Conservative orthopedics is modern chiropractic care. The old ways suggest a different reason altogether for getting adjusted. This old way is based on flawed theories suggesting neurological interference, meaning, a pinched nerve leading to disease. I have written about this before in attempt to show that this theory is ridiculous and a modern version is more appropriate and justified. The pinched nerve idea does happen, but it causes radiculopathy type symptoms into an extremity. Numbness, tingling and weakness are a few symptoms based on this entrapment or compression of nerve tissue. This happens all the time and is a real problem.
Even though there is a heavy influence in the scientific literature showing the modern version of chiropractic medicine's legitimacy, there is still a lot of old school doctors out there that believe in this theory of subluxation-based disease.
In class yesterday, the instructor gave us a summary of a bunch of techniques in chiropractic that have become popular among non-medical chiropractic doctors. Applied kinesiology and toftness were discussed by the professor and from the tone of the conversation, she believed there was legitimacy in the use of these technique systems and almost suggested their use. She told us about her approach to finding the "subluxation". It consisted of scanning the area with her hands superficially and when she gets a stomach ache, she "knows" there is an issue there. That isn't quackery, is it? The technique systems out there, use this subjective approach and they are frowned upon by a large majority of DC's and of course, medical doctors. The toftness device was banned by the Oregon Chiropractic Board due to the inability to prove it's diagnostic objectivity. This is why chiropractic will struggle forever.
It was really weird how she approached the conversation. She acted like my dad used to when he'd let us get away with things my mom would not when I was a kid. She told us, this conversation never happened, then proceeded to spew her belief's all over us like a preacher from the pulpit. I was offended by her. I kept thinking, we've been working so hard to get protocols memorized and the committee that has worked so diligently to help chiropractic grow into a mainstream/supported profession was being kicked in the proverbial undercarriage by this "believer". Her rebellious approach was somewhat supported by the class by them giggling at her unorthodox comments of going secretly against the University's commitment to integrative chiropractic care. As a side note, integrative chiropractic utilizes objective qualities from a biomechanical/medical perspective that make sense in all medical disciplines. I threw the packet of techniques into the trash on my way out the door. Her copyright violation also struck a cord with me.
I don't know if I was alone with all this when we were being subjected to her beliefs, but I do know there are reasons people don't go to the chiropractor and this "established" veteran chiropractor is one of them.
Some may think I am not open to other ideas. Some may think I am a bit too serious with all this. You may have good reason to believe this, but in my opinion, the only reason to not use scientific/objective approaches to patient care is for the doctor's benefit only. Whether that be emotional, financial or just some need to rebel from the medical standards in place, those reasons do nothing for patient care. In the end, the public becomes confused by all these technique systems and the profession becomes less legitimate and strong.
I will never buy into a technique system no matter how challenging it gets in practice or in school.
All for now
Great article, Nate, thanks for posting this. However, I disagree with your assertion that, "...the only reason to not use scientific/objective approaches to patient care is for the doctor's benefit."
ReplyDeleteDo you think that there are people out there who will, under certain circumstances, respond more favorably to a subjective/spiritual approach to care? If so, do you think that filling the need for this type of care could be done in a manner that does not oppose the scientific paradigms that you are discussing?
In my opinion, the strictly scientific/objective approach, as tremendously important as it is, is still in its infancy within our profession, and health sciences as a whole have still got quite a ways to go. This leaves plenty of room for growth, change, and even the inclusion of things that we once did not understand.
The realm of subjective healthcare includes much more than AK and toftness devices, and i believe that honest use of or at least respect for these approaches can sometimes be appropriate, even by doctors.
Thanks for the thoughtful comment Leon. I see your point with all this. I guess from my personal experience, my first assumption is that DC's who buy into technique systems are immediately guilty of fraudulent activity. Knowing our instructor who was pushing this forward, I can now see that she's really doing this FOR the patients benefit and not hers. But, I do think she also does this out of rebellion, to go against the norm for some reason. I don't know her reasoning, so maybe I will ask her.
ReplyDeleteTo answer your question about people who respond better to more subjective/spiritual care, I think there will always be people who respond well to this sort of thing. Partly because they seek it out and perhaps because they have something against mainstream approaches. As long as they get results, that is fine by me. My qualm is that we as doctors cannot assert ourselves as able to "tap" into this energy, as some of the techniques suggest.
I know that the science in our profession is at it's infancy, but I see the science as a way to prove chiropractic therapies in an honest manner. If science defines the limits on our profession and the benefits of our work, I think that really sets us up for better patient interactions, greater public trust and busier practices. We cannot state that our work does something that it hasn't been proven to do because this is dishonest and really suggests there is a different motive besides the patients well being in mind.
To finish this long winded response to your awesome comment, I will say this; science will define the ethical line in our profession. There is always something to discover and there are research methods designed to find truth. What can we trust without these boundaries? I am not against learning more about new methods of treatment and expanding my clinical knowledge base, but I am against following an unproven method and chucking the objective approach I have been learning for 3 years.
Interesting post Nate. I must say I'm not surprised this lecture happened, but I am disheartened by it.
ReplyDeleteMegan - The interesting thing about all this is how many of the tools we use to assess in an evidence-based manner have low sensitivity and low specificity. It is all we have though. I think we can extrapolate information from these tools and order better, more invasive examinations if needed. What I don't understand is why these doctors think there is a better method than the scientific method out there to gain information about their patient. It makes them look like amateurs and reduces our legitimacy as practitioners. Our authority is seriously effected by these rebels.
ReplyDelete