Point/Counterpoint: Seeking A Second Opinion Part II:
Best for the Profession or Best for the Public?
SOURCE: Dynamic Chiropractic
By James Winterstein, DC,
President,
National University of Health Sciences
This is the second in a series of articles about expanding chiropractic practice into the realm of medicine. [1] We hope you will find these 2 articles of interest.
See also:
Point/Counterpoint: Seeking A Second Opinion Part 1″
A Prescription for Professional Disaster
Recently, I had the privilege of testifying for the chiropractic physicians in New Mexico who currently have some prescriptive rights and wished to expand that scope to improve their ability to provide stronger, more complete primary care.
It should be clear that I was asked to appear in behalf of the chiropractic physicians there or I would not have been there. It is not my purpose, as president of National University of Health Sciences, to dictate the direction of the chiropractic profession, but to provide the education that is required by the profession.
In this instance, the request to provide advanced education in pharmacology came to the university several years ago, just as requests to provide education in acupuncture came to the university 41 years ago and requests to provide education in “over-the-counter” medications came from Florida some 20 years ago. Our institutional charter says that we will “provide education,” which is what we have done in New Mexico, and which we intend to continue to do in New Mexico and elsewhere when asked.
Some members of the profession appeared before the New Mexico Senate Judiciary Committee and testified against the wishes of the New Mexico chiropractors – not as invited guests, but as intruders into state concerns. Some of the senators even received calls from out of the United States urging action against the wishes of the New Mexico DCs. I consider this kind of activity to be completely inappropriate and negative toward the profession. New Mexico DCs see a need that can be met with additional education and an expanded scope of practice. They, it appears, have a concern for the public, while their detractors have a fiercely held belief that the chiropractic profession must always remain what it was when formed by its originators.
What I heard from the detractors was not just negative, but actually derogatory toward the educational process of the New Mexico chiropractic physicians. Furthermore, what I heard was that the detractors are opposed to the concept that chiropractic physicians are educated to practice primary care, which according to Council on Chiropractic Education (CCE), is a clear requirement.
Is the Chiropractic Profession Determined Not to Progress?
I am disappointed that members of the chiropractic profession seem intent on interfering with their own colleagues, who wish to expand their education and their practice rights, based on the idea that “chiropractic must be what it has always been.” Those who are opposed to the efforts of the New Mexico DCs suggest that if chiropractors have the right to use prescriptive substances, they will, like the osteopaths, become “quasi-allopaths,” and in so doing, lose their identity as members of the chiropractic profession. In reality, however, I think that argument is specious.
Certainly the osteopathic profession is highly successful today and it continues to identify itself as “osteopathic medicine,” not allopathic medicine. Despite the continually-heard derogatory comments made by those members of the chiropractic profession who suggest that “osteopathy” has gone the way of “allopathy,” apparently the osteopathic profession does not see it that way. At the same time, osteopathic medicine has gained stature and social authority that far exceeds that of the profession in the 1950s, prior to its move toward the use of prescriptive rights.
I can think of no profession other than chiropractic medicine that is so determined not to progress. What I have seen is that other non-allopathic professions, such as osteopathic medicine, have taken steps to broaden their practice rights, and often this has occurred on a state level, without interference from other members of the same profession. Psychology is an example where some states have given the PhD practitioner some prescriptive rights. Optometry is another example that began with one state making changes and others eventually following suit. What I have not seen happen, as implied by those members of the chiropractic profession who resist change, is that either psychology or optometry has become a “quasi-allopathic” profession. Members of the general public still recognize members of those professions as what they are and have been.
The Needs of the Public
So, where does this leave us as we consider the question suggested by the title of this article? I have been part of the profession since 1964 when I enrolled at National. That covers a time span of 47 years, so I could hardly be considered a “novice” in the profession. During those years, one of the aspects of our profession that has bothered me most is that we constantly talk about ourselves and what “we” want. Even when we submit papers on questions of societal need, such as those submitted prior to the passage of the recent health care legislation, we talk about ourselves.
Is the real question about “chiropractic” or is it about what the society that we supposedly serve really needs? Is it about what society truly needs or about what we think society needs? Does society need to see a chiropractic physician weekly for the rest of one’s life, as suggested by members of the profession who oppose expansion of scope? Or should we be concentrating on the real needs of the public? I think it is and should be the latter.
Perhaps if we asked ourselves how we could better serve the public, our profession could move beyond serving the 7-8 percent of the population we have served for the past 30 years or more. Perhaps if we sought to truly serve the needs of the public, our profession would be growing instead of shrinking, as evidenced by diminished student numbers in our chiropractic programs.
While some in our profession denigrate osteopathic medicine, perhaps we could take a page from its history and observe how much it has grown as a profession since the decision to change perspective on the practice of osteopathic medicine in the late 1960s. While some say osteopaths have stopped the practice of “manual medicine,” the evidence suggests this is not true – the profession continues to research the effectiveness of its form of manual medicine. The point is that some osteopathic physicians practice more like allopaths and some practice more like chiropractors; but their goal is to serve the public as osteopathic physicians, not allopathic physicians.
As a profession, we should be primarily concerned with the needs of the public and how we as a health care discipline can best meet those needs. Some of the chiropractic physicians in New Mexico have learned by practice experience that they could better serve their patients with some use of a limited prescriptive formulary. They undertook additional education and have received the legal right to use a limited formulary.
Time to Take the Next Step
At the recent hearings on the proposed bill [H.R. 127] that would expand those rights, they lost the request, thanks primarily to negative testimony from members of the profession who do not wish to see our profession utilize any kind of prescriptive medicines. Those same people refuse to see that what was prescriptive a few years ago (Motrin, Naproxen, Nexium, Previcid and Prilosec among others) are now “over-the-counter” and anyone (with no training whatsoever) can recommend them. During the testimony, however, they made the case that chiropractors (as they called them) are not nearly educated enough to use even a limited formulary.This is a sad state of affairs, in my opinion. While Drs. Brimhall, Soltys and I were invited to testify for the chiropractic physicians in New Mexico, those who testified against the bill were not – at least by any recognized organization I am aware of, but chose to interfere in the practice of those physicians who wish to better serve their public, based on the premise that they must keep the chiropractic profes-sion pure! Again – for them, it is all about the profession – as they see it. They made light of the Dynamic Chiropractic surveys that were cited in favor of limited prescriptive rights, saying the survey only represented a “couple hundred doctors.” While that statement was being made, I was looking at that specific survey, which was answered by 720 chiropractic physicians – not a “couple hundred.” A more recent survey shows that the profession is almost evenly split on the subject.
It is past time for us to take the next step. We see patients every day who are on numerous medications – often conflicting and fre-quently overutilized – but because we do not have the clinical authority to prescribe, we cannot “unprescribe,” nor can we prescribe thoughtfully from a more chiropractic perspective.
Nothing would keep a DC from practicing manipulation only – from limiting one’s practice as one chooses; but with additional education, what good argument is there that the chiropractic physician should not be permitted to serve the public by the addition of a limited formulary? It is time to move into the future. Let’s take the next step, whether it causes tiering of the profession or not. To stand still is to regress, and that is not acceptable.
Enjoy the second article in this series:
Dr. James Winterstein, president of National University of Health Sciences since 1986, graduated from then-National Chiropractic College in 1968. Among his varied professional accomplishments, he is a former president and board chair of the Council on Chiropractic Education, and a former president of the American Chiropractic College of Radiology.
1. Majority of Alabama Chiropractors Favor Limited Prescription Rights
Chiro.Org Blog ~ Feb 18, 2011
I find this topic somewhat interesting. I’m not exactly sure how I feel about limited prescription rights for doctors of chiropractic. I believe the profession may want to find a consultant service that does some legitimate questionaires/studies of/for practitioners looking at the pros and cons of prescription rights. I was wondering if prescription rights could be good for both the public and(vs. “or”) the profession? Just asking.
Hi Karl
I have mixed feelings, as I have stated before. I have seen the “results” of the Alabama questionnaire, but I have not seen the actual QA. One thing’s for sure…you can (almost) always get the result you want by carefully posing questions. I’d love to see a non-involved party that specializes in data gathering review this QA to determine if it enabled expression of both sides of the issue.
I also think that people have failed to take into account the potential for a backlash from the medical community. I wonder what the reaction from those who are in favor of prescribing would be if allopathic physicians suddenly began performing manipulations on their patients and treated musculoskeletal problems in house instead of referring them to us? Probably alot of outrage and righteous indignation.
This foray into prescribing will irritate many in the medical community. There is no getting around that. It doesn’t matter if areas of New Mexico are medically under-served. This is going to be see as an encroachment on “their turf”. And for all intents and purposes it is! I don’t want PCPs here in Maine to manipulate, perform postural assessment and functional movement screens. I don’t want them to design and supervise rehabilitative exercise programs. That would detract from my patient base in the community.
That brings us to the point.
This is about grabbing market share. I’m not buying the altruistic arguments put forth by those who are pro-prescription. How many of those doctors are really planning on moving into the desert and treating about 10 medicaid patients a day from a nearby reservation for next to no money? I’d venture to guess the answer is none. How many practice in a moderately to heavily populated are and would love to see upwards of 50 patients a day regardless of why they came in the door? I think we know the answer.
Hi Maine
The real issue should revolve around training. According to the WHO (World Health Org) an MD should receive an additional 1800 hours of training before attempting to provide chiropractic care.
I don’t know what National College provides in their Advanced Practice classes. Is it comparable to the training a MD received in pharmacology? If not, why not? Who will provide this training? An MD, or someone who took a few weekend classes?
Once again, I’d like to pose the Big Question:
Wasn’t the struggle about leveling the playing field, and not about joining the other team???
I agree. I would pose the question to our colleagues who want to prescribe, what drugs exactly do you feel would benefit the patient? There are drugs that patient’s need. That much is obvious. Type one diabetics need their insulin, people with acute bacterial infections need an antibiotic and so on. But what about many of the other drugs?
Do we really want to get into the business of prescribing meds that have shaky evidence behind them at best? Statin drugs have so many negative side effects, and have been shown to make no difference in the patients lifespan. I cannot believe they are still on the market. Anti-depressants? They are not backed by good research either. The risk for suicide goes up in patient’s in their teens and early twenties with SSRI use.
Pain medication? Do we want to put our patient’s on potentially addictive narcotics? Is this why people go to chiropractic school?
Perhaps I’m naive, but I thought that the attraction to our profession was that it is a natural, drug free alternative to some rather drastic and nasty medical interventions that are being used as front line treatment instead of last resort.
Most PCP’s don’t want anything to do with neuromusculoskeletal(NMS) conditions. Why? they are very time consuming and they have little related training. The majority of PCP’s/P.A.’s and N.P.’S refer to a P.T. or D.C. I would venture to say most P.T.’s not all…. are pro medication/accepting of medication vs. D.C.’s for NMS conditions. At least that’s the perception the allopathic profession has. A low back pt. sees the P.A. who prescribes NSAIDs and a P.T. referral. It seems to me it’s possible that the P.A. step could eventually go to the D.P.T. There are several realities evidence based medicine/health care/cost containment are here. Getting people out of pain quickly regarding NMS conditions is important especially to help avoid chronic pain which is on the rise/expensive. I’m not sure I’m correct but chiropractic has two major competitors for NMS type pts. NSAIDs and D.P.T’s/P.T.’s. Just as side bar I wonder how many D.C.’s have NSAIDs in their medicine cabinet?
I don’t see why we need to be able to write scripts for NSAIDS when they are over the counter medications. Is that what this battle is really all about? Some DC’s want the ability to send a patient to CVS or Rite Aid to get ibuprophen or naproxyn, when they could just go there and buy it themselves? I think there is more to it than that. It seems to me that these DC’s are no longer content to treat NMS complaints. They want to branch out into more of a general practitioner role.
Certain demographics of the general public have shown they have no idea what they are doing when purchasing OTC non-prescription medication. Overuse and prolong use come to mind. There’s plenty of information regarding the mis-use/use of NSAIDs and the yes, the potential danger.
Maybe I’m wrong here ,but NSAIDs are here to stay in the treatment of NMS conditions. Why? Inexpensive to relatively cheap, perceived as effective for many and probably the most prescribed medication(s). Its been a long time, but I believe the Rand Study 1992 said, spinal manipulation and/or OTC medication was effective/appropriate Tx. for low back pain. For some there may be an argument to manage a pt. with a “hot disk” if you will with a short trial of pain medication (for pain reduction) along with spinal manipulation/flexion distraction.
There are many patients that can’t tolerate the pain and resort to/talked into surgery. Spinal surgery is expensive and been shown to be ineffective for some patients. As I mentioned before chronic pain is a growing/expensive pyscho/social condition. This is not a secret to health care professionals/actuaries and health care economists.
Patients with NMS conditions initially need to get out of (perceived) pain as quickly as possible. To accomplish this I believe some practitioners would like to have the ability to reduce/control pain with medication and provide physical medicine/chiropractic procedures. For some patients this may be the answer to avoiding prolong/chronic pain, which again is a growing and expensive Pt. demographic. It may a way to better control certain patients from getting lost in the system (back and forth between practitioners). Just a thought and an opinion with the cost of health care skyrocketing over the last 12 yrs. and NSAIDs/pain medication here to stay as well as spinal manipulation the practitioner who will/can provide this type of management may be viewed as the most cost effective (DPT?).
I believe the primary care system wants to find a way to reduce (almost avoid) the NMS patients. The health care system is going to get very aggressive to find ways to become more efficient. Chiropractic treatment is very effective for many NMS conditions/patients but certainly not all. Could we have a greater impact with positive patient care and reducing Pts. from becoming chronic/lost in the system? I’m not sure but its something to think about. I have a feeling there are decision makers thinking about this.
I hate to re-open this discussion as it seems to be mostly just a repeat of the usual ramblings of a profession that refuses to evolve however I cannot resist. Philosophical debate has consumed the profession since its inception and instead of ever stepping back and considering what is needed for the greater good of humanity, Chiropractic continues to center on the desire to satisfy its own wants rather than the needs of the patient. I have often heard of patients entering a DC’s office , with low back pain, and not wanting to have a cervical adjustment. I know numerous DC’s that will not treat them. This is because chiropractors like Dr Clum have a backwards perception that the profession of chiropractic is about imposing their personal values on patients rather than allowing patients to benefit from the aspects of chiropractic that they wish to avail of. Is the patient who leaves the chiropractor’s office without the treatment for low back pain because they would not have their neck treated better off or worse off than if the chiropractor had just treated the low back? I think that we all know the answer to that question.
The desire of a chiropractor to advance their educational expertise in a manner that adds an additional tool to their doctor’s bag to use responsibly is commendable and should be encouraged rather than demonized. The commentary by the detractors of the NM initiative shows that chiropractic in their hands is much riskier for patients in the long run than in those that choose the path of lifelong learning. Funny how the ICA will encourage fake CE credits to learn about the latest gimick that will put an extra 50 patients a week in your office but frown on legimate educational opportunities for chiropractors. No doubt the foundation of Life West is well rooted in Sid the Kid’s values of money money money money. If education was really their focus they would likely require an undergraduate degree with more than a 2.5/4 GPA. Taking advice from a president of Life chiropractic on education requirements for the safety of the public is kind of like asking Ronald McDonald to design your school’s cafeteria menu…..great for business but the impact on individual health is likely to be less than stellar.
Darrell
Darrell
It’s never too late to join the conversation.
I’m not clear how chiropractic’s continued discussions about philosophy, or the use of words like: “adjust” vs. “manipulate”, or subluxation” vs “manipulable lesion” has any impact on the greater good of humanity.
I was also surprised of your complaint against a DC who chose NOT to adjust a patient who wanted to dictate their care to the doctor. I have had some patients who’s low back pain came solely from occiput, and others who’s headaches were reduced by correcting their pelvis.
Yes, much of LBP comes from the pelvis or lumbar spine, but the simple truth is that no one can predict WHO will fall into these smaller groups where their cause/source is remote from the site of complaint.
I understand the importance of honoring a patient’s request to NOT do a specific thing (such as adjusting cervicals, or hand vs. instrument adjusting) BUT if it runs counter to my judgement of what needs adjusting, then my only option is to dismiss the patient for failure to comply. There may be two of us in the room, but only one of us is the doctor.
I’m less clear about your issue with Sid, or Life College. As a Palmer grad, we heard that Life was a less rigorous program than ours, but I took that as the usual “my-school’s-better-than-your-school” hyperbole.
Finally, I agree that any DC who wants to expand his practice by taking more schooling should be welcome to do so. Are there lots of medical schools waiting with open arms to teach DCs how to prescribe? I doubt it.
My biggest concern is the huge backlash the Profession will experience from Organized Medicine for poaching on their drugs-only preserve. Any moderately observant DC should already be aware of that backlash in California and Texas. Ask yourself…who’s going to pay all those lawyer fees when the AMA comes a-knocking? It definitely won’t be me!
Frank,
Thank you for your quick response. I appreciate your invitation to clarify my previous statements and as such I have tried to do so below. I hope you will accept my statements in the respectful manner in which they are intended
You said:
“I’m not clear how chiropractic’s continued discussions about philosophy, or the use of words like: “adjust” vs. “manipulate”, or subluxation” vs “manipulable lesion” has any impact on the greater good of humanity.”
My Response:
The ability of a profession to have in house discussions in relation to historical perspectives or terminology issues has little to no impact on humanity. The ability of a profession to work in a concerted effort to increase the health of a population certainly does affect humanity. That has not been the case with the profession of chiropractic as the profession is widely known as the most prolific infighter of all of the health professions. The inability of chiropractors to have meaningful discussions with each other on matters of mutual importance certainly has affected their impact on society. Therefore my statement as to the inability of chiropractors to put their swords down and work towards the greater good, in the interest of humanity, is quite relevant
You said:
“I was also surprised of your complaint against a DC who chose NOT to adjust a patient who wanted to dictate their care to the doctor. I have had some patients who’s low back pain came solely from occiput, and others who’s headaches were reduced by correcting their pelvis.”
My response:
I did not say that I have a complaint against a DC who would not let a patient dictate care. I think that you will agree that most low back pain comes from a lumbar or pelvic issue as is evidenced by your statement ” Yes, much of LBP comes from the pelvis or lumbar spine…..” and therefore not treating a patient who likely has a lumbar problem because they only want you to treat their lumbar spine is to protect the doctors fragile ego instead of truly attempting to work for the benefit of the patient. It is certainly your professional responsibility to inform a patient of your recommendations. That being said, the doctor knows best mentality is certainly an antiquated model as most effective health care interventions now recognize the importance of the patient as an equal partner in order to create true compliance with recommendations. A trial of treatment to the most likely cause of the issue, the low back, followed by a need to address the possibility of other causes if the usual care is not successful is actually responsible doctoring however, throwing the patient out of your office before you even know what is causing their problem for sure is simply irresponsible. Abdominal aortic aneurysms
are also an unlikely cause of low back pain however I am certain that auscultation of the abdominal aorta for the presence of bruit is not a normal part of most practicing DC’s exam routine.
You Said
” I’m less clear about your issue with Sid, or Life College. As a Palmer grad, we heard that Life was a less rigorous program than ours, but I took that as the usual “my-school’s-better-than-your-school” hyperbole.”
My response
I dont know how to further clarify my issue with Sid or Life College however I will try.
Sid is likely a wonderful person ( if he is still alive) and considered by many as the the father of Life West by most accounts. That being said, any figure that is unable to maintain the ability to have his “university” credentialed certainly is not an individual that I would want to highlight as my professional mentor. My statement as to entry to the school is actually quite factual and as you have brought up Palmer I guess I will qualify that Palmer has the same dismal standard for admission. In fact, Palmer has a reduced schedule program that can see an individual take reduced course loads if they are not able to take the gruelling schedule ( note the sarcasm). This way, even though they probably wont pass the board exams, the college still gets their money. In actuality, few chiropractic colleges actually prepare their graduates for the real world of collaborative patient care. This is too bad and needs to improve substantially
Which leads me to your last statement.
You said:
” Finally, I agree that any DC who wants to expand his practice by taking more schooling should be welcome to do so. Are there lots of medical schools waiting with open arms to teach DCs how to prescribe? I doubt it.
My biggest concern is the huge backlash the Profession will experience from Organized Medicine for poaching on their drugs-only preserve. Any moderately observant DC should already be aware of that backlash in California and Texas. Ask yourself…who’s going to pay all those lawyer fees when the AMA comes a-knocking? It definitely won’t be me!”
My Response:
It is very encouraging that you have recognized that chiropractors should have the ability to expand their practice. What is discouraging is that you think that DC’s need MD’s to teach them how to prescribe. The act of prescribing is actually the ability to give order or explicit instruction. As you are apparently the only one in the room that is a doctor, this is actually your responsibility is it not?
Where your logic has failed to congeal with fact is in your assertion that pharmaceutical intervention is actually the expertise of medical doctors. In fact, the ultimate control in this field lies with the Pharmacist who is in fact the expert in this field. If you want to compare the requirements for pharmaceutical education for chiropractors to have limited prescriptive rights, the most legitimate parallel would be that of dentistry. If you do not have confidence in your ability to diagnose as a doctor that is one thing. if you do, which i am fairly certain is the case, then all you need is some instruction as to the proper application as well as contraindications for a limited formulary. I don’t think any credible source would argue that a chiropractor is unable to learn that with proper instruction. I am certain that there are a number of pharmacy schools that would welcome a partnership with the profession of chiropractic. If you agree with this, then your opposition to my proposition is strictly a philosophical one and therefore it represents your professional interests rather than what is in the best interest of your patients.
In closing, the willingness of the chiropractic profession to accept certain limited pharmaceutical interventions as useful actually has more chance of building relationships with the AMA when done properly. This is clearly evident by the fact that the New Mexico medical association had no opposition to chiropractors assuming a more responsible role with respect to the prescription of medication. The AMA is simply a trade organization to promote the advancement of the profession of medicine. If that is your biggest concern I can assure you that they have bigger fish to fry than a couple of chiropractors in New mexico trying to better themselves so that they can continue to offer their patients the best in evidence informed care. I was unaware that we had gotten soft in our old age. It seemed that we used to welcome a good fight rather than hide from it. All we seem to do now is fight with each other.
Thanks again for providing a forum to respectfully debate these issues.
All the Best
Darrell
Hi Darrell
I see I have my work cut out for me in responding to your comments. I will respond to each point in the same order as you made them.
You state: The ability of a profession to work in a concerted effort to increase the health of a population certainly does affect humanity…… The inability of chiropractors to have meaningful discussions with each other on matters of mutual importance certainly has affected their impact on society.
These “meaningful discussions” you refer to are probably the ongoing failure of the ACA and the ICA to “unite” as the sole body representing the Profession, yes? In reality, these groups represent the extremes of our practice (and philosophical) approach, in the same way our 2 political parties do, and so it is not surprising that one side will refuse to “lay down” for the other. This is certainly the meat of the conflict, and I won’t bore you with the particulars of the argument, as they should be apparent to anyone who has paid attention over the years.
The REAL issue is that fewer than 15% of the Profession actually belongs to either group, leaving the field to those firebrands, who perhaps want to defend or promulgate their own positions and beliefs. So, in reality, you can’t state that either group speaks FOR the Profession…they seem to speak to their own needs and interests. Just as Sarah Palin does NOT speak for all Conservatives, neither does the ACA or the ICA speak for all of the Profession.
Finally, however, I believe that the debate between both camps is a valid one. Will Chiropractic remain the holistic “no drugs, no surgery” alternative, that enabled the Profession to grow to the 3rd largest healing Profession, or will it follow in the steps of Osteopathy and be subsumed? IMHO, I say “NO!”
DOs used to be much like us, whereas today few of them “manipulate” as a primary treatment approach. My feeling is that there is already 2 distinct professions that can provide drugs and surgery for those who choose it, and I see NO NEED whatsoever for us to follow that path. I prefer that we remain the ALTERNATIVE approach for the large mass of people who already tried the allopathic approach with minimal or iatrogenic results.
I had to smile when I read your comment: not treating a patient who likely has a lumbar problem because they only want you to treat their lumbar spine is to protect the doctors fragile ego instead of truly attempting to work for the benefit of the patient. because this proposes that only Ego is involved in that doctor’s choice.
I agree that the Doctor’s role is to help the Patient, but it is equally important for the Doctor to be in harmony with the Patient. If Patient requests are in conflict with that Doctor’s training and intuition, then I believe it IS in the Patient’s best interests if the Doctor chooses NOT to treat the Patient.
You said: any figure that is unable to maintain the ability to have his “university” credentialed certainly is not an individual that I would want to highlight as my professional mentor.
I couldn’t agree more, although I suspect that Politics probably played a large role in Life’s loss of accreditation by the CCE.
You also said: It is very encouraging that you have recognized that chiropractors should have the ability to expand their practice. What is discouraging is that you think that DC’s need MD’s to teach them how to prescribe…. The act of prescribing is actually the ability to give order or explicit instruction. As you are apparently the only one in the room that is a doctor, this is actually your responsibility is it not?
Where your logic has failed to congeal with fact is in your assertion that pharmaceutical intervention is actually the expertise of medical doctors. In fact, the ultimate control in this field lies with the Pharmacist
Hmmm. The principle difference between Allopathy and Chiropractic is the opinion of whether the body needs external tools (like drugs) to heal.
Our assessment of a patient leads to 3 choices:
(1) We manage the case, using our own toolbox, OR
(2) We refer a patient for co-management (for example, an patient with neck pain AND an undiagnosed condition like diabetes, OR
(3) A patient presents with low back pain, and we refer them to an oncologist because the cause of that pain is (probably) multiple myyeloma.
In all 3 cases, we have done what we were trained to do: diagnose and then manage the case. In none of these cases did we need to add “limited prescription rights” to our toolbox to properly “serve the patient”.
I agree with your suggestion that DCs who DO want to prescribe get their training from a true specialist, be it MD or Pharmacist. I will defer to your suggestion of which is preferable.
I do respectfully disagree that: “all you need is some instruction as to the proper application as well as contraindications for a limited formulary” Does the term “iatrogenic” strike you with as much apprehension as it does me? I hope so.
Personally, I am not interested in adding to the roles of those who are harmed by drugs. That is not to say that diabetics don’t need insulin…. certain disease processes respond brilliantly to medicine.
But, what about the health consequences for using muscle relaxers and NSAIDs? There is very little literature that supports the SAFETY or EFFICACY of these drugs, beyond the fact that they reduce inflammation or relax muscles FOR A SHORT PERIOD. No one argues with those facts. What IS open to dialog are the long-term iatrogenic consequences of using these drugs. The literature is rampant with articles citing how many patients die from their use.
Ask yourself: How would you feel if one of your patients bled out from using the NSAIDs you prescribed? It happens ALL THE TIME.
My philosophy of care asks this simple question: “If you have a rock in your shoe, and your foot hurts…do you need to take aspirin, or acupuncture (or whatever) for a cure? NO!!! You want someone to LOCATE and REMOVE the rock from your shoe!” THAT is what distinguishes Chiropractic from Medicine.
According to numerous articles, a HUGE percentage of people who present to hospitals and MDs have a neuromusculoskeletal basis for their complaint.
If Chiropractic had not been marginalized by decades of plotting by Organized Medicine, there would not be enough DCs to manage (or co-manage) that HUGE group.
So my choice is to endeavor to educate the Planet about what Chiropractic already, and historically does, to slowly increase the percentage of people who seek our care, rather than trying to adopt the medical approach, in the hopes of seeing more patients. In reality, there is NO guarantee that this medical pose would ever succeed, no matter how hard the expanded-practice segment may wish it to be so.