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RE: not meant to be chastising: why are chiropractors called "Dr"
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RE: not meant to be chastising: why are chiropractors c... - June 15, 2008 9:51:06 PM
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Tom Reeves DPT ATC
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Hey, its choirpractor, not chiropractor
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RE: not meant to be chastising: why are chiropractors c... - June 15, 2008 9:59:52 PM
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Jon Newman
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The following link doesn't answer Proud's question but it may make people feel better. At least in Connecticut. link In terms of accredidation (a necessary part of the process for an institution awarding a clinical doctorate degree), see here I'm sure a chiropractor reading here can chime in on the history of progression to a clinical doctorate. I'll add to Proud's question and ask how chiropractors came to be considered physicians by some. Like Rod, I used to get more upset. However, now that "doctor" has been subject to low redifinition (<---click it) I look for other qualifiers to help understand who the doctor in question is.
< Message edited by Jon Newman -- June 15, 2008 10:06:48 PM >
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RE: not meant to be chastising: why are chiropractors c... - June 15, 2008 10:09:13 PM
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TexasOrtho
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Jon you always have some of the more interesting links in your posts. Good reading. Bas you know I am all about the color. I just struggle to stay within the lines at times. Here is a snippet of an article from the skeptical inquirer. Sorry it's lengthy, but I thought it might illustrate the problems chiros are having. I'd encourage those interested in the PT/chiro issue to learn more about what we are (and are NOT) up against. Homola S. Chiropractic: a profession seeking identity: the chiropractic profession is resisting changes that will establish it as a back-pain specialty while seeking an identity that will continue to allow chiropractors to treat a broad scope of health problems.(Chiropractic & Homeopathy Under the Microscope). Homola. Skeptical Inquirer 32.1 (Jan-Feb 2008): p19(4) ------- Choices for the Future Back pain is one of this nation's most common medical problems, accounting for $50-100 billion in health costs annually (Pelletier 2002). Despite the need for a back-pain specialty that combines the use of spinal manipulation with physical therapy modalities, it does not appear that the chiropractic profession plans to take advantage of the growing back-pain market by specializing. Spinal manipulation is only one treatment of many available in the treatment of back pain. A back-pain specialty would require the use of a variety of physical treatment methods in concert with various medical specialties. Chiropractors who adjust subluxations to restore and maintain health do not qualify as back specialists. Chiropractic as an alternative method of primary care for general health problems is far from being accepted by the scientific community. A 2005 report by the Institute for Alternative Futures reported that the future of chiropractic is uncertain because of economic challenges and the limitations in chiropractic science and methods. The Institute predicted four possible scenarios for chiropractic: (1) slow, steady growth as support mounts for the use of manipulation in the treatment of back and neck pain; (2) a downward spiral from competition and healthcare costs; (3) evidence-based collaboration in the care of neuromusculoskeletal conditions; or (4) chiropractors will become healthy life doctors "specializing in preventing disease with health-management plans" (Institute 2005). Concerned that the chiropractic profession "has failed to define itself in a way that is understandable, credible and scientifically coherent," a group of evidence-based chiropractors offered a model for "spine care" that focuses primarily on treatment for back pain. The purpose of the plan is to "help integrate chiropractic care into the mainstream delivery system while still retaining self-identity for the profession" (Nelson 2005). The plan was not well-received by the chiropractic profession at large, which is loathe to restrict chiropractic treatment to back pain, preferring instead to claim a broad scope of health problems as its purview. On June 15, 2005, the World Federation of Chiropractic, at its Eighth Biennial Congress, unanimously agreed that chiropractors should be identified as "spinal health care experts in the health care system ... with emphasis on the relationship between the spine and the nervous system" (World 2005). This definition fails to place proper limitations upon chiropractors who use spinal adjustments to treat general health problems, plunging the profession deeper into pseudoscience and away from establishing an identity for chiropractors as back-pain specialists. Most states continue to define chiropractic as a method of adjusting vertebral subluxations to restore and maintain health, allowing chiropractic treatment of almost any ailment. ---------
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Rod Henderson, PT Board Certified Orthopedic Specialist (or Super-Freak) Certified Strength and Conditioning Specialist www.texasorthopedics.blogspot.com
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RE: not meant to be chastising: why are chiropractors c... - June 15, 2008 10:09:25 PM
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proud
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Hey Seb, Again I agree. But when are governments responsible for allowing the confusion to persist? Truly, if governments can mandate that you and I wear seatbelts for our "safety"...then why does Alberta reimburse for a mode of treatment often based on psuedo-science and with regards to cervical manipulation....a pretty clear history of uncertainty sourrounding not only it's safety....but is clinical applicability? The term "Dr" needs to be restricted for the safety of the public. Alberta could be in deep water here.... I note that chiropractic has a rich history of fighting these things. The legal team may not be aware of the type of machne they are up against. But I will say this: In todays "easy access" media environment, it gets pretty hard to shuffle things under the carpet. It's full exposure nowadays and I think the notion of a class action lawsuit could spread like wildfire( with the internet and other modes of communication available these days). Anyway, let's hope something positive comes out of all this and some government accountability is placed on the table.
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RE: not meant to be chastising: why are chiropractors c... - June 15, 2008 10:39:01 PM
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Sebastian Asselbergs
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Proud, the reimbursement issue is indeed a biggie. A result from lobbying many years ago - and not in the least by creating so many adjustment-dependent patients who were more than willing to call their MPPs.... Our own reimbursement was ensured thanks to our subservient relationship with the "ruling class" of those days: the medical doctors. It is not as if we were so lily-white in our paid services. Take a look at the ultrasound machines, SWD, and many other modalities for which the health plans were paying for many years - and still are for too many clinics. I am not saying this is in the same vein as the "doctor" title issue; just that when governments are starting to look closely at professional standards and practices, we better be sure we are clean....Good thing is, research is starting to help us with that.
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RE: not meant to be chastising: why are chiropractors c... - June 15, 2008 10:57:39 PM
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rwillcott
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Back to the issue of chiros calling themselves doctors. There is a chiropractor in the city I work in that has the personalized license plate 'bac doc'. Is chiropractor a doctor of the back? Sure gives the public this impression. When I think of back doctor I think of an orthopaedic surgeon that specializes in back surgery. Big difference.
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RE: not meant to be chastising: why are chiropractors c... - June 16, 2008 6:31:57 AM
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Sebastian Asselbergs
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"Back to the issue of chiros calling themselves doctors." It is legal in North America. That is pretty much the end of that issue, unless you want to start some political lobbying to change it. The second issue is misrepresentation - THAT is a sticky problem. I agree that your example can be confusing the public - for the betterment of the chiro's caseload. I have seen "spinedoc" and such on plates. Tacky, and reminiscent of the "assmann" plates from Seinfeld...... However, since bac doc and spinedoc and such are NOT defined professions, I do not think you can do much about it. And let's face it, do we really have to worry about people who need to market with their license plates?!? More like Real Estate than anything professional medical.... Rambling on...maybe the bac doc is just darn proud of himself and wants the world to know? It all seems to come to marketing: DCs have been doing that since their beginning, while PTs have only very recently started doing that. I think that as in all things, there are smart, decent, and classy marketing ploys - and then there are ED ads, political ads, chiroplates, an snakeoil ads.... But mostly a question of "caveat emptor" - advertising is a game of deception in general. Buy a blue pill and you are young, happy and make women smile, while your lawn drowns, the turkey burns, your grandchildren cringe and the dog shakes its head...... Yet, the ads are hugely successful - demand is enormous... Is it deceiving? Hell, yes. That is marketing. And if a chiro wants to do that kind of stuff at that level, s/he will always be no better than a product. going for coffee now.
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RE: not meant to be chastising: why are chiropractors c... - June 16, 2008 8:07:30 AM
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Jon Newman
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A little digging around and I found these two pdfs. The first is a pdf of the 2007 standards for Doctor of Chiropractic education. It won't answer the question of what constitutes minimal standards for a profession to call itself a doctoring profession but it does tell us what standards are required of DC programs. The second pdf is an essay titled, Chiropractic History: a Primer (Keating, Cleveland, Menke.) In it, and assuming it is accurate, the answer for how the title doctor first came to be used is stated this way: quote:
In 1886, when Daniel David (“D.D.”) Palmer first hung his shingle as a magnetic practitioner in Burlington, Iowa (Gielow 1981, pp. 43, 105), the licensing of doctors was still a novelty in the Hawkeye State. Encouraged by the belief that he had a personal excess of vital magnetic energy, he offered his services to the many patients who were wary of orthodox medicine. As was the custom of the day, Palmer adopted the title “Doctor,” and conducted his clinic with little concern about interference from his allopathic competitors. DC education standards Chiropractic History: a Primer
< Message edited by Jon Newman -- June 16, 2008 8:13:40 AM >
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RE: not meant to be chastising: why are chiropractors c... - June 16, 2008 9:29:28 AM
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rwillcott
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I would love to see a film depicting the life of DD Palmer.
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RE: not meant to be chastising: why are chiropractors c... - June 16, 2008 2:57:04 PM
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bonez
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quote:
ORIGINAL: rwillcott Between the Yarn Barn and Cracker Barrel, hiliarious! What a great analogy. Great post TexasOrtho. The fact the PT schools are part of highly prestigous universities is the reason why we are well respected. The Chiros recognize this as well. In fact they made an attempt to become part of a University in western Canada during the late 1990s. Fortunately the university declined the request after meeting with chiro offiicials and touring their 'college' and recognizing they had no research to support their claims. I know nothing I say for the next while will be taken seriously but in the province of Ontario the government has given the college there the right to grant degrees As a degree granting institution there can be a DR degree. On the side of the university affiliation, if we all really wanted life to go in an evidenced/tuition controlled world, would affiliating the Chiro program not have forced it to rise to the current standards in education? Why would the world not want that? I have heard the argument that there woul be too much benefit to appearing of higher standard than deserved but really the additional scrutinity would have forced the put up or shut situation to unfold I think. So all I can think is that maybe nobody really wants the profession to survive.
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RE: not meant to be chastising: why are chiropractors c... - June 16, 2008 3:24:40 PM
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proud
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Bonez, The problem( and you could speak to the issue) is that although CMCC has made strides towards evidence based practice, the underlying pseudo-scientific themes and theories persist. Unsupported by science, chiropractors must either fall back upon Palmer's views or admit that the "subluxation" theory is erroneous. As such, without the subluxation theory, chiropractors are reduced to manipulative therapists practicing a very limited modality shared by osteopaths, physiatrists, sports trainers, physical therapists and others. Without the theory, chiropractic's claim that it is a unique and comprehensive "alternative" to standard medicine is lost. Essentially, without the theory, Chiropractic becomes redundant in the eyes of acedemic institutions. Why bother with chiropractic if it has nothing unique to offer the health care system. PT's have become entrenched in the health care field as experts in that arena anyway. That is why it is pointless for acedademic insistutions to affiliate with Chiropractic. That and the fact that the pseudo-science called the subluxation persists( it's still in there CMCC........). So it remains embarrassing for universities to align with it. Perhaps?
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RE: not meant to be chastising: why are chiropractors c... - June 16, 2008 7:56:31 PM
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rwillcott
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When you have chiro's referring 8 year olds for x-rays to a hospital to help identify subluxations you're not going to be respected. This is the case in Alberta where a group of Radiologists have refused to perform x-rays requested by chiro's. Link: http://www.healthwatcher.net/chirowatch.com/cw-alberta.html This is because during a radiologists training they are not taught that a subluxation exists. Let alone a subluxation that is suspected to cause asthma or hearing problems. Finally, there understanding of research aids them in knowing not to afflict unnecessary radiation on an innocent child for no purpose.
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RE: not meant to be chastising: why are chiropractors c... - June 17, 2008 1:04:40 AM
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bonez
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quote:
ORIGINAL: proud Bonez, The problem( and you could speak to the issue) is that although CMCC has made strides towards evidence based practice, the underlying pseudo-scientific themes and theories persist. Unsupported by science, chiropractors must either fall back upon Palmer's views or admit that the "subluxation" theory is erroneous. As such, without the subluxation theory, chiropractors are reduced to manipulative therapists practicing a very limited modality shared by osteopaths, physiatrists, sports trainers, physical therapists and others. Without the theory, chiropractic's claim that it is a unique and comprehensive "alternative" to standard medicine is lost. Essentially, without the theory, Chiropractic becomes redundant in the eyes of acedemic institutions. Why bother with chiropractic if it has nothing unique to offer the health care system. PT's have become entrenched in the health care field as experts in that arena anyway. That is why it is pointless for acedademic insistutions to affiliate with Chiropractic. That and the fact that the pseudo-science called the subluxation persists( it's still in there CMCC........). So it remains embarrassing for universities to align with it. Perhaps? If you re read my post wrt the concept of an affiliated college needing to be current with scientific literature or fall by the wayside then you should not need your post. In order to meet and continue to meet degree granting status the Ontario college has to redo it's teachng staff status on the front of advanced degrees. This also keeps the college on the top of what is current. Similar to the PT world many of the graduated practitioners go off and attend weekend seminars which may then add to there questionable practise patterns. The College has no means of control over those courses or condones them. I am always the first to admit and take a stand against members of my profession that " don't" get it but remember that we all have skeletons in closets. On this very board I saw one of your profession that is training lots of your members to treat movement dysfunctions by moving the opposite side for miraculous cures. From the outside looking in this looks scary and witchcraftish yet lots of your smart school friends probably go off and take the course. Or the funny little tools to remove tissue adhesions that you pay big bucks for certification in? Neither of these are likely to cause tetrapalegics but none the less stand on shakey ground. Or patients in my area going on their second year of weekly ultrasound treatment with little reassessments done. The chiro profession for all its bad press seems to have shown in studies to have high patient satisfaction and this is probably what keeps it afloat.
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RE: not meant to be chastising: why are chiropractors c... - June 17, 2008 6:45:06 AM
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Sebastian Asselbergs
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Bonez, I have no argument with looking at my own profession to clean itself up. And you see many of us doing that here - including proud. However, under discussion here is the core-tenet of chiropractic specialty - manipulating the spine - and what it means in context for the CMCC and the case at hand. It is not really good debating etiquette when we start to introduce "but look at how bad our profession is" arguments. This has been a tactic of may of the "straights" when defending their practice: "Look at how many people die in hospital due to MDs and drugs" etc etc. These are logical fallacies. We DO argue vehemently about EBM and what it means - however, as a whole our profession was never founded, nor did it adhere for decades, to a very poor theoretical construct as it foundation. Once you take away the so-called specificity of manipulation, the lack of palpatory accuracy, the contentions that manipulation cures all ills (or at least very many), what is chiropractic left with? Being excellent therapists - many of whom I worked with - but is it really distinct as a scientific profession? Or can it only be distinct when it hangs on to more outlandish claims?
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RE: not meant to be chastising: why are chiropractors c... - June 17, 2008 6:53:35 AM
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TexasOrtho
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Bas. I think you hit at the core of the problems for the chiros. Bonez I appreciate your contributions as well, but I have to agree with Bas' comments. It almost seems like a no-win proposition to me. The chiropractic profession can't remain solvent practicing based on the subluxation theory, but without it they loose their identity. I know there are those in the chiropractic community trying to reform, but I think it might be too little too late. Bonez you seem to have a pretty level head on this and other issues. Where do you see the chiropractic profession heading in 10-20 years?
_____________________________
Rod Henderson, PT Board Certified Orthopedic Specialist (or Super-Freak) Certified Strength and Conditioning Specialist www.texasorthopedics.blogspot.com
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RE: not meant to be chastising: why are chiropractors c... - June 17, 2008 12:05:55 PM
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proud
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quote:
Once you take away the so-called specificity of manipulation, the lack of palpatory accuracy, the contentions that manipulation cures all ills (or at least very many), what is chiropractic left with? Being excellent therapists - many of whom I worked with - but is it really distinct as a scientific profession? Or can it only be distinct when it hangs on to more outlandish claims? What Seb said. Bonez, from my reading here I know you to be most lilely an excellent clinician. But your last argument trickled down the typical path I have seen in the past. Suggesting other professions have "problems" does nothing to advance the notion that Chiropractic should gain university status. In the end, without the pantheistic views of Palmer, good Chiropractors become good Physical Therapists. It's a duplication that is confusing and really not required.
< Message edited by proud -- June 17, 2008 1:36:53 PM >
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RE: not meant to be chastising: why are chiropractors c... - June 17, 2008 9:25:56 PM
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bonez
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You all are right about the sound of the last post and as so often is the case, the intention meant is not that which was read. My intention was to indicate that the training institution has little control over their former students once they leave their college and start taking quick fix seminars. Similarily the comment about the PT "witchcraftish" stuff was meant to show that while the "smart" people you went to school with got it in school it does not stop them from taking these kind of courses after they are in practise. You can not also make a practitioner follow the correct evidence in any profession if they choose not to, hence the ultrasound comment. For me when I see them presented here , or in my community they are all be it out of context and still strike a cord. I have little faith in collegues that bring out the surgery kills"x" arguement or pills and faith are evil demons posts. The truth is that for anyone to be in Sandra Nette's position is horrible and re directing the arguement in "other directions" does not help at all. Nor do I try to defend them here. I have been in practise for 22 years and in college palmers activites were presented as historical info not what our day to day studies were about. There is not really any reference in my day to day work that has anything to with the palmer activity unless I encounter an additional response to a treatment encounter that I am unable to explain. As far as 20 years from now I can't answer for you because I think my practise experience is unique. I do believe that we have a unique role to play in a MSK world , I do believe in what the evidence says and I still see patient satisfaction issues that support my belief. My personal opinion is that there is a general dissatisfaction for patients in mainstream healthcare and many seek alternative approaches which create a rich bed of manure for the "weeds" to grow in. Sadly I think that the experience of many here reflect their experiences with those "weeds" I also try to be objective when I look at all situations but forgive me but I do feel the hate at times here and wonder how you pursue the science when your criticizers slam the door before you get your mouth open. The original theme in this post was about how we came to use the title Dr. My thoughts would be this I don't feel wrong to have the title as I don't instantly associate it with medicine but with the pursuit of higher learning to limit available in my area of practise. Long before this title was hijacked by healthcare the educational system placed the title with the highest level of education in a field. I can't say that I put it on my ID or licence plates nor do I have a website or TV ads. My practise is probably one third or better Md referral and the highest compliment for me is when they call me Dr.
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RE: not meant to be chastising: why are chiropractors c... - June 17, 2008 10:19:43 PM
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TexasOrtho
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Bonez you really seem like a good egg. Your post had me look up the origin of the words doctor and physician. The etymology is interesting. The term doctor is indeed derived from the Latin word doctre, meaning "to teach". It was first used in the English language in the 14th century to refer to learned men of scripture or doctors of the church. The term medical doctor came to be known in the late 14th century. The word physician comes from the Greek noun physis meaning "nature". So in a literal sense, the qualifier "medical", "chiropractic", "physical therapy", or "academic" would be necessary to determine if the use of the term doctor is appropriate for an individual. Regrettably, I have to admit the term "doctor of chiropractic" is justified. The problem is, quite frankly, one of public perception and ignorance. My solution would be transparency as proposed by many in our profession. Saying "I am a doctor of physical therapy/chiropractic" is as appropriate as saying "I am a doctor of medicine". Ok the English lesson is over, I'm going to watch the Celtics win a championship.
< Message edited by TexasOrtho -- June 17, 2008 10:24:42 PM >
_____________________________
Rod Henderson, PT Board Certified Orthopedic Specialist (or Super-Freak) Certified Strength and Conditioning Specialist www.texasorthopedics.blogspot.com
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RE: not meant to be chastising: why are chiropractors c... - June 18, 2008 1:27:16 AM
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bonez
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quote:
ORIGINAL: TexasOrtho Bonez you really seem like a good egg. Your post had me look up the origin of the words doctor and physician. The etymology is interesting. The term doctor is indeed derived from the Latin word doctre, meaning "to teach". It was first used in the English language in the 14th century to refer to learned men of scripture or doctors of the church. The term medical doctor came to be known in the late 14th century. The word physician comes from the Greek noun physis meaning "nature". So in a literal sense, the qualifier "medical", "chiropractic", "physical therapy", or "academic" would be necessary to determine if the use of the term doctor is appropriate for an individual. Regrettably, I have to admit the term "doctor of chiropractic" is justified. The problem is, quite frankly, one of public perception and ignorance. My solution would be transparency as proposed by many in our profession. Saying "I am a doctor of physical therapy/chiropractic" is as appropriate as saying "I am a doctor of medicine". Ok the English lesson is over, I'm going to watch the Celtics win a championship. Notation accepted Please don't regret that we all may learn something here. I really subscribe to the more modern thought of philosopy(sp), the classics had the great thinkers. The church can be just about as bad as this topic for some of us. lol These individuals were some of the original doctorates for the more "modern" world they often also became embroiled in religion as well. I believe that health care hijacked the term way back to stand out as experts. Inerestingly we here think the surgeon to be the ultimate status but in the UK way back when they were definitely not on the same level as the "doctor" and you can still find surgeons not using the title there. The sad part seen on this board for me is that if someone came through my profession and continued on to other doctoral degrees they are now somehow "tainted" because they were DC first. They validity of their work now stands as suspect. They are termed bias to chiro and we shouldn't trust or accept their work. If we accept this kind of logic then any one who does research that is positive to their own profession should expect their body of work to carry less weight because of this bias. I don't think that we should accept that kind of thinking because we all have studied the way to critically appraise research on it's science not it's authorship. We can miss important new direction to complement what we all do.
< Message edited by bonez -- June 18, 2008 1:39:58 AM >
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