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Criticism of other healthcare professionals - Page 2  

post #31 of 49
Quote:
Originally Posted by BigE View Post
You are doing yourself and your profession a great disservice.
I couldn't agree more.

This thread has been tugging at my brain all week and I was going to write a long thoughtful post, but then I thought... why?
post #32 of 49
Quote:
Originally Posted by Baja View Post
Skidude, please do me a favor. I'm serious:

Please point out the "name calling" I have done anywhere on this thread.
Quote:
October 27th, 2008, 05:26 PM
Baja vbmenu_register("postmenu_981724", true);
Member
Join Date: Mar 2006
Location: New Jersey
Posts: 524


Quote:
Quote:

Quote:
Originally Posted by Xtreme22

This dr office is telling me it is fine, maybe do some PT. Here is the thing...back in the beginning of October when I went to see this Dr, I didnt get a good vibe from him right away. He couldnt get my muscles in the legs to relax enough to really check the movements, and seemed like he really wasnt interested in the history of the knee just waht was going on now.

And my biggest pfffff with him...last comment I had for him...beginning of October...I said... Hey I need to get this thing right before ski season starts...

and his reply.... Shook his head at me and walked out the door. I was like what a prick...I was joking but still being half serious!!

Your ortho sounds like a schmuck. And there are plenty of them in the medical profession.

There are many other examples. You can try to justify yourself all you like, however your posting style is not productive.
post #33 of 49
...
post #34 of 49
Whenever I've gone to a chiropractor, the result is always the same: adjust something.

This practice has resulted in producing more damage than what was originally present.

My solution to this was to use a top rated sports medicine clinic headed by MD's instead. The next few injuries were no longer treated by chiropractic. Nor were they treated by medicines.

The results are FAR more positive than the panacea that I obtained using chiropractic services. By the way, my sample size of chiropractors is statistically significant. I've never met a chiropractor that did not try to adjust something. I've also never met a chiropractor that did not try to sell me a long term plan for spinal health. I did meet one, that was so in love with his treatments that he adjusted his newborn infant after delivery.

If all you know how to use is a hammer, everything looks like a nail.
post #35 of 49
Chiropractors have a place in treatment of the simple strain/sprain, but for a more serious injury it is important to see an MD trained in sports medicine. A quick and accurate diagnosis is a must.

If a chiropractor is willing to order an MRI to rule out serious disc injury before begining treatments, I think that would help to make sure that an adjustment will no do more harm then good.

I suffered from an L1 vertebrae fracture in a water skiiing incident many years ago. My experience with the medical care field following that incident was very interesting. After being released from the hospital, I went to an ortho who immediately recommended surgery - even without sufficient dianostic testing or taking a shot at less invasve treatment.

I went to get a second opinion from a sports medicine doctor (another ortho) who recommended rest for 6 weeks and then physical therapy. After the physical therapy, I was reevaluated. The fracture healed and there was no need for surgery. In fact, surgery was never indicated.

I went back to the original doctor to discuss and found out he had moved into a brand new office in the hill country and (my thoughts) he wanted to do the surgery to pay for the office space.

I am now 15 years post accident and am doing very well. About 5 years post accident, I went to see a chiro because of some low back pain. He told me that he would not adjust my spine because of the prior injury. I thank him very much for that and started another round of PT which again solved the problem. The chiro directed the PT but did not actively participate.

Something my sports medicine guy told me was that my injury was serious, but not so much so as to make me a cripple. He said that it was important to get out and do everything I did before, including skiiing. He said to be more careful maybe then i was in the past (no double diamond was too steep, no mogul too big), and I have followed his instructions and toned down my aggressive ski persona.

Now I pride myself not in taking the hardest slopes as fast as I can but in skiing in control, not falling and looking for POW rather then steeps and bumps. Like this I will ski until the day I die!!!!!

Rock on!

Check out my band's new website! www.peace-corps.net
post #36 of 49
Thread Starter 
It's interesting to see how some people judge entire professions by the actions or words of one person. (whom they happen to disagree with) That speaks volumes, for sure.

jdistefa, I don't understand why you're so upset with this thread. If you practice legally and ethically, then what's the problema? Perhaps you think all of your colleagues are ethical and competent? Newsflash: they aren't.

Shoot... you could have a field day criticizing my colleagues! The chiropractic profession has plenty of people who have no business being in healthcare. A number of them should be in jail for things they do in their offices.


And BigE, still stuck on your own personal experiences I see. Don't you know there's a whole other world out there that doesn't revolve around you? You're welcome to actually live up to your word and stop participating any time now, since we all know that this thread doesn't do anything for you except get your emotions riled up.


Skidude, I'll concede on the schmuck comment, even if I did present it as "he sounds like a schmuck" based on what the poster described, instead of "he is a schmuck." It still was a classic derogatory label. But I have to ask... does the description of the doctor's attitude and actions (and lack thereof) sound like something that deserves "respect?"

And as far as "many other examples," nah, I don't think so. You would have posted them. And contrary to what you think, this thread has been very productive for many people, despite the immature comments that have piled up here.


Thanks for posting, SAskiBUM. Whenever a poster like BigE tries to stereotype all members of a group, someone always chips in and invalidates it. (while, in this case, simultaneously validating some of the observations I've been making all along) Glad to hear you're still skiing.
post #37 of 49
Quote:
Originally Posted by Baja View Post
If you practice legally and ethically, then what's the problema?
This thread is not about me.


Quote:
Originally Posted by Baja View Post
Perhaps you think all of your colleagues are ethical and competent? Newsflash: they aren't.
All things exist on a bell curve.


Quote:
Originally Posted by Baja View Post
Shoot... you could have a field day criticizing my colleagues!
I'm not you .
post #38 of 49
Baja,

You must've missed the part where I said my sample size is statistically significant.
post #39 of 49
Thread Starter 
Quote:
Originally Posted by Baja
If you practice legally and ethically, then what's the problema?
Quote:
Originally Posted by jdistefa View Post
This thread is not about me.
Then here is another wonderful opportunity to explain what it is you disagree with, and why this thread bothers you so much. If you are a medical or orthopedic professional, I'd really like to know your viewpoint on this.


Here's another example of what I'm talking about, that happened last weekend: A massage therapist I frequently send patients to wakes up with slight pain in the left scapula area. As the day goes on, it gets worse and worse, has a couple of colleagues massage the area over the day, she can't sleep that night at all, gets very worried and goes to the ER the next morning. Long story short: hours of waiting, exams, tests, X-rays, ruled out lung, gall bladder, heart, fracture, etc. Total time in hospital is over 10 hours. Diagnosis? "Tight muscles." Discharged with a prescription of muscle relaxers. Muscle relaxers don't help.

After two more days of increasing pain, goes in to see an ortho. After examination and workup, concludes that she "pulled a muscle," (but couldn't tell her which one, even when she asked him, since, as a massage therapist, she obviously wanted to know) and recommends ice, rest, and muscle relaxers.

Another day goes by with muscle relaxers and ice having no improvement, and calls me to come in on Saturday. Explains to me the whole situation, so I take a look. I find the left sixth rib/costotransverse is subluxated and very tender to the touch, lateral wedging of T5/T6, spastic rhomboid major, and restricted serratus anterior. A basic A-P costothoracic adjustment took about 15 seconds, 2 other spinal adjustments and trigger point work on both muscle areas took approximately 3 minutes. Total time in my office was 8 minutes. She reports 80% improvement immediately. She stopped in again on Monday morning and reports 100% improvement.

It was so easy to find and so easy to correct, virtually any chiropractor, PT, or "old timer" osteopath would find it and handle it just as easily. I would even go so far as to say that maybe a rare ortho could have diagnosed a rib joint problem, and possibly have treated or (more likely) referred appropriately. But the majority of MD's or orthos? No way.


But many of you here are telling me that I should not be suggesting that an MD or ortho is not the best professional to see first for problems like this. I should be showing "respect" to the wasteful, ineffective, and sometimes harmful care that is so often given in cases like this. I shouldn't be pointing out the fact that MD's and orthos simply lack the necessary training and competency to handle these situations correctly, whereas most chiropractors and PT's see problems like this several times a week.

I'm sorry, I won't do it. MD's and orthos, as a profession, have proven themselves to NOT be the premiere standard or highest authority of non-traumatic NMS care. Emergency, traumatic injuries, disease management? Yes! With flying colors and thank goodness for the knowledge and technology they possess today. But non-traumatic NMS cases are much better off going to a chiropractor or PT first, competently analyzed, then treated or referred as needed. In many cases, they can bypass the medical profession completely.

It's nothing personal. The training, knowledge, and experience just isn't there.
post #40 of 49
Thread Starter 
Quote:
Originally Posted by BigE View Post
Baja,

You must've missed the part where I said my sample size is statistically significant.
Let's see....

There are over 75,000 practicing chiropractors in the US, about 6,900 in Canada, and probably 7,000 - 9,000 more worldwide. (3,500 in Europe, maybe a couple of thousand in South America)

Probably over 90,000 total in active practice today.

So what was your sample size number, BigE? Was it even in triple digits?
post #41 of 49
You don't know much about statistics do you?
post #42 of 49
Thread Starter 
You don't have an answer?
post #43 of 49
Thread Starter 
Here is some more interesting reading/research on this subject:


http://www.chiro.org/ChiroZine/ABSTR...wledge.sht ml

Quote:
...the Chiropractic group (n = 51) showed statistically significant higher average grade than the orthopedic residents. Expressed in other terms, 70% of chiropractic students passed the knowledge questionnaire, compared to an 80% failure rate for the residents.
Chiropractic students (in their last semester of core/basic chiropractic curriculum training only) outscored medical orthopedic residents by a huge margin on a competency test of medical orthopedics and neurology, designed by chief orthopedic residents.

Chiro students outscoring medical doctors in their own field of expertise. Oh, but chiropractors aren't "professionals" according to duke walker. They are "janitors" compared to the MD "architects."

If that doesn't speak volumes as to what I've been suggesting on this thread, I don't know what does.



http://www.ppchiro.com/index/Educati...ic_vs._Medical

Quote:
The Parker College study reported that on average, chiropractic college involves 372 more classroom hours than medical school. Chiropractic students also have more hours of training in anatomy, physiology, diagnosis, and orthopedics (the musculoskeletal system).
The specific comparison of classroom hours in anatomy, physiology, diagnosis, orthopedics, and radiology are of particular interest. There were 4 medical doctors in my class at chiropractic college, and they were all impressed with the level of anatomy and diagnostic training, claiming it was more comprehensive and challenging than their medical training.


http://chiropractichealth.suite101.c..._for_back_pain

Quote:
"...patients who turned first to chiropractors and other alternative-medicine professionals for care were hospitalized and had surgery 60 percent less often and spent 85 percent less on pharmaceuticals than those with medical doctors as primary care providers."

"A March 2004 study revealed that chiropractic care is more effective at treating chronic low-back pain in the patients’ first year of systems than traditional medical care."



http://www.settlementcentral.com/page0052.htm

Quote:
"Conversely, orthopedic surgeons are at the top of the food chain. As mentioned before, they are indispensable in treating bone injuries and other disorders. However, when it comes to soft tissue damage, most people find better results with chiropractic."

"On the other hand, the knowledge of the medical practitioner is somewhat limited when it comes to soft tissue damage and treatment. A well-informed chiropractor will often prevail over a general medical practitioner when it comes to testimony regarding soft tissue injuries and treatment thereof."

There you have it.

So, all you folks who have "obvious disagreements" with me and my criticisms, what do you have to say now?
post #44 of 49
Quote:
Originally Posted by Baja View Post
Then here is another wonderful opportunity to explain what it is you disagree with, and why this thread bothers you so much. If you are a medical or orthopedic professional, I'd really like to know your viewpoint on this.


Here's another example of what I'm talking about, that happened last weekend: A massage therapist I frequently send patients to wakes up with slight pain in the left scapula area. As the day goes on, it gets worse and worse, has a couple of colleagues massage the area over the day, she can't sleep that night at all, gets very worried and goes to the ER the next morning. Long story short: hours of waiting, exams, tests, X-rays, ruled out lung, gall bladder, heart, fracture, etc. Total time in hospital is over 10 hours. Diagnosis? "Tight muscles." Discharged with a prescription of muscle relaxers. Muscle relaxers don't help.

After two more days of increasing pain, goes in to see an ortho. After examination and workup, concludes that she "pulled a muscle," (but couldn't tell her which one, even when she asked him, since, as a massage therapist, she obviously wanted to know) and recommends ice, rest, and muscle relaxers.

Another day goes by with muscle relaxers and ice having no improvement, and calls me to come in on Saturday. Explains to me the whole situation, so I take a look. I find the left sixth rib/costotransverse is subluxated and very tender to the touch, lateral wedging of T5/T6, spastic rhomboid major, and restricted serratus anterior. A basic A-P costothoracic adjustment took about 15 seconds, 2 other spinal adjustments and trigger point work on both muscle areas took approximately 3 minutes. Total time in my office was 8 minutes. She reports 80% improvement immediately. She stopped in again on Monday morning and reports 100% improvement.

It was so easy to find and so easy to correct, virtually any chiropractor, PT, or "old timer" osteopath would find it and handle it just as easily. I would even go so far as to say that maybe a rare ortho could have diagnosed a rib joint problem, and possibly have treated or (more likely) referred appropriately. But the majority of MD's or orthos? No way.


But many of you here are telling me that I should not be suggesting that an MD or ortho is not the best professional to see first for problems like this. I should be showing "respect" to the wasteful, ineffective, and sometimes harmful care that is so often given in cases like this. I shouldn't be pointing out the fact that MD's and orthos simply lack the necessary training and competency to handle these situations correctly, whereas most chiropractors and PT's see problems like this several times a week.

I'm sorry, I won't do it. MD's and orthos, as a profession, have proven themselves to NOT be the premiere standard or highest authority of non-traumatic NMS care. Emergency, traumatic injuries, disease management? Yes! With flying colors and thank goodness for the knowledge and technology they possess today. But non-traumatic NMS cases are much better off going to a chiropractor or PT first, competently analyzed, then treated or referred as needed. In many cases, they can bypass the medical profession completely.

It's nothing personal. The training, knowledge, and experience just isn't there.
A subluxed rib is on the differential diagnosis for thoracic pain. It is commonly missed in the ER because it is not a life threatening condition, and is therefore off the radar of most ER docs. Having said that, I know several ER docs (including myself) that also have a fellowship in sports medicine and routinely manipulate subluxed ribs in the ER.

As I'm sure you're aware, much of the diagnostic work in the ER is of a "rule out" rather than "rule in" variety. In other words, many patients are discharged from the ER without a specific diagnostic label, but at the same time significant limb or life threatening disease has been - within realistic confidence intervals - ruled out.

As I mentioned to you earlier in this tedious thread, it is a very different thing to be working at the coal face. When faced with a patient who has undifferentiated throacic/chest/back pain in an acute care facility, you are going to get absolutely burned by making the assumption that such pain is mechanical/musculoskeletal. Based on the patient's age, risk factors, and story, one is often obligated (based on ethics, and competency) to do reasonable investigations (which cost money and take time) to rule out ominous disease.

Part of what effects this process (and has been written about in numerous thoughtful articles discussing cognition and heuristics in clinical practice) is the context of the patient encounter. The ER/hospital environment can skew the consideration of possible illnesses and resultant investigations in a way that is quite different than office/clinic based practice. Furthermore, there are time, throughput, and triage pressures that create practical barriers to the workup of non-urgent problems. This should not be confused with competency.

In the scope of your chiropractic practice, chances are very good that you have missed a multiple myeloma, lymphoma, metastatic prostate ca, epidural abscess, retroperitoneal abscess, prodromal shingles, pancreatitis, pyelonephritis, lower lobe pneumonia, bone infarct, aortic dissection, etc, etc.... all of which can commonly present as back pain. Therefore, without a doubt you've caused harm by missing a critical diagnosis in a patient that presented with non-specific back pain that smelled mechanical. So you treated, maybe it sort of got better but never completely went away. Perhaps you then lost track of the patient and never heard the outcome. Sound familiar...? If it doesn't, you haven't been working long enough . And that's not a criticism of you, it's just life - if you work in clinical medicine, it happens.

I'd be happy to talk to you more in about ten years when you have more grey hair and some of your sharp edges have been rubbed off .
post #45 of 49
Thread Starter 
jdistefa, that was an excellent post, and I agree with most everything you wrote.

With that, I'd like to discuss some points in further detail.


Quote:
Originally Posted by jdistefa View Post
A subluxed rib is on the differential diagnosis for thoracic pain. It is commonly missed in the ER because it is not a life threatening condition, and is therefore off the radar of most ER docs.


In other words, many patients are discharged from the ER without a specific diagnostic label, but at the same time significant limb or life threatening disease has been - within realistic confidence intervals - ruled out.


As I mentioned to you earlier in this tedious thread, it is a very different thing to be working at the coal face. When faced with a patient who has undifferentiated throacic/chest/back pain in an acute care facility, you are going to get absolutely burned by making the assumption that such pain is mechanical/musculoskeletal.
I can appreciate much of what you're explaining here about emergency medicine. I have been in an ER a few times, and just from limited observation, one can surmise the necessity of somewhat different protocols than in a private clinical setting. And in any setting, mine included, the obvious first priority of analyzing a symptomatic patient is to rule out potentially serious, life-threatening trauma or disease. As you point out, many serious organic, urgent problems can present as simple musculoskeletal pain, and in many of those cases, musculoskeletal treatment or therapy is the wrong care to administer.

And no, I have not yet missed a serious diagnosis in my office, and have referred "red flag" findings to ortho or ER consult which have turned out to be hip fracture, AAA, sequestered disc, glomerulonephritis, slipped capital femoral epiphysis (a ski injury, incidentally), and a few other less dangerous diseases. (whew!) But, like you said, it's ultimately a matter of time and numbers when it comes to missing something important.

But taking all of that into consideration, that still doesn't explain how often cases like this one of shoulder/rib pain gets unaddressed after trauma/disease ruleout. If you have diagnosed and manipulated subluxated ribs in the ER, jdistefa, then you must concede that such a thing is not hard to find and treat. Even if further testing needs to be done (after initial rule outs) to rule out gall bladder, lung, viscerosomatic referral, etc., how hard is it and how long would it take to have a competent professional (like yourself, in this case) do a simple, non-invasive, routine ortho workup and treat, providing it's safe to do so? Why did the ER dismissively diagnose this as "tight muscles" and release? Why did an ortho a few days later do the same thing offering nothing but muscle relaxers?

I don't expect answers to these rhetorical questions on this one case. But it happens all the time. This is not just one isolated incidence. And if it happens more than occassionally, then something is wrong with the overall level of care being provided. And as I've been suggesting, the problem begins in the quality of analysis that's being done. And, I'm sorry to say it, but if chiros, PT's, and a few select other docs can quickly and easily analyze non-traumatic NMS dysfunction, than the entire medical team in a hospital facility should at least be able to do the same, instead of discharge a patient with a diagnosis of "tight muscles" and no plan of referral or treatment except drugs.


Quote:
Part of what effects this process (and has been written about in numerous thoughtful articles discussing cognition and heuristics in clinical practice) is the context of the patient encounter. The ER/hospital environment can skew the consideration of possible illnesses and resultant investigations in a way that is quite different than office/clinic based practice. Furthermore, there are time, throughput, and triage pressures that create practical barriers to the workup of non-urgent problems. This should not be confused with competency.
Agreed. In many cases, these "practical barriers" contribute to incomplete or incorrect care. (not that it justifies poor care in the least.) But I still maintain that competency plays a big role in the medical determination and management of non-traumatic NMS dysfunction, particularly of the spine.

I believe a major component in my criticism of medical NMS care is the virtual inability of the medical profession to analyze non-symptomatic NMS dysfunction... e.g., spinal subluxation (especially sacroiliac and atlanto-occipital, since they lack a disc to degenerate and show gross malposition), antagonist muscular imbalances, kinetic chain dysfunction, etc., all preliminary causative factors to serious, chronic body malfunction if left unchecked. The problem as I see it is that medical training is based on diagnosing and treating the well-accumulated end products of, along with the acute injuries that have been predisposed by, many of these simple NMS deficiencies that are easy to find and correct. In principle (both by training and by public education), medicine is addressing many of these problems only after enough damage has occured that the problem is symptomatic.


Quote:
I'd be happy to talk to you more in about ten years when you have more grey hair and some of your sharp edges have been rubbed off .
I would certainly hope sharp edges would get sharper with quality time and experience in healthcare!

I'm sincere when I say that I had more respect for the competency and skill of medical orthopedics in non-traumatic NMS when I was a student and early in practice. In my eyes, it was the "go-to" source and standard for overall knowledge in all things neurobiomechanical. I've been slowly abandoning that viewpoint year by year as my learning and observation grows.

Thanks for your response, jdistefa.
post #46 of 49
Quote:
Originally Posted by Baja View Post
And no, I have not yet missed a serious diagnosis in my office...
That's an awfully confident statement. How do you really know?

Quote:
Originally Posted by Baja View Post
But taking all of that into consideration, that still doesn't explain how often cases like this one of shoulder/rib pain gets unaddressed after trauma/disease ruleout. If you have diagnosed and manipulated subluxated ribs in the ER, jdistefa, then you must concede that such a thing is not hard to find and treat. Even if further testing needs to be done (after initial rule outs) to rule out gall bladder, lung, viscerosomatic referral, etc., how hard is it and how long would it take to have a competent professional (like yourself, in this case) do a simple, non-invasive, routine ortho workup and treat, providing it's safe to do so? Why did the ER dismissively diagnose this as "tight muscles" and release? Why did an ortho a few days later do the same thing offering nothing but muscle relaxers?
First, I can't answer questions about someone else's care, and neither should you . But I would humbly suggest that non-urgent MSK pain is not within the realm of an otherwise competent ER doc. This is a reflection of training, practice spectrum, and the practical time limitations of the ER. What most ER docs (and many orthos) do is write a referral for Chiro/PT care.

Quote:
Originally Posted by Baja991727
I don't expect answers to these rhetorical questions on this one case. But it happens all the time. This is not just one isolated incidence. And if it happens more than occassionally, then something is wrong with the overall level of care being provided. And as I've been suggesting, the problem begins in the quality of analysis that's being done. And, I'm sorry to say it, but if chiros, PT's, and a few select other docs can quickly and easily analyze non-traumatic NMS dysfunction, than the entire medical team in a hospital facility should at least be able to do the same, instead of discharge a patient with a diagnosis of "tight muscles" and no plan of referral or treatment except drugs.
I'm not sure you and I work on the same planet. Nobody ever died from a missed subluxed rib, trigger point, or subtle spinal subluxation. If I can leave work confident that a) I helped a few people, b) maybe made a definitive save, c) gave everyone as much time and respect as I could in the moment, d) didn't kill anyone.... then it's been a good day. To be frank, I wouldn't expect any acute care provider to wring their hands over a non-acute MSK problem and I remain perplexed as to why you expect they should.

Quote:
Originally Posted by Baja991727
Agreed. In many cases, these "practical barriers" contribute to incomplete or incorrect care. (not that it justifies poor care in the least.) But I still maintain that competency plays a big role in the medical determination and management of non-traumatic NMS dysfunction, particularly of the spine.
Sure, but can you realistically expect everyone to be great at everything? I want my ER doc to be able to reduce a fracture well, read an ECG, manage an airway, and have a good nose for wife/child abuse. I want my Ortho to reconstruct my ACL, nail my fracture, scope my shoulder, replace my joint. I don't expect my chiropractor to have any surgical skills, manage diabetes, counsel a family for a traumatic loss, or sedate an acutely psychotic person.

Quote:
Originally Posted by Baja991727
I believe a major component in my criticism of medical NMS care is the virtual inability of the medical profession to analyze non-symptomatic NMS dysfunction... e.g., spinal subluxation (especially sacroiliac and atlanto-occipital, since they lack a disc to degenerate and show gross malposition), antagonist muscular imbalances, kinetic chain dysfunction, etc., all preliminary causative factors to serious, chronic body malfunction if left unchecked. The problem as I see it is that medical training is based on diagnosing and treating the well-accumulated end products of, along with the acute injuries that have been predisposed by, many of these simple NMS deficiencies that are easy to find and correct.
Well thank God we have Chiros, right? I mean, what is it exactly that you expect? MDs are not PTs. Orthos are surgeons, not Osteopaths or Chiros.

The reason why multidisciplinary clinics are so good is that they bring together people with a wide range of competencies. The wise clinician recognizes their range of skills, practice context, and refers or asks for a second opinion when they bump up against their own limitations. To be blunt, the beef I have with your posts is that they're both arrogant and judgemental.
post #47 of 49
Quote:
Originally Posted by Baja View Post
So what was your sample size number, BigE? Was it even in triple digits?
Your survey used 51 -- seems that it does'nt have to be in the triple digits does it? Gee, and you so arrogantly dismissed my claim because "it was not it the triple digits" but you offer research to back your claims that used a sample n=51......tsk tsk.
post #48 of 49
Thread Starter 
Quote:
Originally Posted by jdistefa View Post
But I would humbly suggest that non-urgent MSK pain is not within the realm of an otherwise competent ER doc. This is a reflection of training, practice spectrum, and the practical time limitations of the ER. What most ER docs (and many orthos) do is write a referral for Chiro/PT care.
Quote:
Originally Posted by Baja
In almost all cases, the best thing a medical orthopedist can offer a non-traumatic NMS patient is a referral to a better-trained professional to properly analyze and correct their problems, injuries, or deficiencies.

MD's and orthos simply lack the necessary training and competency to handle these situations correctly, whereas most chiropractors and PT's see problems like this several times a week.
................


Quote:
Originally Posted by jdistefa
To be frank, I wouldn't expect any acute care provider to wring their hands over a non-acute MSK problem and I remain perplexed as to why you expect they should.
Quote:
Originally Posted by Baja
This discussion isn't about acutely "ill" people. I certainly have little or no criticism of ER management of such circumstances, and hold tremendous respect and awe for the professionals who provide that service to humanity.

Again, my criticisms are in the realm both acute and chronic non-traumatic NMS complications. And in that realm, "doing your best to fix things in/at the moment" doesn't cut it.

But the training is severely lacking in functional and global analysis, non-invasive treatment options, and subsequently the ongoing maintenance/wellness and prevention of such problems. Chiropractors and functional PT's, in particular, are better trained, safer and wiser choices for providing the assessment, care and support these people need.
..................


Quote:
Originally Posted by jdistefa
I want my ER doc to be able to reduce a fracture well, read an ECG, manage an airway, and have a good nose for wife/child abuse. I want my Ortho to reconstruct my ACL, nail my fracture, scope my shoulder, replace my joint.

MDs are not PTs. Orthos are surgeons, not Osteopaths or Chiros.
Quote:
Originally Posted by Baja
And when it comes to my generalized criticisms of medical orthopedics, just as I would not send a gunshot victim to an acupuncturist, I would not send a non-traumatic NMS patient to an orthopedist or pain management specialist.

Emergency, traumatic injuries, disease management? Yes! With flying colors and thank goodness for the knowledge and technology they possess today. But non-traumatic NMS cases are much better off going to a chiropractor or PT first, competently analyzed, then treated or referred as needed. In many cases, they can bypass the medical profession completely.

It's nothing personal. The training, knowledge, and experience just isn't there.
...................


Quote:
Originally Posted by jdistefa
The reason why multidisciplinary clinics are so good is that they bring together people with a wide range of competencies. The wise clinician recognizes their range of skills, practice context, and refers or asks for a second opinion when they bump up against their own limitations.
Quote:
Originally Posted by Baja
And, I'm sorry to say it, but if chiros, PT's, and a few select other docs can quickly and easily analyze non-traumatic NMS dysfunction, than the entire medical team in a hospital facility should at least be able to do the same, instead of discharge a patient with a diagnosis of "tight muscles" and no plan of referral or treatment except drugs.

I may not approve of their methods or bedside manner, and may not deem their skills and competency as worthy of recommendation for certain patients under certain circumstances, but I respect their position. I also respect their limitations, (as well as my own) and as such am clearly stating my opinions and observations of those limitations as I see them.

And as I've been suggesting, the problem begins in the quality of analysis that's being done.

....................



Quote:
Originally Posted by jdistefa
To be blunt, the beef I have with your posts is that they're both arrogant and judgemental.
Your opinion is noted. Honestly.

What I've done above is point out how my observations and your observations are "tomato, tomahto." So, not only are we on the same planet, we actually come to the same conclusions.

I'm sure we'd have a reflective conversation if you habitually found chiropractors in your area attempting to treat ruptured ligaments, cartilage degradation, DISH, foraminal osteostenosis, and other conditions that should be referred out to an appropriately trained professional.

In the end, (even though it took a little time to pull it out of you) we concur on the major issues. Yes?
post #49 of 49
I closing this thread until I hear a good reason that this has any relationship to the intended purpose of this forum. A greater respect for fellow members of this forum, and practitioners of the various branches of the medical art and science would seem to preclude continuing this discussion. Bottom line is, I feel this thread has the potential to harm EpicSki by the alienating members through the publication of unwarranted attacks and judgments on a profession(s).
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