Guest misagh Posted June 10, 2003 Report Share Posted June 10, 2003 Hello all, I'm wondering if any of you know of physicians who have gone back to learn about spinal adjustments, or have even done the full 4 year DC degree? Are there mini-courses available for family physicians, for example, for them to learn about some of the important principles of chiropractic medicine and adjustment? I realize it may be difficult to distill 4 years of this training into a mini-course that would be useful... but a physician who has the biomedical science background would perhaps only need to learn the practical side of the chiropractor's art. I figure that there may be something to this form of healing, as many people swear by it. The anecdotal evidence, at least, seems to support its notion of efficacy. So wouldn't it be a good idea for, say, a family physician to know something about this so that not only can he/she actually perform adjustments when necessary but also so he/she can perhaps refer people, when necessary, to competant chiropractors in an informed manner? Thanks... - Misagh Link to comment Share on other sites More sharing options...
Guest j282 Posted June 10, 2003 Report Share Posted June 10, 2003 Hi there: Allopathic medicine rarely if ever refers anything to Chiros. In fact I did a neurology elective in which the attendings swore against the treatment, as a result of implications involving neck manipulation and the potential contributory effect it has stroke inducement via blood clots. If you notice at any hospital in Canada or the United States, Chiropractors never hold staff positions. Your best bet is to practice and consider referals within the proven scope of treatment that you have trained under as an MD. Link to comment Share on other sites More sharing options...
Guest batman Posted June 10, 2003 Report Share Posted June 10, 2003 Although it's a US thing, i think Osteopathic medicine (DO) involves a good deal of manipulative treatments akin to chiro. (I could be wrong though) Link to comment Share on other sites More sharing options...
Guest UofCMeds2005 Posted June 10, 2003 Report Share Posted June 10, 2003 DO's are a combo of both... My friend is in a DO program and she says they enter the same res match as MDs. Most people in her program loose the chiropractic aspect at that point and get immersed in their res. Most of the docs I have taked to don't refer patients to chiros or really believe in thier benefit... It is a very controversial topic - I think... Link to comment Share on other sites More sharing options...
Guest quebecboy Posted June 10, 2003 Report Share Posted June 10, 2003 I recall watching the show on W5 where the neurologists were bashing on the chiros, saying it's dangerous and all. Of course, they did not mention the risks associated with neurology. We must keep in mind that although chiropractic care does have some risks (as does dentistry, phyical therapy, occupational therapy, etc.) they are extremely minimal, compared to many other health care fields, such as medicine, were the use of medication for just about everything causes the deaths of thousands per year. Only one death since 1972 was caused by Chiropractic care. Chiropractic is of course not a perfect science, but medicine is also far from perfect. As an MD, I would not hesitate to refer my patient to see a chiropractor if it could help them and spare the surgery. They do have extensive training (245 credits in university, compared to 173 for dents and 200 for meds), and they are very good in treating various conditions. Instead of bashing each other, chiros and meds should see that chiropractic and medicine have different strengths and weaknesses, and by cooperating instead of putting the other down all the time, the could both offer a better treatment for the patient. Anyways, just my two cents worth, Quebecboy Link to comment Share on other sites More sharing options...
Guest macMDstudent Posted June 10, 2003 Report Share Posted June 10, 2003 As a chiropractor studying medicine, I feel qualified to respond here. Please check the following link to another thread to see my previous comments about chiropractic so I don't repeat myself, and don't have to repeat my defence of myself from when I was attacked on this issue before. j282, haven't we done this before? Quebecboy, it is nice to hear a friendly voice once in a while. pub125.ezboard.com/fpreme...=261.topic For those who don't want to click, I will briefly just repeat the fact that my whole practice as a chiropractor was built on referrals from MD's. These included from a neurologist, from the local ER as well as many family doctors including those certified in sports medicine. I have also had many MD's as patients. By establishing myself as a biomechanical, rational chiropractor who used an evidence based approach to mechanical spinal pain, I established a reputation as "the back guy" and I helped get their patient's backs better, perhaps despite the fact I was a chiro. BTW, physios are now learning manipulation techniques after generations of bad mouthing chiropractors. Why? The evidence supports it now, and they want to help their patients. It is interesting to note that not even 25 years ago, the medical recommendation was to stay in bed for 6 weeks and if it wasn't better after that, then it meant surgery. Today, we know that bed rest is the worst approach, it does nothing but weaken the important stabilizing muscles of the spine and virtually gives you no chance to have a recovery. Things have to change with the times, and anyone who doesn't because of professional bias is doing their patients a disservice. Many hospitals in the USA do have chiropractors on staff. Here's two examples I could find links to, there are many more. There is currently a Canadian pilot project being developed to bring chiropractors into some ER's to deal with minor musculoskeletal problems, but it is not operating as yet. If I can find the details, I will post them. I still hold X-ray privileges at my local hospital. 1) www.chiroweb.com/archives/10/21/11.html 2) www.chiroweb.com/archives/18/14/16.html One should be careful when using the word "never," j282. I thought our previous exchange might have shown that. As mentioned, DO's in the States are trained in manipulation but seldom use it because their time is better spent practicing medicine and referring to a good chiro or physio. In UK, there are also osteopaths that are significantly integrated into the health care system. In Eastern Europe, the medical education there does include a component of what they call "manual medicine" but is really the same thing as chiropractic or "manual physical therapy." I am the first to admit that a lot of what goes on in chiropractic is unscientific and "practice building" but I think I have proven that it is possible to have an evidence based chiropractic practice and be integrated with MD's and the rest of the health care professions. That's all for now, I'll check back later. Link to comment Share on other sites More sharing options...
Guest j282 Posted June 10, 2003 Report Share Posted June 10, 2003 Excellent response MacMDDstudent: This is what I love about medicine, constantly getting educated on issues by the experts themselves I apologize, I was basing my information on what some ill informed "old school" MD's were telling me. My bad on this one, but please don't be mad as I am but a lowly med student trying to find my way in this crazy world call health care Take Care Link to comment Share on other sites More sharing options...
Guest bcdentalgirl Posted June 10, 2003 Report Share Posted June 10, 2003 good discussion. I've been to a chiro several times in my life as have many members of my family to great results. However, I always wondered if there was a bit of a placebo effect. Well, I ended up working for a vet who brought in a chiro once a week for treatments on dogs, cats and even a goat! The results were astounding. these animals had no idea they were being worked on by a chiro, but about 80% showed improvement, including the complete recovery of a daschund who had injured her back so bad, they had thought about putting her down. It convinced me. All hail the chiropractors!!! Link to comment Share on other sites More sharing options...
Guest misagh Posted June 10, 2003 Report Share Posted June 10, 2003 Hey, thanks for the responses! macMDstudent, I'm just wondering what made you decide you wanted to study medicine after being a chiropractor. Is it to have a broader scope of resources at u'r disposal when it came to patient care? Were there some bad elements in chiro that turned you off? Just curious... If I ever become an MD, I'd love to learn about what Chiros are doing, because for the most part the techniques they employ seem to be effective when properly done. Anyways, thnx again... - m Link to comment Share on other sites More sharing options...
Guest macMDstudent Posted June 10, 2003 Report Share Posted June 10, 2003 TY bcdentalgirl for the endorsement! j282, there is hope for you yet! At the U of Guelph vet school they are introduced to manual therapy for animals. I personally know nothing about it, but have heard anecdotal reports of it being a useful tool. The big bucks are in racehorces from what I've heard, but dachsunds are probably the most in need! As far as the placebo effect, that is true for drug trials as well. A little sugar pill will cause control groups to show some "treatment effects." The power of the mind is truly an amazing thing! Link to comment Share on other sites More sharing options...
Guest misagh Posted June 10, 2003 Report Share Posted June 10, 2003 oops, just read the thread you had posted macMDstudent, all my questions were answered there. Link to comment Share on other sites More sharing options...
Guest macMDstudent Posted June 10, 2003 Report Share Posted June 10, 2003 One thing I don't think I mentioned before was that I felt like I learned a lot of stuff in chiro school that I never had the opportunity to apply in the real world. Most people don't realize that chiropractic school is about 70% of the academic part of medicine (i.e. the first 2 years at a tradtional med school) with the rest of it more specific chiro and orthopedic type stuff. Of course, the clinical training is a lot less than clerkship and residency, there is no comparison there. I took gross anatomy with dissection of human cadavers, histology, embryology, neuroanatomy, physiology, neurophysioloy, biochemistry, clinical chemistry, microbiology, pathology, immunology, radiology (taking and interpreting x-rays of skeletal system including bone pathology), health jurisprudence, public health, physical exam (did Barbara Bates book from cover to cover with standardized patients) etc. All our courses were taught by Ph.D's, or MD's, (except the chiro specific courses which were taught by chiros). Many of our profs were faculty at U of T or on staff at Sunnybrook and assured us they were teaching to the same level as medical students. Rather than let all that information that I never used rot and fade away, I wanted to freshen up my memory and apply it in medicine. I also knew it would smooth my trip through med school such that it might not be as difficult as if I had never taken all that stuff. Plus, medicine is just really fascinating and always changing. I don't see I how I can ever get bored again! Link to comment Share on other sites More sharing options...
Guest me maniac Posted June 10, 2003 Report Share Posted June 10, 2003 macMDstudent, I, too, have gone to chiro's and benefited greatly from them. I finally knew what it was like to have a normal back. I went for about 3 years.... the only reason I stopped is because I felt like I was addicted to this guy. Whenever I didn't make it to his office for about three or four weeks, I was in agony! I even scheduled my vacations around my chiro appts! I actually suffered through about 8 months of back pain, refusing to go. Is this normal? Anyhoo, I don 't know what the big deal is about this chiro/MD issue. Why can't MD's realize they are not the be all and end all of medicine? Personally (and THIS IS JUST MY EVER SO HUMBLE (NOT!) OPINION!), I think a lot of it has to do with medicine being "the good ol' boys club" and is definitely old school. We need doctors who have an open mind to these kind of things - hopefully we are the start of that. Anyway, I think it's great you were a chiro. Wanna come fix up my back/neck sometime? me Link to comment Share on other sites More sharing options...
Guest macMDstudent Posted June 10, 2003 Report Share Posted June 10, 2003 Me maniac, the type of back pain you describe is not the majority of cases, but I would see some cases like yours in my office all the time. I would never tell someone they HAD to come in every 4 weeks, but I would say if you recognize the symptoms developing, give me a call and get in here, don't let it get worse. Looking at these people's charts retrospectively, I would often see a pattern of every 4-6 weeks, followed by great relief (usually immediately after treatment) that lasted about the same length of time each time. I can't explain it, it's not really well documented in the literature, BUT if I can help with someone's suffering and they come in on their own free will, then I will do the treatment. This is where the "art" of clinical practice comes in and you can't always follow a guideline exactly. People always ask me "can you get addicted to chiropractic?" My answer is that you have to look at that type of recurrant pain as a manageable but perhaps not a curable health problem. Are diabetics "addicted" to insulin? No, but if they stop taking it then their health will be adversely affected. There is no studies that I am aware of that a manipulation once a month or so is harmful, whereas the result of not getting one may be pain, loss of recreational activities, time off work/school etc. So why deny yourself relief? As far as treatment goes, sorry but I'm on sabbatical for a couple years. But I do plan on having an occupational health/sports medicine direction to my practice when I'm done, in which I still plan to use manual techniques for my patients. Link to comment Share on other sites More sharing options...
Guest UofCMeds2005 Posted June 11, 2003 Report Share Posted June 11, 2003 Hopefully there will be individuals like you around to educate us... Unfortunately, the only advice/info I have had with docs has been negative - but that may reflect a sort of old school territorial beh. But, it is to bad they don't give us more exposure to chiro in med school... Link to comment Share on other sites More sharing options...
Guest cgb2006 Posted June 11, 2003 Report Share Posted June 11, 2003 Let me echo the words of me maniac, the sun doesn't rise and set with MD's. j282, it seems that you've been too easily influenced by your mentors' seemingly narrow minded view of "medicine". The issue of animosity and misunderstanding amongst health care professions is one that really gets to me. Although I am not a chiropractor, I really take statements like those made by j282 to heart. I, like you macMDstudent, came into medicine from another health care profession. Like your's, my profession was and continues to be a profession which is poorly understood by many health professions, including MDs. I've heard many inaccuracies about my profession from MD and other lecturers throughout this past year, as you have about your own no doubt. What really gets to me are people who don't understand what another profession does, yet are so willing to discount it! This happens all the time, and frankly it is sickening. Instead of using your energy to challenge other professions, use your energy to learn about them. You may be surprised. Medicine isn't something only practiced by MDs. There is a huge collection of health professions that comprise it, including chiropractors, psychologists, PTs, OTs, RTs, lab techs, nurses, nurse practitioners, midwives, pharmacists, paramedics, etc., etc., etc......I could go on forever. I encourage all of you to make an effort to become educated as to what it is that others actually do. Then, and only then, will you have the right to criticize. From my own experience in medical school, I can tell you that you won't learn this in the classroom or from your MD mentors, but if you make the effort to educate yourself it will certainly prove to be valuable. I caution all of you to not take on such a narrow perception so early in your careers, there's a lot that can be learned from allied health professions. Arrogance about your own chosen field and ignorance about someone else's registers from miles away, and will cause many of these valuable resources to walk opposite your direction. macMDstudent, stand your ground. Its exhausting, I know, but if you don't try to educate people, no one will. Link to comment Share on other sites More sharing options...
Guest j282 Posted June 11, 2003 Report Share Posted June 11, 2003 You see I am very easily influenced by people who I think have more "knowledge" than myself (ie senior physicians) but when a chiropractor such as MacMDstudent educates me, then I listen to him because he has more knowledge than myself and obviously the Neurologists regarding his profession. BTW What is your health profession. I would love to learn more about it so that I am not ignorant towards it. I think in med school a good idea would be to have a work shop and allow us to get educated on the various allied health professionals. I agree with you, in that there is a strong degree of elitism amongst long time practicing doctors, perhaps a by product of the insane difficulty it is to gain admission. Link to comment Share on other sites More sharing options...
Guest misagh Posted June 11, 2003 Report Share Posted June 11, 2003 Great discussion folks! Thank you for your responses! I'm still wondering, however, if anyone knows of courses or programs that can train MD's in some techniques of adjustments, etc. I was speaking to a Chiro friend of mine a few yrs back and he mentioned mini-courses offered for MD's, but failed to give me any details. He even mentioned an MD or two in his Chiro program. Any ideas where I can go to look for this kind of info? On a side note, my chiro friend could apparently give very good massages, no doubt thanks to his training as a chiro. I figure, even if for some reason I couldn't perform good adjustments on my patients, at least I would be able to give good massages to my future wife - m Link to comment Share on other sites More sharing options...
Guest Climbing Posted June 11, 2003 Report Share Posted June 11, 2003 Hello, As a Physio, I just wanted to clarify one thing. Manual therapy is not just mobilizations or manipulation. There is much more to it. Furthermore, mobilization and manipulation were part of Physio treatments since the birth of the profession during the war. I don't want to bash Chiro, as I think too many PTs do so, I myself see one. I also worked with a surgeon who studied Chiro after MD. Just wanted to show a distinction that manual physical therapy did not start just because of chiro manips. If there are any more questions feel free to ask Link to comment Share on other sites More sharing options...
Guest MDbadly Posted June 12, 2003 Report Share Posted June 12, 2003 Wow great discussion, and lucky me what an appropriate post to ask some advice since there are chiro, PT, and future MDs present. Unfortunately, I have to go with my planB because I could not get into medicine. However, my planB leaves me with 2 options, either chiropractic school or physical therapy. I couldn't decide. Any advice/ suggestions? Thanks! Link to comment Share on other sites More sharing options...
Guest Mens Rea Posted June 12, 2003 Report Share Posted June 12, 2003 May I ask if you are a female? It's interesting that the P/T profession attracts many more females then males. My wife is actually a PT with her own clinic, she absolutely loves it and often says that the treatment she provides the patients is extremely beneficial. Good Luck, if you have any questions about PT you can post them here and I can forward them along to my wife. Are you thinking about Mac's PT program? In any case good luck to you Link to comment Share on other sites More sharing options...
Guest MDbadly Posted June 12, 2003 Report Share Posted June 12, 2003 Mens Rea, I'm male. I know, it's interesting that 90% of PTs are female. I would of thought otherwise. I'm leaning more towords chiropractic. However, I am trying to consider which one will provide me with more financial security. Don't get me wrong, money is not the reason I want to return back to school. If that's the case I would stay where I am at, running a profitable business. I know it's a taboo to mention money but lets be realistic, who wants to spend 4 years and $100 000 in debt (less for PT) and barely making any money. I know PT can find a job easily. Chiropractors, I'm not quite sure. There are some clinics that have tons of patients and other clinics so empty. (Maybe macMDstudent could comment more on this?...Thanks!) ... a bit off topic since this is a med forum. Well, my first choice would of been med school but what can you do but move on to planB. I've read your other post and I think you have a very good chance for medicine. Here's hoping that you will hear good news around this time next year. Take care! Link to comment Share on other sites More sharing options...
Guest Mens Rea Posted June 12, 2003 Report Share Posted June 12, 2003 Hey MDbadly: May I ask, are you a "mature" student (you mentioned returning back to school after running a successful business)? Were you granted interviews this year? Perhaps some small changes to your application may do the trick. I'm not sure how many times you have applied in the past, but another option is to write the MCAT and apply to UWO, Queen's, UofT, McGill etc., if Mac was the only school you applied to in the past. If at this stage you do feel the best move is to follow your plan B, I just wanted to say, don't feel too turned off by the large female ratio in PT, according to my spouse, things are changing quickly in the field. One of her good friends (male) actually landed a job with the Toronto Maple Leafs as Head rehab therapist (he's a PT) he gets free box seats to every game, a great maple leaf penision, stock ownership plans, gets to fly with the team and get free tickets for away games for him and his family whenever he wants, and the salary is starting at 84K + bonus based on a formula factoring the number of games they win. The last PT prior to him joining never had a total annual compensation fall below 100K. I know you mentioned money as a concern, and I know for a fact that PT can be lucrative as well. On that note, I can tell you that my wife's PT clinic is very busy as are her classmates. She has one PT (herself), a PT assistant and a receptionist. Her Net income has been in the 125K range for as long as I remember. Through owning her own business she also gets to write off the lease to her car, gas, pays herself a salary (to reduce the business's taxable income) and also has enough time to teach a course part time at a PT program. So there are avenues that can be rewarding from both a career satisfaction and financial perspective. I don't know too much about Chiro, but I hope this helps with some info on PT. Take care Friend Mike Link to comment Share on other sites More sharing options...
Guest macMDstudent Posted June 12, 2003 Report Share Posted June 12, 2003 I agree that "manual therapy" is far more than manipulation and mobilization. In my practice I used other techniques such as trigger points, myofascial release techniques, muscle energy techniques, manual traction, PNF, massage, etc. I just sort of lump them all together as manual medicine. I believe it was Sir William Osler who said "nothing is beneath me so as to help the suffering of a patient," so don't discount what a brief massage can do. The laying of the hands is a powerful therapeutic tool which should not be ignored, in my opinion. As far as learning to do manipulation as an MD, I don't know the route for that. I remember hearing about a couple "weekend courses" that were offered in the USA but I haven't heard of them in Canada. Maybe I should set up seminars and teach docs to work my way through med school! There is some authors you may want to read up on, to get an idea of techniques. MD's who have done a lot of work on manipulation that you may be able to find their books include Cyriax, Maigne, Mannell, Janda and Lewit. These are old books but the techniques are still the same. There is also another book that I haven't looked at in a while that was a good manual of Medical Manipulation for MD's. It was by Burn I believe. My feeling is that chiropractors are the best trained at manipulation techniques, and practice it the most in their education and on a daily basis. Physios, from what I know (working with a few over the years) can pursue a masters in manipulation (a great program at a university in Australia) or by post grad courses here in Ontario that are weekends/evenings for a year or two. Although they may have adequate training, if they haven't done as much of it as somebody else, they may not be quite as skilled. I am not saying that to put down PT's, because I worked with many and by working together we helped many patients. All I am saying is spinal manipulation is a technical, psychomotor skill. Knowing the set up of the patient, hand placement, the theory is one thing, but it takes a lot of practice to get good at it. It's like any motor skill in sports, for example if you understand the mechanics of the golf swing are you going to win the Masters? It also takes a while to develop a feel, to be able to "see" what the problem is by palpating the patient and developing "the touch." Patients are always surprised when I can find the exact spot that hurts by touch right away, but I couldn't learn that from a book. It wouldn't take me long to show the basics of the techniques to anyone, but you have to do it hundreds or thousands of times to get really good at it, and know how to do it in all different types of pain syndromes for the most patient comfort and best outcome. Anybody can learn to do it and get good at it (whether they are a PT, MD or DC), but my belief is to let the people who do manipulation every day, do the manipulation and let others concentrate on what they do best. As far as chiro vs. physio goes, I would have to say that depends a bit on your personality. I have to admit I found it hard to defend myself all the time as a chiropractor because of all the bad press out there. However, once I was established as a referral source for some MD's, they no longer cared what my designation was, just that I could help their patients. Overall, I think that your life would probably be easier as a PT. You will be part of the traditional "accepted" world of medical and allied health care workers. It is much easier to just get a job somewhere when you graduate, and start earning a salary. Or, you could be an entrepreneur and open your own clinic. However, in chiropractic you have to be very self sufficient because very few if any chiropractors are on a salary. When you graduate and join a practice you have to build your own practice from scratch in most cases, and that can take a while. You also have to be able to withstand the slings and arrows of people with bias, sterotypes and misinformation. That does get tedious and is not really part of PT. The potential for compensation can be large for either. Some chiros I know make serious coin (mid six figures) but in my opinion they are churning out high volume practices that I don't believe give the highest quality care, and engage in what I consider to be unethical, unscientific treatments known as "subluxation based" chiropractic. This is where they try to convince people that all their health care problems are the result of "misaligned vertebrae" and that the ONLY cure is to come and see them once a week for the rest of their lives. That type of thing infuriates me because its such rubbish, and in my opinion is what is causing all the troubles for the rest of chiropractors. The other way to make big money in either chiro or PT is to get into whiplash rehab, and milk the insurance companies for minor complaints. This is why our car insurance premiums are so high! I was in that game for awhile and although the money is nice, I find it just as unethical so I left that field. A couple physios I know own a string of clinics and have lots of physios working for them. The two owners make huge cash (way more than any MD in town, including specialists!). They are good physios with good treatment protocols, so it can be done ethically as well. Overall, you will probaly find that upon graduation from PT school, you will have more options with what setting you want to work in (hospital, private clinic, sports team etc), and decide for yourself whether you want to work for salary or start your own clinic. Either way, there is a potiential to make a very nice income. As a chiro, the options are limited when graduating, with either joining an existing practice and building your own practice within it, or starting your own clinic as basically the only two options. There usually in a gradual increase in income over the years as the practice grows, but that also makes it hard if you ever move because you have to start all over again, whereas PT is more "portable" to another location. If I had to do it over again, I would have gone the PT route myself. A lot less hassle in the long run, with very good career options. There are a few PT's in our med class as well, so that leaves that option open in the future as well. But that's just one person's opinion, and its worth what you paid for it. Link to comment Share on other sites More sharing options...
Guest jmh2005 Posted June 12, 2003 Report Share Posted June 12, 2003 Well, I have to agree, I think that chiropractors are very valuable health care professionals who have a unique set of skills, which can benefit many people. I myself have seen chiropractors and have gained much relief from my chronic upper back and neck pain. Actually, I highly recommend the services of MacMDstudent...an amazing chiropractor who has infact treated me a few times!! Personally, I don't think that PTs should be manipulating the axial skeleton...Myself as a former OT, witnessed the education and training of PTs (which is extensive, however not in axial manipulation) and I would only ever let a chiro touch my back or neck. Many patients would benefit from chiropractic services and we, as future physicians need to spend the time educating ourselves on ALL the allied health care professionals, so that we can best help our patients!! Link to comment Share on other sites More sharing options...
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