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Re: Chiropractic madness!!!!!!!!!!!!
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Re: Chiropractic madness!!!!!!!!!!!! - November 15, 2001 3:18:00 AM
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Andrew M. Ball MS MBA PT
Posts: 271
Joined: September 30, 2001
From: Chapel Hill
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Don,
I'm enjoying this discussion, and I hope that you are too. Hopefully, we'll get a few other RehabEdge.com members to share their views.
First of all, you should know that I don't have a lot of tolerence for pseudoscience, be it PT or DC . . . and let's be honest there is a lot of technical sounding BS in either profession. I have no problem with evidence-based pracitioners, armed with appropriate diagnostic skills, acting as PCP's. The overwhealming majority of DC's and PT's alike don't fit that bill. Not that all need to . . . MD's certainly have their share of incompotents too. A DC as a gatekeeper though? A few could do this competently . . . but not most.
As for your school, I've simply never heard of Western States Chiropractic. So until this morning, I was rather apathetic on the school, I just don't have enough information. I agree that there is a quantum/qualitative piece of care that is not adequately addressed by allopathic healthcare. I'll also agree that there are SOME (maybe 5%or so) of chiropractors adequately trained to be primary care practitioners. Diagnostic skill and safe referral techniques has, in my experience, been the unfortunate exception to the rule however. I've NEVER heard of a DC referring out to early intervention a child with early learning or mobility problems --- presumably because chiro can cure that.
More often I've had interactions with wackos who think they are going to cure autism, cerebral palsy, or asthma with a few quick grade V mobs. Granted, sometimes interactions, tone, or breathing will get better as a function of chiropractic care, but if anything other than mobility and alignment is promoted as the goal of care, the chiropractor is simply operating outside the realm of what's ethical and appropriate to sell to the public.
There are some schools that are heavy into diagnostics, like NY Chiropractic, like National, and upon cursory review --- Western States appears to be a real school too, but the schools with the longest traditions, Palmer and Life, seem to produce more unscientific, non-evidence-based, craniosacral lovin' wack jobs than the others. The real problem for ya'll is that these folks ARE the loudest, and most attractive to the public at large. In PT, we tend to laugh at those kind of art-first, science-never wackos and sweep them under the carpet. In PT they are the Black Sheep that we're trying to eliminate, in DC they are tolerated, if not embraced.
NO wacko not PT, or DC should be a PCP. It's that simple. It's just not safe.
That said, I STILL don't understand the friction between PT's and DC's. It's like the long standing feud between OD's and opthamologists. When they finally got together, they accomplished quite a bit for the patient and made LOTs of money in the process. We'd all be better off if DC recognized that they should stick to spinal alignment, and if PT's recognized that DC's aren't all inherently evil . . . even the wackos are generally more skilled at palpation and spinal alignment. PT's are far more skilled at having the patient keep alignment once corrected. That, to me, sounds like a GREAT opportunity for partnership. Why doesn't anyone do this???
Drew
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Re: Chiropractic madness!!!!!!!!!!!! - November 15, 2001 6:50:00 AM
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NYDC
Posts: 2
Joined: November 14, 2001
Status: offline
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Dear Respected PT's,
This is my first post on this site, and I appreciate you allowing me to voice my opinion.
This thread had leaked over to our chiro. discussion site and I felt compelled to respond. I am a relatively new practicing chiropractor and unlike Mr. Peterson, I disagree with allowing DC's to act as VA primary care physicians. Let me explain my stance...
I'm thrilled I chose this profession and think we treat acute uncomplicated musculoskeletal ccomplaints pretty well. However, beyond that scope of practice a significant amountof DC's are lacking the skills to diagnose and refer to appropriate physicians.
Someone mentioned the varying philosophies of the chiropractic universities. This is a great point. Some schools, such as the one I attended (Cleveland Chiro, L.A.) really hammers diagnosis, pathology and radiololgy. Whereas other colleges are very philosophically driven, and spend less time on those subjects. I think that gap can pose a potential problem. Also, even though I have had a tremendous amount of differential diagnosis education, I don't feel comfortable taking non-musculoskeletal patients. We have enough to work with in lowback and neck pain. It actually frightens me to think that some of my classmates could potentially be someone's PCP. And we all have those similar colleagues, I am not singling out my profession.
Let me also say... It bothers me to hear that there is friction between chiros and PT's. In my estimation there is no better combination when treating MSK conditions.
We both have our specialties. I refer and work with plenty of PT's and it benefits the patients greatly. I am not the only DC with this mindset. The majority of my peers (DC's) work alongside of PT's and it's great.
Keep up the great work that you do.
Sincerely,
Scott Schaeffer, DC, CSCS
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Re: Chiropractic madness!!!!!!!!!!!! - November 15, 2001 9:31:00 AM
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DPDC
Posts: 13
Joined: November 13, 2001
From: Corvallis, OR, USA
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Andrew - again, I'd encourage you to read the article I linked to above. It sounds like your main objection is patient safety or, in the parlance of managed care, quality.
Here's a quote from the article, Richard Sarnat, MD is a board certified opthalmologist and president of AltMed:
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DC: Do you find that the chiropractors currently employed as primary care physicians are qualified to act as gatekeepers?
JZ: The answer is a definitive yes.
RS: Absolutely. We use benchmarks within managed care - how many hospitalizations per thousand people, the rate of pharmaceutical usage, asthma protocols, diabetic protocols, percentages of c-sections, rates of rehospitalization within two weeks, etc. When we first started, there was a leap of faith on our part and on the part of Blue Cross/HMO Illinois. The worst case scenario was raised. Would the chiropractic physicians be missing the proper diagnosis? Would patients show up in advanced stages of disease that should have been recognized earlier and treated differently?
Today, I think none of these worst-case scenarios have occurred; in fact, it's just the opposite. I think all of the best-case scenarios have occurred by seeing people on a regular basis. On average, our network sees the patient roughly once every two weeks. By seeing patients roughly once every two weeks, we've scientifically shown that overall, the patient's health is going to improve by all the benchmark criteria of managed care.
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You mention your disdain for pseudoscience in any professional discipline and of course, I'm in total agreement. However, your reference to personal bad experiences with chiropractors is obviously anecdotal, ie NOT science. You could poll chiropractors and get your share of stories, anecdotes, of PTs injuring patients by trying to adjust their spines. I'm sure you realize that these anecdotes, while helping to shape negative perceptions within PT and DC groups, don't count as scientific evidence. The perceptions may be true, but until they are analyzed by scientific methods, we need to recognize them for what they are.
You mentioned "We'd all be better off if DC recognized that they should stick to spinal alignment." Well, I think that a lot of DCs would agree, and statistically most DCs choose to limit their practice to musculoskelatal problems. However, a good deal of our college curriculum dealt with non-musculoskelatal diagnosis and treatment. With the proper credentialling, as AltMed has done, there appears to be evidence that carefully credentialled chiropractors can effectively function in the gatekeeper capacity. If you have evidence to the contrary, I would be happy to see it.
Like you, I'm not sure why there isn't more cooperation between our fields. I know they both have a lot to offer and their collaboration could represent the best in patient care. There is probably a good deal of turf war, and interprofessional jealosy. Hopefully, with a little more interprofessional dialog such as this, cooperation can be achieved.
Don Peterson, DC
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Re: Chiropractic madness!!!!!!!!!!!! - November 15, 2001 10:55:00 AM
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Andrew M. Ball MS MBA PT
Posts: 271
Joined: September 30, 2001
From: Chapel Hill
Status: offline
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Don,
Let me start off by saying that I'm encouraged by the participation of several new members (Chiropractors) to the RehabEdge.com forum. I think I speak for all members in saying that I enjoy this debate and it's nice to hear the views of those with equally strong convictions that don't agree with our own. I'm learning a great deal about the feelings and perspectives of ya'll, and hope that though continued discussions, I can provide you with the same gift of pause and reflection. I welcome all of you, and look forward to a future of inter-professional dialogue, understanding, and eventually --- cooperation for mutual benefit.
This dialogue continues . . .
Don, I did read the article. I just don't agree with the conclusions. It makes a fair to decent sell for DC's as PCpracitioners, but not as PCphysicians. Awful research though --- even if it was objectively conducted. As a clinician with an MBA in Healthcare Management, and a Ph.D. near completion, I'm in a unique position to speak on the following point:
The outcomes (managed care benchmarks) of this study are great if you're a health care economist, but upon follow-up and quantum (qualitative) study, outcome measures such as hospitalizations per 1000, rates of drug usage, asthma protocols, diabetic protocols, rates of c-sections, etc., etc. have been shown to be VERY poor measures of quality of care. Obviously, no individual clinician ever acts in an unethical way on purpose, but somehow when health professionals are aggregated, usage decisions tend to follow financial incentives, not necessarily best practice. Furthermore, DC and osteopathic philosophy runs counter to allopathic philosophies regarding the concepts of hospitalization, rates of drug usage, asthma protocols, diabetic protocols, and need for of c-sections, etc (especially those in DC who see their treatments as a cure-all). It's no wonder that these benchmarks are better for DC's than MD's . . . that STILL doesn't translate into safe or clinically effective practice of healthcare . . . only less expensive provision. (Not that I'm knocking decreases in healthcare costs care by the way).
My point, therefore, is that the suggestion that this study needs at this point to be refuted is laughable. What ethical DC's, PT's, and MD's alike should do, however, is look into why this study's conclusions were ridiculous, reset outcome measures to something more appropriate, and repeat. You have to admit that there was a pretty silly overgeneralization of safety and quality of care that weren't actually studied. Ya'll have demonstrated by this study that DC as PCP's proved less expensive, the REAL question is was the care provided appropriate, or just less expensive? If a DC believes that he or she can fix all that ails the patient, never refers, never hospitalizes, and never prescribes drugs (some of which are inherent chiropractic philosophies), the same study results will be realized. That doesn't translate into safe nor effective heathcare practice. In some cases, it's quite the opposite. This study, therefore, didn't answer the question of DC's as safe and effective PCphysicians the way that some DC's would like for us all to believe.
All this study showed, is that DC's are liked by MCO's as gatekeepers because they tend not to let patients through the gate --- thereby saving the MCO money. Is anyone really surprised by this? Do chiropractors really want to disseminate this message? Some friendly advice Don --- I'd be careful with the proclamation of this study, it may politically backfire on you guys. And this coming from a PT in favor or DC's as PCpracitioners.
Your point that the healthcare of the client CAN be elevated by a DC (or any other healthcare professional with diagnostic training) seeing a patient on a weekly basis is conceded. I've been saying that as a reason why DPT's should be PCpracitioners . . . but not PCphysicians. Even if a problem is missed for a month or two (as I suspect may occur more often than PCpractitioners of any discipline would care to admit), the frequency of interaction between DC and patient or DPT and patient can't be anything but positive . . . IF appropriate referrals are made. Furthermore, would a DC be willing to relinquish PCP rights to an MD if the patient's cause of back pain turned out to be referred pain from cancer? I'd have a problem with the DC acting as a PC physician at that point, but no problem with him or her acting as a PC practitioner. Same holds true of a DPT. See my point? Do you agree?
As for anecdotal testimonials not being science. In and of themselves, I agree. Beyond that, you've hit a nerve, and though I'm not speaking directly to you, I hope you'll indulge me in using it as a "teaching moment" to other RehabEdge.com members. It's the wacos in clinical practice who taut testimonials as research that ruin it for the rest of us true qualitative researchers.
Consider physics. Quantum (e.g. qualitative) methods have been shown to reveal more physical truths than Newtonian (e.g. quantitative) methods. Don't self censor yourself. Qualitative methods in some ways, reach beyond the truths possible through quantitative methods alone. When used inappropriately by people with an agenda, of course, they have little use. That's not what I meant to imply, and if I offended, it was not my intent. Anyway, allow me to digress for a moment:
Qualitative research completes the circle of research by aiming to, "describe the experiences of people in particular settings and to understand their perspectives. Its purpose is also to develop hypothesis, concepts and theory." It is guided by three underlying assumptions. First, human behaviors extend beyond the observable and incorporate subjective meanings, values, and perceptions that are difficult, (if not impossible), to quantify. Second, actions and ideas can only truly be understood from within the physical, economic, and socio-cultural contexts in which they exist. Third, people (including researchers using any methodology) interpret realities differently due to past experiences and bias. There are therefore no objective truths.
Just as quantitative research has its roots in Newtonian physics, qualitative research is actually rooted from the relativistic philosophies of quantum mechanics. Zukav contrasted these philosophical assumptions as follows:
The old physics [Newtonian/quantitative research] assumes that there is an external world which exists apart from us. It further assumes that we can observe, measure, and speculate about the external world without changing it . . . . the new physics, quantum mechanics [qualitative research], tells us clearly that it is not possible to observe reality without changing it. If we observe a certain particle collision experiment, not only do we have no way of proving that the result would have been the same if we had not been watching it, all we know indicates that it would not have been the same, because the results that we got were affected by the fact that we were looking for it.
The most popular physicist of our time, Albert Einstein, noted the inadequacies of Newtonian physics in explaining the universe. It was only following his drift toward quantum mechanics that the world was graced with the Theory of Relativity (E=mc2), the Theory of Everything (TOE), and atomic energy. If quantitative methods proved inadequate for some of the most important developments in a "hard science" such as physics, it's hard to argue that qualitative methods wouldn't have as profound effects upon the understanding of human behavior --- or for that matter, patient issues such as the one current being discussed.
Perhaps qualitative methods would enjoy greater acceptability among quantitative researchers if they were more accurately referred to as quantum methods, thereby reclaiming Einstein as the father of the discipline.
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Re: Chiropractic madness!!!!!!!!!!!! - November 15, 2001 11:47:00 AM
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mcap
Posts: 652
Joined: February 8, 2000
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NYDC:
Thanks for posting to the site. We welcome all view points.
I admit I have not followed the link yet but I will when I get the chance. I will say, without hesitation, that I don't feel that DCs or PTs are in any way qualified to serve as primary care physicians. If you are talking about direct referal for MS complaints, then that is another matter entirely.
We can argue all day about relative qualifications and philosophies. But for me, one point is particularly important: Chiropractors are severely limited (legally) in the treatments they are allowed to administer. That is the problem. Most of the VA population is elderly, many of them on multiple, daily medications. What are you going to do??? Refer someone to a physician everytime they need medication adjusted, switched or added. And.....how would you even know??
Respectfully,
mcap
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Re: Chiropractic madness!!!!!!!!!!!! - November 15, 2001 12:55:00 PM
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DPDC
Posts: 13
Joined: November 13, 2001
From: Corvallis, OR, USA
Status: offline
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Andrew - I did not mean to imply that this was a study. It's just some statistics collected by an MCO. I was simply stating that there is evidence for the efficacy of the model, DCs as PCP/Gatekeeper.
Obviously there is a difference in opinion between chiropractors and allopaths about patient care, including hospitalization. But you must agree, the dominant model of allopathic care has gotten pretty expensive. And there's a perception that the quality of care has not increased as fast as the costs.
We have plenty of data about the quality, quantity and cost of the current PCP/Gatekkeper model. I have offered some evidence that a DC as PCP/gatekeeper might be cheaper and more effective. Now obviously these MCO's statistics are NOT a well-controlled clinical trial. I don't believe they were presented as such. I think it would be difficult to design a well controlled outcomes study that compares the quality of care delivered to a large group of patients. But the observation of preliminary statistical trends seems to be a good place to start.
You said the managed care benchmarks are not good measures of quality of care. That certainly doesn't surprise me. It would be interesting to analyze the data under different criteria or benchmarks. What are better measurement criteria for quality of care in your opinion? Might be good fodder for a dissertation.
One thing I would like to make clear. In no way do I want to see chiropractors postioned as gatekeepers so that they might occupy a more powerful position and stroke the ego of someone pretending to be a REAL doctor. My interest is entirely on providing better and less expensive patient care. I sincerely believe, and there is ample evidence to support the notion, that less dependence on medication and more emphasis on conservative non-pharmaceutical management is in the best interest of all patient populations.
Mcap mentioned the problem of "adjusting medications" and sending them back to their allopath every time that happened. First, the DC/PCP would have to operate within his scope of practice. Second, and more important, all of us involved in patient care DC, PT, MD all know instance where the patient is OBVIOUSLY on too many medications, some with interaction and/or contraindications. So, heck yeah, make their allopath aware of the situation and make some "adjustments" preferably getting off of some of that stuff.
Lastly I get this numb feeling between my ears at the mere mention of physics, quantum mechanics and E=MC2. I just hafta presume that the people who are talking about that stuff know what they're saying. I could look pretty dumb pretty quick arguing those topics with you.
But I'm serious about trying to get hold of their data and doing another analysis with different benchmarks.
Don
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Re: Chiropractic madness!!!!!!!!!!!! - November 15, 2001 3:32:00 PM
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Andrew M. Ball MS MBA PT
Posts: 271
Joined: September 30, 2001
From: Chapel Hill
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Don,
We agree on far more than I thought that we would. There is clearly support for the idea that healthcare costs have spiraled out of control . . . no argument here. Also, we appear to agree that healthcare costs seem to be driven down by taking MD's out of the driver's seat. I'm a little uneasy about that conclusion too --- despite the wealth of research and publications to the contrary. Now, before you (and everyone else here on RehabEdge call me a loon --- allow me to explain my reasoning).
The fly in my ointment for me is that the makeup of patients on DC caseloads are very different than those on the MD’s caseload.
Specifically, some patients love the chiro/osteo approach (OA) to care, and would love to have a DO or DC as a PCphysician. Sure costs are suppressed in such a model . . . but are these people that would go to an MD even half as frequently for well-care? I suspect not. Certainly not 24 or even 12 times a year. It may not be a fair sample to look at cost of care in this manner because patients of DC's tend to be well patients, and patients of MD's tend to be sicker, as a whole, even those on the caseloads of general practitioners. Some of this may be due to the preventative approach of DC, and I’m not discounting that, but there is clearly an issue of patient self-selection here. No patient with COPD, for example, is going to have or continue to have a DC as a PCP are they? Considering that the DC can’t prescribe drugs, they won’t be a patient for long, that’s for sure. Or will this responsibility, and for that of follow-up care be allocated to the cardiologist? If so, the cost savings to the system will be eating away quite quickly.
This patient self-selection will therefore favor DC's in just about any outcome study that you do (be it $$$ OR clinical). A good study may be to examine if DC's loose patients to MD's in later years of life when care shifts focus from well-care to sick-care. Once the “norm” is established, it would interesting to see if non-MD-PCP’s positively or negatively impact the model.
I'd therefore be interested in testing a model where DC's and DPT's alike are used as well-care PCP's with additional periodic MD screening. If DC's and DPT's as gatekeepers is truly effective, costs to the ENTIRE SYSTEM of care should go down, per life unit (e.g. cost of care for a single person's entire life span). As such ,an IDN, costs of sick-care put upon the MD’s in later stages of the person’s life should be spread among the groups of non-MD-PCP’s who saw the patient groups earlier in life.
The point is, even claims of cost-savings on the part of any non-MD PCP may be biased in our favor by factors beyond our control, so we shouldn't get too excited just yet.
The effects of DC’s and/or DPT’s as well care PCP’s is a different story. I like the idea of a patient seeing a diagnostically trained heatlhcare professional on a regular basis, that' good care in my opinion, but how can 100 visits per year be less expensive than seeing an MD for an annual physical? The cost savings per life unit would have to be extraordinary. We don’t, that I’m aware of, have data on that yet
It occurs to me however, that we’re using similar terminology to describe different things. I have no problem with DC’s or DPT’s as PCpractitioners, and the language that you’ve used suggest to me that THAT’s what you and your colleagues are striving for. On that front, you have my full support. Though you’re using the term PCphysician, I’m getting the feeling that it’s not really what you mean. It boils down to your answer to the following questions? Are there cases in your opinion where a patient DOES need long-term use of drugs? If so, how would you assess this? Would you at that time remain the PCP or refer to an allopath?
You asked about measurement criteria in your last posting. I think a better measurement of DC loads versus MD loads, and THEN examine cost of care. Another way would be cost of care per life-unit (not a completely accurate assessment of quality, but a better reflection than that of a skewed sample). Additional information should be obtained on the same or similar cohort, using quantum methods. Specifically ethnographic interview on those patients who’ve bought into the idea of a DC as a PCP and toward the end of life, describe there healthcare experiences. Are they pleased with a DC following care after their heart transplant? Did they switch to MD as PCP? At what point? Why? As this is not currently possible, and won’t be for quite some time, asking those currently enrolled in AltMed programs about what they would do in cases of catastrophic illness may shed some light upon the issue. I thought I had a Ph.D. proposal . . . but I must admit I’m thinking about changing focus. Let’s talk some more. I’ve got about 5 ideas and like them all . . . I’ll have to choose one soon. This idea isn’t at the top of the list . . . but not at the bottom either. I may take you up on the idea to conduct research, I’d want to include the possible use of DPT’s as PCPractitioners too though. I don’t imagine you’d have a problem with that.
As for quantum methods, here’s the least anyone need know for the purposes of this discussion . . . Research is never free of values and subjectivity. Not even in quantitative research. The researcher subjectively interprets the meanings of even the most precise of measurements. It’s much more useful, quantum physicists and qualitative researchers will proclaim, to simply describe the phenomenon. Research is never free of values and subjectivity, so don’t delude yourself into thinking that it is just because of neat looking statistics. AND MOST IMPORTNATLY . . . Cause and effect cannot truly be determined. There are too many unknown variables and it’s hard enough to control the ones we know about. Furthermore, everything is relative. It’s therefore much more productive to describe and interpret events than to attempt to control them in the ultimate generation of oversimplified cause and effect relationships that are not truly ever generalizable to truth or real life.
Anyway, it’s 8:30 and I’ve got to study for my Quantitative Methods Comp!
Drew
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Re: Chiropractic madness!!!!!!!!!!!! - November 15, 2001 8:11:00 PM
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DPDC
Posts: 13
Joined: November 13, 2001
From: Corvallis, OR, USA
Status: offline
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Drew - Yes you're probably right about the differences in the patient populations between the two providers. I imagine the DC population is generally younger, more physically fit, and more health conscious than other groups. So there may very well be an inherent selection bias in the comparison.
I like the idea of following a group of DC patients into later years and see if they shift to MD for their PCP.
To answer the question on COPD: "Are there cases where the patient needs long-term use of drugs?" Of course. "If so how would you assess this?" Well, off hand I'd say history, lab work, imaging, auscultation and physical exam. "Would you at that time remain the PCP or refer to an allopath?" Of course that would depend on the patient's response to treatment wouldn't it? If, as I've seen, a patient spirals downward with recurring pneumonia, rounds of antibiotics and finally, steroids, there would come a time where I would not feel qualified to remain his PCP. You must admit, however, that's a tough one. Not exactly a disease that allopathic care has "dialed in" a winning treatment. It's my OPINION that chiropractic management may be as effective as allopathic management. The goal would be to keep the patient from getting chronic in the first place. Would our management be as effective as allopathic management? Who knows, to my knowledge the two treatment approaches have never been compared.
The only definition of 'ethnographic' I could find was: "the branch of anthropology that deals with the description of specific cultures." I like it. But I'm a polysyllabophile. Again, it sounds like you're talking about a longterm prospective study. Sounds expensive, but I agree they seem to yield the best info. I don't think that the example you used, heart transplant patients, is realistic. First, there aren't very many of them, second they represent the ultimate in complex cases, and third, FROM THE VA or MANAGED CARE?? They don't pay for those, silly! (kidding of course)
Your explanation of quantam methods makes a little more sense. Truth is a difficult thing to define sometimes. It's like (someone famous) once said, "All that counts can't be counted."
Good luck on the test. God I'm glad it's not me. Best of luck on the attainment of your Post Hole Digger as well.
Don
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Re: Chiropractic madness!!!!!!!!!!!! - November 16, 2001 7:45:00 AM
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DPDC
Posts: 13
Joined: November 13, 2001
From: Corvallis, OR, USA
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Understand that those statements on the demographics of the DC population were assumptions. I think they are correct but don't accept it as gospel. But yes, that's precisely the group that would most benefit from the DC as PCP. Remember, the goal of the model is wellness care, instead of the current sickness care model.
Don't you agree that the continuum of care should run from least invasive to most invasive? With allopathic PCPs, the continuum frequently leapfrogs directly to pharmaceutical management. Especially with musculoskeletal problems (which are the majority of complaints for that demographic group - outside of the common cold.) I presume that you guys (the PTs) have seen enough examples of that phenomomenon.
Don
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Re: Chiropractic madness!!!!!!!!!!!! - November 16, 2001 2:43:00 PM
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Andrew M. Ball MS MBA PT
Posts: 271
Joined: September 30, 2001
From: Chapel Hill
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SJ,
Good points, but I'm not sure it's fair to characterize all of chiropractic that way. I have seen a trend in some of the newer graduates to be far more evidence based and diagnostically competent than DC's who graduated 10 or 15 years ago. The same can be said of our profession. The difficulty is that DC's aren't distinguished on the basis of when they graduated in the same why that PT's are (e.g. Dip, BS, MS/MPT, DPT).
Some of the more "experienced" DC's tend to be the ones that are a little more "out-there," but that quantum finding can be generalized to PT quite well too. Heck . . . I've known a few older MD's that shouldn't be touching patients either.
If Don really means the DC’s should be PCpracitioners, what’s the problem? A DC or DPT is going to pick up symptom logy of anxiety, depression, asthma, emphysema, CHF, cancer, rheumatoid problems, diabetes, hernias, etc. a hell of a lot quicker than the MD PCphysician is going to --- simply by virtue of the fact that they are seeing the patient far more frequently. DC’s and DPT’s should be charged with that responsibility of diagnosis. Appropriate referrals would then have to be made. I trust that a DPT would do that, and I trust that a DC who graduated from one the more scientifically competent of schools would do that. A BS level PT should not either, they are not adequately trained in differential diagnosis, nor are the MS, PT’s or MPT’s who graduated more than 5 to 10 years ago. It simply wasn’t in their training. The problem with DC’s as PCpractitioners, as I see it, is that beyond the age of the chiropractor, it’s virtually impossible to tell the difference between those that are competent and those that aren’t because they all have the same degree. Furthermore, there are a few of the more long-standing “traditional” chiropractic schools that are still cranking craniosacral lovin’, shockra feelin’, used car salesmen of practitioners who have no diagnostic skill beyond subluxation. They have NO BUSINESS being called a doctor, much less a PCpractitioner!
I just hope that they can effectively police themselves.
As for the pro-activity of treatment, that’s the same problem that we have with the bad therapists in our profession. A bad healthcare professional is a bad healthcare professional. A simple example is those (usually younger) DC’s that prescribe exercises and conduct back education classes. I’ve not seen ANY do it quite as well or as effectively as most PT’s, and frankly, I’ve repeatedly seen many errors taught that may actually yield re-injury . . . so why don’t DC’s and PT’s team up in that regard? Most DC’s KNOW that their skill rests in spinal realignment, and most PT’s KNOW that their skills rests in muscular strengthening and coordinative exercises to maintain that alignment. Why feud? I’m talking to all of you now --- DC’s and PT’s alike. Why not team up? Seems like a match made in heaven.
Drew
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Re: Chiropractic madness!!!!!!!!!!!! - November 17, 2001 6:08:00 AM
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doc4bax
Posts: 7
Joined: November 15, 2001
From: o'fallon, IL USA
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When are physical therapists going to learn that they are therapists and not doctors? I certainly don't see the qualifications for a PT or DPT being a PCP (Primary Care Provider). Why doe's the APTA have a beef with chiropractors? Why does the APTA care if patients name Chiropractors as their primary care providers?
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Re: Chiropractic madness!!!!!!!!!!!! - November 17, 2001 8:42:00 AM
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mcap
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Joined: February 8, 2000
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The beef with Chiropractors as PCPs is that it reduces the money that can be used for other services....mainly P.T. Veterans, in many cases, are in dire need of PT services. There are patients with amputations, stroke, orthopedic surgeries, etc. that require rehabilitation. Chiropractic services will reduce the amount available for this?
As for your contension that PTs shouldn't be physicians....we are in agreement. However, I would suggest that there is no substantial evidence that DCs are qualified either. Where exactly is the evidence behind Chiropractic treatment for many of the conditions you would encounter as a PC physician? For many, if not most of these conditions, it simply hasn't been studied. Even in low back pain, most of the task force reviews have concluded that manipulative therapy produces a short term benefit only.
If you read through this board you will notice that many of us lament the lack of reseach in some areas but at least it is acknowledged.
Respectfully,
mcap
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Re: Chiropractic madness!!!!!!!!!!!! - November 18, 2001 1:15:00 AM
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Andrew M. Ball MS MBA PT
Posts: 271
Joined: September 30, 2001
From: Chapel Hill
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Dr. Doc4bax,
You may want to check your facts before you speak. This is going to pinch a bit, but I assume that you wouldn't dish it out unless you could take it too. Keep in mind that I SUPPORT DC's as Pcpractitioners. In the comments that follow I’m speaking to YOU and ONLY YOU. This commentary SHOULD NOT be construed as attacking all DC’s, but rather the lot of arrogant, misinformed, unethical lot of DC’s like you, that in my opinion shouldn’t be touching patients --- much less be a PCP:
When are Chiropractors like you going to learn they are not real doctors? I certainly don't see the qualifications for a DC being given carte blanche rights as a PCP.
Why can't chiropractors like you see that nothing beyond short term benefit has ever been demonstrated for chiropractic care? What's with the arrogance of DC's like you considering the fact that DC, PT, and a back care booklet have proven equivocal in treatment and prevention of LBP? Furthermore, why can't DC's like you admit the inherent danger of the damage they create in their patients by they infusing upon the patient by constant weekly, biweekly, or monthly over-manipulation of joints --- ignoring the importance of strengthening and conditioning of surrounding musculature so as to support that re-alignment? Why are chiropractors so callous as to ignore the fact that chiropractic wellness care eats away at pools of money that patients need when the patient really get sick or injured (e.g. Chiro and PT bill insurance under similar codes.) Why don't DC's warn their patients that most 3rd party payers have an annual cap on these services and that if they have need for rehabilitation following stroke, car accident, or orthopedic surgery, that the DC services prior to injury may rape the patient of their right to more medically appropriate reimbursement for services after injury? Do you warn the patients that you professionally rape in this covert fashion? Isn’t that at least a little bit unethical? Isn’t that dangerous to both patient and society? How can you live with that? How do you sleep at night knowing that? How can you as a chiropractor possibly be serious about a RIGHT to be a PCP while offputting professionals with equal or more training, stealing resources that the patient may need after injury, and generally operating not as a professional, but as the slimy used car salesman of the healthcare industry? What chiropractic school did you go to? Why doesn't the Chiropractic Association look into shutting it down?
As for DPT’s not being qualified to be PCphysicians, I agree. In comparison to you, however, I suppose they may be as they’ve had more extensive training than you. As I said before . . . you’re not qualified either. That said, I support the idea of DPT’s and DC’s as PCpractitioners . . . but I’ve got to tell ya that if your DC colleagues don’t find a way to bar DC’s like you from that right --- they’re going to end up in a world of hurt.
Your arrogant, misinformed and inappropriate statements are PRECISELY why most DC's should NOT be PCphysicicians nor PCpractitioners.
Andrew M. Ball, MS, MBA, PhD(c), PT
P.S. By the way Dr. Peck, I've noticed that your web page notes that you provide "physical therapy" as one of your services. Are you aware of the fact that to do so, without being liscensed as a physical therapist, violates Illinois State Law including, but not limited to the Physical Therapy Practice Act of Illinois? I'm hard pressed to belive that with that attitude of yours that you've got physical therapists working for you . . .
[This message has been edited by Andrew M. Ball MS MBA PT (edited November 18, 2001).]
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Re: Chiropractic madness!!!!!!!!!!!! - November 18, 2001 8:55:00 AM
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Bobcat
Posts: 493
Joined: July 13, 1999
Status: offline
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Er...just back from Italia and I could not resist...
TOP TEN REASONS NOT TO CHOOSE A CHIROPRACTOR AS A PCP (scope limited to the U.S. of A.; views below opinions only of this furry feline):
1. Argument of Discipline: Chiropractors don't practice medicine or science. They might learn either, they don't practice either; are not proficient in either. (Recall any Nobel prize winning Chiros?)
2. Argument of Intellect: Chiropractors are not as smart as Medical Doctors.
3. Argument of Knowledge: Chiropractors are not as knowledgeable as Medical Doctors.
4. Argument of Experience: Chiropractors do not have any depth of experience in handling medical conditions beyond the realm of back "dysfunctions".
5. Arguments of Opportunistic Codification and Utility: A chiropractor is as much a "Doctor" as a doctor of optometry is a "Doctor". When most people in need of medical attention yell out for medical care in emergent or critical situations, they want someone who knows how things work. Oftentimes, a doctor of chiropractic or optometry is not of much use.
6. Argument of Opportunistic Capitalization of Cheap Labor: The only reason health corporations are considering use of non-Medical doctors is for the purpose of cost containment. Chiros are less powerful and less expensive than MDs. This is good for the bottom line of a company that wants to do what it wants in circumvention of the AMA, etc. Some consumers don't know any better and give deference to anything with a Doctor prefix. Thus the effectiveness of certain "doctors" in influencing dumb people.
7. Argument of Ethical Practice: Many Chiros promote methodologies that are grounded in a vapor of causality. Their standards of practice are murky and not lofty. Many chiropractors peddle nutritional supplements and "orthotic aids" with unusual effects. Others also have close associations with personal injury attorneys to help people injured in an accident get the money they deserve. This might include sending clients to get x-rays for no other reason other than to max out the bill. I've heard that radiation can be damaging. I guess that client might get even more than the money he deserves.
8. Argument of Not-Having-Been-Effectively-Weeded-Out: Many chiropractors are the rejects from medical, dental and PT school admissions processes. Such characters should not be watching the gate.
9. Argument of Reputation: Chiros have acquired by their own past exploits a bad reputation for being shysters and snake-oil salesmen. Allowing such sales professionals to enter the arena of medical care lowers the already battered image of medical professionals.
10. Argument of Self-Esteem: Chiros are constantly trying to convince people that they are as qualified as Medical Doctors by concealing the facts. This is pathetic. Pathetic people with low self esteem need professional help; they should not dispense it. Cite: [URL=http://www.chiropage.com/Students/chirovsmed.htm]http://www.chiropage.com/Students/chirovsmed.htm[/URL]
Ciao.
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Re: Chiropractic madness!!!!!!!!!!!! - November 18, 2001 8:58:00 AM
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mcap
Posts: 652
Joined: February 8, 2000
Status: offline
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SJSJSJSJSJSJSJSJSJ:
I don't think doc4box's question was worded in a constructive fashion...BUT...
Let me inject another point to this debate.......
I think the DCs are claiming that they would be in charge of well and preventive care and if the patient is sick they could see their physician. In theory this sounds like a good idea. We all know that the health system is not doing a good job with wellness care and preventative medicine......BUT HERE IS THE ISSUE.....the DC's are not looking at what good wellness care actually should consist of......this is what I mean......
Good preventative medicine includes things that are already recommended but aren't routinely done. These measures include immunizations, mamograms after 50, colonoscopy after 50, flu shots for those at risk (flu kills thousands each year), regular screening and monitoring for diabetic patients, regular cancer screenings for those at risk, prostate palpation and PSA tests, etc. These measures if employed successfully could improve mortality rates and quality of life substantially. They have been proven to do so. Now here is the question......WHAT ROLE COULD CHIROPRACTORS PLAY IN ANY OF THESE SERVICES? They do no provide these services. In fact, I have heard some come out against things like immunizations.
I think wellness as defined by many people includes a desire by generally healthy people to feel better. There is absolutely nothing wrong with this and it is a laudable goal. But these services, should in no way, be paid for by the VA or the american tax payer. I feel that primary care DC providers would be more providing this kind of service although I admit I am not completely familiar with their training.
Respectfully,
mcap
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