midterm Flashcards
“The doctor of the future will give no medicine, but will instruct his patient in the care of the human frame, in diet and in the cause and prevention of disease
Thomas Edison, quoted in “Wizard Edison” in The Newark Advocate
Who am I?
I began my chiropractic eduaction at NYCC in 1985; at the end of 5th Tri, I transferred to Western States Chiropractic College in Portland, Oregon, and graduated in 1989
15 yrs practice experience in Washington DC area, 12+ yrs in my own office
10+ yrs as member of board of directors of maryland chiropractic association
5 yrs as maryland delegate to american chiropractic association
numerous publications in peer reviewed journals and textbook chapters on chiropractic safety and standards
official spokesperson for ACA for 20+ years, interviewed by various national and international media organizations on the topic of the risks of chiropractic neck treatments
regional director (region 4) for new york state chiropractic association
northeast college faculty member full-time since 2005
other courses i teach
i ususally teach 5th tri “chiropractic technique”, 6th tri “chiropractic ethics, practice manageement and the law” and 7th tri “coding, billing & documentation”
warning: i have opinions about this profession
thigns to remember about my opinons:
- you don’t have to agree with them
- they come from over 3 decades worth of experiences, both good and bad
- they are based on available evidence
- i’m heavily invested in this profession
- IM ON YOUR SIDE
- discussion is always welcome
who am I? my mission statement:
my mission is to help my students prepare to successfully practice chiropractic with competence, integrity and compassion.
i come to work everyday to serve thousands of people who I’ll pobably never meet. it is those people — your future patients — that I seek to serve everyday — through you. I serve those people by giving you the ability to help someone get out of pain or lead a life that is just a bit healthier, happier adn more productive.
recent surveys
35 on job satisfaction with 66.7 rating just above ____
chiropractor #5 “most meaningful” job
93% answered yes, chiropractors make the world a better place
lowest stress level at work
singers had highest satisfaction at 91.7 %
fire fighters at 90.0%
highest health care profession was pdiatricians at #4 with rating at 80.0%
lowest insurance claims clerks (39.3%)
gallup poll commissioned by palmer college
released sept 8, 2015
- “chiropractic care has a positive reputation among many U.S adults for effective tratement of neck adn back pain, with about six in 10 adults either strongly agreeing (23%) or agreeing somewhat (38%) that chiropractors are effective at treating these types of pain”
key highlights:
- nearly 70 percent of adult americans believe chiropractors are effective at treating neck adn back pain
- the majority (57 percent) of adults are likely to see a chiropractor, and more than 1/4 of them would choose chiropractic care first for back pain or neck pain
- nearly 1/2 of all U.S adults don’t know if their insurance covers chiropracitc care
U.S adults… 23% strongly agree
46% agree somewhat
16% don’t know/neutral
10% disagree somewhat
5% strongly disagree
over 1/2 of all U.S adults have seen a chiropractor, and over 1/4 would choose chiropractic care 1st for back or neck pain
professional ethics
- a 2012 gallup poll asking americans to rate the honesty and ethical standards of professions:
- the good news: chiropractors’ ratings were still above the median rating for the 22 professions tested and wre at their highest levels in gallup history
- the better news: we still scored way beter than lawyers, business executives, HMO managers and members of congress
- the bad news: chiropractors got the lowest honesty ratings of any health profession, although just marginally worse than pyschiatrists
update: americans ethics ratings of 23 professions are at or below recent levels
oercoming the “chiropractic credibility gap”
things to emphasize:
- education:
- 4 year postgraduate education
- in-depth study of basic sciences including anatomy with human dissection, physiology, pathology and biomechnics
- continues with clinial education including dagnosis, x-ray, hiropractc technique and case management
- concludes with hands-on clinical experience including training at outpatient clinics, VA hospitals and other multidisciplinary training
- licensure
- chiropractors are fully liscenced professionals in all US states and Canadian provices - scientific evidence of safety and effectiveness
- be familiar with important studies that you can tranlate into concrete terms - professional ethics
- we take a professional oath of service upon graduation, adn licensing boards have ethical standards
basic prinicples of healthcare ethics
- legally, the doctor-patient relationship is fiduciary relationship
- the law recognizes there is an inherent imbalance of knowledge and power between a patient and a doctor
- in the doctor-patient relationship, the doctor must hold the patient’s best interests paramount, adn recommend treatments based only on the ptients
- respect for autonomy: the patient has the right to refuse or choose their treatment
- beneficence: a practitioner should act in the best interest of the patient, and the responsibility to offer care that is safe and effective
- non-maleficence: “first,do no harm” (primum non nocere)
- justice: a commitment to fairness and equality in the distribution of scarce health resources
- respects for persons: the patient (and the person treating the patient) have the right to be treated with dignity
- truthfulness and honesty - the concept of gaining the patient’s informed consent for treatment
the chiropractic oath
thirty-nine months from now, you will make the following promise in front of your professionl peers, and your loved ones
I do hereby affirm before all that I hold sacred and these asembled witnesses that I WILL KEEP THIS OATH AND STIPULATION.
TO HOLD IN ESTEEM AND RESPECT those who taught me the chiropractic healing art;
to follow the methods of treatment and best practices that ccording to my ability and judgement i consider for THE BENEFIT OF MY PATIENTS;
to ABSTAIN FROM UNETHICAL BEHAVIOUR; to stand ready at all times to SERVE HUMANITY…
… with COMMITMENT TO EXCELLENCE i will practice my art; I will at all times consider THE PATIENTS UNDER MY CARE OF SUPREME IMPORTANCE;
i will provide the care which I have been taught to give by my alma mater;
through LIFELONG LEARNING i will keep my skills and mind sharp; i will HOLD IN CONFIDENCE all things revealed to me as a doctor of chiropractic
while i continue to keep this oath solemn, may it be granted to me to enjoy life and the practice of chiropractic
the main theme of this course:
chiropractic’s past, present and future
why history?
if you want to understadn today, you have to search yesterday
study the past if you would define the future
key date: september 18, 1895
founding of the chiropractic profession by Daniel David (“D.D”) Palmer in Dvenport, Lowa
key date: september 18, 1895
founding of the chiropractic profession by Daniel David (“D.D”) Palmer in Dvenport, Lowa
background: 19th century medicine in the United States
- “regular doctors” often had spotty education (sometimes based on apprentice training or at small for-profit schools)
- statelaws regulating medical licensure were lax or non-existent
- although it was gradually losing favor, the 2,500 year-old concept of “humoralism” was still the basis of much “conventional” medicine
- blood
- phlegm
- black bile
- yellow bile
much of standard medical practice was based on agressive “heroic” treatments such as blood letting and toxic mercury-based purges thought to “re-blanace
the humors
quacks means quick silver or mercury
- give drugs (chiopractors are called that but don’t give drugs)
- people think others are quacks b/c they use it (or used to)
- surgery could be primitive and brutal, often performed with rudimentary anesthetics and under nonsterile conditions
- for example, medicl mismanagement was the main cause of death of U.S. Predisent James Garfield; he was shot by an assassin in 1880 and died some 10 weeks later of massive infection from doctors repeatedly probing his wounds with bare, unwashed hands
- many contemporaries blamed President Garfield’s death on the substandard (and unhygienic) care provided by his physician, Dr. Doctor Willard Bliss (b. 1825, Brutus, NY)
- despite these accusations, after Garfield’s death Bliss billed the government for $25,000 (equivalent to approx. $750,000 today) for treating the President
- in response to the perceived shortcomings of “regular” medicine, various alternative therapies (medicines) flourished
- homeopathy
- eclectic medicine
- naturopathy
- osteopathy - one major reason for the founding of the AMA (american medical association) 1847 was to differentiate “regular” doctors from these “irregular” alternatives
flexner report on medical education (1910)
- concluded much of then-existing medical education was below par
- led to closing of most existing samll medical schools (and focused most attention on John’s Hopkins)
- led to limited opportunities for african amercans, other ethnic minorities adn women in medicine for the next 50+ years
- report funded by carnegie foundation and reform of medical education funded by rockefller foundation
Abraham Flexner (worked at John’s Hopkins)
homeopathy
- begun in 1796 by Samuel Hahmemann in Germany
- based on theory of similars— therapy based on using a compound that causes similar symptoms in a healthy person. the compound is then diluted and shaken vigorously
- the smaller the dilution, the stronger the cure, ex. 30C = 1/100 x 30 times
- homeopathy CANNOT work according to the currently accepted laws of chemistry adn physics
- remember Avagadro’s Number? 6.022 x 10^23
- if you started with 1 ml of active substance and created a 30C dilution, you are effectively diluting that 1ml of active substance with enough solvent to create a sphere 131 LIGHT YEARS in diameter
- and yet, Homeopathy SEEMS TO WORK according to numerous clinical trials and biochemical experiments
eclectic (variety) medicine
based on vitalism, treating the whole patient and not the pathology
widely used botanicals and herbs based on traditional Native American practices
also used some early physical therapy practices
naturopathy
emphasis on natural cures, such as water cures, herbal medicines, homeopathy adn “pure” lifestyles
influenced by european healing traditions; introduced into the US in 1901 by German immigrant Benedict Lust
the first chiropractic school in new york
in about 1905 the american school of chiropractic opened as part of benedict lust’s american school of naturopathy in new york city (1901)
osteopathy
- a forerunner of chiropratic, founded by A.T Still, M.D, in missouri in 1874. some osteopaths still blame D.D Palmer for “stealing” Still’s ideas
- originally the professions had similar philosophies, based on hte relationship between BONEY STRUCTURE AND HEALTH
- in the US, osteopathy became “mainstream” in the 1950s-1960s. D.O.s are now considered “physicians” in all states, and graduated of osteopathic programs
in other countries (ex. UK, Astralia) it has remained separate and distrinct from medicine and similar to chiropractic
life in 1895
some key events from 1895:
- US president: Grover Cleveland (2nd term)
- first US patent issued for an automobile
- USA consisted of 44 states
- Dominion of Canada had 7 provinces, Queen Victoria was monarch
- form of radiation later called x-ray discovered by Wilhelm Conrad Rontgen in germany
- endownment for nobel prize is established
this was the environment in which D.D Palmer lived and worked
harvey lillard, a janitor in Palmer’s Davenport, Iowa building, “had been so deaf for 17 years he could not hear the racket of a wagon on the street or the ticking of a watch. I made inquiry as to the cause of his deafness and was informed that when he was exerting himself once in a cramped, stooped position, he felt somehing give way in his back and immediately became deaf…”
