1. ROLE OF CHIROPRACTIC IN HEALTH CARE
A. Current Utilization
of Chiropractors
The cornerstone
of chiropractic care is the chiropractic adjustment and segmental mobilization.
Chiropractors also utilize other adjunctive treatments, including physical
therapy, rehabilitation and soft tissue manipulation. With an increase in
conservative or more natural methods of health care, utilization of chiropractors
has risen dramatically in recent years. Millions of Americans now include
chiropractic care as part of their health care programs. Recent studies published
by (1) the British Medical Journal, (2) the Manga Report, and (3) the Rand
Corporation, document the efficacy of chiropractic treatment in treating certain
structural disorders. Acceptance of chiropractic treatment within the medical
profession has grown, as evidenced by the growing number of referrals from
medical doctors in recent years.
B. Historical Role
Historically, many of the early founders of chiropractic believed that a spinal misalignment or subluxation was responsible for disease and other physical maladies. They believed that correction of these subluxations through spinal manipulation could cure most anything. A minority of chiropractors still adhere to this one cause one cure theory. The group is commonly referred to as "straight chiropractors", and they tend to align themselves with the International Chiropractic Association. Most chiropractors currently see themselves as specialists mostly treating soft tissue and skeletal disorders. They regularly interact with other health care professionals and tend to align themselves with the American Chiropractic Association.
II. RECOGNITION AND REGULATION
The chiropractic profession is licensed and regulated in all 50 states, the District of Columbia and many foreign, countries. The federal government recognizes chiropractic care and includes it in health coverage for many of its employees, as well as in Medicare and Medicaid. Many commercial policies also include care, along with many managed care programs. All states include chiropractic care as part of their workers' compensation programs
Every jurisdiction regulates the scope of chiropractic treatment by statute and/or case law. Currently, Michigan has the most restrictive scope of practice, while Oklahoma has the broadest. In Michigan, chiropractors are limited to locating and treating spinal misalignments or subluxations. In Oklahoma, chiropractors are allowed to perform any diagnostic tests and procedures taught at any of the approximately thirteen accredited chiropractic colleges. This allows them to:
Utilize physical
therapy modalities,
Draw blood,
Perform acupuncture,
Do pelvic and rectal exams, and
Assist in childbirth with others.
Chiropractors are prohibited in all jurisdictions from:
Prescribing
medications,
Performing surgery, and
Administering injections.
III EDUCATION
A. Undergraduate Preparation
All applicants to chiropractic colleges must have a minimum of 60 semester hours of college credits from a two or four college or university with state or regional accreditation. The majority of chiropractors have four year undergraduate degrees, and there is a trend to making this a requirement to enter chiropractic school.
B. Chiropractic College
Chiropractic
education is geared to prepare the practitioner to be a portal of entry
or primary care provider in the health care system. The chiropractor is
educated to evaluate, diagnose, treat, consult with and refer to other
members of the health care community
The chiropractor's four year educational training is similar to that of a
medical doctor or osteopathic physician. However, chiropractors receive no
surgical training and much less training in pharmacology. The substitute tends
to be with additional courses in anatomy, physiology and diagnosis.
Chiropractic education at accredited chiropractic colleges follows guidelines
specified by the Chiropractic Council on Education ("CCE") a division
of the Department of Health, Education and Welfare. The CCE is nationally
accredited agency established in 1974 to provide chiropractic colleges with
academic and clinical guidelines.
C. Postgraduate Education
Presently, postgraduate education and residency programs are available in several areas of study. However, CCE standards do not apply to these programs, making their quality and value extremely variable.
D. Continuing Education
The scope of chiropractic practice changes periodically, so chiropractors must keep current. The vast majority of states require a minimum number of hours of board approved continuing education for license renewal.
IV. INITIAL EXAMINATION
All initial chiropractic exam and work up is similar to most traditional medical exams.
1. Information Taking
Initially the patient should fill out an entry data form or a confidential patient health record.
2. Review
The doctor should review this initial information with the patient.
3. History
The doctor should take a comprehensive complaint history. This history taking process is considered by many to be the most important process in the interaction between the doctor and patient. The taking of a complete history aids the doctor in deciding what type of examination and procedures to utilize. A complete history should include:
Present symptoms
and complaints; and
Personal, family and accident history along with a review of systems.
4. Physical
Generally a physical examination should include:
Taking of
vitals, checking ranges of motion, muscle testing,
Neurological and orthopedic testing,
Palpation, auscultation
Observation, and postural examination
A vascular examination.
The physical examination will vary considerably based on location, duration and severity of the complaint.
5. Diagnostic Studies
Following the physical examination, the chiropractor should initiate diagnostic testing, The chiropractor should perform an X-ray study including at least an AP or lateral view on areas of involvement or regions of the the chiropractor anticipates will require manipulation. Plain film radiography rules out bony or soft tissue pathology, and assists the chiropractor in biomechanical assessment. The chiropractor may elect not to take X-rays in the case of a pregnant female, or where current prior X-ray or other diagnostic studies are available.
6. Post-Examination Conference
Following the initial history, examination and diagnostic studies, and prior to commencing treatment, the doctor should conduct a post-examination conference or a report of findings. This conference is vital to:
Discuss findings
from the initial workup,
Explain the diagnosis,
Explain the anticipated treatment program, and
Explain some of the risks and benefits of chiropractic care
7. Referral
In some cases, the patient may have a condition not amenable to conservative care. In this case, the chiropractor should refer the patient to another health care provider.
V. TREATMENT
1. Progress Notes
Once a patient is under active care, the doctor has the duty to maintain thorough daily progress notes. These entries should explain in detail what transpired between the doctor and patient on each visit. In addition, the doctor should date and initial each entry. Adequate daily progress notes are vital to justify continued care and periodic reassessment of the patient's progress and response to treatment.
