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Re: SB 146 Arkansas
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Re: SB 146 Arkansas - February 5, 2007 7:02:00 AM
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proud
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Jbird007,
Well, if that makes you feel more comfortable. And you are correct, people can pay cash.
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Re: SB 146 Arkansas - February 5, 2007 7:51:00 AM
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proud
Posts: 944
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Buddy,
Sorry. I recall from previous talks that you feel, as you indicated, harder cases require more skill. I guess I have never heard your definition of "more skill".
In any case, I have a pretty good article written by Joshua Cleland and John Childs' which reviews the topic of "Does the Manual Therapy technique matter". Reviews some of the literature concerning the actual skill required.
Unfortunately, I searched for it and cannot seem to post it. It is a pretty good read if someone can locate it.
Clearly practicing the application of manipulation will make one more comfortable. No dispute there. I guess the question is "how" much training is required for the actual technical application(given that anyone applying it already has differential diagnosis skills and understands all contraindications of course).
Regards,
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Re: SB 146 Arkansas - February 5, 2007 10:31:00 AM
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james097
Posts: 178
Joined: January 27, 2005
From: West Vancouver BC
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If Baltimore is correct then the Arkansas PTs allowed changes in their act and accepted that they would not manipulate spines and would be rewarded by having direct access to patients. Who the PTs negotiated with is not clear, whether it was with the State, physicians, or with chiropractors. It was a pyrrhic victory indeed for physical theapy.
Does anyone think that when the accuser is also the judge and jury that they will quibble about a minute difference in the amount of force used?
The Arkansas PTs should rewrite their act, contest the chiropractic act and if their requests are refused, resort to more aggressive and confrontational measures.
Their seems to be a misconception amongst PTs regarding physical therapist and phyical therapy.
Only a registered physical therapists can call themselves a physical therapist but anyone can do physical therapy. A personal trainer can supervise my exercises and is performing a physical therapy but can't call herself a physical therapist. This is true at least in BC.
Jim MCGregor
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Re: SB 146 Arkansas - February 5, 2007 10:40:00 AM
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jlharris
Posts: 477
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From: Nebraska
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Some points I would like to get out:
1. Dr. does not equal physician. Physician indicates the ability to diagnose and treat systemic disease. Although SOME DC's still advocate they can cure HTN, DDM, etc with manips, most DC's and everyone else knows that is false.
2. "weekend course" has to stop. My manipulation skills were taught in PT school right along with my other manual therapy techniques.
3. I have no problem with DC's using US, estim and prescribing simple ex's. These are skills that can be easily learned on a weekend course.
4. Research does matter. There are PT's (and a few DC's) that swear cranioscacral therapy in the best thing since sliced bread. Research shows that it's a sham. Your personal experience in a clinic (or mine for that matter) is not generalizable. ie, your manip decreased a persons UE pain - this cannot be stretched to say manips will decrease everyone's UE pain. I know everyone knows this, but I still feel it's important to say.
_____________________________
Jason L. Harris, PT, DPT
My PT Blog
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Re: SB 146 Arkansas - February 5, 2007 11:02:00 AM
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dfjpt
Posts: 238
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James, I beg to differ - it would seem in BC that [URL=http://www.qp.gov.bc.ca/statreg/reg/H/HealthProf/485_94.htm#section%203]both terms are protected[/URL].
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Re: SB 146 Arkansas - February 5, 2007 11:44:00 AM
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jbird007
Posts: 297
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From: USA
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quote:Dr. does not equal physician
You are incorrect as Dr does equal physician for DC's in some states.
quote: Physician indicates the ability to diagnose and treat systemic disease.
According to some state and federal laws your definiton of physician does not match.
quote:Although SOME DC's still advocate they can cure HTN, DDM, etc with manips, most DC's and everyone else knows that is false.
Maybe so, but again Jason, DC's are still recognized as physicians. (whether they treat LBP or infantile colic)
quote:Research does matter.
I respect your personal opinion but disagree. I need zero research evidence to do what I do safely and effectively. If one chooses he needs research then one should use it.
J
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Re: SB 146 Arkansas - February 5, 2007 12:03:00 PM
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ONstudentPT555
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"quote:Research does matter.
I respect your personal opinion but disagree. I need zero research evidence to do what I do safely and effectively. If one chooses he needs research then one should use it."
This is faulty logic. I guess anyone can do whatever they want to do but in health care you need research to prove what you are doing is not just a placebo. Otherwise whats the point..you could blow air on someone and do it safely and effectively and maybe elicit a placebo effect. So obviously research matters in proper health care.
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Re: SB 146 Arkansas - February 5, 2007 12:38:00 PM
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proud
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jbird007,
I must say your slipshod comments about the need to prove what we are doing through research is unfortunate in my opinion.
I think we should strive for that level of responsibility to the public. Understanding of course that "best practice" will always be an inevitable component of what we do. However to say you "need zero research" is a concerning comment indeed.
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Re: SB 146 Arkansas - February 5, 2007 2:23:00 PM
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jbird007
Posts: 297
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From: USA
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100 years of providing effective and safe chiropractic care is good enough for me.
If I could blow on someone,create a placebo effect and rid a person of pain (in a large percentage of people) I would do it.
"Slipshod" JBird
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Re: SB 146 Arkansas - February 5, 2007 3:16:00 PM
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drbuddy
Posts: 429
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From: Pennsylvania
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What if I do diagnose and treat systemic dx? I can order blood work diagnostic imaging, perform a urinalysis, etc. I can counsel patients on a proper diet and use nutritional therapy to address various conditions. I perform physicals for pre-employment and the Dept of Transportation. That is all within my scope here in PA as well as many other states.
So, by your definition and given the info above, am I a physician?
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Re: SB 146 Arkansas - February 5, 2007 3:32:00 PM
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ONstudentPT555
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Do you guys really think that calling your selves physicians is not somewhat misleading. I mean if you introduced yourself as a physician to an MD.. what do you think his/her reaction would be? Can you order MRIs, do injections and prescribe medication as well?
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Re: SB 146 Arkansas - February 5, 2007 4:12:00 PM
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drbuddy
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From: Pennsylvania
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I do not call myself a physician to anyone. If I could legally... I dont know if I would. I would make sure to say that I am a chiropractic physician to be clear and because I am not ashamed to be a chiropractor. I wouldnt call myself a physician to MDs or DOs because it might hurt their ego, lol. Then again, I forget to introduce myself to my own patients as doctor. I only use the doctor title when dealing with credit card companies, insurance companies, etc. Ya know, just to see if it'll get me any extra 'pull'.
Now we're changing the definition a little to include ordering MRIs, performing injections, and prescribing medications?
Here's what I can do - I can perform any physical exam procedure, although gynecological and rectal exams are probably frowned upon. I can order any diagnostic test that I think is necessary. Personally, I've ordered radiographs, CT scans, and MRIs. I could take the radiographs myself if I had my own facilities. I can also order blood work. I can perform a urinalysis in my office. As I mentioned earlier, I can perform DOT physicals.
This is a good discussion. There seems to be a lot of misconceptions out there. I'm glad to help clear them up.
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Re: SB 146 Arkansas - February 5, 2007 4:18:00 PM
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jlharris
Posts: 477
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From: Nebraska
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Buddy,
Yep, all without having to go to medical school. Amazing. My wife could have saved a lot of money, not worried about her grades, and would be practicing already instead of STILL training in her 4th year of residency.
Lawful though, I guess. Some jealousy on my part if that is all true.
Are you able to diagnose as you see fit (eg not limited to the types of diagnosis you may make)? PA's and NP's are also able to this but are not physicians. By definition they are often included in regulations that spell out what services must be order by a physician (ie, blood work, PT, etc) but are not physicians. This is my point.
Like jbird seems to not be willing to accept EBM, I'll never accept/believe a "physician" is anyone else than an MD.
Not to cut you or jbird off, maybe we can return to the original topic. IMO that is how questionably ethical it is for one profession to regulate another, especially when they have competing interests.
_____________________________
Jason L. Harris, PT, DPT
My PT Blog
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Re: SB 146 Arkansas - February 5, 2007 4:21:00 PM
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jlharris
Posts: 477
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From: Nebraska
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Question regarding ordering imaging: Are you able to legally interpret them? I was under the impression that in some states a DC is basically a rad tech. Meaning, they can take the x-ray but not "read" them to make a diagnosis.
There I go keeping us of subject, lol.
_____________________________
Jason L. Harris, PT, DPT
My PT Blog
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Re: SB 146 Arkansas - February 5, 2007 4:25:00 PM
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jbird007
Posts: 297
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From: USA
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Buddy is correct. I believe in California and a few other states DC's can also perform GYN exams and rectal exams if they choose. In Oregon and possibly Washington DC's can deliver babies and suture wounds.
DC's are recognized by state and federal criteria that labels them physicians. There is no room for argument of the laws. Anyone can disagree but it won't change that DC's are recognized as physicians. I do not think PT's should be upset with this as they could easily fight to gain the same status if they choose.
Whether a DC chooses to use the term physician credentials is up to her or him.
My idea is as such; A DC could introduce themselves as a Chiropractic Physician. ie Hello, My name is Dr Popper, I am a Chiropractic Physician. there is nothing misleading there, it sounds professional and clearly states his/her area of expertise.
Pt's with doctorates could follow as such; "Hi I am Dr. Stretchalot, Physical Therapist.
An individual can still use his "doctor" title but by following his name with his/her specialty the patient(or someone else) knows exactly what their position is.
Recently I had surgery, a young man came in and introduced himself; "Hi Jay, I am Dr Reilly, your anesthesiologist."
Perfecto. No guessing or misleading info. Straight and simple.
I belive PT's need to read up on the history of chiropractic. Compare where the roots were laid starting with DD and BJ, the battles they faced, the harrassment, the jailing, the slandering, AMA vs Wilks, the political climbs, and then look at where the profession is now. It wasn't accomplished by moaning and groaning and apathy. PT's have not had to endure the challenges that were faced by the chiros of the past. If you as PT's want to be higher up on the ladder then just do it.
enuf on this topic, thats all.
JBird
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Re: SB 146 Arkansas - February 5, 2007 4:33:00 PM
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ONstudentPT555
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I guess if you called yourself a chiropractic physician it wouldnt be that misleading but I dont understand why you wouldnt just say chiropractor. So DCs can order MRIs, and diagnostic US without MDs in the States ...I didnt know that.. .I dont think they can here in Canada though.
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Re: SB 146 Arkansas - February 5, 2007 4:34:00 PM
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jbird007
Posts: 297
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From: USA
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quote: Not to cut you or jbird off, maybe we can return to the original topic. IMO that is how questionably ethical it is for one profession to regulate another, especially when they have competing interests.
Sorry Jason, I forgot the original topic. What do you think of this? The AMA had no problems "regulating" us chiropractors in the 50's. They didn't mess around, they laid heavy monatary fines on all the top-notch chiros and they jailed us.
J
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Re: SB 146 Arkansas - February 5, 2007 4:40:00 PM
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jlharris
Posts: 477
Joined: April 12, 2006
From: Nebraska
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jbird,
No argument there. The AMA is definitely the bully on the block. Perfect example of why one profession should not be regulated by another, especially when the are "competing".
_____________________________
Jason L. Harris, PT, DPT
My PT Blog
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Re: SB 146 Arkansas - February 5, 2007 4:41:00 PM
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ONstudentPT555
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Joined: July 25, 2006
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Also I didnt know DCs could deliver babies and suture wounds ..at what hospitals would they do this? I guess a DCs scope is much different here. Why go to med school for soo long for Obstetrics/Gynecology when you can go to Chiro school for much shorter period of time and do the same thing .. I guess you learn new things everyday .. maybe DCs should be called physicians/Obstetritian/Gynecologists.
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Re: SB 146 Arkansas - February 5, 2007 4:42:00 PM
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jbird007
Posts: 297
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From: USA
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In my state a DC can draw blood, UA, take plain films, interpet them and make a dx, order MRI and CATs, do DOT exams and high school/college physicals and be treating physicians for Worker Comp cases and MVA's. DC's can also perform IME's. ("treating physician" means the DC directs and manages the case)
A lot of those things fit into that "physician" status and that is why IMO we are recognized as such. But DC's across the states didn't just get assigned that status by asking. It took some work.
JBird
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