Inconsistencies in Chiropractic, by Dr. Ogi Ressel

Friday, March 13th 2009

Warm hellos to everyone!

I'm back!.....with a vengeance!
Let's tackle some of the dogma befuddling our profession!
Let's get into a bit of a clinical issue. Let's talk about some of the beliefs and
misconceptions that we, as chiropractors, have about practice.  

The reason that I mention this is that at Module II in Phoenix last weekend, I grouped doctors in groups and gave them a certain set of clinical questions on patient care to debate together and answer. One of the doctors attending wanted to place a patient on a schedule of care at 3x/wk - a schedule every chiropractor on the planet is familiar with.
When asked why, he couldn't give a reasonable answer. "It is what's done" was his reply.
Interesting.

"But why", I pressed.

After going back and forth for a bit, the end result was that no one knew why patients were
seen at 3x/week, or 2x/wk, or 1x/wk.

Think about this: Why do you see patients 3x/week for 3-8 weeks or so? What is the purpose behind this schedule of care? What benefit will there be for the patient? (The benefit to you is obvious)

And how did this start?

Interesting questions aren't they?

You see, most of us were taught to see patients 3x/week, etc. To venture outside this "accepted norm" would be to open yourself up to possible repercussions from governing bodies - to get on their radar, to become visible, to be called out on it, to venture into the unknown.

Think about it though: "Why do we do this and where is it ever written down?"
Why not 4x/week?
Or 5x/week?
Or, heaven forbid, 6x/week? Oh, my.....
Or whatever you decide based on your experience and expertise?

I wrote a paper which was just published in the JVSR a few months ago. It deals with this issue and I thought I would dedicate a few THOTS to this topic - some of the beliefs and misconceptions in Chiropractic.

Here is an excerpt from that paper:

In the course of care of children and in the process of writing a number of articles and papers, I realized
there are a number of teachings and commonly upheld dogma that I believe have generally framed the
health sciences and consequently, the generally accepted approach to patient care.
I believe that the application of these beliefs has not been of benefit to the public at large in most
instances. It is also my opinion that many of these tenets, as expounded by professional associations,
colleges, learning institutions and regulatory agencies have actually hampered patient care and recovery
in many instances.
As well, they have been used as the framework for political "witch-hunts" by state and provincial regulatory
bodies in the United States and Canada.

I would like to be emphatic when I state that this is not a political commentary - however, I have noted a
number of inconsistencies within the profession which are not congruent with the basic tenets of
the practice of chiropractic. Many of these beliefs and doctrines have not allowed doctors to obtain the
results they could and should have - and have not provided children and their parents with the outcome
they expected.

Some of the inconsistencies I wish to address include overtreatment, frequency of care, re-examinations,
SOAP notes, and case history-taking.

 Over-Treatment:

The first fallacy I thought I should address is the issue of so-called "over-treatment." The doctrine that
patients can be "over-treated" and its subsequent implications has been a political sword for many regulatory
groups and associations within the profession. I feel that there is no such commodity as "over-treatment."

There are a number of reasons for my departure from this commonly held view:

 1. The word "over-treatment" has been borrowed from another health care profession whose paradigm
      is the treatment of varied conditions and diseases of the human body. Because the basic tenet
     underlying this concept is vastly different from chiropractic, I feel it should have no place in
     chiropractic lexicon.

2.   "Over-treatment" implies that chiropractic is based on "treating" some condition. This is totally
      incongruent with chiropractic philosophy of subluxation correction.

3.  Chiropractic care is not predicated on a framework of allopathic thought - ergo, concepts and ideology
      which are upheld by other health care delivery professions should not necessarily apply and dilute the
      Chiropractic Principle.

4.   There is no rational manner with which one could impose the concept that a patient has been
      "over-treated." To assign a numerical figure would be blindly self-limiting. If normal and accepted care
      of a certain patient necessitates, for example, 50 adjustments, and the patient receives 51, that would
      constitute "over-treatment" by definition. If, however, a patient receives 49, that would necessarily
      mean that she/he was not cared for adequately by that same definition. Absurd.

5.   The other discrepancy is that within the profession different groups, associations etc., have varied 
       definitions of what they consider "over-treatment" to be. We contend that if there is such an entity as 
       "over-treatment" then that definition should be uniform throughout the profession, that regulatory bodies 
        of Georgia, Nevada, Ontario, Florida, Alberta amongst others, should have the same understanding. 
        That is not the case. This reality can lead to dangerous conclusions. A doctor could be accused of 
        "over-treatment" in Florida, but be found to be practicing within accepted standards in Texas, or 
         Nevada or Ohio. This inconsistency of philosophy and understanding can be devastating, as it is never 
       set down in written word in any professional standard. Most often it is only a "perceived" or "reasonable"
         or convenient standard that doctors are asked to abide by - whatever that means.

6.   The other aspect of this quandary is its reality - members of our profession taking care of their own 
       families. Many chiropractors check and adjust their children and families 1-2 times per week. That in
       itself translates into 52-104 adjustments in the course of a given year for each family member. Many 
       would consider that figure and frequency as "excessive" if it applied to an actual paying patient. Yet 
       when it applies to a family member, it seems to be totally permissible, reasonable, and utterly accepted. 
       We seem to have two sets of values within the profession when it comes to the issue of "over-treatment"
        - one which is real, and one which is politically convenient. This is a contradiction. According to 
       Dr. Patrick Gentempo, a noted lecturer, friend, and philosopher, contradictions lead to self-destruction.

These are the reasons which led me to abandon the "overtreatment" bandwagon - the reader may formulate his or her own.*

*Ressel, Ogi, Popular Beliefs and Misconceptions in Chiropractic, J. Vertebral Subluxation Res. August 27, 2008

 I hope you've enjoyed my "ranting and raving". It is issues like this and inconsistencies such as
these that really piss me off. Why? Because regulatory bodies adhere to these and often harass
doctors for a job well done. What is also frustrating is that most chiropractors do not have the
clinical justification and expertise to defend themselves and their position adequately.
Well....that's over.
......all part of the PEP Program.
There is no other out there like it!
Warmest wishes,
Dr. Ogi Ressel