March 2010
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Live and Let Live?

Live and Let Live?

The Chiro.Org Blog


SOURCE:   A Chiro.Org Editorial


Here’s a question I don’t have an answer for:

Do chiropractors need to adjust people while the patient is under anesthesia (a.k.a MUA)?

I have no experience to guide me. I have never met a patient whose muscle spasm (or spinal “fixation”) was so great that I was not able to adjust them. Of course, that doesn’t mean that they might not be out there somewhere. I can only assume that’s why someone came up with the idea of MUA in the first place. Until now this never seemed relevant to me, and I didn’t pay attention to the evolution of this practice.

What I do know is that organized medicine is in a huge uproar about MUA.

A March 22 posting on the AMA-News WEBSITE [1] reports on new MUA guidelines adopted in February by the California Board of Chiropractic Examiners, and the response of the medical establishment.

In early February, I reported on a similar story in Texas [2] because of a unique twist: Besides resisting chiropractor’s right to provide MUA, the TMA (Texas Medical Association) decided to challenge Texas chiropractor’s “right” to diagnose. Now, them’s fighting words! This posting generated a lot of responses, and was the most-read posting for February. The Texas Chiropractic Association Web Site recently posted these comments:

Judge Yelenosky, a Texas juror stated: “granted in part as to the Chiropractic Board’s use of the word ‘diagnosis’ in its rule. However, the court reserves judgment regarding ‘diagnosis’ as it relates to scope of practice.” Says the judge, “Turning to the Board’s use of the word ‘diagnosis’ in its rules, the statutory language does not preclude it. There is no statutory definition of the word, and its ordinary meaning is the identification of the nature or cause of a condition, which is not different substantially from ‘evaluation’ or ‘analysis’ (the terms found in legislation that defines the practice of chiropractic in Texas). The issue is not the word, but the scope of practice–diagnosis of what and for what purpose.” Says Judge Yelenosky, “I am reserving judgment on TMA and TMB’s claim that construing the statute to permit particular rules of diagnosis would impermissibly allow the TBCE to authorize the practice of medicine. Expert testimony is pertinent to that question.” [3]

Well, all I can say is that MUA has opened up quite the can-o-worms in Texas and California. I still don’t have a strong feeling about MUA, but I do now have mixed feelings about the uproar it’s generating, and I ask myself…is this a fight worth fighting? I’d love to hear from doctors who have trained to provide this service.


REFERENCES:

1. California Physicians Object to Expanded Scope for Chiropractors
AMA-News ~ March 22, 2010

2. Organized Medicine Attempts To Deny Chiropractors Right To Diagnose in Texas
Chiro.Org Blog ~ February 4th, 2010

3. Follow-up News about the Court Case
Texas Chiropractic Association Web Site posting

8 comments to Live and Let Live?

  • WashingtonChiro

    I am not certified to perform MUA however I would say that this is a turf war and has nothing to do with MUA itself. The fact that MUA is legelly within the scope of practice in California, it most definetly is a fight woth fighting for… the profession needs to hold its ground and maintain its right to perform MUA’s, even if no one were to ever utilize this procedure. As soon as we give up a little ground on this one, it opens the door to be challenged on something else, and something else… until our scope of practice has become so eroded that the profession has become severly marginalized.

  • I’m not sure how it’s a turf war when a MD has to be the one to apply the anesthesia. I seriously doubt that there are any MDs out there attempting to do MUA themselves.

    One would think that Medicine would welcome MUA as an additional stream of income, once they can “got past” the idea of cooperating with a DC.

    I think this is an unresolved issue following the Wilk anti-trust case of the late 80s. Medicine knows it’s OK to accept a referral now, but they’re still unclear how to “work” with us as co-professionals.

  • I think only chiropractors should do chiropractic. I am not really sure why it needs to be done under anesthesia, but I don’t think I would send a patient to have that “procedure” done.

  • I just completed my certification (via Western States). As someone who has experienced cases where an auto accident patient needed a year or more of care to restore them to their previous quality of life, I find that MUA is an excellent procedure to help certain patients get past a plateau by doing more (breaking up more scar tissue, stretching the muscles farther) than one could while the patient was concious. I had had my reservations about this procedure, but witnessing the dramatic improvement of the patients is what won me over. If doctors out there are curious, ask to observe the procedure and speak to the patients afterward. Bottom line you will get your patients back to a better quality of life faster.

  • I know this posting has been up for awhile but I had to leave a comment. I am a 20 year vet in the profession and I can only say that this has nothing to do with MUA and everything to do with medicines prejudice against our profession. When I was in Chiropractic college, they were requiring us to PROVIDE a diagnosis in order to be reimbursed by insurance ( a feeble attempt to keep us out of insurance. This will be a never ending battle. A REAL comparison would be the Arabic nations vow to see Israel pushed to the sea even though they are in talks to compromise. They don’t want the Jews in Israel at all just like the MD’s don;t want us in health care at all. There will always be something. I remember thinking years ago that if we have to continually defend ourselves, we will never be able to move forward out of that mode. We need to forget about defense and start providing offense. Let’s get out there with media, internet and what ever else it takes to tell our story and make our point to our audience, the people. We don’t need to “prove” anything to medicine, we need to show patients what we have to offer through the medium that even the medical profession and drug industry use to sell themselves.


    RESPONSE from Frank:

    Thanks Dr. Jay.

    I agree with your point that we don’t need to “prove” ourselves. I saw a humorous comment yesterday at at a website that said “science doesn’t prove, it provides evidence for or against. If you need proof, then you need to look to mathematics, not science”.

  • This is usually done by a certified chiropractor in this method in a hospital outpatient setting when the patient is impassive to traditional adjustments.

  • All types of anesthesia involve some risk, though major side effects and complications from anesthesia are uncommon. Even so, undergoing anesthesia can cause “nausea, sore throat, headache, muscle aches, or a generalized “hang-over” type feeling. Fortunately these are most often not serious and resolve on their own in hours or a few days after surgery. Even though many patients will feel quite awake and unaffected by the anesthetics after the surgery, the bodies reflexes will continue to be influenced for a minimum or 24 hours. Therefore it is mandatory the patient not drive or operate heavy machinery for a minimum of 24 hours.” http://www.reddinganesthesia.com/general.htm

    To me, the risks outweigh the benfits by a long shot!

    James A Devine DC

  • Exactly, I see the cost outweighing the benefits. Poison the body with toxic chemicals to stretch muscles and scar tissue? No thanks..

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