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DC's - May 12, 2005 4:03:00 PM
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vt2c1ms
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What's the big deal with DC's and the negativity? Several of my patients in orthoptic therapy see chiropractors and love them. My father had polio as a child and swears it helps his back (he supposedly wouldn't be able to walk). My father is one reason I'm pursuing a DPT, so I can treat his back pain with physical therapy. So, if someone can answer this in a professional manner I would appreciate it. I'm always asked questions about DC's from people ever since I chose PT as a profession. Most people believe it is just a turf battle. What's the best way to handle this situation professionally?
Mark :confused:
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Re: DC's - May 13, 2005 2:22:00 AM
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JLS_PT_OCS
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What's your question, why are DCs negative about us, or why are we negative about them?
It does happen both ways, so not sure which part of that question you're asking, or both?
Professionally I tell patients we are trained differently, have different skill sets and emphases, and work in different ways.
It's up to them to get as much information as they want about the two to determine who they'd like to work with. Or both.
As in any profession, there are good ones and bad ones, just like in PT.
To other healthcare providers, I am more honest about my misgivings and the data that exist about how different providers are trained, issues about scientific basis of a profession, entrance standards, student loan default rate, fraud and insurance overutilization, etc.
There are lots of resources out there on the web, so do some searches to see a different view of PT and of Chiropractic. Even here on RehabEdge, look at and read some threads related to these topics.
If you're getting into PT, you might as well get a sense of the current issues...
Try searching for "Skeptical Physical Therapy" or "Skeptical Chiropractic" or something like that out there on the net.
Good luck in your information search.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: DC's - May 13, 2005 4:09:00 AM
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FLAOrthoPT
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when it comes to purely treating a spinal dysfunction and nothing else, you will find PT and DC who treat exactly the same and no discerable difference. In this instance there really is no difference. That being said. The negaitvity comes about from general philospophy of schooling of some (moony) DC.
Most PTs are very logical scientific based, EBM, and will not accept that a manipulation can treat a cold or liver dysfunction. While we know that a facilitated segment could in theory change nerve signals to even organs, it is just too far of a stretch for most PTs to buy into, and we feel that in this scenario a DC is just cheating the public.
We also have resentment of the DC pidgeon holing us into their profession...that is..Pts are taught at entry level to treat all sorts of conditions from wound care to stroke not just spinal conditions. For some reason many DC feel that PTs are only orthopedic spinal in nature and cannot understand why the PT profession exists if they are competent at spinal manipulations.
Another rift exists in the fact that most PTs want to help the pt get better and teach them the skills to be better for a long time...that is primary prevention, avoidance of bad activities, specific HEP, etc. While many Dcs seem to thrive and are even taught specific communication skills to make the pt feel as if they will never get better unless they are fixed by the DC and continue to come in for a predetermined amount of Tx based solely upon XRay or eval but with no concern of reassessing after progress.
Another reason is When the DC treat patients 3 times a week for years and pts go in for their weekly "Adjustment" based solely upon the beleif of subluxtion, then it drives a PT nuts that they feel as if the DC is taking advantage of the pt and moreover the dysfunctions it causes are often close to impossible to treat. I persoanlly hate treating instabiulities from prolonged manipulations, over and over aagin loosening up lig. structures.
Next it seems to drive PTs nuts that "everyone is a candidate for manipulation. Even osteoporotic patients, acutely herniated disks, and even young children. And it seems manipulation, that being their bread and butter, is used to treat even hypermobile situations which just seems inane to most PTs. Now we all know their are some pts who'd rather be fixed than to take personal responsibility for their dysfunctions and would rather have someone stretch them etc, (i make a good living with these pts so I am not going to say anything bad), but it seems that some pts like 16 year old who cannot possibly have that severe of spinal problems are being coerced into regular treatments by a DC. This is just infuriating b/c it not only creates this type of mental attitude of a why me I have back pain at such an early age, but it most likley is creating more problems than it is fixing.
Yes, I'll keep going...Yet another reason their is a rift, b/c of jealousy. PTs feel as competwent if not more than Dc but cannot understand why many pts have such automatic respect for Dc and are willing to pay lotso f cash over a long time, and are willing to go to a DC eevn when in PT, and are the same pts who complain about the 10 dollar co-pay, but will shell out 75 bucks each Dc visit. I think this autonomy and good business drive of a DC drives some PTs nuts out of jealousy.
Overall, I think that there are some Dc out there who'd treat a freshly FRS or ERS patient the same I would and even follow up with a good nm re-ed exercise and good soft tissue work and good behavioral mod teaching, but then again the average DC will not do that and the argument can be made that the avewrage PT does not have enough manual skills to treat some spinal patients. So I think their is a rift based on this untrusting of skill of the average practitioner as well.
Finally, b/c I have to go work, I think the basic underlying philosophy of treating subluxations is not accepted by PTs. So it would be like asking someone with a theological difference to just accept another religion as correct, when deep down they do not believe in the core belief.
The last rift is when a PT or a pt seeing a PT feels the need to go to a chiro simultaneously for the same problem. but it is somewhat understandably maddening for comments like send the pt to a chiro to get their first rib manipulated...in my world, (this is going to sound offensive but it is not I swear) I have no need for DC. I would never send a pt out to a DC, if their was a condition I really couldn't get better I'd either chalk it up to they cannot be treated or refer out to a FAAOMPT or someone at the real top of the field of PT manual ortho Tx. I think that a very good manually trained ortho PT has no need for chiropracters so this creates yet another rift.
So all this being said, the rift between the two professions is understandable and of course prinary reason is turf related and money related like usual. So do I respect a DC opinion i this forum, of course, but yes i shutter when i hear a pt say they go to chiro, mainly b/c it shows me how far behind our profession is at marketing our skills to the general public.
Ok enough for now-
Benjamin Galin, MPT, OCS
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Re: DC's - May 13, 2005 4:51:00 AM
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vt2c1ms
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Very informative. Thank you for your time.
Mark
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Re: DC's - May 13, 2005 5:01:00 AM
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vt2c1ms
Posts: 74
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From: Kansas
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Last question (for now :) ). Obviously, I live in Kansas with toto. There are several DC's (right down the street) who advertise that they perform physical therapy services. That really eeeeeeeeerrrrrrrrrkkkkkkkkksssssssss me!.
What's going on here? So, PT's can claim we offer DC services and PT services?
Mark
P.S. By the way, HealthSouth (PT's) just opened a clinic right next door to the DC's.
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Re: DC's - May 13, 2005 5:10:00 AM
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Sebastian Asselbergs
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Check with the laws of your state. In some states, the use of the term "physical therapy" is off limits to all but PTs. "Physical modalities" is acceptable everywhere.
And no, I do not think there is a chance in **** that you can use "DC" in any claims as a PT.. :-)
Good luck with both Healthsouth and your other neighbours....
_____________________________
Mundi vult decipi
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Re: DC's - May 13, 2005 7:34:00 AM
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JLS_PT_OCS
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Very good, even-handed post, Ben.
I feel my opinions are too well-developed and caustic to post.
Nice job.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: DC's - May 13, 2005 1:50:00 PM
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tc
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I share many of the same opinions as FLA ortho. I do believe there are some DCs out there who have a good head on their shoulders and believe they are really helping people. I do think one helped my migraines. But, so did acupuncture for a while, too. However, I also strongly believe there are more DCs that are in it for the $$ than the benefit of the patient.
Check out [URL=http://www.quackwatch.com]www.quackwatch.com[/URL] for very interesting info. Especially about the way they are taught to market their skills (it's for everyone, for the rest of your life, for prevention, for fixing anything, etc.) Their recruiting techniques are also very suspect.
I work with pediatrics and have had parents tell me that DCs came up to them at "child healthfairs" and make crazy claims about being able to "fix" certain things. And the idea of manipulating a child's spine just makes me cringe!! Yet, they even make children's story books and toys to directly market to kids to get them to *want* to go to the DC!! And the B**s** about you need to get regular adjustments to prevent disease and stay healthy...don't get me started.
About the DCs advertising PT, you'll find this is a common problem, and a common concern of ours as a whole. Read other posts about how other PTs have tried and sometimes successfully stopped this. I think I remember Drew talking about this a while back. I agree with Sebastian, find out what exact wording is legal in your state. If their wording is illegal, you may be able to do something about it and get them to change their advertising.
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Re: DC's - May 13, 2005 5:53:00 PM
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Synergy
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Nicely summed up Ben and I couldn't agree with you more. :)
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Chris Adams, PT, MPT
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Re: DC's - May 14, 2005 7:48:00 AM
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vt2c1ms
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Man, after reading some the websites against DC's (ran by DC's), who in their right minds (especially current students)would pick that career pathway (unless your grades were inadequate in undergraduate school). Unbelievable!!! How can the goverment let those quacks see patients? Would our government let voo-doo clinicians see patients here in America? NO!
Chiro vs. voo-doo (same ball park according to what I read on those websites). But then again, my father swears that it works for his back pain.
What a weird profession.
Mark
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Re: DC's - May 14, 2005 8:58:00 AM
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dosrinc
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When I was a PT student way back in '90 I attended an FPTA conference in Orlando. In the same hotel the Chiro association was holding a meeting. Being a curious student I slipped into one of the chiro lectures, on the big screen I read "WE DON'T CURE OUR PATIENTS, IF YOU TELL YOUR PATIENTS THAT THEY ARE CURED THEY WILL HAVE NO REASON TO RETURN TO YOUR OFFICE" Since then I have been a skeptic and have seen nothing in 13 years of practice to change my mind about the profession as a whole, though I have encountered several individual chiro's who were good people and had good intentions.
Rick
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Re: DC's - May 16, 2005 8:22:00 AM
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Sominus
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From: League City, TX
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VT2C1MS writes:
"Man, after reading some the websites against DC's (ran by DC's), who in their right minds (especially current students)would pick that career pathway (unless your grades were inadequate in undergraduate school). Unbelievable!!! How can the goverment let those quacks see patients? Would our government let voo-doo clinicians see patients here in America? NO!
Chiro vs. voo-doo (same ball park according to what I read on those websites"
The biggest of the two sites that I know about are "Paul's Chiropractic Resources" (home of Allen Bottnick) and a quackwatch site. I have read both extensively.
The Quackwatch site lists many anecdotal stories, some "testimonies", much old, antiquated information (posted fairly recently) and a lot of what I feel is "sensationalist" propaganda. I will admit that SOME of this information uncovers some problems within the chiropractic profession that do need to be solved, but I don't believe that this site shows the truth about what the state of things are in chiropractic.
On the other site I have seen some good information, but interspersed amongst a lot of hate-mongering for the chiropractic profession. Much of the information I have seen takes the form of someone referring to some publication (sometimes written by the author of a forum post themselves) cited as dogmatic truth, yet when challenged by similarly referenced material, that new material becomes magically "untrue" and the person who questions it is "sadly misinformed". To say that these sites are run by DCs is a stretch.
I have posted information showing that the same issues ****ing chiropractic as quackery exist in other professions (MD, DO, DDS, DVM, and even PT just to name a few) yet these have quietly been deleted since they don't match the agenda of the forum/board in question. The truth of the matter is that what can be said of chiropractic can also be said of other medical professions when one takes specific practitioners into account. A fair questions here is, I believe, "Does Chiropractic have more than its fair share of these individuals (who practice such ethical quandries)?" I don't know. But when I see this (written by "Rick" in a post above):
"Since then I have been a skeptic and have seen nothing in 13 years of practice to change my mind about the profession as a whole, though I have encountered several individual chiro's who were good people and had good intentions."
then I would invite you to take a STRONG look at the practices of many other professions, including dentisty. The marketing is the same, the propaganda, sensationalism, "unnecessary treatment", upselling, etc are all rampant. Been to a veterinarian recently? Yup, its there too.
For those who would say that chiropractic is 'medically dangerous', when you examine the statistics you find that on an incidence-based percentage, other modalities (medicinal, surgical, diagnostic, etc) are more dangerous in terms of causing harm and killing people. However, some of these "forums run by DCs" you speak of will not brook discussion of such issues, since the question "isn't about other professions, its about chiropractic." How convenient!
-Michael
(who has seen PTs, DCs, MDs and MOUSEs...)
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-Michael in League City
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Re: DC's - May 16, 2005 8:43:00 AM
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coreconcepts
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Excellent insight Ben! This topic is always of interest to me. As a personal trainer, I exclusively recommend physios. My reasoning is simply from a healthy trust of the industry's philosophy. I have chiros who I consider to be friends, and I think that there are very good chiros out there. In fact, I belive that one of the primary reasons why my one chiro friend isn't thriving is because he is honest. He doesn't claim to be able to treat everything, he tells patients when they no longer need to go to him and he even recommends physios for certain conditions that he doesn't feel he can treat! One of my biggest critiques of DC's is that they very rarely give supplemental exercises (in my experience). I suppose this is part of the "patients for life" mantra that many of them follow.
So where do you draw the line as to what chiropractic care is effective for, and what it is not? It seems that there is good evidence to suggest that chirpractic care (manipulation) has been successful with treating acute neuromuscoluskeletal issues. Conversely, it appears as though there isn't much evidence that it will cure bedwetting, colic or ear infections. (If anybody has literature on this subject, I would be greatful for a link to a study/paper, etc)
I read one chiro's website that sounded great - fitness-oriented, holistic in nature, yadda, yadda... than I got to the "how many times should I see a chiropractor" in the FAQ section and BAM - there it was, cleverly disguised amongst the "it depends on the condition and patient" rhetoric, was the catch-question "you don't see your dentist only once, do you? You need regular appointments to keep your teeth and gums healthy". ARRGGHHH! The same underlying "anchor system", crafted to associate chriopractic care with "regular use or follow-up".
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Re: DC's - May 16, 2005 8:55:00 AM
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JLS_PT_OCS
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While many individual stories about different providers may happen in other professions, there still remains no excuse for any profession built upon pseudo-science or upon marketing.
While other professions may engage in marketing or use marketing, it can be said that some others are, at their root, ABOUT marketing.
It may be that chiropractic is one of those.
One has merely to peruse resources available on the internet to see this.
While the motivation or veracity of individual sites cannot be known for sure, the sheer number of sites about Chiropractic is interesting.
The sheer number being written by or with the assistance of current/former chiropractors (not by anonymous hate mongers, but by people like Sam Homola or Allen Botnick, who have credentials that can be verified) speaks volumes about this.
Is there a site called "PTBase.Com" cataloging the basic scientific flaws and quackery being taught in PT schools and perpetrated through PT practice? No. But there is for chiropractic. Hmm.
Is there a group called "Families Against Abusive PT Practices"? No. But there is for chiropractic. Hmm.
Does the National Council Against Health Fraud have a position paper on Physical Therapy? No. But there is for chiropractic. Hmm.
Do PT accreditors admit that passing standards are way too low for the PT exam and that PT boards have passed and continue to support unqualified, possibly dangerous providers? No. But there is such admission for chiropractic. Hmm.
http://www.prweb.com/releases/2004/11/prweb178574.htm
I think those who disagree with these chiro-skeptical forum boards would like others to think that other professions are the same, and that those sites are dominated by hateful people wrongfully defaming a profession.
The balance of facts do not support that contention.
Certainly not everything said on those boards is true, and it is reasonable to think that there may be bias. But on so many boards? By so many current and former practitioners?
That just doesn't make logical sense.
Now, by all means, we should never paint any person with a broad brush based on what letters they have after their name.
Just as there are bad PTs and bad MDs, there are bad DCs. But the argument that schools, licensing boards, and existing pracitioners are perpetuating bad practices has not been successfully refuted, given the evidence presented.
I will continue to judge each person individually, as should we all, but let's not pretend that there is not legitimate divisiveness, questionable education and practices, and a questionable future in that profession. Also, those concerns exist for legitimate reason, and are not demonstrably found in other professions.
What that means is for consumers and individual providers to determine.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: DC's - May 16, 2005 9:25:00 AM
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Sominus
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From: League City, TX
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Jason wrote:
"Do PT accreditors admit that passing standards are way too low for the PT exam and that PT boards have passed and continue to support unqualified, possibly dangerous providers? No. But there is such admission for chiropractic. Hmm.
http://www.prweb.com/releases/2004/11/prweb178574.htm"
Allen Bottnick wrote that. This is exactly what I spoke of above. Is this number verified by anyone? Or is this an extrapolation based on 1) the total number of chiropractors in the U.S. and 2) the number of people who graduated from Life University from the program that Allen himself graduated from , which is the program he (probably correctly) has a problem with? Allen is the only one I have personally seen sourcing and verifying that number.
Jason also wrote:
"The sheer number being written by or with the assistance of current/former chiropractors (not by anonymous hate mongers, but by people like Sam Homola or Allen Botnick, who have credentials that can be verified) speaks volumes about this."
I leave it as an excersize to the reader(s) of this board to do their research on the writers of their articles. I will admit that there are some good proponents out but there are also some poor ones. I have some respect for Allen Bottnick and have chatted with him a few times, but I do take some exception with the term 'credential' as it relates to him. Yes, he graduated from Life U with a D.C. I am sorry that he feels (possibly correctly) that he got the wrong end of the stick. I do believe that Life U. was screwed up, and that their accreditation issues are rife with scandal on their part AND the accredtor's part. My personal feeling, however, is that he uses the term "Dr." and the initials "D.C." with some hypocracy. It can be argued in many ways, probably many of them "right".
Jason wrote:
"Is there a group called "Families Against Abusive PT Practices"? No. But there is for chiropractic. Hmm.
Does the National Council Against Health Fraud have a position paper on Physical Therapy? No. But there is for chiropractic."
In another part of the rehabedge board there is a frank discussion about the fraud that is a "normal part" of PT practices. I'll let that stand on its own merit (or lack thereof). Searching for the issues yields MANY results. Do they have their own boards? Yup. As many as chiropractic? I don't know, since I didn't count. There is credence on both sides of that issue which I will (and would hope that you would) concede.
I don't say that other professions are the same (as chiropractic), nor do I mean to imply it. What I DO mean and say is that the same issues which plague chiropratic's reputation in some circles is also alive and well in many others. I have seen many deny it outright and cover it up in the form of flowery rhetoric, argument and censorship.
My fingers are tired... :-)
-Michael
_____________________________
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-Michael in League City
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Re: DC's - May 16, 2005 9:37:00 AM
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coreconcepts
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From: Vancouver, BC
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Great thoughts, Jason!
What struck me is the part where you mentioned a "questionable future in that profession". Do you mean to say that you believe chiropractic to have a bleak future? I'm not sure if I'm reading into the context of what you said correctly.
I think we may have touched on this in the health/fitness forum, regarding the inherent laziness of our society, and the subsequent lack of gumption to perform anything that resembles "work". Unfortunately, I believe that this plays right into the hands of the chiropractic profession, where there appears to be a "fix-me" mentality. I'm not implying that patients don't come to PT's with that same mentality, however I do think chiropractic consciously (or subconsciously) espouses this kind of mindset. To conclude, I think that as long as there are people who want the "quick fix", the chiropractic profession, drug industry, fad diets and countless other "gimmicks" will thrive. As much as I (and many others) would love common and scientific sense to prevail, convinceing and deceptive marketing usually wins out.
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Re: DC's - May 16, 2005 9:41:00 AM
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Sebastian Asselbergs
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From: Barrie, Canada
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Michael: you're right - there IS a "frank" discussion on this (generally a "pro-PT board")
board. There rarely is a frank and open discussion on chiropractic boards (FACE, Chiroweb, etc). As soon as any criticism is levied towards any chiropractic, the lister os flamed....
_____________________________
Mundi vult decipi
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Re: DC's - May 16, 2005 9:42:00 AM
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Sominus
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From: League City, TX
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I believe I may have incorrectly attributed some derisive comments regarding Sam Homola in my original (now edited) post. My apologies if this is the case, no harm meant. I have sacked the brain of the person responsible for the incorrect attribution.
-Michael
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-Michael in League City
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Re: DC's - May 16, 2005 10:55:00 AM
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JLS_PT_OCS
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From: USA
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Michael-
Do you believe the statement posted on prweb is false?
The statements and conclusions based upon the citation in that website seem correct, and a very reasonable estimation, to me. The fact that no one else says it does not make it incorrect.
Even if you disagreed about the number of DCs that affects, do you dispute what the accreditor said? That seems a different issue.
Fraud does happen in all professions. I don't think anyone's arguing that. The issue, to me, is to what extent it is going on and where might it be learned?
That's the interesting question. I'm not sure I have an answer, but what I "have" found points in some interesting directions...
Here is some more information for your perusal:
Families Against Abusive Chiropractic Practices:
http://www.faact.com/
Is there a similar website for PT or podiatry or medicine? I wonder why not?
National Council Against Health Fraud's Position Paper on Chiropractic:
http://www.ncahf.org/pp/chirop.html#manipulative
Is there a similar position paper on optometry or PT? Again, I wonder why not?
Here's the NCAHF's Fact sheet, note please that this is extensively referenced, with both books of chiropractic philosophy and with articles from peer-refereed journals.
http://www.ncahf.org/articles/c-d/chiro.html
Chiropractic marketing and manipulating to children is so common in Canada that the Community Pediatrics Committee of the Canadian Pediatric Society has a lot to say about it:
http://www.cps.ca/english/statements/CP/cp02-01.htm
No statement against PTs, physicians, optometrist, or podatrists, though. Go figure.
Here is a statement from a group of Canadian Neurologists, again extensively referenced.
http://www.chirobase.org/15News/neurol.html
Again, no statements against others. Seems to all be about chiropractic. Noting a trend...
In the US, Medicare seems to be having some Chiro billing issues:
http://www.chirobase.org/19Insurance/mc2004.html
Here's some issues with student loans, evidently there is a seriously-high default rate?
This article written by a DC...
http://www.chirobase.org/03Edu/loan.html
How about admission to chiro school? This is a summary of an article cited on the site, from JMPT, a chiropractic journal. Talks about how low the admission standards are to get into chiro school.
http://www.chirobase.org/03Edu/adm.html
I could add more, but really, what's the point?
I'm not trying to be harsh, honestly, but let's not pretend that this profession does not have serious issues... about professionalism, over-marketing and over-utilization of services, standards of admission and graduation, etc.
And please don't say that other professions have those also. Issues with other professions are drops in the bucket, both in terms of numbers and severity, compared to the depth and breadth of evidence out there against chiropractic, some of which I cited above.
That's before I even get into the mall spinal screenings or practice building. It's like a pandora's box, things keep leaping out and getting worse and worse...
Look, I still don't think poorly of individual chiropracTORs until I meet and talk with them and decide. I've met some great ones. Maybe you're one of the great ones, too. I don't know.
I have, however, a big problem with chiropracTIC.
Given the overwhelming available evidence, shouldn't everyone also have a problem with it?
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: DC's - May 16, 2005 12:07:00 PM
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Diane
Posts: 1507
Joined: March 9, 2001
From: Vancouver, B.C., Canada
Status: offline
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Jason, well said.
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