacy, standards in training, or ethical business practices. If they did (meet these standards), I would gladly cheer them on. I have no illusions that MD/DOs exist in a vacuum. We need other, qualified health professionals to care for patients. We work, as a team, to maximize patient wellness.

"What about unnecessary surgery?" "What about overprescription of drugs?", "Medical errors are a serious and common problem.", "How come our malpractice rates are lower?" Basically, I guess chiropractors are saying "clean up your own yard before you **** in ours!"

You don't have a yard. You have a trash-filled lot at the end of the street with a shack on it. We just want you to stop trying to sell it as a mansion to our patients...

- H

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[FoughtFyr]

Alright then, where did you read that? My gown had three chevrons on the sleeve (not that I really care). My point is we are permitted to wear the academic dress of a doctor and do. Do a search on Google on chiropractic graduation "images" and you'll see what I mean.

And if a family member graduated from an institution (other than a chiropractic college) that allowed you to "hood" them, you wouldn't be allowed the three chevrons. How do I know? I seen it happen twice. A classmate of mine in MPH was a DC. While the MDs and Ph.D.s who were recieving their MPHs were allowed to wear their appropriate dress, he was not. Palmer was / is not a recognized doctoral school according to their standards. A classmate of mine in medical school was also not allowed to be hooded by his father, as the rules required that his "hooder" hold a doctorate. A DC was not acceptable.

Anyone can hold a graduation and wear whatever they want. But there actually are customs and standards that properly go with them...

- H

 

[FoughtFyr]

I don't think the website gives a full list of faculty members. I knew you would look so I looked first. I didn't even find a faculty list. If you did then it's possible he is no longer teaching which doesn't matter.

https://www.spinephysicians.org/dr3memnews.cfm

"Terry Yochum, D.C. During June of 2003, Dr. Terry Yochum, chiropractic radiologist and member of the AASP Academy Council was awarded Radiology Teacher of the Year by residents of the University of Colorado, School of Medicine, Department of Radiology. Each year graduating residents have the opportunity to honor the instructor who has provided the highest level of academic and clinical instruction. This is the seventh time Dr. Yochum has received this distinquished recognition. No other radiologist has achieved this acclamation more than twice."

http://www.chiroweb.com/archives/22/17/16.html

"Recognized as an outstanding teacher, Dr. Yochum was invited to lecture at the University of Colorado's School of Medicine, Department of Radiology. Dr. Michael Manco-Johnson put his reputation on the line and lobbied for Dr. Yochum to be appointed to a position on the staff at the medical school, teaching medical radiology residents skeletal radiology. The Yochum edge cut through the medical prejudices, and in his 13 years of teaching, the students have elected him "Outstanding Teacher of the Year" eight times."

Look, there are plenty of schools other than chiropractic that accept DC degrees and allow them to teach. I'm not going to list all of them. Dr. Yochum is teaching in medical school, thats why I choose him as an example.

List any others. And cite credible sources from the schools themselves stating that a DC is qualified to teach (other than chiropractic colleges).

I smell BS. The first article states he won the "award" for the seventh time in 2003. The second states he has won it 8 times (therefore, he must be on staff in 2004). But the school has no publically accessible record of him as being on staff. hmmm. Keep in mind that there is a difference between being asked to lecture and being on staff. In my undergraduate studies, we extensively discussed the qualifications for professorship. I've have sat on University wide committees on the subject. I think it is a very rare instance that a DC would be considered an acceptable qualifying degree.

- H

 

[BackTalk]

But listen to yourself. "I have (changed), or at least I think I have." So you are basing your practice on what? Self-study? Best guess?

The school I attended didn't teach chiropractic the same way that a straight chiropractic school does. We did not learn that subluxation causes all these crazy health problems and the magical cure was the "Chiropractic Adjustment". Basically the school concentrated on the treatment of NMS conditions. We did get some philosophy but the curriculum wasn't based on it. We received just enough to know how chiropractic started and that was about it. So I base my practice on what I learned in school and through post-graduate education.

The problem is that while you may well be a very cautious and careful practitiioner, well learned in health care, there is NO reasonable "check" to insure this.

In most states chiropractic is held to a medical standard. That standard is enforced by either the department of professional regulation or the chiropractic board of examiners. The problem is it's usually not enforced until someone gets hurt.

The profession, which, by your own admission has not changed, has not standardized what the profession will be. There are no limits on what some some chiropractors feel, or are taught, they can treat.

That's right. We have three camps "the mixers" and the "straights" and what I call the "pseudo straights". The straights (diehard philosophical chiropractors) do not treat any disease and they don't claim to. These people truly believe that what they do is real. They claim no responsibility for any conditions other than subluxation detection and removal. They can be dangerous because of missed DX and failure to refer. They do not take responsibility for any health conditions. Again, their only purpose is to find and remove subluxations. Most of the straights do not view medicine as bad or anything like that. Now the pseudo straights are the ones to watch out for. Give them a little education and they're dangerous. They are the "no limit" chiropractor, they're the ones who despise medicine, they feel that chiropractic manipulation can cure epilepsy or diabetes or whatever. The chiropractor of the patient you mentioned earlier sounds like one of these guys. Then you have the mixers who pretty much stick to NMS complaints. They also use other treatments besides chiropractic manipulation. Straights only use chiropractic manipulation and nothing else.

I strongly encourage you to continue your education in healhcare, if for no other reason than to insure you are not harming patients with gaps in your knowledge or training.

I've been in practice for 6 years. In those six years I've never had a patient that was harmed by my knowledge or training. That doesn't mean I'm perfect; in fact I'll admit I've missed a few diagnoses in those years. None of us are perfect 100% of the time and I don't care what specialty you are in. As an ER doc I'm sure you have missed a few and it's probably made you a better doctor because of it. Yeah, it sucks when it happens and you feel like a fool, but you learn from it. I'm not afraid to ask questions. I have many times called the patients medical doctor to consult on mutual patients. I've run by the radiologist's office for a quick read when I was unsure of something I've seen on the film. I do whats best for my patients.

Actually no, I don't see the point. I learned about teeth in medical school because, at that time, I had yet to specialize. I might well have become an maxofacial surgeon. As it stands, I am an emergency physician. So, I am called upon, from time to time, to be "a dentist", and at least stabilize oral illnesses and injuries. So, I guess it is good that I learned about teeth. It is also good that I learned many things I will not use, because I am part of an integrated profession that shares a basic theory, a common lexicon, and the authority to treat and transfer care between practitioners. I am held to that standard as set forth both by law and the prevailing "standards of care" regardless of my specialty. State and national boards have certified that I sucessfully complete a set course of training and that I passed examinations on the content of that training. There is no question between "straights" and "mixers", nor are there competing theories between schools. And I believe in what I was taught.

OK, I didn't know you were an ER doctor. Yeah that analogy wouldn't work well for you. You're confused. You question that chiropractors shouldn't study OBGYN because we won't be treating any OBGYN problems. My point was "we don't learn in order to treat but rather to recognize and refer" Why do you have a problem with that? Would you rather we not have this knowledge and your patients condition worsens due to lack of proper treatment? I don't get that. Even with the quacks in our profession, we still have set standards. Chiropractors have several examinations in and out of school. We have two sets of comp boards (oral and practical examination) in school that must be passed in order to enter the clinics. You must pass three sets of national board examinations in order to be eligible to take the state examination or take part four of the national boards (accepted by most states as a replacement for the state examination). Then there is an optional examination that some states require that covers physical therapy.

On the other hand, it takes no training to say, "ma'am it appears you are pregnant, go see an OB". The problem is that your training does not integrate with that of MD/DOs. You use different terminology, have different approaches, and are not part of the system.

If it doesn't take any training then what's the problem? The only difference in terminology is subluxation and the approach which is subluxation removal. That's the straight chiropractic camp and not all chiropractors live in that camp.

Except that I am talking about the cce-usa.org standards. Are they outdated as well?

I think so. Listen, I don't know every detail in the CCE rule book. Personally, I find no problem knowing that they require courses in OBGYN. Why you have a problem with that is beyond me.

Really, then why are they taught and practiced? Where are your standards? Who protects the public against these "idiots" (your word, not mine)?

I really do not know where these practices are taught. I think most of it comes from organizations outside the chiropractic educational system such as the World Chiropractic Alliance or The Foundation for the Advancement of Chiropractic Education and countless practice management groups like "Body by God" or "CJ Mertz" just to name a few.

Again the public is protected buy the department of professional regulation or the board of chiropractic examiners. Each state has its own rules and practice acts can very quite a bit between states. Chiropractors are like a inner city gang and protect there own. If the board of chiropractic examiners is in charge then violations of the practice act may be overlooked or the punishment may be just a verbal warning. Some states have quacks regulating quacks which is a big problem with this profession as most states make up their own rules. The stronger the chiropractic lobby the more freedom the chiropractors have. Illinois has a very strong chiropractic lobby and thus has one of the most liberal scopes of practice. But in Illinois, chiropractors are regulated by the medical disciplinary board which is mostly medical doctors with a one chiropractor. So in Illinois if you violate the practice act and get caught it probably won't be overlooked.

See, that is where you are wrong. This is not an attack. It is pointing out that chiropractic does not meet the standards that the rest of health care does in terms of proof of efficacy, standards in training, or ethical business practices. If they did (meet these standards), I would gladly cheer them on. I have no illusions that MD/DOs exist in a vacuum. We need other, qualified health professionals to care for patients. We work, as a team, to maximize patient wellness.

When chiropractors point out that most surgery is unnecessary, or that people are being over medicated and medical errors are the third largest cause death in the US, we're just doing what you're doing, "pointing it out"

You don't have a yard. You have a trash-filled lot at the end of the street with a shack on it. We just want you to stop trying to sell it as a mansion to our patients...

When you have the biggest trash dump in town and tell the guy at the end of the street with the little trash filled lot to clean it up, you're being a hypocrite.

 

[BackTalk]

And if a family member graduated from an institution (other than a chiropractic college) that allowed you to "hood" them, you wouldn't be allowed the three chevrons. How do I know? I seen it happen twice. A classmate of mine in MPH was a DC. While the MDs and Ph.D.s who were recieving their MPHs were allowed to wear their appropriate dress, he was not. Palmer was / is not a recognized doctoral school according to their standards. A classmate of mine in medical school was also not allowed to be hooded by his father, as the rules required that his "hooder" hold a doctorate. A DC was not acceptable.

Anyone can hold a graduation and wear whatever they want. But there actually are customs and standards that properly go with them...

Whatever, I wore the doctoral cap and gown along with the hood because I earned it. I even had my brother knight me as he is a fellow chiropractor. Then I went to the local medical school and walked around in my cap and gown and adjusted patients in the lobby. I even wore it to bed that night. Come on....find a parking spot for the ego....

List any others. And cite credible sources from the schools themselves stating that a DC is qualified to teach (other than chiropractic colleges).

What for? Until I prove you wrong? I already have. Dr. Yochum is proof of that and he taught in medical school with nothing more than a "DC". Maybe he's not on staff anymore, it doesn't matter, and the point of your argument was that no school would consider a "DC" as an acceptable qualifying degree. Well the University of Colorado Medical School must have changed the rules. How can so many quotes throughout the internet that are on chiropractic websites and off chiropractic websites be wrong? Are they all making it up?

Keep in mind that there is a difference between being asked to lecture and being on staff

Recognized as an outstanding teacher, Dr. Yochum was invited to lecture at the University of Colorado's School of Medicine, Department of Radiology. Dr. Michael Manco-Johnson put his reputation on the line and lobbied for Dr. Yochum to be appointed to a position on the staff at the medical school, teaching medical radiology residents skeletal radiology. The Yochum edge cut through the medical prejudices, and in his 13 years of teaching, the students have elected him "Outstanding Teacher of the Year" eight times."

 

[russellb]

When chiropractors point out that most surgery is unnecessary, or that people are being over medicated and medical errors are the third largest cause death in the US, we're just doing what you're doing, "pointing it out"

Most surgery is unnecessary? Do you have a reference for that, BT? I agree that some surgeries are unnecessary, but 'most' seems like an exaggeration. I also agree that some people are overmedicated.

Medical errors are the third leading cause of death in the US? I've heard this one dozens of times. It's related to a rather selective interpretation of a report published by the Institute of Medicine in 1999.

Here's a list from the CDC:

http://www.cdc.gov/nchs/fastats/lcod.htm

Deaths-Leading Causes

(Data are for U.S. in 2001)

Number of deaths for leading causes of death

Heart Disease: 700,142

Cancer: 553,768

Stroke: 163,538

Chronic lower respiratory diseases: 123,013

Accidents (unintentional injuries): 101,537

Diabetes: 71,372

Influenza/Pneumonia: 62,034

Alzheimer's disease: 53,852

Nephritis, nephrotic syndrome, and nephrosis: 39,480

Septicemia: 32,238


Here's a link to the Institute of Medicine report:

http://books.nap.edu/html/to_err_is_human/

This is the chapter of interest:

http://books.nap.edu/html/to_err_is_human/Ch2.PDF

 

[FoughtFyr]

Whatever, I wore the doctoral cap and gown along with the hood because I earned it. I even had my brother knight me as he is a fellow chiropractor. Then I went to the local medical school and walked around in my cap and gown and adjusted patients in the lobby. I even wore it to bed that night. Come on....find a parking spot for the ego....

And one of my friends got a mail order Doctor of Divinity degree. He now has a parking sticker declaring him a "clergyman". Doesn't make it right...

What for? Until I prove you wrong? I already have. Dr. Yochum is proof of that and he taught in medical school with nothing more than a "DC". Maybe he's not on staff anymore, it doesn't matter, and the point of your argument was that no school would consider a "DC" as an acceptable qualifying degree. Well the University of Colorado Medical School must have changed the rules. How can so many quotes throughout the internet that are on chiropractic websites and off chiropractic websites be wrong? Are they all making it up?

Nope. They aren't. On your earlier suggestion, I called the Department of Radiology (actually the contact for the Radiology Residency) at the University of Colorado, School of Medicine. Dr. Yochum is "volunteer clinical staff" who has been extended the sole courtesy of being allowed to add outside films (those taken in his office) to the University's Radiology teaching files. He does lecture, and sponsors an outside elective through the department. He is not now, nor has he ever been faculty. They require an MD/DO with board certification in Radiology or a Ph.D./Sc.D. in a relevant basic science for faculty / staff positions. The woman answering the phone was also quite adamant that Dr. Yochum does not practice clinically within the department and I quote "in any way, shape or form." She also stated that the constant internet references to Dr. Yochum on chiropractc sites has created a "significant" volume of phone inquiries to the department. She does state that he is a well liked lecturer but is quick to point out that he is not a formal member of the staff and recieves no compensation for his "work".

Face facts, the DC is not considered an academic degree outside of chiropractic colleges.

So my challenge stands. As in the other thread on the hiring of a "DC" by Harvard Medical School, I have listed references to the hiring standards for colleges and universities (in that case "The Purple Book"). Find one source, outside of institutions with chiropractic colleges, that accept the DC as meeting the requirements for professorship. And please, cite references other than chiropractic targeted popular media - otherwise my long distance bills will get too high. You know, something like an actual link to a university human resources website that states the DC is acceptable.

- H

 

[FoughtFyr]

The school I attended didn't teach chiropractic the same way that a straight chiropractic school does. We did not learn that subluxation causes all these crazy health problems and the magical cure was the "Chiropractic Adjustment". Basically the school concentrated on the treatment of NMS conditions. We did get some philosophy but the curriculum wasn't based on it. We received just enough to know how chiropractic started and that was about it. So I base my practice on what I learned in school and through post-graduate education.

You do realize, as I have posted before, that the only Medicare authorized Chiropractic care is the treatment of subluxations demonstrable on radiograph. From the OIG (available online at: http://oig.hhs.gov/oei/reports/oei-04-97-00490.pdf)

"In 1965, title XVIII of the Social Security Act created Medicare to provide health insurance for people 65 and over, people who are disabled, and persons with permanent kidney failure. Medicare has two parts: Hospital Insurance (Part A) and Medical Insurance (Part B). In 1972, Section 273 of the Social Security Amendment (P.L. 92-603) expanded the definition of physician under Part B of Medicare to include chiropractors. This made chiropractors eligible to participate in the Medicare program. However, the only Medicare reimbursable chiropractic treatment is manual manipulation of the spine to correct a subluxation demonstrated by X-ray.{emphasis added}"

BTW - according to the OIG site (at: http://exclusions.oig.hhs.gov/bygclass.html) 1,805 chiropractic practices are excluded from doing business with Medicare. To be fair, 4,115 medical practices are, but per capita, that gives chiropractors a horrible rate.

So I take it you do not bill Medicare as you do not believe in subluxations?

O.k., if so, that is fair, but do you realize that any physician who does cannot leagally refer any patient to you? We are not allowed to differentiate in the care, or physician recommended follow up, between patients on Medicare on those who are not. This includes recommending Medicare covered services from non-participating providers. If we do, it can be considered Medicare fraud and fines of up to $10,000 per patient can (and have) be(en) imposed. And it was the chiropractors, over the strong objections of the AMA, who won that definition (for chiropractic care) from Medicare.

BTW - As you have been so good as to admit that subluxations are not the cause of all health ailments, and you freely admit that you treat NMS conditions other than subluxations; you have effectively ended the debate. I will always recommend PTs as opposed to chiropractors for the simple reason that it is technically illegal for me to do otherwise. PT services are covered by Medicare. Other than subluxations, chiropractic care is not. As an EP, I treat many Medicare patients. I don't see myself risking $10,000 fines just to send some patients your way...

- H

 

[BackTalk]

Come on buddy, I was just saying when chiropractors (not me necessarily) say those things; they're just pointing it out and not attacking.

However, I do agree on the overmedication part. I see an awful lot of patients whose doctors recommend surgery. No I do not have any references that show "most surgery is unnecessary" but what do think about back surgery? Do you think that it's over utilized for the results it produces?

As far as questioning the third cause of death goes. I believe at the time the IOM study was saying it was the eighth cause of death. Also keep in mind "these reports were based only on hospital admissions, the real number of deaths from medical errors in a doctor's office, such as misdiagnosis or delayed treatment, may be much higher."

And one of my friends got a mail order Doctor of Divinity degree. He now has a parking sticker declaring him a "clergyman". Doesn't make it right...

As you said its "arcane and esoteric trivia" and I agree with that. It's meaningless to this discussion. Right or wrong it won't change what graduates of chiropractic colleges wear to the ceremony. It will be interesting to see what FSU allows the chiropractic graduates to wear.

The woman answering the phone was also quite adamant that Dr. Yochum does not practice clinically within the department and I quote "in any way, shape or form."

Interesting how someone who is not now, nor has he ever been faculty has won the prestigious teacher or instructor of the year award eight times. At the time of the interview below, it was a record 7 times. Sorry but I will have to disagree with you and whomever you talked to.

http://www.theamericanchiropractor.com/articledetail.asp?articleid=228&category=8

Here is part of an interview with Dr. Yochum published this year....

TAC= The American Chiropractor Magazine

TAC: You?re on the faculty of the University of Colorado School of Medicine, as well. Tell us for how long and how did this come about?

Yochum: I have been on the faculty of the University of Colorado School of Medicine, Department of Radiology, since June 1991. They were using my textbook as a teaching aid and had lost their Musculoskeletal Radiologist. Dr. Michael Manco-Johnson called and asked me if I would consider giving some lectures at the University to the Department of Radiology and the residents. I agreed to do so, and the lectures were well received. Wanting to secure me as a faculty member to teach within the department and interact with the faculty and residents, he asked if I would consider applying for a faculty position. I, of course, was elated to do so and he fought very hard for me for this appointment, which I am now very thankful for. I am pleased to tell you that I have won the ?Teacher of the Year? award seven times in the last thirteen years, which is an award given at the medical school graduation by the graduating radiology residents. They vote on the teacher that they feel has given them the most throughout their final academic year. I do believe that I am the only Chiropractic Radiologist in the world on the faculty of a University Medical School teaching Skeletal Radiology.

This seems to be a pet peeve of yours. I'll stick with what I said thus far. Why don't you call Dr. Michael Manco-Johnson and see what he says. It's not that important to me to prove that DC's exist as faculty members in colleges other than chiropractic, with only chiropractic education. I know its true.

You do realize, as I have posted before, that the only Medicare authorized Chiropractic care is the treatment of subluxations demonstrable on radiograph. From the OIG (available online at: http://oig.hhs.gov/oei/reports/oei-04-97-00490.pdf)

No I didn't realize you posted before about Medicare, hmmmm it too bad your statement is wrong. Medicare does not require a DC to demonstrate subluxation via x-ray in order to be reimbursed.

So I take it you do not bill Medicare as you do not believe in subluxations?

Medicare's definition of Subluxation.--Subluxation is defined as a motion segment, in which alignment, movement integrity, and/or physiological function of the spine are altered although contact between joint surfaces remains intact.

I agree with this definition and therefore not committing fraud. Also, I follow Medicare guidelines which state "to demonstrate a subluxation based on physical examination, two of the four criteria under physical examination P.A.R.T list are required, one of which must be asymmetry/misalignment or range of motion abnormality" I use the P.A.R.T examination process.

P.A.R.T. Examination:

(P) Pain ? Most primary neuromusculoskeletal disorders manifest primarily by a painful response. Pain and tenderness findings may be identified through one or more of the following: observation, percussion, palpation, provocation, etc. Furthermore pain intensity may be assessed using one or more of the following: visual analog scales, algometers, pain questionnaires, etc.

Pain/tenderness evaluated in terms of location, quality, and intensity

(A) Asymmetry/misalignment ? Asymmetry/misalignment may be identified on a sectional or segmental level through one or more of the following: observation (posture and gait analysis), static palpation for misalignment of vertebral segments, diagnostic imaging, etc.

Asymmetry/misalignment identified on a sectional or segmental level

(R) Range of motion abnormality ? Range of motion abnormalities may be identified through one or more of the following: motion, palpation, observation, stress diagnostic imaging, range of motion measurements, etc.

Range of motion abnormality (changes in active, passive, and accessory joint movements resulting in an increase or a decrease of sectional or segmental mobility); and ligament.

(T) Tissue/Tone texture may be identified through one or more of the following procedures: observation, palpation, use of instruments, tests for length and strength etc.

Tissue, tone changes in the characteristics of contiguous, or associated soft tissues, including skin, fascia, muscle, and ligament.

O.k., if so, that is fair, but do you realize that any physician who does cannot leagally refer any patient to you? We are not allowed to differentiate in the care, or physician recommended follow up, between patients on Medicare on those who are not. This includes recommending Medicare covered services from non-participating providers. If we do, it can be considered Medicare fraud and fines of up to $10,000 per patient can (and have) be(en) imposed. And it was the chiropractors, over the strong objections of the AMA, who won that definition (for chiropractic care) from Medicare.

Don't worry about it; chiropractors do not need a referral from anyone in order to see Medicare patients. Also, does anything Medicare does ever make any sense? The system is run by the government so what does that tell you?

BTW - As you have been so good as to admit that subluxations are not the cause of all health ailments, and you freely admit that you treat NMS conditions other than subluxations; you have effectively ended the debate. I will always recommend PTs as opposed to chiropractors for the simple reason that it is technically illegal for me to do otherwise. PT services are covered by Medicare. Other than subluxations, chiropractic care is not. As an EP, I treat many Medicare patients. I don't see myself risking $10,000 fines just to send some patients your way...

As a doctor you can refer to whoever you want. There will come a day when Medicare will be overhauled and Medicare will be reimbursing chiropractors (as they should) for all the services they are allowed to perform per scope of practice. It will include x-rays, examinations and physical therapy. The plan is already in works. It will save money in the long run as we will not have to refer the patient back to the MD who then orders the film. Give it a couple years then you can refer your patients to me without fear of being fined.

 

[russellb]

I see an awful lot of patients whose doctors recommend surgery. No I do not have any references that show "most surgery is unnecessary" but what do think about back surgery? Do you think that it's over utilized for the results it produces?

It probably is overutilised based on the relatively ordinary results it produces, although that's really more of a judgement call on my part than based on hard data. My feeling is that L-spine surgery will become more limited in the near future to very specific patient groups.

I believe at the time the IOM study was saying it was the eighth cause of death. Also keep in mind "these reports were based only on hospital admissions, the real number of deaths from medical errors in a doctor's office, such as misdiagnosis or delayed treatment, may be much higher."

And as our ability to diagnose and treat more conditions continues to increase, then you can expect the number of deaths related to medical error to increase. That's something that you really have to keep in mind when you interpret these findings and that's part of why I mentioned that I feel that this report is often misquoted and misinterpreted.

Think of it this way, BT: if we are eventually able to effectively diagnose and treat all conditions, then the ONLY cause of death would be medical error. I'll give you an illustrative example. Think of screening mammography. Based on the available evidence (which is quite controversial, I should add), we think that lives are saved by screening mammo. However, given the number of mammos read, there will always be a certain number of cancers that are missed, i.e., medical errors. The single best way to get rid of these errors would be to eliminate the test. But, presumably, getting rid of the test would cost lives. The more that we can do, the higher the bar is raised.

It's really an issue of seeing the forest for the trees in that the results of the report have to be placed in proper perspective. It's easy to quote the numbers. It's much harder to look very carefully at them in an attempt to understand what they really mean.

 

[FoughtFyr]

Interesting how someone who is not now, nor has he ever been faculty has won the prestigious teacher or instructor of the year award eight times. At the time of the interview below, it was a record 7 times. Sorry but I will have to disagree with you and whomever you talked to.

Actually, it is not. The "instructor of the year" is not necessarily limited to faculty. I know of at least one school that has given the award to a resident. Dr. Yochum is not faculty, but he does teach. I'll grant that. He is currently and actively instructing - as a "volunteer community instructor". That is not a faculty position, and there are no rule about who may serve a such a capacity. Many medical schools have nurses in a similar role. At my school an RN did win "teacher of the year" as did a LSW. But niether were faculty. And yes, it does make a difference. A professorship, and the tenure that can be obtained, is an extremely high honor in academic medical circles.

Dr. Yochum does absolutely nothing to refute my argument that the DC is not considered an academic degree outside chiropractic circles.

No I didn't realize you posted before about Medicare, hmmmm it too bad your statement is wrong. Medicare does not require a DC to demonstrate subluxation via x-ray in order to be reimbursed.

Actually, it does. What I posted was a direct quote from a Medicare document, not my take on it. The cited source was included as a hyperlink.

Don't worry about it; chiropractors do not need a referral from anyone in order to see Medicare patients. Also, does anything Medicare does ever make any sense? The system is run by the government so what does that tell you?

No debate on any of the above, but this thread was, at least at one point, on the relationship between PT and chiropractic and how physicians fit in. I fit where I keep out of trouble with the federal government.

As a doctor you can refer to whoever you want. There will come a day when Medicare will be overhauled and Medicare will be reimbursing chiropractors (as they should) for all the services they are allowed to perform per scope of practice. It will include x-rays, examinations and physical therapy. The plan is already in works. It will save money in the long run as we will not have to refer the patient back to the MD who then orders the film. Give it a couple years then you can refer your patients to me without fear of being fined.

Except that by your own admission / description the profession of chiropractic can not seem to cohesively decide what their practice is based on, yet alone what its scope should be...

- H

 

[BackTalk]

Actually, it is not. The "instructor of the year" is not necessarily limited to faculty. I know of at least one school that has given the award to a resident. Dr. Yochum is not faculty, but he does teach.

Did you read the quote from the TAC magazine? Dr. Yochum specifically says: I do believe that I am the only Chiropractic Radiologist in the world on the faculty of a University Medical School teaching Skeletal Radiology.

Why would a man with such an impeccable reputation make such a statement if it weren't true? I think I have provided enough proof already and my opinion remains unchanged.

Dr. Yochum does absolutely nothing to refute my argument that the DC is not considered an academic degree outside chiropractic circles.

I think it does. They obviously trust him enough to use his textbook in medical school. I would imagine if they thought his degree was of no academic value, they wouldn't even consider a textbook written by a chiropractor.

Actually, it does. What I posted was a direct quote from a Medicare document, not my take on it. The cited source was included as a hyperlink.

Your hyperlink and the information it contains is outdated. After 2000 Medicare no longer requires an x-ray to demonstrate subluxation. That is if the doctor uses the examination process I outlined earlier (PART). By using the PART examination you can be a chiropractor and treat Medicare patients without believing the philosophical chiropractic definition. If the doctor does not use the PART examination process they can use a new or prior x-ray, MRI or CT. I think your argument was that since I do not believe subluxations exist (the philosophical chiropractic definition) then I am billing Medicare fraudulently. That's not true as the Medicare definition of subluxation does not say anything about nerve interference or innate intelligence or anything like that. The definition can be met fairly easily through x-ray. Most Medicare patients have degenerative arthritis which is visible on x-ray. Many times degenerative arthritis affects alignment, movement integrity, and/or physiological function of the spine and contact between joint surfaces remains intact which, is the Medicare definition.

No debate on any of the above, but this thread was, at least at one point, on the relationship between PT and chiropractic and how physicians fit in. I fit where I keep out of trouble with the federal government.

It's OK to be cautious with the FEDS and especially the IRS. I don't blame you for that. But, you could still refer a patient to chiropractor and not get in trouble. I think if you found someone that was a member of the NACM http://www.chiromed.org/ you wouldn't have any problems. I often see Medicare patients that have been to PT and everywhere else with no relief. In fact, I see it all the time. This is not a slam against PT or anything like that. Medicare patients seem to respond well to chiropractic NMS care, thats all.

Isn't your brother in law a chiropractor or something? I thought you mentioned someone in your family was a chiropractor and was taking all sorts of goofy pediatric seminars.

 

[FoughtFyr]

Did you read the quote from the TAC magazine? Dr. Yochum specifically says: I do believe that I am the only Chiropractic Radiologist in the world on the faculty of a University Medical School teaching Skeletal Radiology.

Why would a man with such an impeccable reputation make such a statement if it weren't true? I think I have provided enough proof already and my opinion remains unchanged.

So call there yourself. My opinion, likewise, remains unchanged. He is not a professor. You assume the quote is verbatim accurate. I wouldn't make that assumption about any media outlet. Likewise, we do not know if Dr. Yochum was adjusting his lexicon to the occasion. I trust the website listings of current faculty, the University's phonebook (also listing current faculty), and the discussion I had with the program.

As I said, he does teach. He is not a professor, nor does he posess the qualifications to be.

BTW - if we are to take the quote above as gospel, a point I am not conceding, then he still bolsters my arguement. One chiropractor who admits his boss took a HUGE risk allowing him to lecture, does not prove that the DC is generally regarded as an academic enough degree to teach at the university level.

I think it does. They obviously trust him enough to use his textbook in medical school. I would imagine if they thought his degree was of no academic value, they wouldn't even consider a textbook written by a chiropractor.

Now you take me out of context. There are any number of authors to textbooks frequently used in medical school and residency programs that do not hold academic standing to become professors. In my field, several paramedics have authored chapters of texts in common use. Some lecture as a matter of routine. That does not make them eligible for positions as professors.

Your hyperlink and the information it contains is outdated. After 2000 Medicare no longer requires an x-ray to demonstrate subluxation. That is if the doctor uses the examination process I outlined earlier (PART). By using the PART examination you can be a chiropractor and treat Medicare patients without believing the philosophical chiropractic definition. If the doctor does not use the PART examination process they can use a new or prior x-ray, MRI or CT. I think your argument was that since I do not believe subluxations exist (the philosophical chiropractic definition) then I am billing Medicare fraudulently. That's not true as the Medicare definition of subluxation does not say anything about nerve interference or innate intelligence or anything like that. The definition can be met fairly easily through x-ray. Most Medicare patients have degenerative arthritis which is visible on x-ray. Many times degenerative arthritis affects alignment, movement integrity, and/or physiological function of the spine and contact between joint surfaces remains intact which, is the Medicare definition.

O.k., if my link is outdated, please provide the more current government reference.

It's OK to be cautious with the FEDS and especially the IRS. I don't blame you for that. But, you could still refer a patient to chiropractor and not get in trouble.

Well, that would lead to a completely different discussion as to the standard of care.

I think if you found someone that was a member of the NACM http://www.chiromed.org/ you wouldn't have any problems.

Then, under Medicare, I am back in trouble. As you and PublicHealth have posted previously, the NACM represents a minority of chiropractors. I would need to have at least three in my area before I do not violate the antitrust provisions of the relevant acts. I understand that some physicians take this risk. Many do so blindly. Almost none of my knowledge regarding Medicare regulations came from medical school, but rather from my MPH.

Isn't your brother in law a chiropractor or something? I thought you mentioned someone in your family was a chiropractor and was taking all sorts of goofy pediatric seminars.

Actually, he is a "pseudo-mixer" and a complete nut. What he did was take the L.C.P. (Legion of Chiropractic Philosophers) honorary award coursework at Palmer. He described this to the rest of the family as an "honorary Ph.D.", and stated that his "research" for this award enabled him to be a pediatric chiropractor. There is nothing on Palmer's website that indicates the L.C.P. has anything at all to do with kids, and he is not a diplomate of pediatric chiropractic.

BTW - he practices in Illinois. He routinely advises against vaccinations, argues for the right to perform school physicals, and, in addition to his claims to be a pediatric chiropractor, he also touts himself as a primary care physician. He does believe that he can treat any condition, short of significant trauma, that presents to him. He also believes he is qualified to attend births, and has found a midwife who agrees with him (based on his coursework at Palmer - see my bias about OB/GYN training? A little knowledge is a dangerous thing...). So, he will be delivering his own child, at home. This will permit him to not only care for his wife (keeping her of the hands of "evil" MDs), but also to immediately adjust his infant to relieve the problems of "birth trauma".

BackTalk, I would fully support a system where chiropractors such as those in the NACM, represent a viable alternative to "traditional" PT in the same fashion that DOs complement MDs. I do agree that different approaches and philosophies are good for patients and the art of healthcare as a whole. Unfortunately, in order for this to occur two things would have to occur that never will.

First, chiropractors would have to agree that medical clearance, at the minimum, was necessary prior to beginning treatment. Realistically, I have a difficult time believing that in three years of school, a chiropractor (or anyone else) can learn not only the science and art of treating NMS problems but also become sufficently expert as to exclude other significant medical conditions.

Second, chiropractic would have to "clean house" of the nutjobs who practice unsupported techniques far beyond the scope of NMS problems. Medicine does the same. Anyone who practices outside their scope will lose (in order of severity) their hospital privledges, insurance, and license. Chiropractors do not have near this level of oversight.

Like I said, it will never happen...

- H

 

[FoughtFyr]

Hey BackTalk, quick question, I had posted this on another thread, but you didn't see it or "bowed out". What is your opinion/reaction to these studies?

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=10768681&dopt=Abstract

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

It seems to me that the NIH studies "in favor" of chiropractic, detailed to in an earlier post on the "Chiropractors in the VA" thread, indicate that chiropractic is only "as effective" as traditional therapy. Given the risks demonstrated above, why is it that medicine should "accept" chiropractic? No real improvements and lots of risks...

- H

 

[BackTalk]

Actually, it is not. The "instructor of the year" is not necessarily limited to faculty.

Really? Are you part of the faculty of UC School of medicine? How do you know?

Dr. Yochum is not faculty, but he does teach. I'll grant that.

So you're saying that he is not faculty, yet he teaches there. Do you have your own definition of faculty or something?

So call there yourself. My opinion, likewise, remains unchanged. He is not a professor.

Never said he was a professor. I said he was part of the faculty who teaches skeletal radiology.

You assume the quote is verbatim accurate. I wouldn't make that assumption about any media outlet.

I've read it from more than one media source so its nothing new to me. With a reputation like Dr. Yochums, he really doesn't need to adjust his "lexicon to the occasion".

I trust both the website listings of current faculty, the University's phonebook (also listing current faculty), and the discussion I had with the program.

Maybe Dr. Yochum choose not to be listed so he wouldn't be subjected to this type of discrimination.

As I said, he does teach. He is not a professor, nor does he posess the qualifications to be.

As I said, he's on staff, the "DC" degree is an acceptable degree and he's soooo good students have voted for him and he has won "teacher of the year" a record eight times.

Now you take me out of context. There are any number of authors to textbooks frequently used in medical school and residency programs that do not hold academic standing to become professors. In my field, several paramedics have authored chapters of texts in common use. Some lecture as a matter of routine. That does not make them eligible for positions as professors.

So you are saying that medical schools will use textbooks written by just about anyone with no regard for their credentials?

Now are we playing semantics again? So you're saying faculty=professor? You basically agreed with me let's not quibble over semantics.

O.k., if my link is outdated, please provide the more current government reference.

http://www.wpsic.com/medicare/policies/wisconsin/chiro1.shtml

Read the part that says:Effective for claims with dates of service on or after January 1, 2000, an x-ray is not required to demonstrate the subluxation.

Then, under Medicare, I am back in trouble. As you and PublicHealth have posted previously, the NACM represents a minority of chiropractors. I would need to have at least three in my area before I do not violate the antitrust provisions of the relevant acts. I understand that some physicians take this risk. Many do so blindly. Almost none of my knowledge regarding Medicare regulations came from medical school, but rather from my MPH.[/b]

Personally I am not for the NACM but figured a chiropractor who was a member would be acceptable for you. Your right, you need to stay away from Medicare altogether, the stress is too much for you to handle.

Actually, he is a "pseudo-mixer" and a complete nut. What he did was take the L.C.P. (Legion of Chiropractic Philosophers) honorary award coursework at Palmer. He described this to the rest of the family as an "honorary Ph.D.", and stated that his "research" for this award enabled him to be a pediatric chiropractor. There is nothing on Palmer's website that indicates the L.C.P. has anything at all to do with kids, and he is not a diplomate of pediatric chiropractic.

Now I understand why you are so prejudice against the chiropractic profession. Man, I have never heard of the "Legion of Chiropractic Philosophers". Just by their name I can tell they're quacks. Palmer is where it all started and they still cling to those outdated unproven chiropractic theories. It's like they just can't get out from underneath it. Changing the name of the school would be a start. LCP is just another quack outfit that's unrelated to the chiropractic colleges. Again, a lot of the quackery within the profession is not taught in school but rather by these renegade gangsters of healthcare who start their on groups.

BTW - he practices in Illinois. He routinely advises against vaccinations, argues for the right to perform school physicals, and, in addition to his claims to be a pediatric chiropractor, he also touts himself as a primary care physician. He does believe that he can treat any condition, short of significant trauma, that presents to him. He also believes he is qualified to attend births, and has found a midwife who agrees with him, so, he will be delivering his own child, at home. This will permit him to not only care for his wife (keeping her of the hands of "evil" MDs), but also to immediately adjust his infant to relieve the problems of "birth trauma".

Russellb, has changed my thoughts on vaccination considerably. Personally, I wouldn't advise parents on vaccination issues. We just do not have the training to do that. If we learn anything in chiropractic school about vaccination it's usually something bad. So the parents only receive one part of the story. As a medical doctor you should question him on what gives him the knowledge and authority to advise against vaccination.

Chiropractors can go for a diplomate in pediatrics upon graduation. From what I understand, he didn't even do that but tells people he is a pediatric chiropractor. It funny, most of the chiropractors that choose the pediatric program are quacks. They preach against vaccination and also think they can cure all sorts of childhood illnesses such as ear infections.

PCP? A chiropractor really cannot function in that capacity even though Illinois statute says we are primary care providers. There is not much we can do for people with heart problems, diabetes or infections just to name a few. The only thing we can do is refer them. I do agree with him for the right to perform school physicals. I do pre-employment physicals, sports physicals and DOT physicals. In Illinois it is legal for DC to do a school physicals. The problem is not all schools will honor it. The problem has to do with the school code and not state law. The school code specifically draws out who is allowed to perform school physicals and chiropractors are not acknowledged. I believe it allows nurses and PA's. With that said its a slap in our faces. This is something that chiropractors are fighting for in Illinois. It didn't make it to the table this year, but I believe it will next year. Does this guy you speak of practice near St. Louis?

He is crazy to have a home birth as he's not qualified to handle any emergencies that may arise and neither is the midwife. This guy is crazy and he is putting his wife and unborn child at risk. When you mean "attending" do mean actually delivering the baby?

BackTalk, I would fully support a system where chiropractors such as those in the NACM, represent a viable alternative to "traditional" PT in the same fashion that DOs complement MDs. I do agree that different approaches and philosophies are good for patients and the art of healthcare as a whole. Unfortunately, in order for this to occur two things would have to occur that never will.

First, chiropractors would have to agree that medical clearance, at the minimum, was necessary prior to beginning treatment. Realistically, I have a difficult time believing that in three years of school, a chiropractor (or anyone else) can learn not only the science and art of treating NMS problems but also become sufficently expert as to exclude other significant medical conditions.

Second, chiropractic would have to "clean house" of the nutjobs who practice unsupported techniques far beyond the scope of NMS problems.

Like I said, it will never happen...

You're right that it won't happen. First, I feel confident that we do not need medical clearance to begin treatment. We don't need the RD giving us permission to treat patients. Also, it would never work because MD's don't refer to chiropractors to begin with. We already have that problem with the PCP being gatekeeper for the HMO's.

Chiropractic school is 4 academic years not 3. Medical school is 4 academic years right? Most students that enter into chiropractic school have a bachelor's degree; those that don't still have to take the same pre-medical studies that medical doctor's take (physics, chemistry, organic etc) which, can be crammed into an accelerated program.

I agree with the last one. Absolutely!

 

[BackTalk]

Hey BackTalk, quick question, I had posted this on another thread, but you didn't see it or "bowed out". What is your opinion/reaction to these studies?

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=10768681&dopt=Abstract

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

It seems to me that the NIH studies "in favor" of chiropractic, detailed to in an earlier post on the "Chiropractors in the VA" thread, indicate that chiropractic is only "as effective" as traditional therapy. Given the risks demonstrated above, why is it that medicine should "accept" chiropractic? No real improvements and lots of risks...

- H

This is interesting. I'll admit that I'm not very good at analyzing research data. Russelb is the man when it comes to these studies. He makes an honest unbiased evaluation of the data. Maybe he will comment.

Attitudes on immunization: a survey of American chiropractors. The sample in this study was only one percent of American chiropractors and of that 1% only 37% responded. The sample is to low to accurately come to the conclusion that a "significant" number of chiropractors harbor anti-immunization sentiment. It is probably true that a significant number of chiropractors do harbor anti-immunization sentiments but this study doesn't prove it.

I really do not know what to make of the remaining studies. I do agree more research should be done concerning strokes and chiropractic care. I didn't read the VA thread. Not sure what you are asking, could you rephrase the question?

 

[FoughtFyr]

So you're saying that he is not faculty, yet he teaches there. Do you have your own definition of faculty or something?

No, while the definition varies from institution to institiution, a general definition is "limited to regular, full-time personnel at institutions whose regular assignments include instruction, research, and/or public service as a principal activity, and who hold academic rank as professor, associate professor, assistant professor, or instructor at the institution."

It has to do with the ability to determine the content of coursework freely and without significant oversight. For this reason many schools further define by "tenure-track" and non-tenure track". But in either case the standards for faculty are much higher than those to lecture or instruct.

EDIT: In most cases the doctorate degree is the minimum requirement for faculty membership. This discussion began as I believe that most universities do not consider the DC a "doctorate" in this sense. I still yet yet to see an institution, other than a Chiropractic College, that will accept a DC as a qualifying degree for faculty admission. The question of who actually teaches classes is not part of my argument. The other side of this is that DPTs may be acceptable outside of PT departments in areas such as physiology or kinesthesiology (sp?).

Never said he was a professor. I said he was part of the faculty who teaches skeletal radiology.

And I disagree. He is "volunteer clinical staff". Semantics yes, but with significant import inside of academia.

Maybe Dr. Yochum choose not to be listed so he wouldn't be subjected to this type of discrimination.

Or maybe he is not employed by the University but volunteers his time to teach...

As I said, he's on staff, the "DC" degree is an acceptable degree and he's soooo good students have voted for him and he has won "teacher of the year" a record eight times.

Ahh, now we agree. He is "on staff", not faculty.

So you are saying that medical schools will use textbooks written by just about anyone with no regard for their credentials?

No, I'm saying the credentials needed to write texts differ from those needed for faculty status. Many residents write textbook chapters, that doesn't make them professors.

Now are we playing semantics again? So you're saying faculty=professor? You basically agreed with me let's not quibble over semantics.

Semantics, sort of. I guess there is a difference betweeen calling someone an officer and calling them a general. And both are soldiers. It is a matter of academic rank.

http://www.wpsic.com/medicare/policies/wisconsin/chiro1.shtml

Read the part that says:Effective for claims with dates of service on or after January 1, 2000, an x-ray is not required to demonstrate the subluxation.

Thank you. I appriciate the link and stand corrected.

Personally I am not for the NACM but figured a chiropractor who was a member would be acceptable for you. Your right, you need to stay away from Medicare altogether, the stress is too much for you to handle.

Not really, it is just another area where chiropractors and physicians, even meaning well, can get tanged up.

Now I understand why you are so prejudice against the chiropractic profession. Man, I have never heard of the "Legion of Chiropractic Philosophers". Just by their name I can tell they're quacks. Palmer is where it all started and they still cling to those outdated unproven chiropractic theories. It's like they just can't get out from underneath it. Changing the name of the school would be a start. LCP is just another quack outfit that's unrelated to the chiropractic colleges.

Just to clarify, the LCP is taught at Palmer as a professional enhancement. So it is "taught in schools".

See: http://www.palmerinstitute.net/Professional_Enrichment/Colloquium.htm

Again, a lot of the quackery within the profession is not taught in school but rather by these renegade gangsters of healthcare who start their on groups.

So Palmer College is a "renegade group"?

Does this guy you speak of practice near St. Louis?

No.

He is crazy to have a home birth as he's not qualified to handle any emergencies that may arise and neither is the midwife. This guy is crazy and he is putting his wife and unborn child at risk. When you mean "attending" do mean actually delivering the baby?

Yes, and he convinced his wife and mid-wife that it is o.k. by showing them the records that he "trained" in OB/GYN at Palmer.

Chiropractic school is 4 academic years not 3. Medical school is 4 academic years right?

Define academic year. Medical School is four years with two 12 week (or so) summer breaks or ten semesters. Thus by Federal FA rules it is 5 academic years. But then this education is capped by a residency. You said that you have been in practice for six years. A Physical Medicine and Rehabilitation Physician (the closest MD/DO to a chiropractor) who started medical school at the same time as you started chiropractic college would just now be starting to practice on their own (four years of medical school, one year internship, four years of residency vs. three years of chiropractic college and six years in practice). You feel the two are equal?

Most students that enter into chiropractic school have a bachelor's degree; those that don't still have to take the same pre-medical studies that medical doctor's take (physics, chemistry, organic etc) which, can be crammed into an accelerated program.

Yeah, do you really want to start comparing entrance qualifications? Can't you see where there is likely some question from those who start in programs more rigorous in entrance standards, stay in the programs longer, and still (usually) feel a bit overwhelmed at the start of their practice that another group, with lower admissions' standards can be "as competant" in 1/3 the time?

- H

 

[Freeeedom!]

Back talk...please do not 1. compare entrance qualifications or 2. compare academics between medical school and chiropractic school...you will come off very foolish.

From various websites Life :"students may complete the program in 12 quarters (three calendar years), "
Palmer: "Palmer West's 13-quarter Clinical Practice Curriculum, introduced in 1994..." sounds like 3 and 1/4 year

National University REALLLLY sets its goals high with this statement "with a minimum cumulative GPA of 2.50 on a 4.00 scale. NUHS is the only chiropractic college to so boldly increase its academic standards for students--and consequently, its standards for the chiropractic profession. "
WOW!!!!!

Then later states " By enrolling for 10 consecutive trimesters, the program can be completed in three years and four months."
10 CONSECUTIVE, wowsers!! That is kinda like school!

Logan states "guide the students through a year-round curriculum of 10 trimesters. " That is 3 years.

Texas states "The curriculum is based on a trimester system. Ten trimesters (3 1/3 years) are required to complete the requirements for graduation. Trimesters begin in early September, January and May. "

It seems as though there are obvious variances not only in length of programs but also in entrance requirements.

 

[BackTalk]

No, while the definition varies from institution to institiution, a general definition is "limited to regular, full-time personnel at institutions whose regular assignments include instruction, research, and/or public service as a principal activity, and who hold academic rank as professor, associate professor, assistant professor, or instructor at the institution."

It has to do with the ability to determine the content of coursework freely and without significant oversight. For this reason many schools further define by "tenure-track" and non-tenure track". But in either case the standards for faculty are much higher than those to lecture or instruct.

EDIT: In most cases the doctorate degree is the minimum requirement for faculty membership. This discussion began as I believe that most universities do not consider the DC a "doctorate" in this sense. I still yet yet to see an institution, other than a Chiropractic College, that will accept a DC as a qualifying degree for faculty admission. The question of who actually teaches classes is not part of my argument. The other side of this is that DPTs may be acceptable outside of PT departments in areas such as physiology or kinesthesiology (sp?).

Listen, I don't see the point of arguing over this any longer. I think I provided enough evidence from enough sources that say Dr. Yochum is "on the faculty". Call it staff or volunteer work, whatever.

Just to clarify, the LCP is taught at Palmer as a professional enhancement. So it is "taught in schools".

Right now I'm going to say its not. I don't know what this "Palmer Institute" entity is, and have never heard of it. It looks to me like it's not part of the Palmer Chiropractic School. If this is indeed part of the chiropractic college, and I doubt it is, it may be considered as "taught" at Palmer but it's not taught in any other schools that I'm aware of.
Here is the actual Palmer Chiropractic website http://www.palmer.edu/PCC/PCCmain.htm I do not see any reference to this LCP degree, diplomate or whatever you want to call it. I do not see it mentioned nor do I see a link to the Palmer Institute of Quackery. Listen, that place is absolutely ridiculous. I'm not a fan of chirobase, but you should send them a link to this place.

So Palmer College is a "renegade group"?

Not necessary. There may be graduates of Palmer that are.

Yes, and he convinced his wife and mid-wife that it is o.k. by showing them the records that he "trained" in OB/GYN at Palmer.

He's crazy. He needs an intervention before he seriously hurts someone. I hope he has a few paramedics parked out in the driveway in case there is a complication.

Define academic year. Medical School is four years with two 12 week (or so) summer breaks. By Federal FA rules it is 5 academic years.

An academic year is two terms (eight months) and the school year is three terms (12 months). "The chiropractic program is arranged so that a student may choose to complete the curriculum in three and one-third consecutive years. The curriculum contains a minimum of 4,620 classroom hours of instruction."

You feel the two are equal?

In class room hours, yes.

Yeah, do you really want to start comparing entrance qualifications?

I've already admitted on several occasions that entrance requirements to Chiropractic College were much lower than medical school.

But then it is capped by a residency. You said that you have been in practice for six years. A Physical Medicine and Rehabilitation Physician (the closest MD/DO to a chiropractor) who started medical school at the same time as you started chiropractic college would just now be starting to practice on their own (four years of medical school, one year internship, four years of residency vs. three years of chiropractic college and six years in practice).

Yes, Physiatrists education is a lot longer than a chiropractor. It must suck to go to school that long with today's crappy insurance reimbursements. Is it worth it?

 

[Freeeedom!]

"Yes, Physiatrists education is a lot longer than a chiropractor. It must suck to go to school that long with today's crappy insurance reimbursements. Is it worth it?" ...Backtalk

To answer the above question: yes. As a third year EM resident, I have the best job anyone could have. As an attending I will make >180k for less than 40hrs a week. That does not suck...and I will always know (as will patients, relatives, friends, neighbors) I am a REAL doctor. Sounds like a low blow, but why not say it like it is? Hell, I as a third year resident I make >70k year...life is good and getting better.

As for faculty...my ID badge says medical school "Faculty"...do I put it on my CV??? Nope, I think "Dr" Yochum needs a reality check, obviously his opinion of himself needs the medical school "faculty" nomenclature to feel important. I wonder what the other "faculty" members think of his use of terminology for self promotion???

Whatever, this is not my fight. You guys can go at it.

 

[FoughtFyr]

Right now I'm going to say its not. I don't know what this "Palmer Institute" entity is, and have never heard of it. It looks to me like it's not part of the Palmer Chiropractic School. If this is indeed part of the chiropractic college, and I doubt it is, it may be considered as "taught" at Palmer but it's not taught in any other schools that I'm aware of.
Here is the actual Palmer Chiropractic website http://www.palmer.edu/PCC/PCCmain.htm I do not see any reference to this LCP degree, diplomate or whatever you want to call it. I do not see it mentioned nor do I see a link to the Palmer Institute of Quackery. Listen, that place is absolutely ridiculous. I'm not a fan of chirobase, but you should send them a link to this place.

Go to www.palmer.edu and hit the link on the lower right that says "Prof. Advancement" (or go to the "professional advancement" tab at the top of the website you provided). That leads to "The Palmer Institute" which is taught at / through Palmer College by Palmer instructors. But I'm glad that you agree it is quarkery.

Quote:
You feel the two are equal?

In class room hours, yes.

You are absolutely insane if you believe that Chiropractic College even comes close to the academic load of medical school. But, given your careful choice of words, I will agree with you. Medical students, in the first two "pre-clinical" years spend as much time in the classroom as chiropractic students do in three. The next two years spent on the wards is where the difference lay (and the fact that we must assimilate in two years what you do in three).

Yes, Physiatrists education is a lot longer than a chiropractor. It must suck to go to school that long with today's crappy insurance reimbursements. Is it worth it?

Nope, it doesn't suck. It is what is needed to perform safely. You have made my point for me. There is no way that chiropractors can, in three years, learn how to treat NMS pathology and learn a sufficent amount of other pathology to reliably screen their patients. It is simply not possible. Couple that with the fact, one you readily admit, that some chiropractors feel they can treat any of the pathology they find, and you have a recipe for disaster.

But don't take my word for it. In a study, (see: http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=10768681) 17% of chiropractors who treat children, when presented with a hypothetical case of a two-week old with fever, would treat them rather than refer them out. Now, I am not sure how much you know of emergency pediatrics but take my word for it, any patient less than 28 days old who presents with fever represents an extreme emergency that carries significant morbidity and mortality when untreated.

Look, it is not my brother-in-law who keeps me from respecting chiropractors as a profession. Every village has its idiot. It is the often repeated supposition that, in three years, chiropractors learn not only the science and art of chiropractic care for NMS insults but also obtain health screening and diagnosis skills equivalent to a physician.

- H

 

[FoughtFyr]

As for faculty...my ID badge says medical school "Faculty"...do I put it on my CV??? Nope, I think "Dr" Yochum needs a reality check, obviously his opinion of himself needs the medical school "faculty" nomenclature to feel important. I wonder what the other "faculty" members think of his use of terminology for self promotion???

Whatever, this is not my fight. You guys can go at it.

O.k., but at least back me up that "faculty" means a bit more in academic circles than just someone who teaches.

- H

 

[BackTalk]

To answer the above question: yes. As a third year EM resident, I have the best job anyone could have. As an attending I will make >180k for less than 40hrs a week. That does not suck...and I will always know (as will patients, relatives, friends, neighbors)

I guess you like being on call over the weekends or working 12 hour shifts. While you're on call, I'll be out on my boat sippin some cold ones. Are you sure you will make that much? Earlier, FoughtFyr was complaining about the expense of making a few long distance phone calls.

I am a REAL doctor

As for faculty...my ID badge says medical school "Faculty"...

I bet you catch wood every time you pass by the mirror. Don't forget the stethoscope around neck, I would hate for you to be mistaken as a chiropractor.

do I put it on my CV???

Yeah, you probably do.

I think "Dr" Yochum needs a reality check, obviously his opinion of himself needs the medical school "faculty" nomenclature to feel important.

I seriously doubt that one.

 

[FoughtFyr]

Earlier, FoughtFyr was complaining about the expense of making a few long distance phone calls.

Of all the things I said, this is the one joke you hold to?

Whatever. I guess it was easier to post a reply to him than to address the fact that the Palmer Institute is affiliated with Palmer College; that the DC is not viewed as an academic doctorate in most institutions of higher education; and that chiropractic college is nowhere close in rigor or time to the level of training needed to become an MD/DO.

But hey it is all good because according to you, the less qualified students who become chiropractors suddenly become the better students and learn everything they need to know in 1/3 the time. It must be all of those adjustments you guys do on each other.

- H

 

[BackTalk]

Hold your horses....I doing this between patients, lunch and notes.

Go to www.palmer.edu and hit the link on the lower right that says "Prof. Advancement" (or go to the "professional advancement" tab at the top of the website you provided). That leads to "The Palmer Institute" which is taught at / through Palmer College by Palmer instructors. But I'm glad that you agree it is quarkery.

You are right. I have nothing further to add.

You are absolutely insane if you believe that Chiropractic College even comes close to the academic load of medical school. But, given your careful choice of words, I will agree with you. Medical students, in the first two "pre-clinical" years spend as much time in the classroom as chiropractic students do in three. The next two years spent on the wards is where the difference lay (and the fact that we must assimilate in two years what you do in three).
The next two years spent on the wards is where the difference lay (and the fact that we must assimilate in two years what you do in three).

Now that's not exactly agreeing with me. My point was the number of hours in class room study was close to equal for both professions. That is four years of medical school and 3 1/4 of chiropractic school.

Nope, it doesn't suck. It is what is needed to perform safely. You have made my point for me. There is no way that chiropractors can, in three years, learn how to treat NMS pathology and learn a sufficent amount of other pathology to reliably screen their patients. It is simply not possible. Couple that with the fact, one you readily admit, that some chiropractors feel they can treat any of the pathology they find, and you have a recipe for disaster.

I disagree. You care to explain this?

Medical students flunk basic musculoskeletal test

Most medical residents failed to demonstrate even basic competency in musculoskeletal medicine, according to a study published in the April 2002 Journal of Bone and Joint Surgery. Kevin B. Freedman, M.D., MSCE, and Joseph Bernstein, M.D., MS, gave a basic competency test to 85 residents on their first day of residency at the University of Pennsylvania School of Medicine. The investigators had validated the examination by surveying 124 orthopaedic program directors who reviewed the test, rated the importance of individual questions, and established a minimum passing score. Before drawing a final conclusion, however, the researchers recognized that orthopaedic surgeons may not be the best group to validate such an examination because (1) orthopaedic surgeons provide only a small proportion of musculoskeletal care and thus may not perceive what is important to the non-orthopaedic practitioner, and (2) orthopaedic surgeons may overemphasize conditions requiring surgery. Therefore, the investigators sent the competency examination to all 417 program directors of internal medicine departments in the United States. Using instructions identical to those given to the orthopaedic program directors, the 240 internal medicine directors who responded were asked to rate the importance of each question and to suggest a passing score. The investigators then compared the responses of the orthopaedic directors to those of the internal medicine directors. The orthopaedic program directors suggested a minimum passing score of 73.1 percent; the internal medicine program directors proposed 70.0 percent as the passing score. Interestingly, the comparison of the ratings of the questions revealed that the weights assigned by the two groups were similar.

Based on the criteria established by the orthopaedic program directors, 82 percent of the test group failed to demonstrate basic competency in musculoskeletal medicine. According to the standards set by the internal medicine program directors, 78 percent failed to exhibit basic competency in this field. The researchers concluded that medical school preparation in musculoskeletal medicine is inadequate and that using a second set of criteria from internal medicine directors further validated the findings of the initial studies with orthopaedic program directors. The average amount of time spent in courses or programs in medical schools dedicated to orthopaedics was only 2.1 weeks for all the residents taking the examination. Freedman and Bernstein suggest that the two weeks of instruction is probably inadequate and that the time may not be spent in an efficient way. They noted that many orthopaedic directors place too much emphasis on surgical therapies for more complex disorders.

Source: Journal of Bone and Joint Surgery, April 2002, Volume 84-A, Number 4.

But don't take my word for it. In a study, (see: http://www.ncbi.nlm.nih.gov/entrez/...t_uids=10768681) 17% of chiropractors who treat children, when presented with a hypothetical case of a two-week old with fever, would treat them rather than refer them out. Now, I am not sure how much you know of emergency pediatrics but take my word for it, any patient less than 28 days old who presents with fever represents an extreme emergency that carries significant morbidity and mortality when untreated.

Well how high was the fever? The hypothetical doesn't give numbers or patient history or exam finding to analyze. Most of the time it's just a "wait and see" approach anyway. My kids have had plenty of fevers that required no medical attention. Now if they gave us some numbers that were awfully high along with some distinct sysmptoms then I would agree that the patient should be sent to the ER. Personally I would say, not my department either call the pediatrician or take them over to the ER. I wouldn't want the responsibility of something going wrong. I'm curious as to what treatment the chiropractor would provide. Probably upper cervical adjustment.

Look, it is not my brother-in-law who keeps me from respecting chiropractors as a profession. Every village has its idiot. It is the often repeated supposition that, in three years, chiropractors learn not only the science and art of chiropractic care for NMS insults but also obtain health screening and diagnosis skills equivalent to a physician.

Listen, medical doctors do not know everything. There is no way! Rather, I should say one medical doctor could not possibly know everything. This is why we have specialists. Chiropractors have plenty of education in the physical diagnosis and differential diagnosis department to safely screen patients. I never said that we have the equivalent skills in diagnosis that a medical physician has. I would say we have adequate diagnostic skills for being primary care practitioners not primary care providers.

 

[Seaglass]

Well how high was the fever? The hypothetical doesn't give numbers or patient history or exam finding to analyze. Most of the time it's just a "wait and see" approach anyway. My kids have had plenty of fevers that required no medical attention.

I think this illustrates the point. In an infant less than 1 month of age ANY fever gets an admission and workup for occult bacteremia with ABX therapy. So it doesn't matter how high, and unless your kids were less than a month old your experience is with a different subset of patients.

Chiropractors have plenty of education in the physical diagnosis and differential diagnosis department to safely screen patients.

As you appear to be the most reasonable chiropractor here, and given your above response to the clinical situation presented, I find this hard to believe. This presentation is a basic case that any EM or Peds intern would know what to do with. Most medical students would have no problem with this.

 

[Seaglass]

Reference

Reference 2

An important note is that a delay in diagnosis or treatment is likely to result in serious complications including death in this patient population.

 

[FoughtFyr]

Now that's not exactly agreeing with me. My point was the number of hours in class room study was close to equal for both professions. That is four years of medical school and 3 1/4 of chiropractic school.

I agree. Classroom hours maybe. I am not familiar enough with chiropractic college to disagree with the numbers you posted. If taken verbatim then it appears the hours spent in the classroom may be similar. However, medical students spend the final two years of school "on the wards", not in the classroom. In most students' third year, the hours are nearly inhumane (often 90+ weekly) so there is no way anyone could spend more time.

You care to explain this?

Medical students flunk basic musculoskeletal test

Most medical residents failed to demonstrate even basic competency in musculoskeletal medicine, according to a study published in the April 2002 Journal of Bone and Joint Surgery. Kevin B. Freedman, M.D., MSCE, and Joseph Bernstein, M.D., MS, gave a basic competency test to 85 residents on their first day of residency at the University of Pennsylvania School of Medicine.{snip}

Exactly my point! After four years of school these groups of students failed! That is why more study (i.e., residency) is required! And this is just NMS! It says nothing of their ability to screen and diagnose! But chiropractors can do both in only three years? And, by the way, the test was not given to newly graduated chiropractors so this says nothing of their comparable skill. Truth be told, I doubt that my NMS skills are as good as a PTs. That way I utilize them!

Well how high was the fever?

By definition a fever is > 38 degrees celcius.

The hypothetical doesn't give numbers or patient history or exam finding to analyze. Most of the time it's just a "wait and see" approach anyway.

Not at less than 28 days old. In this age group fever is always a serious concern. The hallmark study (see: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=875262) remains the standard of care. "Neonates, once infected with a bacterial process in one area, such as the urinary tract, are at risk for seeding of the bacteria into other areas, such as the meninges. Because bacterial sepsis and meningitis can have such subtle presentations in this age group (e.g., change in sleep or feeding pattern, diarrhea, jaundice), a complete septic workup, including lumbar puncture, and hospital admission are generally recommended." (from: Harwood-Nuss A ed. "The Clinical Practice of Emergency Medicine, 3rd. Ed." LW&W: Philadelphia. 2001. pp. 1172)

My kids have had plenty of fevers that required no medical attention.

Hopefully not in this age group. Otherwise you took one hell of a chance, but I am glad everything turned out o.k.

Now if they gave us some numbers that were awfully high along with some distinct sysmptoms then I would agree that the patient should be sent to the ER. Personally I would say, not my department either call the pediatrician or take them over to the ER. I wouldn't want the responsibility of something going wrong. I'm curious as to what treatment the chiropractor would provide. Probably upper cervical adjustment.

Again, fever in this age group is just one example of the rare, but potentially dangerous, conditions that are best evaluated by a physician. Another, since you brought up school physicals, is HOCM (hypertrophic, obstructive cardiomegaly) a.k.a. IHSS (idiopathic hypertrophic sub-aortic stenosis). Do you, as a chiropractor feel you can evaluate for this condition? Are you familiar with it? Do you feel confident you could find those patients at risk and refer them out? I ask because this has killed several student athletes in the Chicago area in the past few years, and they had physicals!

Listen, medical doctors do not know everything. There is no way! Rather, I should say one medical doctor could not possibly know everything. This is why we have specialists.

Absolutely true! This is why PTs have medical referals. One person (the MD) specializes in screening and evaluating the patient. The other (the PT) in treating them. What you claim (and Illinois law supports in letting chiropractor advertise as PCPs) is that chiropractors are equivalent to PTs in their ability to treat NMS problems, but also have the skills of an internist or family practitioner when it comes to screening and diagnosis.

Chiropractors have plenty of education in the physical diagnosis and differential diagnosis department to safely screen patients. I never said that we have the equivalent skills in diagnosis that a medical physician has. I would say we have adequate diagnostic skills for being primary care practitioners not primary care providers.

Adequate by whose standards? Against what measure? And what insures that once a non-NMS condition is found, if it is, it will be properly referred as opposed to "treated" chiropractically?

- H

 

[BackTalk]

I think this illustrates the point. In an infant less than 1 month of age ANY fever gets an admission and workup for occult bacteremia with ABX therapy. So it doesn't matter how high, and unless your kids were less than a month old your experience is with a different subset of patients.

Listen, I don't treat patients with fevers. I don't even treat 2 week olds. If a 2 week old neonate was brought to my office with a fever, I certainly would call the pediatrician our have the parent take the patient to an ER. Most chiropractors don't act the way the study portrays. That study surveyed 150 chiropractors and I believe only 60% responded and out of that 60% only 17% said they would treat the patient. I don't think that represents 17% of the actual population of chiropractors. You are right as I was thinking the patient was an infant. I should have read the study more thoroughly.

As you appear to be the most reasonable chiropractor here, and given your above response to the clinical situation presented, I find this hard to believe. This presentation is a basic case that any EM or Peds intern would know what to do with. Most medical students would have no problem with this.

The chiropractic curriculum focuses on NMS complaints. I have no idea what the medical protocol is for a 2 week old neonate a fever. I'm not a primary care physician nor do I try to pretend to be. Thanks for the info as I have learned something new today.

 

[FoughtFyr]

Most chiropractors don't act the way the study portrays. That study surveyed 150 chiropractors and I believe only 60% responded and out of that 60% only 17% said they would treat the patient. I don't think that represents 17% of the actual population of chiropractors.

What invalidates this study model? Why do you think this 17% were somehow "different". The survey was sent to 150 licensed chiropractors who reported they treated children. Random chance is random chance, but I find it hard to believe that the actual number would be far from 17%, and there is absolutely no evidence to suggest that it would be (your personal feelings aside).

The chiropractic curriculum focuses on NMS complaints. I have no idea what the medical protocol is for a 2 week old neonate a fever. I'm not a primary care physician nor do I try to pretend to be. Thanks for the info as I have learned something new today.

Exactly! But not everyone who presents to a chiropractor has an NMS complaint. The question here is not can you recognize an NMS complaint, it is can you find the underlying, non-NMS condition safely and reliably. As I said, I have seen many patients in the ED who were being treated by chiropractors for what was thought to be "just back pain". Unfortunately, it wasn't. The most serious conditions I have seen "missed" to date are hydronephrosis from multiple renal cysts leading to obstructive nephropathy and breast CA with mets to the spine. Both may have had better outcomes if their conditions were recognized earlier.

And let us not forget that some chiropractors feel they can effectively diagnose and treat non-NMS complaints. As you have pointed out, Illinois allows chiropractors to advertise as "primary care physicians". If a patient, believing their chiropractor to be a PCP presents with a medical condition, will it be recognized? The study in the post above (which was limited to those chiropractors who stated they routinely treated children) suggests that medical conditions may not be addressed in a manner consistent with best known practices. That is the problem.

As I have said before "the eyes can not see what the mind does not know..."

- H

 

[BackTalk]

Exactly! But not everyone who presents to a chiropractor has an NMS complaint. The question here is not can you recognize an NMS complaint, it is can you find the underlying, non-NMS condition safely and reliably. As I said, I have seen many patients in the ED who were being treated by chiropractors for what was thought to be "just back pain".

Chiropractic College focuses on conditions that mimic NMS complaints as well. Look at the curriculum and the courses we take. Most doctors don't give chiropractic any credit. I'm proud of my education. I don't know all the answers to the questions you ask. I'll swallow my pride and admit that I do not know the medical protocol for diagnosing idiopathic hypertrophic subaortic stenosis. How many family doctors would get this diagnosis? Like me, the symptoms would raise red flags and the patient would be referred out. I'm sure as an ER doctor; it's something you are trained to recognize. Also, isn't the condition rather uncommon? Would a physician assistant or nurse recognize it? They can do school physicals too.

I'm sure that you have seen people in the ER who have been misdiagnosed by chiropractors. I'm sure you have seen plenty of patients that stumble into the ER who have been misdiagnosed by their family doctors too.

And let us not forget that some chiropractors feel they can effectively diagnose and treat non-NMS complaints.

That is true. Don't have an argument for that one. Effectively diagnose? I think most chiropractors are pretty good. You know, I think you're using me to vent all the things you should be telling your brother in law. Have you ever asked him the questions your ask me? I would imagine Thanksgiving is quite entertaining at your place...

As you have pointed out, Illinois allows chiropractors to advertise as "primary care physicians". If a patient, believing their chiropractor to be a PCP presents with a medical condition, will it be recognized?

Good question. They should do a study that involves sending patients to chiropractors for complaints that are non-NMS or mimic NMS complaints. To be fair, they should do the same for GP's and see how they do.

The study in the post above (which was limited to those chiropractors who stated they routinely treated children) suggests that medical conditions may not be addressed in a manner consistent with best known practices. That is the problem.

I agree. What do you think about PT pushing for direct access? You know, there are some states that already see physical therapists as portal entry providers.

I'm heading to the lake, remember, when Freeedom is on call being a real doctor, I'll be at the lake on the boat sippin cold ones. Well, at least that is the plan for this weekend. Have a nice weekend I'll check in on Monday.

 

[FoughtFyr]

Chiropractic College focuses on conditions that mimic NMS complaints as well. Look at the curriculum and the courses we take. Most doctors don't give chiropractic any credit. I'm proud of my education. I don't know all the answers to the questions you ask. I'll swallow my pride and admit that I do not know the medical protocol for diagnosing idiopathic hypertrophic subaortic stenosis. How many family doctors would get this diagnosis? Like me, the symptoms would raise red flags and the patient would be referred out. I'm sure as an ER doctor; it's something you are trained to recognize. Also, isn't the condition rather uncommon? Would a physician assistant or nurse recognize it? They can do school physicals too.

The symptoms are extremely subtle. Generally tests are ordered when there is a family history of early deaths from any cause (as the disorder was often missed). A PA or nurse should pick it up. If they don't then the physician providing practice oversight for them is not doing their job. The family doctor should not miss it. If they do, and there were any signs, including family history, detectable, there will be one hell of a lawsuit, and I would not want to be at that hospital M&M.

I'm sure that you have seen people in the ER who have been misdiagnosed by chiropractors. I'm sure you have seen plenty of patients that stumble into the ER who have been misdiagnosed by their family doctors too.

Yep, but the difference, at least in my experience, is that the family doctors realize the stakes. No one gets out of medical school without watching a patient die, and directly feeling a sense of "responsibility" for the failure of medicine to "save" that patient. This is even more true in a family practice or internal medicine residency. That feeling is awful, and it is why most physicians work so hard to identify treatable illnesses as early as possible. Given the knowledge of our own inadequacies in this regard, it is difficult, if not impossible, to pass that responsiblity off to another profession with less training. Especially one laden with "quackery" (your word).

You know, I think you're using me to vent all the things you should be telling your brother in law. Have you ever asked him the questions your ask me? I would imagine Thanksgiving is quite entertaining at your place...

True. But the "wives" no longer allow any discussion on the topic, which is difficult because my wife has her MPH also, and he is adamantly against immunizations.

It is not that I am venting, it is that he is a nut. You cannot discuss (or argue) with him because the foundation of his knowledge is outside of reality. I do respect your willingness to cite sources, question unproven practices and debate with facts and reasonable supposition. As I said, when "speaking" with chiropractors such as yourself, I can at least envision a "place at the table" for chiropractic. As an MD, I appriciate the different theory that "created" osteopathy. While I realize that the difference between MDs and DOs is today quite small, the introspection they once forced on allopathy was good for the medical arts as a whole. I see the same potiential, when speaking to reasonable practitioners such as yourself, for chiropractic.

Of course we are so close and yet so far...

I agree. What do you think about PT pushing for direct access? You know, there are some states that already see physical therapists as portal entry providers.

I disagree with it. Period.

I'm heading to the lake, remember, when Freeedom is on call being a real doctor, I'll be at the lake on the boat sippin cold ones. Well, at least that is the plan for this weekend. Have a nice weekend I'll check in on Monday.

Have fun! And BTW - Freeedom is a decent guy; you have to remember in most physicians' experience your reasonability is the exception, not the rule...

- H

 

[Freeeedom!]

Sippin cold ones on the boat??? Ain't that illegal? See you in the ER with my "wood"!! Be careful, you are one of the last of a dying breed of DC's...numbers are dropping and so are the qualified candidates...be careful, you may need an actual doctor some time.

HAH!
Life is good!
Life is good!

 

[BackTalk]

In the office for few hours before I leave....alright guys.....I'll admit the REAL doctor title goes to the ER doctors such as you two and Seaglass. Its pretty amazing the stuff you know and can remember. How you can remember such a huge body of knowledge is amazing.

We play it safe on the lake but if I do end up in the ER I'll rest assured knowing you guys can fix me. Basically you can drink on the lake even while driving a boat, but you can't be intoxicated (strange law). The lake hospital does great business because of it. I may be dumb and you have proven that here, but I'm not stupid enough to get intoxicated and risk someone getting hurt or going to jail.

What does PGY-1 mean? Freeedom, I was just playing with the wood comments and all that. Another question, do you doctors work in trauma centers? One of the family doctors in the town I practice in moonlights at the local hospital (not a trauma center) ER late at night and I'm pretty sure he didn't do a residency in emergency medicine. Can Family doctors cover the ER in non trauma centers without doing a residency in EM?

 

[FoughtFyr]

In the office for few hours before I leave....alright guys.....I'll admit the REAL doctor title goes to the ER doctors such as you two and Seaglass. Its pretty amazing the stuff you know and can remember. How you can remember such a huge body of knowledge is amazing.

I don't think anyone here is insinuating that. I think your statements struck a chord with EPs because we are consistently screening and evaluating a wide variety of patients, often with less information than we would like. Given our knowledge of the times we are "right for the wrong reasons", or just flat out "miss", we find it difficult to believe that chiropractors can reasonably learn to treat NMS conditions and to screen patients with far less time spent in training. That, and we are most often the ones who discover the errors of the chiropractors.

We play it safe on the lake but if I do end up in the ER I'll rest assured knowing you guys can fix me.

Good, but I don't think anyone here wishes that on you. BUT, we will be here if if it does happen. I am superstitous, would you please knock on some wood (NOT freeedom!'s )!

I may be dumb and you have proven that here, but I'm not stupid enough to get intoxicated and risk someone getting hurt or going to jail.

I do not think you are dumb. Nor do I think that you are unskilled. In fact, I would bet that your ability to detect many NMS conditions exceeds that of most ED physicians. No one here has stated otherwise. The question has been what are the limits of your knowledge and training.

What does PGY-1 mean?

Post graduate year 1. It refers to a first year resident.

Another question, do you doctors work in trauma centers? One of the family doctors in the town I practice in moonlights at the local hospital (not a trauma center) ER late at night and I'm pretty sure he didn't do a residency in emergency medicine. Can Family doctors cover the ER in non trauma centers without doing a residency in EM?

The short answer is "yes they can". That said, most hospitals will no longer hire FPs in this capacity. Generally because most insurance companies will no longer cover them if the ED is not staffed with BE/BC EM physicians. Some internists and family practitioners were "grandfathered in" to EM board eligibility, but that pathway was closed 12 years ago. Of course, a group of FPs sued, and the suit was only settled last year, but that is another story. There are still some smaller facilities where FPs do still moonlight. Trauma center designation has nothing to do with this practice - but you would be hard pressed to find a level one or two center that is still staffed in this way.

BTW - I was going to post a "quiz" of presentations frequently missed in basic physicals, but you seem to be misinterpreting my concerns. I do not think that you, personally or professionally, are "dumb". I do respect what you have accomplished academically and professionally. I just do not believe your training enables you do safely do all of the things you believe can. I do not believe that the DC is widely viewed as an "academic doctorate". And while I agree that studies have demonstrated chiropractic to be "as effective" as traditional medicine in treating low back pain, the fact the it does not represent a superior treatment tips the risk vs. benefit scales against it. This is because the profession, as a whole, is not standardized in terms of treatments, training or philosophy and is rife with "quackery". If a reasonable, balanced and regulated approach to chiropractic can be created, with sufficent regulatory oversight, public education and safeguards, I would support it. But as long as significant differences remain based on the location of a chiropractors training (does a Logan grad equal a Palmer grad, and so forth), their philosopy and practice styles (straights, psuedos- and mixers), and degree of integration with the medical providers in their communities, I can't. The public does not know how to separate the "wheat from the chaff" in chiropractic and niether do I.

Have a great weekend.

- H

 

[Seaglass]

Yeah, I don't think you're dumb Backtalk, in fact you've added a lot to the discussion of Chiro over the years that has been both helpful and informative. I think the main thing is scope of practice and whether or not Chiros are actually qualified (by our standards) to do a lot of the things they say they can. Now you can argue that our standards don't apply or that most chiros know their limits, but that's just where I'm coming from.

 

[Freeeedom!]

Originally Posted by BackTalk
Another question, do you doctors work in trauma centers? One of the family doctors in the town I practice in moonlights at the local hospital (not a trauma center) ER late at night and I'm pretty sure he didn't do a residency in emergency medicine. Can Family doctors cover the ER in non trauma centers without doing a residency in EM?

Another point to this observation is that there have NEVER been enough board certified EM physicians to cover all available positions available, therefore coverage must be obtained by other individuals...namely FP, IM or general surgery.
I was moonlighting with a general surgeon, and I saw so many deviations from the standard of care that I was simply amazed.

 

[BackTalk]

I didn't want to hijack that other thread so I'll post this here...

Chiropractors cannot write prescriptions in any state.

This is true. I know of no state where chiropractors have prescriptive authority. I would rather see the term "choose not" rather than "cannot". The reason I say this is I've always been told that when chiropractors began to establish themselves as a profession, they were offered prescription rights and turned them down and actually went as far as to demand that it be written into law that the profession is a "drugless" profession and does not utilize medications. With that said, I like to feel we choose not to prescribe medications as opposed to being told we "cannot" prescribe them.

There is one DC school that has been trying to institute pharmacology into its program, but generally medications are seen as completely against the chiropractic principles.

Pharmacology is part of the curriculum as is toxicology. Which DC school are you talking about H? I admit the courses I had in college were not adequate enough to allow chiropractors to prescribe medication. I agree that it does clash with many chiropractic principles. The thing is most chiropractic schools realize that medications are a part of our world and many times those medications save lives. Listen, I'm a DC and have a MD as my doctor. I also take medications. I also get adjusted quite often by my brother who is a DC. You doctors should go to a DC or a DO if you can find one that does manipulation. Getting adjusted makes you fell great and you should experience it. Many chiropractors are no different from me.

Did you know that there are actually medical doctors who get treated by chiropractors on a regular basis? When I worked with an orthopedist (MD) I treated him all the time. In fact, there are MD's who see chiropractors on a regular basis for bad discs. A friend of mine treats a few.

In Oregon (and possibly other states) chiropractors can de-prescribe, that is they can directly tell a patient to stop taking medications prescribed by a physician. This is an area of great debate, both inside chiropractic and out.

I didn't know that about Oregon. Personally, I wouldn't want the responsibility of telling a patient not to take a medication. Then again it depends on what it is. If you have a patient that eats 1600mg of Motrin a day and has been doing it for months to even years, don't you feel that it's a problem? In a case like this I would probably speak up and tell them it's not good. I'm sure you would too. Usually people do not die from pain but they do from renal failure, liver failure or hemorrhaging. I would never tell a patient to stop taking something like a heart medication or anything like that. I would tell them they need to discuss it with their doctor if I thought something wasn't right.

Another thing, I've heard that Oregon even allows DC to deliver babies and do minor surgical procedures. I don't know if that's entirely true. I think the reason was that the state was so rural and people many times just couldn't travel far enough to find medical doctors. Since many chiropractors worked in rural towns, they were allowed to perform these procedures.

I am not sure about your friend. Most "die-hard" chiropractors I know (often called "straights") wouldn't want to prescribe.

Absolutely true. It goes against all their beliefs.

Most "mixers" also tend to stay away from the issue of meds.

Not necessarily. They are more open to what works and will utilize things outside of chiropractic (manipulation) such as clinical nutrition, physical therapy and also acupuncture. Straight chiropractors only rely on manipulation of the spine and that is it (for those who didn't know). Personally, I'm for chiropractors having limited prescription authority. That is with additional training. You may think its crazy but that's where I stand. You really do not have to worry about the "straight chiropractors" prescribing drugs as again it goes against their beliefs.

Chiropractic theory would be absolutely against the idea, as chiropractic care is generally viewed as maximizing the body's ability to care for itself.

Good answer. The thing is there is part of the profession that views chiropractic as a specialty treating neuromuscular complaints. These chiropractors understand the need for medications. Some of the schools are starting to sweep the philosophy of chiropractic under the rug and starting to distance themselves from it. They are teaching more of a science based curriculum, teaching how manipulation works from a scientific standpoint rather than from a theory or belief.

If you are merely denoting the lack of difference between an MD and a DO, I agree completely and I generally consider the two interchangable. I apologize if my post above was unclear. Please insert "MD/DO" anywhere I wrote "MD

I do the same thing. From what I understand there is no difference. I can imagine how DO's would get pissed. It's kinda like when a patient says to them "so you're like a chiropractor, right?"...hehe....that really pisses them off. I respect DO's just as much as MD's. In fact, my kid's pediatrician is a DO. He knows so much and is such great doctor. People fight over seeing him, as opposed to his ******* MD partner. Now MD's don't be offended. We all got bad apples.

 

[FoughtFyr]

This is true. I know of no state where chiropractors have prescriptive authority. I would rather see the term "choose not" rather than "cannot". The reason I say this is I've always been told that when chiropractors began to establish themselves as a profession, they were offered prescription rights and turned them down and actually went as far as to demand that it be written into law that the profession is a "drugless" profession and does not utilize medications. With that said, I like to feel we choose not to prescribe medications as opposed to being told we "cannot" prescribe them.

Come on. You can not presrcibe them. Period. I don't know what you have been told about "being offered prescription rights" but as I always understood it, drugs are not now, nor have they ever been consistent with chiropractic. This is like saying LCSWs were once "offered prescription rights" because the scope of their practice, like medicine and chiropractic is defined by law. I'm sure that some legislator, ignorant to the principles of chiropractic might have entertained the idea of prescribing rights, but there is no way that would have evr benn passed into law.

But don't take my word for it. Here are the presidents of many Chiropractic Colleges seemingly agreeing that prescription drug use is far outside of chiropractic. (See: http://www.worldchiropracticalliance.org/tcj/1994/mar/mar1994e.htm)

"The chiropractic profession of tomorrow will be shaped by the chiropractic students of today. Therefore, the role our chiropractic colleges play cannot be underestimated. Yet, many of us know very little about the wide variety of educational approaches taken by our schools. To obtain a brief -- but insightful -- glimpse into the colleges, The Chiropractic Journal sent each college's president a questionnaire with five basic questions. The answers, in their entirety and unedited, are printed below.


Q. Should chiropractic colleges offer courses in the use of prescription drugs?

{Others snipped for brevity}

LIFE COLLEGE
1269 Barclay Circle
Marietta, GA 30060
404-424-0554
President and Founder Sid E. Williams, D.C.

A. The answer is NO! The practice of medicine is centered around the prescription and administration of drugs; therefore, years of intensive training, including internships and residency practice in the utilization of drugs with patients, are required of the person seeking an M.D. degree, and with justification.

The skillful chiropractor, on the other hand, has no need for drugs in his practice. When the chiropractor corrects subluxation, the subsequent vivification of tissue, along with other natural processes and procedures, enables the body to heal itself. It would be ridiculous and embarrassing to our profession for a chiropractor to take a simple didactic course in prescription drugs and think he was qualified to "practice medicine" in the same way that it would be ridiculous for a medical doctor who takes a weekend course in spinal adjustment at some motel to think he is qualified to provide a patient with competent chiropractic services.

Medicine is more than remembering the names of a few pills, and chiropractic is far more than cracking a few bones. The dignity and safety of both professions require that they always be mutually supportive, but forever separate and independent."

- H

 

[FoughtFyr]

Pharmacology is part of the curriculum as is toxicology. Which DC school are you talking about H? I admit the courses I had in college were not adequate enough to allow chiropractors to prescribe medication. I agree that it does clash with many chiropractic principles. The thing is most chiropractic schools realize that medications are a part of our world and many times those medications save lives. Listen, I'm a DC and have a MD as my doctor. I also take medications. I also get adjusted quite often by my brother who is a DC. You doctors should go to a DC or a DO if you can find one that does manipulation. Getting adjusted makes you fell great and you should experience it. Many chiropractors are no different from me.

Western States Chiropractic College attempted in 1997 to introduce legislation in Colorado that would have allowed prescribing rights. (See: http://www.chiroweb.com/archives/15/08/07.html). Western States'es President retired in 2003. As he was seen as the driving force behind the "medicalization" of WSCC's program, it remains to be seen in what direction the school will go. (See: http://www.worldchiropracticalliance.org/tcj/2002/aug/aug2002c.htm)

Did you know that there are actually medical doctors who get treated by chiropractors on a regular basis? When I worked with an orthopedist (MD) I treated him all the time. In fact, there are MD's who see chiropractors on a regular basis for bad discs. A friend of mine treats a few.

Yep. I used to go to a Palmer Grad (in 1993). I felt a sharp pain in my neck, into my shoulder and down my left arm ("shooting" through my ring finger) after a cervical manipulation. A later MRI revealed a herniation at C6-C7. No thanks, I'll leave the rest of my discs where they are.

I didn't know that about Oregon. Personally, I wouldn't want the responsibility of telling a patient not to take a medication. Then again it depends on what it is. If you have a patient that eats 1600mg of Motrin a day and has been doing it for months to even years, don't you feel that it's a problem? In a case like this I would probably speak up and tell them it's not good.

The prescription dose limits are 2400mg per day and the toxic limit for a 70kg person is roughtly 14g. So if the ibuprofen worked, and the patient showed no adverse drug effects, I'd say continue to take it.

Usually people do not die from pain but they do from renal failure, liver failure or hemorrhaging. I would never tell a patient to stop taking something like a heart medication or anything like that. I would tell them they need to discuss it with their doctor if I thought something wasn't right.

O.k., I am not going to get into a discussion about the theories of the implications of long term pain, but I wil tell you that there are lots of MDs who would argue that long term pain is quite bad for you. I do agree with you, if you have a concern regarding a patient's medication, you absolutely should refer them back to the prescriber. Without question. The difference is that you should not instruct the patient to stop taking the medication in the meanwhile. In Oregon that is allowed.

Another thing, I've heard that Oregon even allows DC to deliver babies and do minor surgical procedures. I don't know if that's entirely true. I think the reason was that the state was so rural and people many times just couldn't travel far enough to find medical doctors. Since many chiropractors worked in rural towns, they were allowed to perform these procedures.

I have no idea, but as Obstetrics one of the areas of highest malpractice, I find it hard to believe that their insurance would cover this.

Not necessarily. They are more open to what works and will utilize things outside of chiropractic (manipulation) such as clinical nutrition, physical therapy and also acupuncture. Straight chiropractors only rely on manipulation of the spine and that is it (for those who didn't know). Personally, I'm for chiropractors having limited prescription authority. That is with additional training. You may think its crazy but that's where I stand. You really do not have to worry about the "straight chiropractors" prescribing drugs as again it goes against their beliefs.

Good answer. The thing is there is part of the profession that views chiropractic as a specialty treating neuromuscular complaints. These chiropractors understand the need for medications. Some of the schools are starting to sweep the philosophy of chiropractic under the rug and starting to distance themselves from it. They are teaching more of a science based curriculum, teaching how manipulation works from a scientific standpoint rather than from a theory or belief.

We will simply agree to disagree here. There is no amount of "additional training", short of four years followed by a residency that would equip you for this. Any DC that wants prescribing rights should go to medical school. Go the DO route if you feel it is closer to your "holistic" roots or if you want to use OMM. I really think this goes back to my earlier point that you really have no idea how extensive the training is for physicians. And even with this training, most feel ill-prepared outside a limited practice area. There is simply too much at stake. From the outside looking in, it might appear easy but it is not. You have no more business prescribing drugs, in any form, than I do manipulating spines.

As for schools "moving away" from chiropractic, I again ask what they are moving toward. If the answer is "science" or "medicine", then we already have schools for that. Take the MCATs and apply.

- H

 

[BackTalk]

Come on. You can not presrcibe them. Period. I don't know what you have been told about "being offered prescription rights" but as I always understood it, drugs are not now, nor have they ever been consistent with chiropractic. This is like saying LCSWs were once "offered prescription rights" because the scope of their practice, like medicine and chiropractic is defined by law. I'm sure that some legislator, ignorant to the principles of chiropractic might have entertained the idea of prescribing rights, but there is no way that would have evr benn passed into law.

Well that's what I heard I didn't say it was etched in stone. Also you have to realize that this was over a hundred years ago. If chiropractors pushed for prescription rights they may have got them.

Yep. I used to go to a Palmer Grad (in 1993). I felt a sharp pain in my neck, into my shoulder and down my left arm ("shooting" through my ring finger) after a cervical manipulation. A later MRI revealed a herniation at C6-C7. No thanks, I'll leave the rest of my discs where they are.

Palmer grad...why would you do that when you admit your brother in law is a total quack and he went to Palmer? I serious doubt that the chiropractors treatment caused a disc herniation, I'm sure it was preexisting and he/she just aggravated it further. How's the neck doing? You should come see me; I've had great success treating disc herniation.

The prescription dose limits are 2400mg per day and the toxic limit for a 70kg person is roughtly 14g. So if the ibuprofen worked, and the patient showed no adverse drug effects, I'd say continue to take it.

Sometimes "adverse drug effects" take time to present themselves. Question, who usually dies quicker, a person with untreated high cholesterol or a person who develops liver failure from taking Lipitor?

Would you take 2400mg of vitamin M a day for your neck problem and do it for months to even years if you were not exhibiting "adverse drug effects"?

The difference is that you should not instruct the patient to stop taking the medication in the meanwhile. In Oregon that is allowed.

I really do not know why Oregon gives DC's the authority to do that.

We will simply agree to disagree here. There is no amount of "additional training", short of four years followed by a residency that would equip you for this. Any DC that wants prescribing rights should go to medical school. Go the DO route if you feel it is closer to your "holistic" roots or if you want to use OMM. I really think this goes back to my earlier point that you really have no idea how extensive the training is for physicians. And even with this training, most feel ill-prepared outside a limited practice area. There is simply too much at stake. From the outside looking in, it might appear easy but it is not. You have no more business prescribing drugs, in any form, than I do manipulating spines.

As for schools "moving away" from chiropractic, I again ask what they are moving toward. If the answer is "science" or "medicine", then we already have schools for that. Take the MCATs and apply.

I understand your point. What do you think about dentists and or podiatrists that have full prescription rights? Is their training equivalent to yours? What about optometrists who prescribe limited medications? What about naturopaths? What about PA's or NP's who most of the time see patients on their own and prescribe medications?

I think chiropractors would like the ability to prescribe limited prescriptions for NMS complaints such as muscle relaxants or pain medications. Sometimes there is not a whole lot we can do when a patient crawls through the door. We then have to get a hold of their PCP or send them to the ER.

You watch, there will come a day when chiropractors have limited prescription rights or a completely new degree program called a DCM. Legislation has been put forth in Colorado and Illinois in the past. Both times it failed. But there is that great thing we call PERSISTANCE. Right or wrong, I think its just a matter of time.

I think that Psychologists are pushing for prescriptive rights too.

 

[FoughtFyr]

Palmer grad...why would you do that when you admit your brother in law is a total quack and he went to Palmer? I serious doubt that the chiropractors treatment caused a disc herniation, I'm sure it was preexisting and he/she just aggravated it further. How's the neck doing? You should come see me; I've had great success treating disc herniation.

Given that my wife was 15 yo in 1993, he wasn't my brother-in-law yet. (I also hadn't met my wife yet). Yes, I'm a cradle-robber, but a legal one!

And I have no question he caused the herniation. There are studies that have found herniations to be one of the risks of spinal manipulation, and I know when the symptoms started. Why is chiropractic so convinced that there are no risks associated with their care?

The neck is fine. When the symptoms "flare up", a few ibuprofen does the trick. No way I will ever be spinally manipulated again.

Sometimes "adverse drug effects" take time to present themselves. Question, who usually dies quicker, a person with untreated high cholesterol or a person who develops liver failure from taking Lipitor?

Well, given the statistics of "number needed to treat", I waould say that on a population basis, more people would die without Lipitor than die form Lipitor-induced hepatic failure. But I don't have the study in front of me.

Would you take 2400mg of vitamin M a day for your neck problem and do it for months to even years if you were not exhibiting "adverse drug effects"?

If it controlled my pain? Yes.

I really do not know why Oregon gives DC's the authority to do that.

We agree.

I understand your point. What do you think about dentists and or podiatrists that have full prescription rights? Is their training equivalent to yours? What about optometrists who prescribe limited medications?

Dentists, yep, dental school is very arduous. Their pharm training is extensive and should be. Podiatrists give very few systemic drugs. I am not sure about their training. I'm not sure that they have "full" prescription rights. I don't think optometrists can prescribe. I believe they have some medications they can use "in the office" to facilitate testing.

What about naturopaths?

Utter quacks. Money grubbing frauds who should be relegated to a deep circle of hell for preying on the ill and needy. And they can not prescribe. They can, against the spirit but not the letter of the law, suggest dietary supplements to their "patients" - a word I am loathe to use in this setting; "victims" would be more appropriate.

What about PA's or NP's who most of the time see patients on their own and prescribe medications?

If inappropriate oversight is being exercised, I question the ethics of the MD/DO under whom they practice. and I have never said the existing system is flawless. I only assert you have yet to make a persuasive arguement to change it.

I think chiropractors would like the ability to prescribe limited prescriptions for NMS complaints such as muscle relaxants or pain medications. Sometimes there is not a whole lot we can do when a patient crawls through the door. We then have to get a hold of their PCP or send them to the ER.

I think lots of folks would "like" the right to prescribe. Nurses for one would love to be able to adjust orders for over the counter medications in hospitalized patients. But, in most institutions they can't. The problem with allowing chiropractors to prescribe pain medications or muscle relaxers goes back to the base argument here. What is your ability to screen for other conditions? There are times when a patient with a chief complaint of back pain could be hurt by these meds.

You watch, there will come a day when chiropractors have limited prescription rights or a completely new degree program called a DCM. Legislation has been put forth in Colorado and Illinois in the past. Both times it failed. But there is that great thing we call PERSISTANCE. Right or wrong, I think its just a matter of time.

And if I remeber correctly there were groups of chiropractors who argued against both concepts. You still have yet to give a reason to "reinvent the wheel". Why allow this practice? How is the public better served by a DCM than by an MD/DO?

BTW - even if I am wrong about the prescriptive rights above (those of DDS, podiatry, etc.), your argument still falls apart. It is like suggesting that since nicotine is highly addictive and legal, heroin should be legalized.

I think that Psychologists are pushing for prescriptive rights too.

Clinical psychologists (and there is a difference) have them in some states, but given that obtaining a residency in clinical psych is more competitive than getting into medical school and the training is at least as arduous, I don't have room to comment. However, most psychiatrists are adamantly against this.

- H

 

[BackTalk]

Given that my wife was 15 yo in 1993, he wasn't my brother-in-law yet. (I also hadn't met my wife yet). Yes, I'm a cradle-robber, but a legal one!

Perv....hehe...everyone should have a trophy. I bet she makes you look good on back of the Harley. 26 eh?...I bet you self prescribe Viagra don't ya?

And I have no question he caused the herniation. There are studies that have found herniations to be one of the risks of spinal manipulation, and I know when the symptoms started. Why is chiropractic so convinced that there are no risks associated with their care?

You keep telling yourself that. Chiropractic is a conservative approach to treating disc herniation. Who did these studies you speak of? If there was such a risk I would think that chiropractic colleges wouldn't teach techniques on how to treat it.

The neck is fine. When the symptoms "flare up", a few ibuprofen does the trick. No way I will ever be spinally manipulated again.

Ok then, live in pain. I wonder if a study were done on the complications arising from cervical spine manipulation compared to the complications arising from taking NSAIDS, which would fair better.

If it controlled my pain? Yes.

I would hate for you to risk self induced hepatitis. Start taking some proteolytic enzymes. It works great for inflammation with little to no side effects. Also, get on some omega three fatty acids and glucosamine. That disc in your neck is degenerating by now. It certainly lacks proper function and will only worsen with time. Seek the services of an osteopath that specializes in manipulation since you have given up on chiropractic.

Dentists, yep, dental school is very arduous. Their pharm training is extensive and should be. Podiatrists give very few systemic drugs. I am not sure about their training. I'm not sure that they have "full" prescription rights. I don't think optometrists can prescribe. I believe they have some medications they can use "in the office" to facilitate testing.

Dental school may be arduous but its not medical school. Most of it is superficial except for the study of the head and neck. Same can be said for podiatrists and the lower extremity. Keep that in mind as you may question if they have the skill to properly screen patients for other conditions when prescribing medication. You act as though it's ok for a podiatrist to prescribe medications even with lack of equivalent training in pharmacology (as that of an MD) because they do not usually prescribe systemic medications. Aren't ALL drugs systemic to some extent? Anyway, I know what you meant. Well if that is the case, then why would it be so bad for a chiropractor to take additional training and only prescribe a handful of meds? I feel that our ability to screen for pathology outside of dental exceeds that of a dentist.

Utter quacks. Money grubbing frauds who should be relegated to a deep circle of hell for preying on the ill and needy. And they can not prescribe. They can, against the spirit but not the letter of the law, suggest dietary supplements to their "patients" - a word I am loathe to use in this setting; "victims" would be more appropriate.

HeHe....sounds like they're right up there with chiropractors.

I think lots of folks would "like" the right to prescribe. Nurses for one would love to be able to adjust orders for over the counter medications in hospitalized patients. But, in most institutions they can't. The problem with allowing chiropractors to prescribe pain medications or muscle relaxers goes back to the base argument here. What is your ability to screen for other conditions? There are times when a patient with a chief complaint of back pain could be hurt by these meds.

What is a podiatrist, dentist or even an optometrist's ability to screen for pathology? All three are specialties and so is chiropractic. With chiropractic, we learn everything, not just one area. I would think that gives us an edge over these other 3 professions who have prescription rights.

And if I remeber correctly there were groups of chiropractors who argued against both concepts. You still have yet to give a reason to "reinvent the wheel". Why allow this practice? How is the public better served by a DCM than by an MD/DO?

You are correct. The straights always ruin it when this profession tries to expand. They do not want to change; they want to continue to believe in the imaginary subluxation. The longer they can convince the public that this thing exists, the longer they can dupe them out of their life savings. If we were to throw the subluxation nonsense out of the window, these gangsters of healthcare would be out of business and your brother in law would be moving into your basement. hehe Seriously, I feel that with time these old time straight chiropractors who hold much of the influence will be dying off. When they do, there will be less opposition to deal with.

Clinical psychologists (and there is a difference) have them in some states, but given that obtaining a residency in clinical psych is more competitive than getting into medical school and the training is at least as arduous, I don't have room to comment. However, most psychiatrists are adamantly against this.

Clinical psychologists lack equivalent training in pharmacology as a medical doctor. Also, they do not have the medical background of a psychiatrist and therefore lack the proper diagnostic skills to screen patients.

What do you think about pharmacists? Ultimately, they have the highest training in pharmacology. But do they have enough training in physical diagnosis to properly screen patients and also prescribe medications. I believe they can prescribe medications in Florida.

 

[FoughtFyr]

BackTalk, we have to argee to disagree. I'm not going to move you and you are not going to move me. I think we can also agree to continue to keep the other side "honest" by demanding studies, facts, and reasonable suppositions during debate. And that will be our role in helping others to make informed choices about these issues.

With all due respect,

- H

 

[BackTalk]

Hey, if we didn?t disagree there would be no debate. Anyway, I?m sure we will be talking again soon.

-BT

 

[aphistis]

Dental school may be arduous but its not medical school. Most of it is superficial except for the study of the head and neck. Same can be said for podiatrists and the lower extremity. Keep that in mind as you may question if they have the skill to properly screen patients for other conditions when prescribing medication. You act as though it's ok for a podiatrist to prescribe medications even with lack of equivalent training in pharmacology (as that of an MD) because they do not usually prescribe systemic medications. Aren't ALL drugs systemic to some extent? Anyway, I know what you meant. Well if that is the case, then why would it be so bad for a chiropractor to take additional training and only prescribe a handful of meds? I feel that our ability to screen for pathology outside of dental exceeds that of a dentist.

What is a podiatrist, dentist or even an optometrist's ability to screen for pathology? All three are specialties and so is chiropractic. With chiropractic, we learn everything, not just one area. I would think that gives us an edge over these other 3 professions who have prescription rights.

Describe the extent of your pathology training in chiropractic school, please. This semester alone in our path course, we're responsible for the etiology, clinical presentations, radiological findings, histopathological findings, treatments, & prognoses for a little over 300 diseases. If you get more pathology training than a dentist in school, I'll eat my loupes. As dentists, our area of specialty IS the head and neck, and pursuant to that, of course most of our education & training will focus primarily on that region of the body. If you think, however, our education in the rest of the body is "superficial," you need to spend some time reviewing a dental curriculum. Hell, for that matter, a number of dental schools take their basic sciences *with* the med students. I'd be willing to pony up a handsome sum on the number of systemic diseases presenting with oral manifestations against the number that present with "vertebral subluxations." For someone calling on other health professionals to reject stereotypes of your profession, you don't seem to mind employing them yourselves. It's pay-or-play time, champ.

 

[BackTalk]

Describe the extent of your pathology training in chiropractic school, please.

150 hours (1 year) pathology I & II with lab. Also took Histology and cell biology with lab. Follow link below for description.

This semester alone in our path course, we're responsible for the etiology, clinical presentations, radiological findings, histopathological findings, treatments, & prognoses for a little over 300 diseases. If you get more pathology training than a dentist in school, I'll eat my loupes.

Whupdido. I really do not now the exact details of the dental curriculum and can only rely on what my brother tells me. He's in his third year at the University of Tennessee - Memphis. He said most course work is geared towards head and neck.

As dentists, our area of specialty IS the head and neck, and pursuant to that, of course most of our education & training will focus primarily on that region of the body.

Oh goody, you agree with me champ.

If you think, however, our education in the rest of the body is "superficial," you need to spend some time reviewing a dental curriculum. Hell, for that matter, a number of dental schools take their basic sciences *with* the med students.

Those are "basic" sciences. I'm talking about clinical science. After basic sciences (last two years) the dental and medical students go their separate ways. Here, I went to Logan, you can review the curriculum here. http://www.logan.edu/pdf/logan_catalog.pdf

I'd be willing to pony up a handsome sum on the number of systemic diseases presenting with oral manifestations against the number that present with "vertebral subluxations."

What about dental subluxations? We adjust those too.

For someone calling on other health professionals to reject stereotypes of your profession, you don't seem to mind employing them yourselves. It's pay-or-play time, champ.

My intention was not to insult the dental profession. My point was that a DC studies more of the whole body than does a dentist. Listen, I respect dentists and am not trying to belittle your profession.

 

[jesse14]

I respect the hell out of MD's and all the training they must endure. But when i had my car accedent no MD did anything remotley close to that of my DC. I went to 3 MD's and they ALL did the same thing. They examend me, took my HR,BP,reflexes, and touched my back to see if what they did made it hurt. They all put me on a high dossage pain killer and told me to come back in 2 weeks. Yes, the pills helped the pain, but you all must understand that it's not the pain that needed to be relieved:it's the cause of the pain. After 3 tries with MD's i turned to a chiro and he did almost everything the MD's did, but he used other examination methods to assess my back. HE used ultrasound therapy, heat/cold therapy and spinal manipulation of L4-L5 to help the pain. After 3 vists a week for 3 weeks my pain was gone! And even after the 3rd visit i could feel huge relief minutes after the adjustment.

So, you can say what you will about chiro education vs Medical eduction and what not but all i will say is this.......CHIRO WORKS

(NOt saying one is better than the other, just that in my case chiro did a great job of helping me)

 

[niko327]

I respect the hell out of MD's and all the training they must endure. But when i had my car accedent no MD did anything remotley close to that of my DC. I went to 3 MD's and they ALL did the same thing. They examend me, took my HR,BP,reflexes, and touched my back to see if what they did made it hurt. They all put me on a high dossage pain killer and told me to come back in 2 weeks. Yes, the pills helped the pain, but you all must understand that it's not the pain that needed to be relieved:it's the cause of the pain. After 3 tries with MD's i turned to a chiro and he did almost everything the MD's did, but he used other examination methods to assess my back. HE used ultrasound therapy, heat/cold therapy and spinal manipulation of L4-L5 to help the pain. After 3 vists a week for 3 weeks my pain was gone! And even after the 3rd visit i could feel huge relief minutes after the adjustment.

So, you can say what you will about chiro education vs Medical eduction and what not but all i will say is this.......CHIRO WORKS

(NOt saying one is better than the other, just that in my case chiro did a great job of helping me)

There are nice stories about chiropractic (like your's) and some not so good, the plural of anecdote is not data. My story about chiropractic follows:
After lifting some 300lb SOB with SOB into the back of my ambulance without the advantage of a one man stretcher I went home with terrible back pain. The next day I woke up and couldn't move. I too went to my doctor who gave me muscle relaxants and pain killers which did absolutely nothing for me. A couple of days passed and I got desperate. I decided to see a chiropractor. At first the massage therapist lady worked on me, followed by some electrical stimulation on my back. I have to say the massage therapist did make me feel very slightly better, unfortunately this was temporary and the pain came back as soon as she was done. Then the chiropractor came in, said some stuff that made little sense and to told me he had to "adjust" my back. So he contorted my shoulders in one direction and my pelvis in another, I heard a crack and saw fcuking stars. I told him to get his hands off of me or I'd rip his nuts off. The pain was twice as bad when I left his office. What the heck happened to do no harm?? I was really disappointed by the whole experience. I had seen a chiropractor once before this experience and got some electrical stimulation and massage for a rhomboid spasm which seemed to help. I had not gotten an adjustment at that earlier visit though.

 

[jesse14]

There are nice stories about chiropractic (like your's) and some not so good, the plural of anecdote is not data. My story about chiropractic follows:
After lifting some 300lb SOB with SOB into the back of my ambulance without the advantage of a one man stretcher I went home with terrible back pain. The next day I woke up and couldn't move. I too went to my doctor who gave me muscle relaxants and pain killers which did absolutely nothing for me. A couple of days passed and I got desperate. I decided to see a chiropractor. At first the massage therapist lady worked on me, followed by some electrical stimulation on my back. I have to say the massage therapist did make me feel very slightly better, unfortunately this was temporary and the pain came back as soon as she was done. Then the chiropractor came in, said some stuff that made little sense and to told me he had to "adjust" my back. So he contorted my shoulders in one direction and my pelvis in another, I heard a crack and saw fcuking stars. I told him to get his hands off of me or I'd rip his nuts off. The pain was twice as bad when I left his office. What the heck happened to do no harm?? I was really disappointed by the whole experience. I had seen a chiropractor once before this experience and got some electrical stimulation and massage for a rhomboid spasm which seemed to help. I had not gotten an adjustment at that earlier visit though.

I'm sorry you had such a bad expereince with your chiro. I have no explanations or idea as to why your adjustment would hurt so much. All i know is that from personal experience, I feel relief with in minutes of my low back adjustment. I also find it amazing how when i have a headache my chiro can adjust my neck and not 5 minutes later does my headache dissapate. I'm starting to think that i want to be a chiro and that's what I think i will do because i believe in its abilities. It simply makes sense to me. As for that guy who say's DC's only treat three thing.......... You're a *****! Leran of what you speak before you speak it.

Thanx for the replie