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Re: Chiropractic Demonstration Project
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Re: Chiropractic Demonstration Project - March 30, 2005 9:35:00 PM
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Diane
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From: Vancouver, B.C., Canada
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Todd, I think Chirx summed it up best.
[QUOTE]The school administration is great at making you think you are just as good as a GP and a PT. Its how they take the focus off chiropractics half truths and pseudoscientific beliefs. The problem is much deeper then a DC saying he does physical therapy. The problem is a DC PERFORMING what he thinks is physical therapy on a patient that needs a physical therapist.[/QUOTE]Back to the misleading, screwy schools messing up eager-to-be-educated minds. Individual chiros, like Ken, can be told by us that what they are doing (impersonating physiotherapists/ physical therapists) is wrong and bad, and they might listen and change their presumptuous behavior, but these outrageous so-called schools are still saying/teaching whatever gobledeegook erroneous nonsense they want and are cranking out these people who have been told that not only are they chiropractors but also physiotherapists and doctors!
Chiro schools, these self-referrent self-promoting so-called centers of higher learning that place themselves outside of all public scrutiny are nuts. The ludicrousness of their attempts to buy their way into universities to gain more prestige and marketability is exceeded only by their persistant and baseless hubris and carefully honed ability to market themselves into the public mind. They continue to churn out graduates with airy notions of themselves who are left 150K in debt for their limited "education", a hollow title, and unconscionable instruction to turn their patient population into psychologically dependent domesticated sources of income for life. I fully support Allen Botnick's contention that they are cults; several other chiros have come on Chirotalk to support his contention.
Having said that, I agree with you that as a PT I wouldn't support chiro by having any referral relationship. To anyone, if as a PT you think manip is so all-fired important go to Child's class and learn how to do it yourself.
We need to take our rightful place wherever we exist, like in Arkansas. Don't cave in to the illusions that chiros have learned to spin about themselves or their mirage of legally protected bits of behavior such as manipulation. They exist in their own mirage of blatant assumption.
PTs, don't let chiros intimidate you or jostle you aside: we are bigger than we think, bigger than they are in every way: we are grounded in science, and taught to be ethical; our education is integrated with reality and the prevailing thoughtful culture; more logical because we are taught to use our minds to think with, not to 'believe' made-up ideas. There's room for honest pride in ourselves and our education and the work we do; we've earned it. As times evolve, we can't lose. We've got all the right stuff going for us. Those 'professions' who don't, will cease to adapt in any meaningful way and will eventually disappear.
Not looking to start a fight, just speaking my mind,
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Re: Chiropractic Demonstration Project - March 31, 2005 1:59:00 AM
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JLS_PT_OCS
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Not sure I feel comfortable following Diane's post.
Don't you just hate having to get up in front of class to present your book report after the smartest and most well-informed kid in class? How do you follow that?
But here I go...
Chirx-
Agree with you completely. My statement about a "certificate in chiropractic" was a joke, as if implying a few courses gave me the knowledge/skills/ abilities of a DC. Silly. Just as the idea that a "certificate in physiotherapy" confers the knowledge/skills/ abilities of a PT. Equally silly. And really, offensive.
I have to say, though, that the way the law is set up, it seems DCs sort of need to jump through those hoops [at least that one, in Maryland] to get reimbursed for modalities. It seems that it is as much of a survival decision as anything else. When one is trying to dig themselves out of $100K debt while working as an "associate" at another's practice, with a family to care for, matters such as what we are discussing here begin to appear orders of magnitude less important.
Let's not forget, for every story about one misleading or "quack" chiro, there may be one hotpack/ultrasound therapist, and one chiro doing what they need to do to survive and get out of debt, and one excellent therapist, and one good mixer type chiro such as Greg just trying to help people. It definitely is not such a black and white, "them evil and bad, we good" sort of thing; I don't think trying to cast it that way will help us through this any better. Now, I'm not disagreeing with anything that's been said so far, and I think all of us on this thread (both PTs and DCs) are on the same page.
From what I have read about the DC profession (mostly from DCs I have met in person, but also from some I have read about online) it seems Diane's synopsis above is spot on correct.
Todd-
On "helping" others expand their scope...
Don't know what to tell you, here, buddy. I don't think that my discussing rehab concepts with a DC will damage my profession any more than a DC might think discussing manipulation or the "subluxation" that many of them admit is bogus will harm their profession.
I just can't see all DCs as the evil Sith Jedi, my direct experience has taught me differently.
In fact, I have learned a lot about the human body and how it works and how to rehabilitate it from people with the letters DC, ATC, and CSCS after their names. Does their profession invalidate their contribution? I think not.
I can find a balance between supporting my profession's growth and also learning what I can from practitioners outside my field.
I stand by my statements that I think this demonstration project may "demonstrate" a lot of things, and if Diane is correct above, perhaps this is really a good thing for PTs.
Think about this...if no challenge from Chiros, would the PT profession have evolved as quickly, as efficiently, and as purposefully as it has in the last 15 years? Would we have such a solid research base, such high practice standards?
Being a free market guy, I think competition is important for growth, and this seems another example of that.
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: Chiropractic Demonstration Project - March 31, 2005 4:17:00 AM
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dosrinc
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From: Bonita Springs
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Diane: please tell us how you really feel!
Jason: great follow up post!
I appreciate the conversation with all involved.
Rick
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Re: Chiropractic Demonstration Project - March 31, 2005 5:28:00 AM
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dross
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From: NJ
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Some chiropractic schools have courses in physiotherapy modalities like U/S, electrical stim, heat/cold application, etc. They also teach some basic rehab (more spine then anything else). Part IV of the NBCE (chiro boards)has a seperated physiotherapy section that I think is optional. Maryland, as I pointed out, has a seperate exam. The students that didnt get the PT hours in school have to take a course in physiotherapy after graduation to sit for the test. Its not a "certificate", its an added privledge on your license. I know, it sucks for you guys and it would piss me off too.
I think it has to be an all or none kind of things. Singleing out a guy like Greg as a good DC who does rehab is nice, but it sends mixed messages. The APTA either has to wage war or let it go. You guys have the backing of the AMA for the most part. I still dont understand why you dont tap into that for some help.
DCs and PTs working together is a nice thought. But it not realistic. Chiros think there is nothing you can do that they cant, so why bother. I think Ive posted this before here but I'll write it again. The DC/PT relationships out there (for the most part) are DCs hiring a PT from an agency that are here on a Visa (mostly from the Phillipines). Its not collaberative, its a way to have a "rehab clinic". I have worked in these places, I know what goes on. I have a DC degree and an MD degree, my wife is recruiter for PT therapy mngt company in the midwest. I have a very good understanding of the machinations of the DC/MD/PT relationships. The APTA needs to step up and show some muscle.
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Re: Chiropractic Demonstration Project - March 31, 2005 6:40:00 AM
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JLS_PT_OCS
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Chirx,
Agreed with you for the most part about APTA stepping up, I think they're doing as good a job as they can.
There are lots of us in PT that feel the important issue is to focus on how services are represented to the public and not what individual providers do. I have no desire to be invading people's DC practices and telling them they can or cannot perform certain exercises. Then what legal leg do we have to stand on to keep legislatures from taking away manual therapy from us, just to keep the professions separate. That's the kind of legislative battle that wouldn't be good for either side.
Also, I must respectfully disagree with your contention that the AMA and physician groups support PTs. They do not. Our biggest opponents to Direct Access and further practice priviledges are the AAOS (american academy of orthopedic surgeons) and the Physiatry groups. While individual physicians like, respect, and trust us to collaborate and improve patient care, their organizations uniformly oppose us. Our biggest roadblocks and biggest opponents to further practice evolution, from a legislative standpoint, are MD/DO groups. All Arkansas business aside.
I will do for you what I do for many physicians I work with...help educate them about our skill set and show them how competent and well educated we truly are. Most physicians are simply unaware of the depth of knowledge and skill that we bring to the table. That's not their fault, it's our fault for not doing better marketing. In my opinion.
_____________________________
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: Chiropractic Demonstration Project - March 31, 2005 6:40:00 AM
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UTDC
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chirx,
Again, huge generalizations. I have spent my entire career working alongside PT's (and MD's). I have never worked in a P.I. mill nor have I worked with anyone from the Phillipines....
Jeff
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Re: Chiropractic Demonstration Project - March 31, 2005 7:08:00 AM
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Jeep
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From: USA
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Chirx posts:
>>have a DC degree and an MD degree, my wife is recruiter for PT therapy mngt company in the midwest.<<
Since when is New Jersey in the midwest?-????
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Re: Chiropractic Demonstration Project - March 31, 2005 7:32:00 AM
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dross
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From: NJ
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Jason,
My mistake. I allways thought the MDs with you guys on things like this. You would know better then me about what goes on behind closed doors. I figured orthos and physiatrists refer to PTs because of trust and respect that developed over the years. I assumed they were on your side. Learn something new everday.
UTDC,
Of course these statements a generalized. I think everybody reading this knows that. I cant speak for each and every DC. I give my opinion based on a mix of my experiences and the experiences of my friends who are DCs. Im glad you never worked in a PI mill. You can tell me how your practice runs anytime.
JEEP,
My wifes company is based in Vegas, her territory is the midwest, she does her job from home.
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Re: Chiropractic Demonstration Project - March 31, 2005 9:16:00 AM
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JLS_PT_OCS
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It's OK, Chirx.
I think a lot of individual physicians feel differently than their professional associations do, but getting involved in those organizations on top of job and family, etc. is often just too difficult.
I do think it is primarily a marketing / awareness thing. I think a few money-minded physicians are behind those types of opposition to us. Perhaps you are motivated to write to the AMA? I'm serious, every little bit helps.
I think the same thing is true of the PT/DC wars, a few practitioners on each side feel the need to go after each other, whereas I might guess that people like me, Jeep, and UTDC/Jeff would get along fine and rather enjoy staying out of each other's beeswax. And might like to have a few beers together sometime, too.
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: Chiropractic Demonstration Project - March 31, 2005 9:59:00 AM
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UTDC
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I'm with ya Jason.
Jeff
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Re: Chiropractic Demonstration Project - March 31, 2005 10:19:00 AM
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Diane
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From: Vancouver, B.C., Canada
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[QUOTE]The APTA needs to step up and show some muscle.[/QUOTE]Ditto that chirx. Also I think Jason is probably right about MD organizations stalling for more time, or just because they feel like it. They probably still see PT as this friendly obsequious group of female placebo dispensors. Those days are gone for good..
I disagree with Jason on one particular point: (call it paranoia, Jason, but I think this holds water:) Chiros will never be our friends, regardless of how many drinking parties are held. No matter what level we think we are at compared to them, they will always in fact honestly feel superior to us, (their schools no doubt told them that of course) so they'll do us no favors. I reckon they want to study us a bit so they can know our ways in order to use us the way they think real doctors do.
It really really is up to PTs ourselves, plus whatever starch we can put into our organizations.
We are the only ones poised to gain anything. The others won't lose much, there will always be enough patients to go around.. but they'll have a perception that if someone gains, they'll have to give something up. Yeah, like control over US and our livelihoods, that's all. That's all. Get busy PTs.
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Re: Chiropractic Demonstration Project - April 1, 2005 1:49:00 AM
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dosrinc
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From: Bonita Springs
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The APTA is powerless to "step up" until the number of members more closely represents the number of practicing PT's. All of us interested in advancing the PT profession need to emphasize the importance of membership to those feeding off of the system without any contribution!
Rick
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Re: Chiropractic Demonstration Project - April 1, 2005 3:02:00 AM
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JLS_PT_OCS
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Agreed, Rick
And I can definitely see where you are coming from, Diane.
I have had similar experiences.
I had two chiropractic experiences yesterday--
1. I had a CA (chiro assistant) call me at home, randomly, and tell me that her "doctor" was inviting people in for a free spinal screening as he does every year, and there was no obligation to me after the screening. I told her I didn't have any back or neck pain. She said that was OK, many people don't realize how much they need treatment until they get screened. :)
Thinking back, I should have taken her up on it and reported back, but I wasn't thinking and said no thanks, and additionally I thought it was unethical to recruit patients that way. She then stated "i'm just doing my job." (how is this an excuse for unethical behavior?) and asked if I wanted to be put on the clinic's "Do not call" list. Can you believe it?? I about fell over... imagine doing so many cold calls and fishing trips that the clinic itself maintains a do not call list??? What the hell???
What a freakin' quack snake oil salesman...
2. Went to the gym where my martial arts class is, and right inside it was a table set up by a DC offering free injury evaluation of gym goers in pain and talking about payment accepted and that type of thing. Advertised 'sports therapy' and treatment of back, neck and sports injuries. No mention of 'physical therapy' or subluxations, or spinal screening. I thought "good for him" and that is the kind of marketing that PTs should do more of, as in my opinion we have more to offer that population, especially in the way of exercise rehab and injury diagnosis.
So there we have it, the current state of the DC profession - some crazy quacks, some reasonable and skilled practitioners.
This type of thing is why I can't bring myself to lump all DCs into one category and dismiss them as crazy or unethical. It is an interesing dichotomy.
This is what is so important about standardization of treatment, in any profession.
Thoughts?
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: Chiropractic Demonstration Project - April 1, 2005 3:47:00 AM
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Jon Newman
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Jason makes a good point that you can't judge an individual within a profession. However, each profession has a guiding philosophy upon which you can make some judgements. This does not mean that an indivdual holding that professional title pledges allegiance to that philosophy but they are supposed to be, hence their professional designation. It is how the public comes to understand what they are getting.
jon
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Chiropractic Demonstration Project - April 1, 2005 4:10:00 AM
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hmgross
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I could NEVER imagine stooping to the level of #1. What the hell indeed. Why wouldn't you just put your "free screening" thing in the paper as a general invitation.
I like #2. I am in the process of offering free informational sessions in the evening to let more people know what services a PT can provide and that they don't need to be suffering from any catastrophic illness or injury to benefit from PT (and also to let people know more about direct access). Any helpful ideas on how to present the DA info without stepping on the drs. toes?
_____________________________
Holly Gross PT
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Re: Chiropractic Demonstration Project - April 1, 2005 5:08:00 AM
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SJBird55
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Holly, in your current situation, you really don't want to step on any physician's toes. The physicians in our little town are definitely against direct access. Their fear is more that the less healthy population may potentially be at risk by initially visiting a physical therapist. And, the context of our conversation was around Medicare patients. To a degree, I do agree with the physicians. That agreement is basically because the elderly in our area are not soley aging without comorbidities.
If you did present direct access information... well, I would hammer home the point that we communicate with physicians on a daily basis. If physical therapy really isn't warranted then we can probably expedite the patient to the appropriate physician. If physical therapy isn't warranted, we can at least educate the patient on what the patient needs to be doing in the "now" period of time instead of waiting and doing nothing until a physician visit. Somehow you might want to plant the seed that if a person has some specific problem actively performing or functioning, that seeing a physical therapist might be helpful (that kind of alludes that our focus isn't to "medically" help people - but help them return to function), which might not irritate physicians as much.
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Re: Chiropractic Demonstration Project - April 1, 2005 5:10:00 AM
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Diane
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What do you mean Holly, "the DA info"? Never mind, I see it means direct access.
SJ, what do the physicians in your town make of the illogic of the fact that PT has direct access in 39 of your states? Does that make all the people in those 39 states more at risk because PTs have direct access? Can they prove based on studies direct access for PTs is dangerous or are they merely operating under a convenient excuse to maintain staus quo?
I wouldn't let myself, if I were you, get sucked down by their argument, which makes no sense. Here's how I see the facts in your area, given what I have learned from your posts:
1. Which is the best scientifically trained profession to be out there fielding NMS complaints? Us.
2. Who is currently out there with direct access fielding NMS complaints? Chiro, massage, Reiki, crystal healers, etc. (I grant that at least one of the above is relatively dangerous at this time. None of the above have the integrated quality of training PT does.)
3. What does the public with NMS problems need? At the moment the only choice they have is allopathic (to get access to PT) or the SCAM (so-called alt med).
4. What might they benefit from? Science-based PT direct access.
5. What do they not currently have access to? Science-based PT.
6. Why? Because some group of MDs is interested in maintaining status quo for some perverse reason while making it seem like they're trying to protect their patients.
This is the same reason the south plantation owners didn't want to free their slaves; they liked things the way they were and didn't want their lives to change. They are being presumptuous to argue that they are safeguarding the health of the public by preventing PT from throwing off its chains. If they were actually concerned with their own argument, they would be trying to put a stop to what is already available to their patients through current direct access. Likely the overall comfort level of the community would improve as PT took its place in the community with direct access, somewhere people could go straight to with their aches and pains, that was not non-allopathic or anti-allopathic.
I ask you again, who better trained, equipped, worthy by reason of our educational levels, to manage the non-pathologic misfortunes of life in a human body (such as benign persistant pain problems) but us? By not fighting for direct access (which I guess in your area means finding a way to get around these MDs and their quaint, self-important notions) how many people are going underserviced and are putting up with discomforts because of the lack of direct access to someone with a very good, very honorable, very science based and sober and well-honed education in exactly the area of expertise they need? Get busy PTs, there are a lot of people who still don't have access to us. I believe the next stage of your duty of care lies in changing the status quo so that people can come to see a secular, no-scam, no-voodoo NMS practitioner pre-wired with high trust factor, without having to see an MD first. Don't cave to any mental games played by other professions.
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Re: Chiropractic Demonstration Project - April 1, 2005 6:11:00 AM
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JLS_PT_OCS
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Well said, Diane.
And good point, Jon.
You are right in that every profession does have a guiding philosophy or approach, and assumptions by the public should be appropriate based on that.
Having said that, I'm glad I decided on PT.
:)
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: Chiropractic Demonstration Project - April 1, 2005 7:27:00 AM
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SJBird55
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Diane, please don't go off on me. Medicare patients are the 65+ population. I disagree with you. From what I have seen in our community, as I said, the majority of our 65+ population are not the "healthy aging." These physicians that you are calling "self-important" aren't that way at all. They don't have a chip on their shoulders... in fact, it bothers them to a slight degree that I won't call them by their first names. That even includes when I call their homes and head out on a horse with them.
Michigan doesn't have direct access. I can't say that I necessarily view physical therapists as being the first in line to be seen for all neuromusculoskeletal problems. We can't order any diagnostic tests. So, then, the person who may need immediate testing has to play the waiting game... Compared to family physicians, I do believe that we are the professional of choice for neuromusculoskeletal issues - but without the capability to rule out a condition that may have a high probability of being present, what's the point? I don't believe that every patient requires diagnostic testing, but there can be evaluative findings, subjective history and subjective reports that would entail further diagnostic testing. For example, a simple fall by a 12 year old on an outstretched hand when he was tackled playing football. Sure, I could use a tuning fork to give me an idea as to whether there might be a fracture - but I can't order the radiographs. What's the point in seeing me first? I can explain the RICE... but I can't actually do what was right in that case. A physician is needed. In the 65+ population... many elderly folks will non-specific complaints. Back pain or shoulder pain may not always be what it neuromuscularly seems. I don't have full faith in our profession as a whole that we would do a good job in ensuring that what we think we are treating is what we really are supposed to be treating. The elderly are a different breed - nonspecific complaints of pain, generalized weakness, increased confusion - those are indicative of active pathology. That back pain may actually be from a urinary tract infection. So, putting aside all titles... looking at education and training alone... I do the "grandma test." Would I want my 97 year old grandma to come to me or any other physical therapist if she started having back pain OR would I want her to see her physician? Sure, there are some you you that post here that I would trust wholeheartedly... but do you that post here represent our whole profession? The answer to my "grandma test" is she should see a physician. We do have skills and we do have expertise, but we also have limitations. Someone's care and life and health should never be considered a "mental game." I don't know, Diane, but I don't cave to mental games. Then again, to be real contraditory in my comments - even physicians, especially certain specialists, are not adequately trained in treating the geriatic population. I read that some time ago on Medscape and how the education for physicians is supposedly going to go through some changes because of the lack of knowledge in the normal aging process and how life choices of patients can affect their current presentation.
Another issue to consider is that in those states that do have direct access, is it truly direct access? I will assume that if 3rd party payers are involved, then it isn't direct access. The third party payers require physician evaluations and referal to physical therapy services.
I'm not against direct access... I just think that there should be safety measures in place so that our profession doesn't become the new "snake oil." What would be awesome with direct access would be a greater ability to use more of our skills/training/knowledge to an even further potential and become more strongly involved in the community... target prevention... creatively reach people before they get themselves into the messes that they do.
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Re: Chiropractic Demonstration Project - April 1, 2005 8:52:00 AM
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hmgross
Posts: 292
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From: Minnesota
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I don't think having a physician referral for PT always means that all medical conditions have been "cleared". Several years ago, I got a referral for PT elderly female, Dx: Low Back Pain. I was unable to reproduce her symptoms, her pain was constant and aching, and when I went into the bowel/bladder question, she hadn't had a bowel movement in six days. I took out my stethescope, could hear no bowel sounds. I wrote a brief note about what I found, sent her back to the clinic and I saw her daughter the next day (I had been over in the hospital), and the patient had been admitted with intestinal blockage and a diseased gallbladder. So you can't guarantee that a referral from a physician means PT is appropriate. With direct access, I ask the same medical screening questions that I ask everyone else I see. In Minnesota, Direct Access means you can see someone for 30 days for a previously undiagnosed condition. Some of my patients get sent directly to the dr. after I eval them and determine they need to see the dr. Some people are seen up to two weeks, then if no great improvement, I send them in. Others are seen for up to the full 30 day period and are either DC'd or recommended to see their physician for a follow up and determine if an additional round of PT is needed. I have several BCBS and other thirdparty plans that do not require a referral in order for me to be paid (I do my own insurance submission). I even called them to make sure I wasn't doing something misleading and would have to pay them back!
_____________________________
Holly Gross PT
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