More Infuriating Chiropractic Garbage...

[Jon Newman]

Hi Nari,

Generally the type of PT degree you have does not dictate your salary, at least not that I'm aware of. Someone can correct me if I'm wrong about that.

Currently, there is no difference in the PT Practice Act between DPTs and PTs of other degree standing. There is a difference in the Practice Acts of PTs and PTAs. Because of this, I don't see things unfolding as a shift in job descriptions. At least not without a simultaneous shift in practice acts. I don't see there being three Practice Acts (DPT, PT(other) and PTAs) but I suppose there could be.

While there has been a curriculum change for MPT to DPT there has not been one in the PTA degree that would suggest that they could achieve a shift in the Practice Act that would allow a shift of job description (as far as I know.)

[JaneS]

Hi All,
To me, the only people entitled to the title of doctor are
1. Those who have graduated with at least a MBBS (bachelor of medicine;bachelor of surgery) which is the basic medical qualification for a G.P.
2. Those who have completed a PhD in any discipline whatsoever.

The rush to become recognised as 'doctor' is really rather amusing if you think about the history of the term.

Did you know that orthopaedic surgeons, until about 15 years ago, were addressed as 'Mr'? Compared to the local GP, mechanic or other skilled tradesman, specialist medical professionals were considered gentlemen. When I had a fracture, the orthopaedic surgeon absolutely insisted on 'Mr'. I think it was the Americans who revolutionised the form of address for medical practitioners. This has followed on for other health professionals.

All specialists (including orthopaedic surgeons) may not behave like gentlemen. However, I wonder when they will get sick of sharing the title of 'Dr' with so many other health professionals. Then there will be another shake-up of titles.

Jane

[emad]

Oh , so late to catch this Discussion :

The same problem here with the public regarding the title "Dr." It is a cultural problem .There is no direct access here to physiotherapist from the official point of view because any accrediting Authority for physiotherapists at the end complies with an authrity forumlated by doctors whom are not ready to lose power /authority .
I do NOT know why this title has that magic effect ,despit patients with experience they prefer to deal with physiotherapists .
Pharmaciests and dentists have the legal permit to use this title .......To avoid the tile Dr. being a problem ..I believe it has to be legal only for those whom obtain PhD .

Emad

[Jason Silvernail]

Well, of all the elements of Vision 2020, the DPT/Doctor thing is what gets the most amount of controversy.

There are even some parts of the US PT population that aren't big supporters.
I think most people in this group have an opposition to the use of the title, and like Jane S, they have their own personal opinions about who should use this title and who shouldn't. I can understand that point of view.
However, no less an organization as the Institute of Medicine has argued that privileges for non-physician (for our chiropractic readers "physician" refers to a medical doctor) health care providers should be enhanced along with the rigor of their education and standards of practice. Maybe the Commonwealth countries like Canada, the UK and Australia have a great system and the competition among providers is more of an even playing field. That's great. But that's not what's happening in the US.

If you look at the transcripts of some famous legal decisions against PTs, you can see the weight of the title in the arguments. The most recent case is described http://www.chiroweb.com/archives/21/05/09.html. Read the last sentence from that chiroweb article a few times. It says [emphasis mine] "Other state boards are encouraged to follow Arkansas' lead to ensure that the chiropractic profession is protected, and that the ability to perform spinal manipulation and adjustments stays in the hands of doctors of chiropractic." So, on the "who should be called doctor?" thing - that ship has sailed. Wake up and smell the attacks on scope of practice.

I too find it sort of funny that here in the states we have to get a doctorate to do something folks do very successfully in Commonwealth countries with bachelor's degrees. That says a little bit about perception, about legislative history, about anti-PT agendas, and about american culture all at once. But then, as Jane S points out, you can say the same thing for our physicans (MD) versus theirs (MBBS).

In the end, we will look back on all this concern over title and realize it was much ado about nothing. My family practitioner doesn't refer to himself as "doctor" out of the clinic, and my cousin the PhD in marine biology doesn't outside of her field, either. I think it will turn out to be a non-event, but it's significant as it takes away a key argument used to restrict our practice. The argument never had any real data behind it, but now it's even less appealing for legislatures. We'll see how things go from here...

[emad]

Well , every time I think of those humans behavior ,the evolution be evidenced again and again . In spite of the civilization , every time humans act like being live in wildness ...Who takes first ..who is fastest ...who is strong previal ..no doubt in spite of the contuning organising of societies .

I have an idea ...Physicians are interested so much calling themselves "Doctors" ..why not call ourselves "Professors " .They call themselves as they like ...and we have the same right .

Searching for the title "Doctor " history gives out the following http://en.wikipedia.org/wiki/Doctor_%28title%29:

Doctor means teacher in Latin. It has been used continuously as an honored academic title for over a millennium in Europe, where it dates back to the rise of the university. This use spread to the Americas, former European colonies, and is now prevalent in most of the world. As a prefix — abbreviated "Dr" — its primary designation is a person who has obtained a doctorate (that is, a doctoral degree), which, with the exception of higher and academic doctorates

From the nineteenth century onward, "doctor" has been commonly used as a synonym for "physician" in Anglophone and many other countries; this term is commonly used as a title of address for physicians, whether or not they hold a doctorate. The primary medical qualification in the UK and in many Commonwealth countries are the 'Bachelor of Medicine and Bachelor of Surgery' degrees (MB BS, MB BCh, MB ChB, BM BCh or MB BChir, depending on the University granting the award). In the UK the title "Dr" is officially conferred by the General Medical Council to graduates whose names are included on the list of 'registered medical practitioners',

By the way , I do not know If Chiros are medical schools students or not ? seems strange ..but we have no of them ...

Noway ,no change ..what happened took place ..Searching for the word "Doctor" gives many choices doctor of

Pharmacist, see Doctor of Pharmacy
Veterinarian, an animal doctor
Doctor of Chiropractic
Doctor of Naturopathic Medicine, physicians in some States
Doctor of Osteopathy,
Doctor of Physical Therapy
Doctor (title), a title of respect

Doctor Of Physical Therapy interred the history ....Just sometimes in USA i think patients will search DPT ...

cheers
Emad

[Jason Silvernail]

Thanks emad- a quick search of the history of the term "doctor" is enough to realize how non-medical it really is.
And perhaps how silly arguments over such things truly are...

[emad]

You are welcomed Jason

The coming century is the century of Minorites because they will reflect on their experiences


Emad

[Diane]

Emad:

I do not know If Chiros are medical schools students or not.

No, they are not. They are physician impersonators who managed to legalize themselves just over a century ago in the US when it was still the wild west; no one knew what they were doing, no one was in charge yet, when actual "medical" practitioners/doctors had no good tools yet to set them apart, like vaccination/public health/antibiotics/anesthesia. It was nomenclature misfortune that became legal-ized, and that everyone's been living with ever since. The U.S. solution seems to be, let's turn everyone into doctors then - if one group managed to acquire the social camouflage that goes with the title, then every group should have the right to the same camouflage.

By way of contrast, the osteopaths (D.O.'s) in the U.S. decided collectively to acquire actual medical training alongside osteopathic training. In the U.S, they are therefore true physicians. Check out the Flexner Report, which tried to standardize the mess that existed in the U.S. in the early part of the century.

When Flexner researched his report, many American medical schools were "proprietary," namely small trade schools owned by one or more doctors, unaffiliated with a college or university, and run to make a profit.

Chiropractic schools apparently wanted to retain this particular facet, i.e., keep schools private and run to make a profit. They decided to keep the doctor title while they were at it, turning the whole profession into a non-cooperating social renegade, a perception they usually manage to flip around and pretend is instead the true representative of health, wealth, wellness, truth, goodness, free enterprise, God, the American Way, etc etc., that has become largely a sociological phenomenon that exists mostly to separate people from what's in their wallets at every step from training to treatment.

[nari]

I tend to agree with Jane that the only group entitled to use the name 'doctor' are the PhDs, but the MBBS lot altered that a long time ago.

I think only the USA PTs are in a tizz about it; and I understand that comes from a traditional stance that doctors of medicine need to tell PTs what to do and how to do it. The long slog of history has come up against them.

Very few people here who are 'able' to call themselves 'doctor' actually do. They do not sign their name as 'dr' nor do they answer phones as 'dr.X'. This included the PhDs.
They simply do not consider it anything of importance. It is a good example of the difference in culture and history.

Nari

[Crazy Pole]

Hi all,

I thought I might provide a slightly different perspective on this same story.

Having recently graduated from a DPT program, we were told that another large motivator behind the transition from Masters to Doctors was that a Doctoral degree was a better representation of the number of credit hours achieved beyond a Bachelors. Here is a link to the Program that I attended DPT_cirriculum. Unfortunately, it does not list the total number of credits, but I believe it was in the neighborhood of 120. According to our Director, a number of Masters degrees are achieved with 30 credits.

Of course, none of this speaks to the fact that I have learned more relevant info from this site in one year than I did in 3 years of PT school, but that's a whole seperate thread.

Wes

[nari]

Wes,

What is 'clerkship'??? Sounds extraordinary.

Nari

[Crazy Pole]

Hi Nari,

Clerkship refers to an arrangement that the University had with a few local clinics. During our didactic component, we had the opportunity to go in smaller groups and do a combination of observing and a fair amount of lower-level interventions in order to get more familiar with patients, clinics, clinicians, etc. When not in the clinic, we spent time in the classroom taking in lessons on clinic etiquette and the sort. We also spent some time taking about APTA-related issues.

Hope that helps.

Wes

[nari]

Thanks for the explanation, Wes. A similar thing exists here, but not under that name - just 'placement'.

Nari

[emad]

Thanks Diane for knoweledge regarding chiros .

To be honest , the title "Doctor" causes problems for many health professionals acrossing the world , the problems are varying from culture to another ..In most 3rd world areas the situation is boring because of litereacy level and culture is more restricting ,however currently Physicians are losing The title respect because of many reasons one of them The Physician income in relation to other basic workers in societies .

I do not know what is the situation in USA ,however i can remember very well in one of the movies A psychologist in the movie and another person called her A doctor ..replied another one they are not real doctors ...

cheers
Emad

[Randy Dixon]

I think there are other reasons the term "Doctor" is losing some of the respect it once had. I remember when I was young there was a big debate among physicians about the ethics of advertising. The consensus was you should have your name in the white pages of the phone directory, then they said placing your name in the yellow pages was acceptable, but it should be a simple placement. That was the state of the argument then, today on the radio, I would guess the number one advertisers on the air are physicians, pushing their wares including all types of surgery. They are ridiculous. They are selling arthroscopy like it was ice cream.

[nari]

Randy

That is astounding.
The rules that applied 'when you were young' still rigidly apply here. Nobody can peddle their wares publicly, and if they do, there are some severe retributions. Deregistration follows if they continue to self-promote on air or on paper. The chiros are bound by the same rules with their association.

Physios can place large prominent ads in the yellow pages, but can say nothing other than who works with them and the specialties they like to practise.

What is happening in the US?

Nari

[bernard]

Originally Posted by Nari

What is happening in the US?

hmmm... Sold?!

[nari]

It would seem so, generally speaking.

Nari

[Mariette]

Hi Jason
I'm on a panel at a seminar and a chiro is giving a lecture on "The role of spinal manipulation in chronic pain management"
Any suggestions for questions that I can ask?
Mariette

[Diane]

Mariette,
I posted a link to a radio interview of a chiropractor, David Seaman, earlier in the thread - here it is again: Interview link.
It's about 15 minutes long. It might give you some ideas.

[Jason Silvernail]

Hi Mariette.
Sure. Ask if there's any evidence from clinical trials showing manipulation to be of benefit in the chronic population. There are proven benefits for exercise interventions, you could also state.

This blog discussion should help you frame your questions also:
http://blog.myphysicaltherapyspace.c...opractic_.html

Best,
Jason

[luca m]

Mariette,

A quick look at the Cochrane Reiviews is more supportive of massage therapy than of manipulation for subacute and chronic low back pain.

Jason,

Very interesting blog discussion regarding DC's and DPT's. As a DC who went on to do a fellowship to learn more PT and rehab, I could have become a PT and done a fellowship in ortho/manual therapy and arrive at the same place I am now for 1/3 of the cost. damn!

[Jason Silvernail]

Luca-
I'm glad you enjoyed it. It will be interesting to see what the future brings for our professions.
The funny thing about manipulation, as Jon Newman has correctly stated, that the more rigorously it is studied the fewer number of people and situations it seems to apply to, and the more generalized the effects.
I'm one of the few people here at Soma who use it regularly, but like most manipulative practitioners I began to see the limitations of it's usefulness and began to look elsewhere.

[Crazy Pole]

Diane,

Great link to the interview; thanks for sharing. Do you, or anyone out there, know of the 2002 study he referenced about MRI before and after manip? I tried to do a search, but haven't had the greatest success. Any assistance would be greatly appreciated.

Thanks,
Wes

[luca m]

Wes,

I think this might be what your looking for:

The effects of side posture positioning and spinal adjusting on the lumbar Z joints: a randomized controlled trial with sixty-four subjects. Cramer GD. Spine, 2002 Nov. 15 Vol. 27 (22), pp 2459-66.

Sorry no link, had a hard copy of it in a binder.

[Jon Newman]

Hi Wes,

Here's the abstract to Luca's reference.

Author Cramer, G; Gregerson, D; Knudsen, JT;Hubbard, BB; Ustas, L; Cantu, JA

Title The Effects of Side-Posture Positioning and Spinal Adjusting on the Lumbar Z Joints: A Randomized Controlled Trial With Sixty-Four Subjects.

Source Spine. 27(22):2459-2466, November 15, 2002.

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.

Wes, let me know if you want the full text.

[Crazy Pole]

Luca and Jon,

With your help, I was able to find it full text. Thanks for the assistance.

Wes

[Diane]

Here is a link to a Canadian story today about a woman who died after neck manipulation by a chiropractor.

[Jason Silvernail]

Here's a link with even more infuriating Chiropractic Garbage!
Hard to believe our professions don't get along, huh?

Ridiculous Tennessee Situation

[luca m]

Being Canadian, I'm unaware of any provincial chiropractic organization that has attempted to restrict PT's from manipulation here.
Dianne, have you heared/seen anything like this in BC or elsewhere in Canada?

Seems

[ptguy]

Luca,

There was a case in Quebec, I believe, where some chiros pretended to be patients. I believe the Supreme Court found in favour of the PTs but again this was a ways back and I am unsure of the specific details.

The irony is that virtually all of the high quality research regarding manipulation has been done by physiotherapists.

Steve

[Jason Silvernail]

I think this brings to light many of the things we are dealing with in the States, in terms of practice protection, etc.

We definitely have to deal with a lot of stuff you guys in the Commonwealth countries had sorted out from the start...

[Diane]

I vaguely remember that too Steve. PTs won.

I'm sure that the difference between Canada and the US is that in Canada PTs carved out and consolidated that turf early, very early, because most of the ones that maniped were army guys from the Brit army who were also in charge of setting up PT infrastructure. These guys would have brooked no nonsense from chiros, I'm sure. As it stands, PTs in Canada have always had the right to manip, at least in English speaking Canada, as far as I know, as long as they were taught by someone who knew the moves.

That they never had any good theory that made sense is a side issue, but one that manipulators will have to face sooner or later.

[Diane]

Here's a link to a magazine article about neck manip and stroke.

[Jon Newman]

Hi Diane,

The day you posted your last link to Self magazine, there were 30 replies in the comment section of the magazine. Today there are 48. The comments are as revealing as the article.

[Diane]

Yes Jon,
Some things just never change. Deny, deny, deny.

[Diane]

Today there are 54 comments.

[Jason Silvernail]

Funny how criticism of the chiropractic profession involves the same old tired arguments in response - those comments can be lifted and put anywhere else and they'd fit right in...

[Diane]

The lines are so scripted. Straight out of chiro school's justification for their own existence. Taught to students from day one. Propagated out to chiro "consumers" after that. Very tired wornout raggedy memes from a hundred years ago til the present day. Still hooking the non-thinking public.

[luca m]

I was never taught any of these "lines" in chiro school. Where much of "the bullxxxx" is taught is in these marketing seminars that some chiros pay big bucks to attend. These practice management seminars. They go as far as training your staff to be part of the "practice building", providing the videos and brochures, etc.

What has baffled me for years is this. I practice in a very wealthy community. There are a number of "high volume", "subluxation-based", "bring your children 'cause birth is the original trauma to your spine" kind of chiros. I can't figure out why the corporate executives, and other highly educated individuals are the greatest users of these types of chiros. I would think they would be smarter than that.
Is it posh? Between brunch at the country club and golf lessons they see their chiropractor? I don't know.

Some of these clinics look like country clubs. Juice bars, leather couches, indoor landscaping, fireplaces burning, plasma TV's dispensing "education".

I have lost many patients to this type of chiro because of the patients expectations based on past experiences. The maintenaince care I sell to my patients is self manteniance, but many would rather have someone else "help" them. "Just lay down and let me restore your innate".

Dianne,

The reason some of these lines sound scripted is because they are. These are lines I've heared at these seminars. (I went to one as a recent grad. Never again.)

Even though our regulatory body has rules against these "questionable practices" that are violated regularly. Punishments are laid out via fines and suspensions but they don't deter much at all.

I think I hate the crap that goes on more than Dianne does, because it is more personal to me, being in the profession. But I don't agree that dropping a nuclear bomb on the entire profession is the way to go to stop it.

The DC doing these things won't be harmed very much by removing accrediation from colleges, or removing them as regulated professionals. Most of them have cash practices and a strong cult following, I mean patient base, and they will continue to thrive as an unregulated profession like reflexology or iridology or reiki, etc..

It will hurt guys like me however.

Not finished my thought but more later.

[Karie]

Jon

Just to add a little more flavor to the talk here, I learned today that Humana (major insurance company) uses chiropracters to determine medical necessity for PT reviews because they can perform PT in their practice. Great!!!

Karie

[Jon Newman]

Hi Karie,

I'm not sure of the details of who gets to perform a review for medical necessity in general (Humana or otherwise.) I was under the impression that you only had to be a graduate of a health care profession with the result that nurses can review PT and PT can review chiropractors, etc. Do you have a link or further information?

Attached are some thoughts on the whole concept of medical necessity.

I had seen a chiropractor writing (I'm unsure where I read it except for somewhere on the world brain) about care being "clinically indicated" versus "medically necessary." There is something appealing about this terminology.

[Karie]

Hi Jon,

The article you posted is very good and it's interesting that it mentions an extreme case that "Humana" was involved in. I'm told (don't have a link for this) by the WI State Insurance Commisioner's office that Humana has the most complaints against them. That aside, I have become accustomed to rehab nurses reviewing our notes but never a chiropracter before. This information came about from a patient of mine and I had never heard of a chiropracter reviewing PT or any other health professions plan of care prior to this situation. This person has a self-funded plan from the employer that is managed by Humana and indeed has the vague language of PT services are a benefit as long as it is "medically necessary."

In my opinion, this just adds more fuel to the fire between chiropractic and PT. I would not want to be in a postion to determine chiropractic necessity and they should not be determining PT necessity.

Thanks for letting me vent!
Karie

[Diane]

Now there are 159 comments including a long post from Christa Heck, the woman in the story who had the stroke, who is finding out about a little something that runs through chiro consciousness called denial.

[Crazy Pole]

I know it's preaching to the choir by now, but nice to know that others are fighting too...

Wes

[Diane]

In the interests of keeping all the chirotopics in one thread, I'm bringing this link here. Note # 10.

Mostly this is a grocery list of "how to be a good salesman" ideas. Not "how to be a good clinician", mindful of science and discovery and their implications for a manual practice.

[cathyph]

That seems like a pretty long list for the short attention span I've noticed amongst chiros. In a recent cold laser class, the instructor (a chiro) emphasized that "It's all about showmanship! Your clients expect it!" That along with "You should be selling $300-$400 of supplements PER MONTH, PER PATIENT" made for a long 2 days. Some good tidbits underneath it all, and fascinating theatre.

[EricM]

Just last night I watched a compelling tv show about healing. I have no idea if this station is available anywhere else but here, but if you get a chance to watch it, do so, it was really good. It looked like it might be a British production but I cant be sure. The subject was placebo. It takes a highly skeptical look at various 'cures' and deconstructs the mechanisms involved. It concluded that the single most important factor in determining the effectiveness of any treatment is the belief and conviction in the treatment displayed by he/she providing it. The chiro's probably got it right, showmanship seems to be important.

[christophb]

If that's the case, I'm screwed

[EricM]

Before you write yourself off Chris, lets make sure I got that right. It might have been that the effectiveness of the placebo effect of any treatment depends of conviction in the effectiveness displayed by the practitioner. Dang, now I'm going to have to watch it again.