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Re: SB 146 Arkansas
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Re: SB 146 Arkansas - February 5, 2007 4:43:00 PM
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jbird007
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I beleive Naturopath doctors have even a wider scope such as minor surgery etc.
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Re: SB 146 Arkansas - February 5, 2007 5:00:00 PM
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TC PT
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Sorry to interrupt this discussion but I have a question for jbird. Do you believe the "roots" laid by the founding father of the field of chiropractic deserved any better treatment?
From Wikipedia: "Chiropractic was founded in 1895 by Daniel David Palmer, based on his assertion that all health problems could be prevented or treated using adjustments of the spine (spinal adjustments), and sometimes other joints, to correct what he termed vertebral subluxations."
In my opinion it's a miracle chiropractic has been able to not only survive but thrive despite a founding philosophy of that sort. No disrespect intended...it's actually a tribute those who came after DDP to overcome that beginning. That is,of course, just my opinion.
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Re: SB 146 Arkansas - February 5, 2007 5:08:00 PM
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ONstudentPT555
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Jbird,
Sounds good. Why go to med school for soo long and do so many years of residency when you can do surgery as a Naturopath and Deliver babies as a DC with such a shorter period of time in school. Something to think about for potential MD students.
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Re: SB 146 Arkansas - February 5, 2007 5:10:00 PM
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drbuddy
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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."
As far as radiographs are concerned, I am pretty sure that DCs can take and interpret the films in all states. With everything else, we interpret the actual images as much as any family doc would, read the report. Actually, if it's related to he area of complaint and not just a rule in/out something bad, I like to take a look at the imaging too.
Chiropractic scope varies widely from state to state, depending on when it was written last, if the state is made up of primarily subluxationists or others, and based on need. For instance, in many western states that are sparsely populated, the scopes include minor surgery and delivering babies. This is because historically it was tough to find an MD in some parts, so it was nice to have DCs do those things too. Michigan's scope is horrible because it is made up of mostly subluxationists. New York's scope is horrible as well because it is old and they have many weak state organizations and they are afraid to open up the scope to have it updated in fear of being attacked by other providers. PA's scope is pretty broad, mostly due to a strong state organization and the fact that it was revised fairly recently.
What's med school cost these days? I was in school 8 years and spent well over $150,000, so I'm not sure if I had it that much easier. I do acknowledge that it is very difficult to go through med school and residencies, without a doubt.
I know my abilities, but more importantly I know my limitations. I am a chiropractor, no more, and certainly no less.
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Re: SB 146 Arkansas - February 5, 2007 5:17:00 PM
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drbuddy
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Tom, what did medicine look like back in the 1890's? I imagine it was much different than it is today.
True, chiropractic was founded that way, but shortly after people began to defect from that camp and started teaching a more holistic approach, meaning treating the person and not the disease using nutritional therapy, exercise therapy, etc. It's funny because it was actually an MD that graduated from DC school that opened up a competing school to the Palmers. He felt that the education should be more rigorous and include more basic sciences as well as have hospital rounds for learning. I believe all that was set up as early as 1906.
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Re: SB 146 Arkansas - February 5, 2007 5:17:00 PM
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ONstudentPT555
Posts: 224
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"For instance, in many western states that are sparsely populated, the scopes include minor surgery and delivering babies. "
Does this actually happen .. I mean what hospital would DCs be performing surgery in without proper residency training.
"I was in school 8 years and spent well over $150,000, so I'm not sure if I had it that much easier."
Well MDs are in school for 8 years plus 6-7 years of residency for surgery.
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Re: SB 146 Arkansas - February 5, 2007 5:20:00 PM
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jlharris
Posts: 477
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Thanks for the information Buddy. Just checked on the DC practice act in my state (Nebraska). X-rays can be taken and read to make a diagnosis but only for the axial skeleton.
Here's how it reads. Very interesting reading.
[QUOTE]
The diagnosis and analysis of the living human body
for the purpose of detecting ailments, disorders, and disease by
the use of diagnostic X-ray, physical and clinical examination, and
routine procedures including urine analysis; or (2) the
(b) The science and art of treating human ailments,
disorders, and disease by locating and removing any interference
with the transmission and expression of nerve energy in the human
body by chiropractic adjustment, chiropractic physiotherapy, and
the use of exercise, nutrition, dietary guidance, and colonic
irrigation.
(2) The use of X-rays beyond the axial skeleton as
described in subdivision (1)(a) of this section shall be solely
for diagnostic purposes and shall not expand the practice of
chiropractic to include the treatment of human ailments, disorders,
and disease not permitted when the use of X-rays was limited to the
axial skeleton.
[/QUOTE]
_____________________________
Jason L. Harris, PT, DPT
My PT Blog
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Re: SB 146 Arkansas - February 5, 2007 6:08:00 PM
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jbird007
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Tom, I believe Buddy did a great job of answering your question. Remember blood letting and barber poles?
I am unsure why you believe "it is a miracle" that chiropractic survived and thrived.
The reason is simple. People got better.
And now here we are in the future and after all the abuse and ridicule us old timers took, everyone and their uncle wants to manipulate and your PT association has a focused agenda to OWN manipulation by 2025.
I will be long gone by then but I think one or two DC's might be pretty pissed off. BUT, if our government continues with its communist manifesto, DC's could be eradicated all together.
JBird
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Re: SB 146 Arkansas - February 5, 2007 6:17:00 PM
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ONstudentPT555
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This discussion has become soo dysfunctional.
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Re: SB 146 Arkansas - February 5, 2007 6:27:00 PM
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ptdan23
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From: Orlando, FL
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I am not sure while medical doctors are not trying to do something about chiropractors performing pelvic exams, doing sutures, pronounce time of death, etc.
Dan, PT MTC.
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Re: SB 146 Arkansas - February 5, 2007 6:47:00 PM
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jbird007
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quote:I am not sure while medical doctors are not trying to do something about chiropractors performing pelvic exams, doing sutures, pronounce time of death, etc.
What do you want them to do?
Should DC's stop PT's from manipulating too?
btw..DC's can be coroners in my state.
ON student, I thought the posts were informative and enlightening. Why do you think the discussion became dysfunctional. Would you prefer a different ending? How can I help? ;)
JBird
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Re: SB 146 Arkansas - February 5, 2007 7:33:00 PM
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dfjpt
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Jbird and others, "The reason is simple. People got better"
News flash: People get better from everything under the sun, or in other words, spontaneously. Yet chiropractic is usually there trying to take credit for it (but never wanting to really examine if it is so). Worse yet, most of the folks in your clan keep on treating patients anyway, claiming that they'd get "worse" without "chiropractic adjusting". How do you justify that?
Another thing, the real separation between your kind of "doctoring", and the medical kind, came along around the same time antibiotics did. Medical "doctoring" moved on - chiropractic stayed with its "33 principles", some sort of mishmash about innate something requiring constant attention of the chiropractic sort to keep flowing, or something.. How do you justify that?
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Re: SB 146 Arkansas - February 6, 2007 1:40:00 AM
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Jeep
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[QUOTE]Question regarding ordering imaging: Are you able to legally interpret them? [/QUOTE]Yes. Not only able, but required, to interpret them.
This goes back to the AMA boycott of the profession. They would not take films of DC patients, and any medical facility that did, faced losing their license. As a result, DCs had to acquire radiology acumen, and has done exceptionally well, not only at the clinician level, but on the post-grad level.
There is also a highly competitive three year radiology residency program, which, when completed, allows the candidate to sit for the diplomate in radiology{DABCR} exam.
EG.
http://www.logan.edu/pages/radiology_educ_residency.asp
http://www.scuhs.edu/continuingeducation/data/index.asp?id=224
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It is now well recognized that chiropractic radiology includes, but is not limited to, plain film radiography, fluoroscopy, tomography, ultrasonography, radioisotope imaging, computed tomography, digital radiography, and magnetic resonance imaging. Individual practices may vary by intent, licensure, and scope of practice laws.
http://www.acbr.org/
----------------
A few papers that demonstrate DC radiology acumen you will find interesting:
de Zoete A, Assendelft WJ, Algra PR, Oberman WR, Vanderschueren GM, Bezemer PD.
Reliability and validity of lumbosacral spine radiograph reading by chiropractors, chiropractic radiologists, and medical radiologists.
CONCLUSIONS: Small differences with little clinical relevance were found. All the professional groups could adequately detect contraindications to chiropractic treatment on radiographs. For this indication, there is no reason to restrict interpretation of radiographs to medical radiologists.
---------
Taylor JA, Clopton P, Bosch E, Miller KA, Marcelis S.
Interpretation of abnormal lumbosacral spine radiographs. A test comparing students, clinicians, radiology residents, and radiologists in medicine and chiropractic.
... that the test results of chiropractic radiologists, chiropractic radiology residents, and chiropractic students was significantly higher than that of the corresponding medical categories {general medical radiologists, medical radiology residents, and medical students, respectively}; that no significant difference in test results was identified between chiropractic radiologists and skeletal radiologists or between chiropractic and medical clinicians;
[QUOTE] 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. [/QUOTE]We are responsible for ANYTHING/EVERYTHING imaged on films we take.
Funny, how the original AMA boycott has evolved things. For example, the radiology facilities at National include an MRI that I've been told that the largest users of their MRI are local MDs.
National's MR is or was the only open gantry unit in that area of Chicago.
This unit is also used for research. I think you will find this one interesting:
Cramer GD, Gregerson DM, Knudsen JT, Hubbard BB, Ustas LM, Cantu JA.
The effects of side-posture positioning and spinal adjusting on the lumbar Z
Abstract:
STUDY DESIGN: A blinded, randomized controlled trial was conducted.
OBJECTIVE: To test the hypothesis that chiropractic side-posture
manipulation {adjusting} of the lumbar spine separates {gaps} the
zygapophysial {Z} joints. SUMMARY OF BACKGROUND DATA: Spinal adjusting is
thought to gap the Z joints, yet no studies have conclusively validated this
hypothesis, and some investigators have reported that the lumbar Z joints do
not gap during rotation. METHODS: For this study, 64 healthy student
volunteers {32 men and 32 women} ages 22 to 30 years with no history of
significant low back pain were randomized into four groups of 8 men and 8
women each. Interventions included lumbar side-posture spinal adjusting
{manipulation} and side-posture positioning. Anterior to posterior
measurements of the Z joints from MRI scans taken before and after
side-posture spinal adjusting and before and after side-posture positioning
were compared. RESULTS: Observers performing the measurements were blinded
as to group and first and second scans. Reliability of the measurements was
established. Differences were found between the groups {F = 24.15; P <
0.000, analysis of variance}. Side-posture positioning showed greater
gapping than the control condition {mean difference, 1.18; P < 0.000};
side-posture adjusting showed greater gapping than the control condition
{mean difference, 1.89; P < 0.000}, and side-posture adjusting showed
greater gapping than side-posture positioning {mean difference, 0.71; P =
0.047}. CONCLUSIONS: Spinal adjusting produced increased separation
{gapping} of the Z joints. Side-posture positioning also produced gapping,
but less than that seen with lumbar side-posture adjusting. This study helps
to increase understanding about the mechanism of action for spinal
manipulation.
------------
[QUOTE] 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. [/QUOTE]Actually, this went on way beyond the 50s. The AMA had a DC jailed in Louisiana in 1974.
As for Teston- Ignorance, disregard, or personal disagreement with the Arkansas state PT practice act is not an excuse. The Arkansas practice act clearly outlines what is mobilization vs manipulation{regardless of what "name" Teston chose to call it}. His biggest problem was that he chose to ignore his state act, and treat outside of the scope of the state act, which clearly states that spinal manipulation can only be performed by a DC or MD{go figure that one!}. This is not purely a decision made by the Arkansas DC board. Teston made numerous appeals, and all the courts agreed with, and upheld the DC board.
http://tinyurl.com/2ldlfx
So I have no sympathy for Teston. He knew{and is responsible for knowing} the act/regulations of the state in which he practiced and was licensed, and chose to disregard it.
Sorta reminds me of a few miles of controversial freeway in my area. It provides an important connection between two other freeways. However, in order to construct this freeway, a comprimise was reached which limited the speed on this little piece of freeway to 45mph. It is a six lane, divided freeway! Looks and functions just like all the other freeways!! The 45mph limit is IMO absurd!! Does that make going 65mph exempt from the posted 45mph? Should I expect not to risk getting a ticket if I go 65mph? How about if I protest and insist that my speedometer indicated I was only going 45mph?
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Re: SB 146 Arkansas - February 6, 2007 4:56:00 AM
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jlharris
Posts: 477
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From: Nebraska
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Thanks for the information Jeep.
I disagree with the fact that mob vs manip is clearly differentiated - maybe in theory but not in practice.
Did he do it on purpose. Maybe, I don't know. My opinion is that the fines were still excessive if not warranted. DC operating w/o a liscense get's a $500 fine and the PT is found to have manipulated by a mole that the DC board sent in and is fined the max of $5,000?
IMO, the point they were trying to get across was not "practice in your scope" but "don't mess with us and our protected treatment".
BTW, you have to intentionally go 65mph for the speedometer to read 65mph. I've had people rolling from supine to sidelying and have a cavetation. I'm sure if I was in Arkansas with that mole, I would have been fined $5,000 for it.
_____________________________
Jason L. Harris, PT, DPT
My PT Blog
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Re: SB 146 Arkansas - February 6, 2007 5:28:00 AM
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jbird007
Posts: 297
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From: USA
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What the Arkasas PT did was illegal in his state.
dpt: I won't waste time with you. Your argument is old and wore out.
JBird
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Re: SB 146 Arkansas - February 6, 2007 6:02:00 AM
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drbuddy
Posts: 429
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From: Pennsylvania
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Onstudent, no hospitals needed. Minor surgery I would guess includes injections, mole excission, sutures, etc. I dont know what it's like where you are at, but I have had some of those things done by my family doc in his office. Like I said, it's more of a historical thing than anything else. Nowadays, I'm guessing not too many chiros do all of that in their office.
Right, 6-7 years for surgery, but how about a family practice doc?
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Re: SB 146 Arkansas - February 6, 2007 7:45:00 AM
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mcap56
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From: New York, NY
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Military PTS can order imaging, prescribe certain meds and are primary care musculoskeletal practicioners. They would not call themselves physicians however....
Marc
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Re: SB 146 Arkansas - February 6, 2007 7:51:00 AM
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jbird007
Posts: 297
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From: USA
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marc, again , because they are not recognized as such. I would almost bet they would your the title if it was recognized at the state and federal levels. Maybe this is something for your associations to work on.
It really doesn't matter what a doc does, according to legalities and bureacratic bs, if they honor a title it sticks.
IMO PT's should be able to write limited scripts. If I were a PT this is what I would focus on first.
JBird
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Re: SB 146 Arkansas - February 6, 2007 9:23:00 AM
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jlharris
Posts: 477
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From: Nebraska
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jbird,
Agreed, if it wasn't illegal what he did, the courts would have thrown out the fine. My point has to do with the severity of the fine and how it was brought about.
Buddy,
Family practice doc would be BA or BS degree (4 years) MD degree (4 years) and 3 years of residency in acute and OP settings. So that's 11 years minimum. The key here is that their residency is done in hospitals and OP clinics that are part of the health care system; and not in isolation of it. Not a harp on the quality of education, but on the ability to actually treat systemically ill people on a high frequency basis. PT's don't have that exposure, and I'm fairly certain the majority of DC's don't either.
That doesn't mean a DC isn't competent to do a physical, UA, x-rays, etc. I do think it makes them not as competent to treat non MSK conditions (eg DDM, HTN, RA, etc). Obviously all my opinion.
_____________________________
Jason L. Harris, PT, DPT
My PT Blog
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Re: SB 146 Arkansas - February 6, 2007 9:50:00 AM
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jbird007
Posts: 297
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From: USA
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quote:Agreed, if it wasn't illegal what he did, the courts would have thrown out the fine. My point has to do with the severity of the fine and how it was brought about.
Honestly IMO I think the Arkansas PT was a "whipping boy" and a strong scare message was trying to be implied. I dislike anyone or organization/s who gets off on authority power, even in my own profession. No doubt it is a turf war. I choose to avoid it.
quote:That doesn't mean a DC isn't competent to do a physical, UA, x-rays, etc. I do think it makes them not as competent to treat non MSK conditions (eg DDM, HTN, RA, etc). Obviously all my opinion.
I agree Jason. And I might add PT's could easily perform physicals, UA's and x-ray. It is hardly rocket science. Many MD's can not and do not want to read an x-ray. I find that odd. Or many of the ones that do read them, rule out fracture and say, "It's arthritis!". It drives me nuts. I teach my CA's how to read x-rays and they become very good at it.(although they can legally only take films and not read them, it is advantagous to me that they know how to view them).
From another angle, other heathcare people are slowly doing the jobs of MD's. I am not sure how MD's feel about it but it must be having an impact on them. With PA's, DC's and PT's taking on more aspects of healthcare the MD's must be scratching their heads just a bit. Than again, maybe they do not care. For example I just recently started doing high school physicals for athletes. I charge $15 per kid.(parents love me and think about a family with 4-5 kids all playing sports and every year they have to be re-examined). The medical clinics here were charging $80-120. Since I started doing them I do approx 400-500 kids a year. I am picking their pockets huh? Gulp! btw, I upped my building insurance in case they burn it down. ;)
JBird
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