Doctor Title

[discogenic]

im reading a lot of "you just dont understand" comments from the chiropractors, but not a lot of "heres how we operate and this is what it does to make our clients health better".

 

The whole reason I'm even pursuing this discussion is to point out to you that it is irresponsible to make authoritative-sounding statements in a forum like this, or worse to your future patients, when you clearly lack any such authority. That would go for any topic; in this case, chiropractic specifically.

[marilynpac]

You know I don't fully understand it either, but there are so many other medical issues I don't understand. I just was grateful that it worked. While I was going through the severe hyperthyroidism and my nervous system was hit so hard I actually went hard of hearing....I was thankful for the accupuncture, it helped calm everything down. Sometimes mainstream medicine doesn't have all the answers and there is a reason accupuncture has been around helping people for thousands of years. We don't have all the answers that's why medicine is always progressing. Sometimes we have to go backward to move forward. More people are demanding alternative routes due to ABX resistance, too much radiation exposure, and just too much medication. My Endo always says to me " By the time the patient comes into my office he is on so much medication that it's difficult to tell the difference between the real health problem and all the side effects from all the meds the patient is on"....so he takes at least three months to wean the patient off all the useless meds that are doing more harm than good. Believe it or not the patient actually starts feeling better immediately. At one time docs use to laugh at exercise, never recommend it and kept patients in bed for months. Look at the complete 180 the medical comm has done. Just b/c we can't explain everything doesn't mean alternative medicine and natural medicine doesn't have a place. I'm still recovering from the pneumonia and yes I have my chicken soup everyday!!!!1

[discogenic]

if you percieve any authoratative statements from me, its just an echo of what ive come across from places like the AMA. and no, discogenic, im not so closed minded as to discount evidence on any topic out there, and by disagreeing with you on this one, it doesnt mean that i am indeed closed minded. i imagine that since you have a fixation on the PT vs chiropractic aspect in your questions you probably have some study you are getting ready to pull out to try and discredit me once im painted in a corner by my own words. well go ahead and drop that bombshell and see how well that works.

 

There is no "vs." in my mind. I have friends who are PTs. I refer patients to PTs. I've had patients sent to me by PTs. I've treated PTs as patients.

 

Of course there are studies that have shown chiropractic treatment more effective than PT. That doesn't make PT worthless, nor does it mean chiropractic is the end-all treatment. The whole point I am trying to make to you is that you have no idea that those studies exist because you have essentially zero knowledge in this area. And it's not the lack of knowledge I'm knocking; it's your authoritarian position in the face of your lack of knowledge that disturbs me. If you were a stock broker or a dumptruck driver, I wouldn't be as concerned. But you appear to be on your way to becoming a healthcare professional.

 

marilyn, i agree with you on the fact that we dont understand a lot about the world around us. but my issue is the fact that chiropractic has method after method after method where things just "work" and thats why they use them. there isnt much of an explanation as to what is going on... as if chiropractors are the gatekeepers to the fortress of mystery. most of what you do in a days work can be broken down and understood.... most of what a chiropractor does in the day cant be broken down and understood. that leaves a big gaping hole where they can use the system as they see fit.

 

im a religious person, and cant prove my beliefs to anyone in a way that would compel them to believe as i do, but im not about to turn it into a business model.

 

Let's rephrase. YOU don't understand it. That's not the same as "can't be broken down and understood". From your earlier comments, it's clear that you can't even differentiate between normal movements and spinal dysfunction. Be aware that research into spinal dysfunction is being done by PhDs, MDs, and PTs. It's not just a chiropractic thing. Again, I'm not picking on you for your lack of expertise. I'm trying to point out that you don't know what you don't know, and you should temper your comments as such.

[marilynpac]

Well okay, the only thing I can add is that I went to a Pri-Med conference in Chicago one year. It was put on in conjunction with Harvard Medical School. One of the Drs stood b/f the audience and said, " A patient came into my office and said...Doctor I come here, you give me an exam, I leave with a RX that cost me 50 bucks, I go to my Chiropractor, he manipulates me and I leave feeling like a million bucks!". Yes, the entire audience of health care providers laughed. So there you have it, right out of the mouths of the patients themselves. Believe it or not my Chiro takes care of a lot of MDs too....

[ventana]

oh I love a good banter!!!! :-)

 

lets just not forget that EBM is not stories of how it worked for cousing bill or anut nancy....

 

show me some studies..... come on Chiro's prove your profession works better then the 30% placebo effect, show me the studies that chiro is moe effective then rest or other treatments for low back pain (yeah I have read everything I can get my hands on for years about this and news flash - the only thing that works with non-neural low back pain is exercise and weight loss..... nothing else - -now that is the EBM I am talking about....)

 

It is great people get relief from modalities and treatment - but we need to look at real studies and facts (or as close as we can get) and can not be distracted with "well it worked on uncle bill" type stories - yes I know EBM is expensive and hard to attain but you would think that since the entire premise of chiro is unvalidated that chiro's nation wide would be jumping all over studies to prove it.

[discogenic]

oh I love a good banter!!!! :-)

 

lets just not forget that EBM is not stories of how it worked for cousing bill or anut nancy....

 

show me some studies..... come on Chiro's prove your profession works better then the 30% placebo effect, show me the studies that chiro is moe effective then rest or other treatments for low back pain (yeah I have read everything I can get my hands on for years about this and news flash - the only thing that works with non-neural low back pain is exercise and weight loss..... nothing else - -now that is the EBM I am talking about....)

 

It is great people get relief from modalities and treatment - but we need to look at real studies and facts (or as close as we can get) and can not be distracted with "well it worked on uncle bill" type stories - yes I know EBM is expensive and hard to attain but you would think that since the entire premise of chiro is unvalidated that chiro's nation wide would be jumping all over studies to prove it.

 

Spinal manipulation is THE most studied intervention for low back pain, with over 40 randomized trials published over decades. There are studies on acute low back pain, chronic low back pain, low back pain with radicular component, acute neck pain, chronic neck pain. Benefits have been seen for spinal manipulation in all of these categories. There are treatment guidelines from all around the world (multidisciplinary, not just chiropractic) that, based on the evidence, recommend spinal manipulation. The evidence goes way beyond anecdotes and single case studies.

 

Another key point: there is no individual treatment that is the panacea for neck and back pain. Treatment A may work for some, while Treatment B works for others. Spinal manipulation has been shown over and over to be at least as effective, and in some instances more effective, than anything else out there. Will it work for everyone, 100% of the time? No. But neither will anything else. That goes for PT, meds, injections, or whatever.

 

So, with at least as much evidence behind it as any other intervention, it is unscientific to say that chiropractic care is not a valid form of treatment for these cases.

 

And I disagree that exercise and weight loss are the only things that work for back pain, although both can be important.

[marilynpac]

Right on discogenic, I couldn't agree more.....

[fyrelight74]

We had a patient yesterday where I work as a clinical MA/scribe(family practice). The patient has thoracolumbar scoliosis and chronic low back pain. She was being seen for a referral to physical therapy AT a chiropractor's office.... She said "they're only charging me $3500 for daily treatments by PT and chiropractor for the next 3 months"! My doc was floored. He was a chiropractor before he went to med school and said he didn't like the trickery that goes on in chiropractor offices... insurance fraud with just charging the insurance and not the patient copays, positioning patients in such a way for xrays to "show improvement" when it is really just a slightly different position than the previous xray. He will not take xrays from a chiropractor, as he said they are usually not even diagnostic quality. We already had radiology xrays showing only the scoliosis. The chiro office had sent over a request for the PT with a diagnosis written that stated "with radiculopathy". The patient had no signs or symptoms of radiculopathy. He wrote her a referral for PT 3 times per week for 4 weeks only, and advised she see a PT only office, rather than a chiro office that has a physical therapist on staff.

[marilynpac]

We cannot give blanket judgement here. If that were the case no one would ever go to MDs or midlevels. I've had more bad experiences in MDs offices than I have ever had with my Chiros and I've had 3 Chiros. My Chiro only takes XRs in the beginning and he doesn't give out his XRs to docs. You can almost talk to every other person on the street and they can give you a war story that they have had with a health care provider, I know I have mine living in a rural area. It doesn't stop me from trying to find excellent health care providers for myself and my family...they are out there. People have to b/c their own foot soldier and take self responsibility. Is there a cure for cancer yet? No, but I've heard docs tell their patients there is. I'd like to know what research company found the cure I'll take stock out in that one. As for insurance fraud, I assure as a RN first more fraud was commited by the docs than you can ever wrap your mind around.

[discogenic]

discogenic, i guess your concern about my lack of tempered tone and authorative sounding comments is similar to my concern i have towards you and your work. you derive your authority from the chiropractic community, and not from the medical community... that makes you folks essentially self appointed. since you are fixated on what i supposedly dont know, let me tell you what you dont know... you dont know how much i know about chiropractic. when someone disagree's with you, the line "you just dont understand enough" isnt always going to give you an edge. and your condescending comments about me needing to keep an open mind about chiropractic care for the sake of patients is a copout. and to say that because i dont agree with you, and imply that that is closemindedness that could cause me to be a poor practitioner is pretty off the wall.

what concerns me is a PA/chiropractor that tries to straddle both worlds, picking and choosing what world they want to be in and what practices they want to blend. at least a DO would have the benefit of learning manipulation from the standpoint of its place with regard to medicine. for a chropractor to take it upon themself to do this blending without structure and without study and integration concerns me much more than any supposed lack of awareness you think i have toward your profession.

 

Let me make it clear that I am in this forum to learn about the PA profession, not to argue about the merits of chiropractic. Having said that, if someone disagrees with me AND HAS A KNOWLEDGE OF THE FACTS, that's a debate and that's good. If someone disagrees with me but clearly has little more than the most basic grasp on the issue, then that's a waste of time. I'm not asking you to keep an open mind about chiropractic. I'm asking you to study the relevant science and literature THEN proceed to make your authoritative proclamations. You're not there yet, and while you don't see it, your comments speak for themselves.

[marilynpac]

My, my, my, after all the banter on this thread I think I'll go to the peace and quiet of the Middle East.....

[discogenic]

i think my comments echo a lot of the concern thats out there on this subject. you cant even get some folks on here to entertain a lot of nursing theory out there, let alone make the jump into being receptive towards chiropractic work.

 

im not looking to lead the charge towards the downfall of the chiropractic profession, and if i seem over-animated here, that doesnt correctly reflect any intensity towards it in my heart. but i dont feel like its appropriate to dismiss the concerns about it either. there are research results that fall on both sides of the issue of chiropractic treatment. an entire industry has emerged to operate in that void.

 

good luck on your pursuit's.

 

Thanks. Likewise.

[docpowers]

PAMAC, I have said this over and over as to why I want to be a PA also. I want to be able to offer a more complete health care to my patients. I realize I can't do it all and that's why we refer to specialists. But many of the specialists would not treat without using drugs in chiropractic situations that drugs are not necessary. And please open your eyes to the fact that there are many medical doctor's that are doing acupuncture, homeopathy, Nutritional supplementation. We need not to be dogmatic in saying "medicine has all the answers and If they don't have the research then I won't accept it". And yes chiropractic is doing research all the time, but it is small amount in comparison to medicine. They just did a medicare project. I'm not sure if the results are released yet. The chinese don't even completely understand how acupuncture works.(they have theory). My medical doctor said he wanted to do acupuncture. I've had doctor's offices refer patients to me for chiropractic and acupuncture. No one field has all the answers. What may work for one may not work for another. Everyone is an individual and is unique. The natural health care field is a several trillion dollar industry because people are looking for answers that medicine doesn't have. I'm sure your going to do good in whatever area you pursue, but please be open to other possibilities if medicine doesn't have the answer for your patients. Good Luck and I believe we have beaten a dead horse long enough.

[ventana]

two points -

#1 if it is so established that Chiro is effective for low back pain why have I as a clinician, who has spent countless hours reading and researching the subject, not aware of that? Maybe the supporting evidence is only in the chiro journals? Maybe the studies were poorly designed (read ALOT of those that did not compare to anything, just what percentage of the patients got better) I suspect that once you take the placebo effect and the fact that by far the majority of LBP is self limiting the efficacy of chiro adjustment is in line with all the other modialities - which is only better then placebo in the short run but at follow up time frames in the 6,12,24 month time frame there is no difference - I never found even a single study proving that any modality is more effective in the long term for the typical LBP I am not talking HNP or discogenic or radic pain, but instead the "my back hurts" complaint. If someone has a study to prove this PLEASE post it here as I am really curious.

 

#2 still scares the heck out of me to have a PA/Chiro who I sense is a little bit cocky and not overly concerned about learning about the PA field but instead what he can do as a PA and a Chiro combined. I am hopeful that an admissions committee willl review you application very closely. It seems you are not aware of the finer points of being a PA in that it would be VERY difficult to function both as a PA and a Chiro in any setting. To be dedicated to being a PA it should be your primary career goal, it is not a stopping point or an extra ribbon to wear on your chest, it does not make you a Chiro that can prescribe, it does not allow you to be an independent allopathic provider. Good luck, but I for one am unimpressed and continue to be scared at the thought of the legal and medical lines getting crossed to feed an ego.

[marilynpac]

I hope more health care providers learn alternative medicine. My husband works at a nuclear power plant, b/c of what he does he can NEVER be under the influence. He is substance tested all the time at random. It would be nice to know if he b/c ill that he would have more choices available from our health care provider other than a Rx pad.

[discogenic]

two points -

#1 if it is so established that Chiro is effective for low back pain why have I as a clinician, who has spent countless hours reading and researching the subject, not aware of that? Maybe the supporting evidence is only in the chiro journals? Maybe the studies were poorly designed (read ALOT of those that did not compare to anything, just what percentage of the patients got better) I suspect that once you take the placebo effect and the fact that by far the majority of LBP is self limiting the efficacy of chiro adjustment is in line with all the other modialities - which is only better then placebo in the short run but at follow up time frames in the 6,12,24 month time frame there is no difference - I never found even a single study proving that any modality is more effective in the long term for the typical LBP I am not talking HNP or discogenic or radic pain, but instead the "my back hurts" complaint. If someone has a study to prove this PLEASE post it here as I am really curious.

 

Here's a RCT from 2010 which compared back school, PT, and spinal manipulation for chronic LBP, and included a 1-year follow-up: http://www.ncbi.nlm.nih.gov/pubmed/20053720 Study conclusions: "Spinal manipulation provided better short and long-term functional improvement, and more pain relief in the follow-up than either back school or individual physiotherapy." Note: this is not a 'chiropractic journal'.

 

And ideas have changed regarding the natural history of low back pain, and it isn't always self-limiting and often goes on to become chronic recurrent unless it is addressed correctly.

[bradtPA]

 

#2 still scares the heck out of me to have a PA/Chiro who I sense is a little bit cocky and not overly concerned about learning about the PA field but instead what he can do as a PA and a Chiro combined.

 

I have to second that. The moment you begin to perform chiro independently while holding your PA license you are in violation of your scope of practice unless your supervising physician can also perform manipulations. You can't close down the PA office at five and turn a sign around saying "chiro six to nine" and start manipulating no matter what other licenses you have.

[docpowers]

Not true. Show me where thats at

[marilynpac]

What about the PA that learns manipulation from the DO that serves as the SP?

[discogenic]

I have to second that. The moment you begin to perform chiro independently while holding your PA license you are in violation of your scope of practice unless your supervising physician can also perform manipulations. You can't close down the PA office at five and turn a sign around saying "chiro six to nine" and start manipulating no matter what other licenses you have.

 

Not true. Show me where thats at

 

I'm kinda new to the PA world, but I think I'm with docpowers on this one. I was just reading somewhere on this forum of a PA that moonlights as an xray tech (his/her prior job), and I'm sure there are other examples. Why couldn't a licensed DC practice chiropractic outside of his/her PA setting, provided the distinction was made clear?

[bradtPA]

Not true. Show me where thats at

 

It's called the PA scope of practice, something you have failed to research or we would not be having this discussion. On graduation, you are a PA, obligated to follow the scope of practice delegated to you by your supervising physician. No matter your previous training or ability, you have to abide by it or be subject to sanction by your state medical board.

 

An example. I am perfectly comfortable in a family practice setting, seeing and treating children. Yet, my supervising physician is an internal medicine physician who sees adults only. I am therefore limited to seeing adults only.

 

Contact the Virginia Medical Board if you doubt me, and ask their opinion. They are the ones responsible for PA oversight.

[bradtPA]

I'm kinda new to the PA world, but I think I'm with docpowers on this one. I was just reading somewhere on this forum of a PA that moonlights as an xray tech (his/her prior job), and I'm sure there are other examples. Why couldn't a licensed DC practice chiropractic outside of his/her PA setting, provided the distinction was made clear?

 

See my comments above. For the same reason the cardiovascular PA who has been harvesting vein for bypass grafts for twenty years and then switches specialties to family practice cannot continue to practice as a cardiovascular PA and harvest vein with the family practice physician as a supervisor, you cannot continue to manipulate unless your physician is trained to do so and delegates the skill to you.

 

If you are wanting to go to PA school just to prescribe medicines and continue to essentially be a chiro with a script pad, you must find a DO to supervise you.

[marilynpac]

Thanks Brad you answered my question too.....

[bradtPA]

The DO can In theory train the PA and then delegate the ability, just like any other PA task.....

[discogenic]

I have to second that. The moment you begin to perform chiro independently while holding your PA license you are in violation of your scope of practice unless your supervising physician can also perform manipulations. You can't close down the PA office at five and turn a sign around saying "chiro six to nine" and start manipulating no matter what other licenses you have.

 

Not true. Show me where thats at

 

It's called the PA scope of practice, something you have failed to research or we would not be having this discussion. On graduation, you are a PA, obligated to follow the scope of practice delegated to you by your supervising physician. No matter your previous training or ability, you have to abide by it or be subject to sanction by your state medical board.

 

An example. I am perfectly comfortable in a family practice setting, seeing and treating children. Yet, my supervising physician is an internal medicine physician who sees adults only. I am therefore limited to seeing adults only.

 

Contact the Virginia Medical Board if you doubt me, and ask their opinion. They are the ones responsible for PA oversight.

 

See my comments above. For the same reason the cardiovascular PA who has been harvesting vein for bypass grafts for twenty years and then switches specialties to family practice cannot continue to practice as a cardiovascular PA and harvest vein with the family practice physician as a supervisor, you cannot continue to manipulate unless your physician is trained to do so and delegates the skill to you.

 

If you are wanting to go to PA school just to prescribe medicines and continue to essentially be a chiro with a script pad, you must find a DO to supervise you.

 

Brad, the key here is "in the PA setting" vs. "outside the PA setting". While functioning as a PA, in a PA setting with a supervising physician, then yes you are correct; a DC/PA has to function only as a PA and within the PA scope of practice. But outside the PA setting, say in a separate chiropractic office down the street, I see no reason why a licensed DC couldn't practice chiropractic within the chiropractic scope of practice.

 

If anything, I would think the DC/PA would be more "acceptable" to those who aren't real keen on chiropractors. After all, that DC now knows everything any other PA knows and should therefore make him/her a better DC. I'm not saying that DC/PA should be able to practice as a PA in a chiropractic setting though. On that we agree.