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Andrew M. Ball MS MBA PT -> Re: Chiropractic madness!!!!!!!!!!!! (October 31, 2001 4:09:00 AM)
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SJSJSJSJSJSJSJ,
I may be wrong, but I don't belive that the new bill allows for DC's to be primary care physicians, only primary care practitioners.
I don't think it's appropriate for the DC to replace the MD, and unless I'm reading the bill wrong, that's not what's happening.
So to answer your questions:
How old are these patients? Mostly Sr.'s, but why does that matter?
Generally, are they a healthy population?
The ones that had a DC as their primary care pracitioner would be. If they needed to see their MD with greater frequency than once or twice a year, the primary care physician may be assigned as the primary care practitioner.
Do you really think they are going to really require just spinal adjustments/manipulations for their care? No. I don't, but that's the point of being a primary care pracitioner. It assigns new responsiblity for the provider seeing the patient most frequently to alert the PCphysician of any potential problems. That requires better clinical diagnosis skills of the DC or DPT. I think that most DC's can do this (the question may be, will they), and most DPT's are better prepared for this increased responsiblity than either you or I were trained (though we may have both picked up a thing or two during our years of experience). So no, I don't think that spinal manipulation is all that these patients are going to need, but once again, you're incorrectly assuming that PCpracitioner is the same thing as a PCphysician. It is not.
Will the provision of spinal manipulations address the vast comorbidities that these folks may also have? No, but no one is saying that it should. The DPT or DC should be able to identify a greater span of potential comorbities and alert appropriate medical personel.
I wonder if there may be an increase in potential problems if the veterans rushed to chiropractors as the first medical professional to treat them for whatever ailment? That too, is a distortion of the facts SJ. The DC may be the first medical person that the patient chooses to seek out. Being a PCpracitioner places an increased burden of responsiblity upon them to identify problems outside the scope of thier practice and refer appropriately. I've heard many wack-job DC's state that they can cure asthama, autism, CP, etc. Though they can perhaps make some of these things better, and can sometimes "cure" asthama, maniuplations shouldn't occur for that reason alone. The same is ture of back pain. It could be cancerous, but they've got the ability to x-ray (which is something that most schools are gearing up to train DPT's to be able to do). The PCpracitioner designation carries with it increased responsiblity to not only think within the scope of one's discipline alone---which is in my experience, the primary problem with many DC's---but a responsiblity to recognize the limitations of one's profession as well. It will force DC's and DPT's alike to become far better and far more responsible diagnosticians---or face the consequences I think that DC's have a much farther way to go with this, so if they don't become more responsible in this regard, if we just give 'em a little more rope, they'll hang themselves.
"The APTA doesn't agree with the bill or whatever because those in our profession would be losing funding... that's nice." That's not why the APTA disagrees. The APTA, as I understand them, feel that DC's don't usually refer to PT's when it's appropriate as it is. They [DC's] often incorrectly think that they can do it themselves and in some cases, bill for it. Having DC's as PCpractioners, like PA's or Nurse Pracitioners, will likely decrease the amount of referals that we get because of this silly and longstanding feud that we've had with them over the years, compounded by a subordinate status of no longer being on equal footing.
With most of those folks, would a chiropractor as a primary care provider be a very realistic kind of thing that would be beneficial for veterans? Primay care provider is an ill defined term that can be used to mean PCphysician or PCpracitioner. For the sake of clarity, let's not use it on this forum anymore. If you mean PCphysician, then the answer to your question is no. It would not be realistic to have a DC replace an MD as a primary care physician. The answer is different if you're asking if a DPT or DC can be a PCpractitioner:
For an active and healthy 60 year old who sees his cardiologist every 6 months and his DC or DPT twice a month for that "twinge" in his low back, I think his DC or DPT is an appropriate designee as the PCpracitioner. In reality, that's who his PCpracitioner is anyhow . . . the formal designation simply carries with it some increased responsibilities for picking up on diagnosis (and offers some legal recourse to the patient when the practitioner fails to do so) that the DC's all welcome, and DPT's from some select schools welcome.
I believe that it does in fact make sense to designate the most frequent provider of care as a PCpracitioner and bestow upon them increased responsiblity for the overall health of the patient. That's all the PCpracitioner does . . . it does not replace the PCphysician.
Drew
[This message has been edited by Andrew M. Ball MS MBA PT (edited October 31, 2001).]
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