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Point/Counterpoint: Seeking A Second Opinion on Expanded Chiropractic Practice Part I

Home/Editorial, Expanded Practice/Point/Counterpoint: Seeking A Second Opinion on Expanded Chiropractic Practice Part I

Point/Counterpoint: Seeking A Second Opinion on Expanded Chiropractic Practice Part I;
A Prescription for Professional Disaster

The Chiro.Org Blog

SOURCE:   Dynamic Chiropractic

By Gerard Clum, DC

President Emeritus,
Life Chiropractic College West

There has been a lot of recent traffic to our postings about Alabama [1] and New Mexico’s attempts to gain prescription rights. For that reason, we are featuring 2 articles, both pro and con on the topic of expanding chiropractic practice into the realm of medicine. We hope you will find the following 2 articles of interest.

See also:
Point/Counterpoint: Seeking A Second Opinion Part 2:
Best for the Profession or Best for the Public?

The expansion of the scope of practice of chiropractors to prescribe drugs is an absolute non-starter for me. In recent weeks, this conversation has moved to center stage, as evidenced by activities in the states of New Mexico, South Carolina and Alabama, as well as at the biennial gathering of the World Federation of Chiropractic (WFC).

Legislation proposed to expand the authority of chiropractors in New Mexico to prescribe broadly failed; the South Carolina measure appears to be mired in committee; and the Alabama State Chiropractic Association voted down a proposal to seek such an expansion. The WFC, while presenting a forum on this issue, has not changed its policy that the practice of chiropractic is without drugs and surgery.

The battle lines are rather well-drawn and clear. One element within the profession seeks to alter the history, tradition, conceptualization, culture, laws and regulations under which we have existed throughout our entire existence to include prescription authority of various extents. This view is being opposed by members of the profession who object and perceive the very heart of our clinical approach being hijacked and transformed into the practice of medicine.

“Conflicts Clarify!”

A recent legislative hearing in New Mexico did just that: it clarified the intent and extent of the drug lobby in chiropractic. In the past, whenever the question of prescription authority in chiropractic came up, it was always related to injected vitamins and nutritional support, as opposed to the common understanding of prescription medications associated with the practice of medicine.

In Santa Fe, N.M. on March 17, 2011, the veil was pulled back on that charade as representatives of the National University of Health Sciences and University of Western States joined members of the executive committee of the New Mexico Board of Chiropractic Examiners in seeking legislation that would allow the use of “primary care drugs.” Further, these representatives indicated that they were part of the solution for New Mexico’s primary care shortage with their willingness and self-perceived ability to treat patients with hypertension and diabetes, among other maladies. It is now clear and on the record that this is not about nutrition in any shape or form; this is about the practice of primary care medicine under the auspices of a chiropractic license.

During the recent meetings of the assembly of the WFC, held in Rio de Janeiro, our European colleagues repeatedly referenced Switzerland as an area of the world with prescription drug authority extended to chiropractors. In the process, it became clear that the “prescription” authority given to a chiropractor in Switzerland is the ability to tell a patient to take anything; the patient can walk into a pharmacy and buy without a recommendation of any prescriber. If the chiropractor suggests it, the federal health insurance will pay for it. The chiropractor has no authority for recommending drug use beyond that which every Swiss citizen possesses on their own!

This dialogue is laden with overlapping, confusing and variable meaning terms that must all be clarified for any rationale conversation. For example, what is a drug – a regulated/controlled product to address a specific health care circumstance. Some will point to the inclusion of high-dose vitamin therapy as potentially being removed from the practice of chiropractors if these products were defined as drugs, and therefore restrictions will exist if provisions aren’t made for the prescription of “drugs.” Further, the question of what a prescription embraces must be considered.

In the United Kingdom, the recommendation for a patient to obtain a lumbar support or a rib belt requires a “prescription.” In the U.K., the British Chiropractic Association (BCA) polled its members on their thoughts about “prescription” authority for chiropractors. As the concept of what required a prescription was far broader than prescription medications and included products routinely associated with chiropractic practice, the survey question received considerable support. It must be noted that they never sought to address the specific question of prescription medications and never sought to involve members of the other three associations in the U.K. that collectively rival the size of the BCA.

For this conversation to be meaningful, regardless of which side of the question you support, the terms of reference must be understood. Additionally, the strengths and weaknesses of literature and survey data brought in support of this position must be appreciated.

Primary Care Provider

Consider the term primary care provider. Every chiropractic program in North America indicates that it educates and trains its students to be “primary care providers.” This is a correct statement. It is informative to understand that if an institution does not assert this view it will not be accredited in the United States. Period. Therefore, to point to all of the chiropractic programs supporting the chiropractor as a “primary care provider” is a gun-to-the-head position. It may in fact be the view of all of the colleges, but it remains a fettered assertion. Primary care provider in the chiropractic context is not a primary care provider in the medical context. They differ in scope, education, clinical training and authority.

The very definition of primary care provider is open to wide interpretation and variance. These interpretations are not limited to the chiropractic profession, as profound differences are also found in medicine, nursing, etc. There is no agreed-upon definition of “primary care provider.” Some definitions are procedure- and task-specific; others are more conceptual and related to broad duties. To use the term in a fashion that conveys universal agreement as to what the term means is dishonest.

The 2007 version of the CCE Standards does not define primary care provider; rather, a “primary care chiropractic physician” is defined as follows: Primary care chiropractic physician = An individual who serves as a point for direct access to health care delivery, the doctor of chiropractic’s responsibilities include: (1) patient’s history; (2) completion and/or interpretation of physical examination and specialized diagnostic procedures; (3) assessment of the patient’s general health status and resulting diagnosis; (4) provision of chiropractic care and/or consultation with continuity in the co-management, or referral to other health care providers; and (5) development of sustained health care partnership with patients.

The only aspect of this definition that makes it unique to chiropractic is the phrase “provision of chiropractic care.” This vague definition is further made troublesome because the Standards make repeated reference to “primary care physician” or to the “primary care setting,” as opposed to the term defined.

Our colleagues, as evidenced in New Mexico, play “fast and loose” with this issue of “primary care provider,” repeatedly and consistently linking the fact that every chiropractic college asserts to train “primary care providers,” and further suggesting by inference and implication that primary care in the chiropractic context is the same as primary care in the medical context. This is simply not the case, and an error of omission or perhaps even commission to assert the same.

Taking Privileges With Prescriptions and Patient-Centered Care

Other arguments asserting “best practices” require us to have access to prescription authority are also being put forward. The reasoning goes as follows: The Neck Pain Task Force identified a series of interventions supported in the literature for the care of axial neck pain. Among these procedures were spinal adjusting (spinal manipulation, to be true to their language), certain exercises, nonsteroidal anti-inflammatory agents (NSAIDs), acupuncture, etc. In light of these findings, it is now being asserted that chiropractors need prescription authority for NSAIDs.

Little thought appears to have been given that this reasoning would call for every physician utilizing “best practices” relative to neck pain to be trained in spinal adjusting (manipulation). The reality is that NSAIDs were identified as an approach with adequate evidence to support it. Period. It was never asserted that NSAIDs required manipulation to be effective or that manipulation required NSAIDs to be effective, or that the use of the two together was superior to either alone. The use of the “best practices” argument in this area is disingenuous.

The “patient-centered care” argument is being used to advance the drug issue onward. This argument holds that we should be offering patient-centered care. Agreed! But the argument further suggests that this means if a patient comes to a chiropractor and wants prescription drugs for their problem, the chiropractor must provide the same to be consistent with the spirit and intent of the policy of patient-centered care!

The “if we can put them on drugs, then we can take them off of drugs someone else has prescribed” argument is next. From an interprofessional perspective, this is “living in a powder keg and giving off sparks.” The common-sense side of the consideration is that the drugs chiropractic patients would be given by other providers for pain, muscle spasm etc., are all patient required need (PRN) drugs that patients invariably remove themselves from without any professional advice or counsel.

The drug issue is being argued to be the panacea for the future of the chiropractic profession. It is asserted that interprofessional differences will lessen, interprofessional respect will increase, patients will flock to chiropractors and economic strength will follow the adoption of this practice. Those would all be nice things, but to assert that they will flow from such a central change in the paradigm of the profession causes me to ask, “What kind of drugs are you on?”

Enjoy the second article in this series:

Best for the Profession or Best for the Public?

Dr. Gerry Clum is the former president of Life Chiropractic College West (1981-2011) and the past president of the World Federation of Chiropractic. He is currently a member of the executive committee of the Foundation for Chiropractic Progress.

1. Majority of Alabama Chiropractors Favor Limited Prescription Rights
Chiro.Org Blog ~ Feb 18, 2011

About the Author:

I was introduced to Chiro.Org in early 1996, where my friend Joe Garolis helped me learn HTML, the "mark-up language" for websites. We have been fortunate that journals like JMPT have given us permission to reproduce some early important articles in Full-Text format. Maintaining the Org website has been, and remains, my favorite hobby.


  1. John Wernz June 6, 2011 at 9:49 am

    I graduated from Dr. Clum’s Chiropractic College after transferring from a “mixer” School. The tremendous costs in money, effort, and time ..for Both…..were largely a waste, because in practice I never use 99% of it…EVER!!!! Maybe things have changed since then, but Chiropractic Education seemed to value it’s own income, status, and existence far more than creating a Chiropractor that can survive by providing services that far exceed those of his/her Medical competitors.

    Most Chiropractors I’ve visited (and this has been a lot)… if they are succeeding financially, do so by excellent business practices, not by excellent Clinical results (Although they say they get them). So if we are given the right to prescribe drugs, it may be an excellent business (money) decision, but a disaster clinically.

    Almost everyone gets well quickly with Chiropractic and holistic methods. But the money is really in drugs and association with the Medical System! So what do we do? If we reject prescription authority, do we demise in numbers & income as a profession?

    If we accept it do we increase in numbers and income… but our patients deteriorate and become like those in M.D. waiting rooms? (I am in the habit of dropping in on M.D.’s waiting rooms and checking out the patients)? We may have to cave in to the Devil to be allowed to exist????

    RESPONSE from Frank:

    Dr. Wernz,

    Many DC students wonder why they take classes in things like nephrology, when they are not likely to need it on a daily basis.

    • Doctor means a learned person. When a patient comes to us, and we adjust them, part of what we are telling them is that their neck pain is NOT coming from an apical lung tumor, or any of the other numerous things that can cause (or mimic) neck pain. That’s our job…to diagnose them, and to design a plan to help them. So…you may never see a patient in the beginning stages of renal failure, BUT, if you do, you need to recognize that the patient needs a STAT referral. That is why you took all those *other* classes.
    • Should we blame chiropractic schools for failing to train students how to be good business managers? Perhaps the schools should be encouraged to require business training along with the pre-med classes as pre-requirements for entry to our schools. But all these students were adults when they applied to the school, and they should have realized they were going into the business world, and that it was their own responsibility to learn how to succeed in business.

      All too often, Americans want to shift the blame for failing students onto the schools and teachers, when we all know that it’s really the failure of the family to see that their children are well prepared to succeed

  2. Frank M. Painter, D.C. June 6, 2011 at 2:08 pm

    A certain individual who is in favor of promoting the medicalization of chiropractic has been trying to suggest that Dr. Clum’s New Mexico testimony denigrated the profession, as though we weren’t capable of learning how to become medipractors. I removed his original posting because it was unsupported by any documentation.

    Excuse the (potentially) pejorative term, but turning DCs into MDs has been classically been referred to as creating medipractors, so it’s just a convenient term to describe the medicalization of our drug-less profession. The truth is, if the vast majority of the profession actually do want prescriptive rights (and I doubt that) then the change will come. That’s different than a vocal minority wishing it were so.

    If you have the authentic transcripts from the New Mexico hearings, and you feel that comments from either side denigrated the profession, then share the evidence. It will make your opinion unassailable.

  3. Maine Chiropractor June 6, 2011 at 3:01 pm

    I don’t think I’d blame the schools for giving us unnecessary training. If anything the curriculum needs to be more difficult. They need to work harder to separate the wheat from the chaff so to speak. I don’t hold out high hopes for that however as their admissions process is just crazy (at least where I went, most of my colleagues say the same though). It’s clear that the profit motive drives the admissions department at chiro colleges. This relates directly to the prescription drug debate. If the admission standards in chiropractic education improved, there would be the opportunity for DCs to get advanced placement in osteopathy or medical schools. They could graduate sooner. Then they would be able to do both prescribing and chiropractic without fundamentally altering the profession for those of us who have no desire to push pharmaceuticals. As things stand now, the GPA’s that most students bring to chiropractic college, coupled with the way they frequently waive entrance prerequisites make this impossible. If we cleaned up the admissions process, then this whole ugly argument could be avoided.

  4. Kirk Manson DC June 6, 2011 at 10:37 pm

    I was not aware transcripts of the testimony in NM was available. Please state where I might obtain these documents. As a DC involved in the AP program I would be very interested in seeing these statements.

    RESPONSE from Frank:

    This testimony was held in front of the New Mexico Senate Judiciary Committee. I believe it’s routine to tape, and perhaps even to transcribe, all such meetings.

    A quick review of their website shows they have all of 2010’s meetings available, so they probably have recordings of this meeting as well, stashed away somewhere:

    This particular topic is a very “hot button” for proponents on both sides of the issue. We posted the articles so the profession can see what’s going on in their name. My only interest is for the accuracy of any statements anyone may make about what was said there…not their interpretation or opinion of what was said, but what was actually said.

  5. Dr. Arno Sullivan, D.C., M.D. June 8, 2011 at 1:04 pm

    Dr. Gerry Clum is the former president of Life Chiropractic College West (1981-2011) and the past president of the World Federation of Chiropractic. “He is currently a member of the executive committee of the Foundation for Chiropractic Progress”

    Progress?? Seems like an oxymoron!

    RESPONSE from Frank:

    And your point is?

    I see you chose to become an MD. Bravo!

    How do you feel about DCs prescribing meds after taking a short course?

    That’s THE question.

    The real issue is whether DCs should be allowed to practice medicine without your license. That’s a very simple analog choice…yes or no.

  6. Maine Chiropractor June 8, 2011 at 4:11 pm

    Dcs who wish to practice medicine should go back to school and get additional letters after their names just as Dr. Sullivan did. Instead of spinning their wheels on the DCM issue, those who are of a medical persuasion should work on developing relationships with medical or osteopathy schools. Perhaps the development of an advanced placement program that recognized and transferred the appropriate credits (if the candidate is qualified and taking undergrad GPA and prerequisites into account) would be a better avenue?

  7. Las Vegas Chiropractor June 18, 2011 at 3:42 pm

    I tend to agree that we should be able to prescribe medications, however I also see how it could be misused. It would mean kiss our cheap malpractice insurance goodbye. I would just like to have more tools to help treat very acute conditions. I wish that could come up with a nice alternative like just being able to prescribe pain meds. It would save the medical community as a whole a lot of money.

  8. Charlotte Chiropractor September 7, 2011 at 11:32 am

    I think if someone wants to have limited prescriptive rights than they should after completing continued education. I do’nt think we have to go and get MD after our names to prescribe steroids, pain pills and muscle relaxers.

    • Frank M. Painter, D.C. September 7, 2011 at 11:45 am

      Charlotte Chiropractor,

      Can you tell me why you feel that taking a short Continuing Ed class should empower someone (or anyone for that matter) to prescribe “steroids, pain pills and muscle relaxers”?

      I hear your interest, and now I’d like to hear your logic.

      If you were an MD, how would you feel about that?

      How would you feel if someone took a weekend class and then professed that they were providing chiropractic care, without first earning a DC degree from a CCE-accredited school?

  9. Adam Chaifetz, D.C., D.I.B.C.N. September 13, 2011 at 10:19 am

    MD’s can learn manipulative techniques in seminars, as well as Doctors of Physical Therapy. I definately would like to see courses in pharmacology for D.C.’s and certification for those who choose to prescribe. PA’s and Nurse Practitioners have the training to do this, and I think D.C.’s could be qualified also. For those who choose not to, it would be their choice. Chiropractic is to restrictive, and those who would like to expand the scope of practice should be free to do so.

    • Frank M. Painter, D.C. September 19, 2011 at 11:32 pm

      Hi Adam

      Yes, PA’s and Nurse Practitioners are trained in drugs, BUT they are trained by the medical establishment, as a support for the allopatic model of care.

      The DCs you are talking about, who’s going to train them…somebody at National College? You MUST see the difference, and believe me, the AMA and every State Medical Society will too.

      I’m not against the *idea* of judiciously using meds to help patients. I’m against the foolish belief that Organized Medicine is just going to stand idly by while you march into their pharmacy with your hand out. Look at how they over-reacted in Texas to MUA.

      Our whole profession struggled just to pay the costs for JUST ONE COURT BATTLE (Wilk). Who’s going to pay for ALL those fees for fighting case after case in every State? It sure won’t be me.

  10. Indiana Chiropractor September 19, 2011 at 10:48 pm

    Adam is right. MDs can already manipulate their patients with no training. Here in Indiana, MDs or DOs can perform acupuncture with no training. A medical license means you can do anything. If you think we DCs own manipulation, you are sadly mistaken. I also think you’ll see nurse practitioners pushing for this in their scope very soon once the Doctor of Nursing Practice degree is starting to be awarded (come 2015).

    We chiropractors treat 1 thing: subluxations. Manipulation is a tool, it is not the tool. Having only 1 tool is entirely too restrictive.

    @Painter: When I graduated last year in June 2010, I had to have the same prerequistes as a student entering a medical or osteopathic program. Pharmacology is course work offered in the professional program. Why you think chiropractic schools couldnt incorporate pharmacology courses into their programs is beyond me.

    The days of drug free chiropractic are over. The CCE has said this. The ACA today said this. New Mexico said this. And soon, other states will too. Change isn’t coming- change is here.

    We MUST come together and figure out a solution to this debate that works for the majority of our profession. If we don’t, chiropractic is going to end up in some new form that NOBODY likes.

    Open your minds and your ears, and I’ll do the same. But change is upon us, whether any of us like it or not. We must choose our battles, because we don’t have the resources to fight them all.

    • Frank M. Painter, D.C. September 19, 2011 at 11:01 pm

      Hi Indy,

      It’s not my concern what MDs can do with their license. The fact that they *can* manipulate with minimal training doesn’t make it right, and it certainly does not assure them of any measure of success with it. I don’t recall hearing that we *own* manipulation, but I do say: Nobody Does It Better! And I say that with pride! The Back Letter reported (1998) on “MDs Employ Spinal Manipulation After a Short Training Course“, and the results were exactly what you would expect.

      If chiropractic doctoral programs remain with the same fixed number of hours they have now (like 4800) which classes do you think you could do without, to fit in the pharmacy material? The ideal solution is to maintain DC training like it is now, to turn out fully trained and integrated doctors, and then let them enroll in classes to learn formulary, like we already do with Diplomate programs.

      You claim: “The days of drug free chiropractic are over”. A few DCs in New Mexico and a few politicos in the ACA don’t speak for the whole profession…they only speak for themselves. The simple truth is that IF a majority of DCs choose to go in the same direction, hand in hand, no one will be able to stop them.

      Yes, change is in the air. It might be a profession moving to drugs and minor surgery, or it might be a majority tarring and feathering that vocal minority. We’ll all stay tuned to this big time. We live in interesting times!

  11. Susan December 9, 2011 at 5:01 pm

    As an MD let me offer a few tidbits of information. First, we (meaning a lot of MDs) would welcome prescribing chiropractors since we are both considering what would benefit the patient. I have researched subluxation and I actually believe there is something credible to it.

    However, I think it is wrong for straight chiropractors to prevent other within their own profession from offering prescriptions and minor surgery to patients “who may actually want such a chiropractor in their life.”

    Adam and IndianaChiropractor in their blog from above are correct, chiropractic is changing. I have a number of chiropractors here in Augusta, GA refer me patients and I in return refer patients to them. Most of these patients unfortunately had never been to a chiropractor but when they come away from these chiropractors (2 generally) they say things like I wish my chiropractor would prescribe me medications as well then I wouldn’t have to go to my general practitioner for prescriptions.

    As far as the training that would be needed for pharmacy rights, I believe Dr. Painter and Dr. Clum are over evaluated things. Most medical schools and nurse practioner programs simply provide a 90 hour course in pharmacy. Thus, most chiropractic colleges could offer a similer course “during” their chiropractic school training and not offer a diplomate program for such a course because that would be overkill.

    Furthermore, I believe it was Dr. Painter who stated who would teach such a course well that is simple. A pharmacist could be hired by most chiropractic colleges to teach the course and most towns and cities have pharmacist who would perhaps enjoy teaching these classes on a part time basis.

    As a orthopedic specialist I don’t look at chiropractors as competition or the enemy in the healthcare field; as a matter of fact, I consider chiropractors as equals and a necessary component in the healthcare paradigm. If some chiropractors (straights) don’t see any interest in providing drugs then don’t but I for one would like to have a relationship with a prescribing chiropractor that I can continue to refer patients with.

    One blog stated that chiropractors have cheap malpractice insurance that would like stay the same if all the chiropractor is doing is prescribing versus performing surgery. Anyhow, I just wanted to add my two cents lol.

    So if you are interested come on and start prescribing because if you don’t some other field will and again one group shouldn’t stop another from broadening their scope.

    Another thing my research did show is that Sherman College dropped the “straight” from their name and South Carolina as a state is considering in providing chiropractors with prescriptive rights. Now what does that say? Maybe some of you who want prescriptive rights should hire lobbyist or contact big Pharma since they would benefit too.

    • Frank M. Painter, D.C. December 9, 2011 at 5:27 pm


      What a breath of fresh air to hear from you. I hope that your whole profession feels the same way, because it looks as though some DCs will continue to push for this.

  12. Susa December 9, 2011 at 7:04 pm

    Dr. Painter I would not speak for an entire profession of MDs. If I did that I would be doing exactly what some are chastising Dr. Clum for doing which is attempting to speak for an entire profession, lol. Since I posted earlier I did think about some more on the subject. I notice that a significant number of chiropractors say that they refer certain patients to MDs; yet, in the same breath a number of these same chiropractors MUST realize that us MDs are PRESCRIBING drugs to those same referred patients. It is ironic that chiropractors are simply referring these same patients over to us and we are doing nothing more simply prescribing drugs, which is something that most DCs could do. Think of it this way. In most states a nurse practitioner can prescribe drugs and the way I see it DCs have way more professional level courses than a nurse practitioner. It’s just mind-boggling as I sit here and think on this. I read some place that chiropractors have the highest loan default rates out of college. Is there any truth to that? One has to wonder what would happen once they have prescriptive rights? Again, I can’t and wouldn’t attempt to speak for other orthopedic specialist but I can honestly say that we don’t stand around the water cooler bashing chiropractors because they want to prescribe drugs if anything we question the infighting between your profession.

    • Frank M. Painter, D.C. December 9, 2011 at 9:42 pm


      Personally, I am not a proponent of prescribing since I find that most patients get beyond the acute pain stage so quickly, and a few of them are already self-medicating with NSAIDs anyway, even though I review the risks for GI bleeds with every patient. When I refer patients, it’s rarely for the neck or low back complaints that presented to my’s for co-morbid conditions that need attention or the very rare patient who does not respond positively to chiropractic care.

      Regarding the in-fighting you mentioned… in reality, all that is generated by a few hundred outspoken extremists. Because they are so vocal, and have generated their own means of being heard (websites, free newspapers), even you have heard about it, but the reality is that this is a small minority. The rest of us continue to do what we are trained to do, wondering what all the fuss is about.

  13. John Wernz February 19, 2012 at 9:43 pm

    I was looking over the replies above (including mine!) and wanted to add these comments.

    I do feel the Chiropractic Colleges teach way too much material that is of dubious value in the real world. (Actually this is symptomatic of all American Education… no wonder people graduate without sufficient skills to make it in the real world). I went to Life West Under Dr. Clum and I have to admit that his hands may have been tied by the rules of Chiropractic Educational regulations on this matter. He may have not been able to deliever a strictly practical and utilitarian approach.

    I could have gotten an immensely valuable education if it concentrated on giving us skills in practical healing… instead of massive amounts of physiology, anatomy, medical like courses, etc. I could have gotten thousands of hours on how to actually make tens of thousands of human beings healthier, happier, and more aware.

    The argument that we need to be trained in how to refer is kind of weird because the presenting symptoms of such need in patients is pretty easy to pick up on. It doesn’t take very much training to know when a person should go to an M.D.. Besides, patients should be showing definite (and REAL) signs of significant improvements in short order through Chiropractic and similar treatments. They almost always do. When they don’t, even if symptomatic evidence doesn’t indicate it, I refer anyway. Thus the patient is protected by evaluation by another professional, and I know whether to continue with concurrent to Medical care, to continue without concurrent medical care, or to advise only Medical care. It isn’t about being called a “Doctor”, or having the respect of your colleagues, or following a disciplined set of principle, or making a fortune as easily and quickly as possible. It’s about keeping our humanity as healers.

    • Frank M. Painter, D.C. February 19, 2012 at 10:14 pm

      Hi John

      I received pretty much the same material at Palmer, Davenport. The biggest complaint was against the class Renal Physiology, since so much of it was dedicated to the minutiae, and not enough practical material about how to spot someone with kidney problems. Personally, I feel like most of the rest of the material was invaluable for me to appreciate the complexity of the body. We are not technicians…we are graduated as first-contact doctors, and so that knowledge is important.

      MDs were lied to about the quality of our education by the AMA for decades. They are always shocked or surprised to discover how learned we are. I for one do not want to see that degrade. If you feel you weren’t better enough prepared to run a business, then pressure your alma mater to change their pre-reqs to a business major/science major applicant. It’s just not realistic to expect a doctoral program to have a sub-major in business.

  14. John Wernz February 23, 2012 at 9:03 pm

    To Frank Painter,

    Frank, that’s a great idea! You said, “pressure your alma mater to change their pre-reqs to a business major/science major applicant.”

    In actuality just some applicable business courses would be good. But not too many, since many business majors graduates I meet don’t seem to know how to run a business.

    Also you said, and I know this is important to you Frank, “Personally, I feel like most of the rest of the material was invaluable for me to appreciate the complexity of the body. We are not technicians…”

    I don’t really care if I’m called a technician or a “Doctor” in title (I ask people to call me “John” I want there respect from clinical results, not certificates, titles, diplomas, etc) . My concern is primarily, secondarily, ….and .. nth-arily to encourage the improvement in people’s lives, especially my patients, physically, mentally, emotionally, etc.

    There are Educators would have us study, for example,… the anatomy of bug parts in rabid detail if they could enforce that…. and then we would be indoctrinated in how important knowing bug part detailed anatomy, physiology, biochemistry, etc. is to understanding higher order forms of life such as us humanoids. There will always be some excuse for wasting our lives on minutiae. People can even command respect and improved incomes for being minutiae experts. They can move from technicians to doctors to experts. They may never help our fellows to improve their lots, but at least they got lots and lots and lots more education and also helped “weed out” the “inferiors” from the educational program that didn’t take well to minutiae-ating at an advanced level. Indeed, following this logic and these systems we could arrive at the health care system and the economy we have today.

    Frank, I think you are a good person. I like what you have to say. But I’m not backing down from this.

    • Frank M. Painter, D.C. February 23, 2012 at 9:29 pm

      Hi John,

      Last things first: In regards to your comment: “I like what you have to say. But I’m not backing down from this.”

      I’m not expecting you to change your feelings, just to know that there are others who found value in their studies. Nobody asked me to learn the minutia of bug parts, and I would agree that would be a waste of our time.

      I also agree that what matters is the RESULTS we deliver, but I also appreciate the respect shown by those who call us doctor. When they ask, I tell them I already know what I do for a living, so they can call me Frank, Doc or whatever they are comfortable with.

      What we do is powerful, magical, in comparison with “usual care”, so it’s no surprise that our patients prefer to call us what we are –> doctor = learned person.

      At PCC we had some business-oriented classes in the last 2 semesters, but they didn’t seem important at the time (a failing on my part) and didn’t feel well prepared (a failing on the teacher’s part).

      It’s my opinion that only adults enter chiropractic school, and they should understand the debt they are incurring, and that they will be running a business, not a playground. The medical system seems to favor hiring their students, whereas I have heard that we seem to “eat our young”.

      I don’t know if this is true, or if it only reflects the whining from some folks who didn’t like the way it goes when you are someone else’s employee. Either way, we learn from our mistakes as much as from our successes….that’s the way of life.

      Thanks for your feedback! We don’t all have to agree on everything to still be brothers.

  15. John Wernz February 29, 2012 at 7:17 pm

    To Frank M. Painter, D.C….. Frank, I really appreciated your comment in reply to mine of … “Thanks for your feedback! We don’t all have to agree on everything to still be brothers.”

    That was great! Indeed, if we can enter into discussion and learn from each other then this is much more powerful than boring belief system espousal s with no possibility of improvements toward greater Truths.

    You also won me over in your comment.. “there are others who found value in their studies”… and it’s true that we “should learn from our mistakes as well as our successes.”

    Perhaps I should have stated my case better… Are Chiropractors students better off having lots of education or improving the real world usefulness of their education?

    • Frank M. Painter, D.C. February 29, 2012 at 8:15 pm

      Hi John

      You ask: “Are Chiropractors students better off having lots of education or improving the real world usefulness of their education?”

      I can’t speak for students, but DCs (chiropractic doctors) are definitely better off being highly educated. That’s why they are called doctors! hehehe

      “real world usefulness”… well now, that reminds me of phrases like “beauty is in the eye of the beholder”.

      How do you define: “real world usefulness” ?

      Is that measured in financial income, or in the DCs ability to spot (diagnose) abnormal conditions that require referral?

      According to NCMIC, our largest malpractice insurer, the #1 cause for suits against doctors if failure to diagnose.

      Does that sound like a failure of the education process, OR a failure of doctors to apply the education they received?

      Question #2: You wrote recently: “I could have gotten an immensely valuable education if it concentrated on giving us skills in practical healing… instead of massive amounts of physiology, anatomy, medical like courses, etc. I could have gotten thousands of hours on how to actually make tens of thousands of human beings healthier, happier, and more aware.

      I’m curious: what classes would you eliminate (???), and what classes would you have added to help you “make tens of thousands of human beings healthier, happier, and more aware“? Just curious.

  16. Frank M. Painter, D.C. February 29, 2012 at 8:24 pm

    #2: You wrote recently: “I could have gotten an immensely valuable education if it concentrated on giving us skills in practical healing… instead of massive amounts of physiology, anatomy, medical like courses, etc. I could have gotten thousands of hours on how to actually make tens of thousands of human beings healthier, happier, and more aware.

    I’m curious: what classes would you eliminate (???), and what classes would you have added to help you “make tens of thousands of human beings healthier, happier, and more aware“? Just curious.

  17. John Wernz March 3, 2012 at 8:53 pm

    To Frank Painter,

    Again, great questions from you Frank!

    When in anatomy class we cut up old stiff dried out heavily chemically preserved cadavers … and spent endless hours looking at drawings and pictures in textbooks and on computer monitors. While this has great value, if the greater percentage of that time time were spent palpating hard and soft tissues, observing body movements, motion palpation of joints and soft tissues, doing before and after comparisons of the same both visually and with palpation, muscle testing specific muscles, describing with fellow students and teachers what anatomic structures we were feeling, seeing, testing, and understanding in an interactive fashion; versus the lecture system non-interactive guy talking at the front of the class for a long time while everyone else sits on their butt. One common argument against what I just proposed is that this gets done in technique classes, clinic, or some other class anyway. I think that is a dumb argument, as the more “real world” anatomy we get the more we can utilize anatomy in the “real world”. I had this gift for being able to feel.. palpate things, and I was teamed up with this “genius” as to what degrees a joint made in ranges of motion. He had memorized what was “normal” from books but couldn’t feel it in practice. I could feel it and describe it on real joints … and I could tell when the “normal” ranges of motions “didn’t feel right (dysfunctional)” He was a great guy and eventually learned to palpate some, but he was always depending on some intellectual concepts or technology too much. We Chiropractors use our hands, eyes, hears, perceptions every day with people who have real physical bodies. So yes, anatomy classes should include study of pictures, online, textbooks, etc., and some lecturing but why not make it a large majority of hands on interactive facilitated learning, to engage the learning experience not just in the cortex.

    Now that’s JUST one idea JUST for anatomy instruction. I could go on with chemistry, physiology, etc…. but what’s the use? Reducing the minutiae in Chiropractic education and having significant chucks of it made more practical has a value so great, evident, and obvious I don’t understand how an argument could be made against it. I’m done debating.

    • Frank M. Painter, D.C. March 3, 2012 at 10:40 pm

      Hi John

      Happy Saturday night!

      Who says you couldn’t do both? Yes, Anatomy class was harsh…standing next to bodies that reeked of formaldehyde was hard, as it is being near death in general. However, we also has palpation classes, and we also had (access to) numerous student clubs, friends, and associates with which to practice exactly the things you mention. I was a member of the Gonstead Club for several semesters, until I became more interested in biomechanics, videofluoroscopy (as a diagnostic tool) and Verne Pierce in particular.

      Our spinal anatomy class in particular was invaluable, and I am endlessly grateful to Chip Morter for his dedication… and the spinal anatomy lab, which helped me completely to understand the tissues I deal with every day.

      I’m not judging you, or any other student…but College is not a place where the Teacher is responsible for your learning. The Student bears that responsibility…and much like life, you only get back what you put in.

      As for Palpation…that is the Art of what we do. Yes, we got a lot of didactic learning…as every student does at any school. The rubber meets the road when we let the thoughts go, and we extend our consciousness through the tips of our fingers, and let our nerve endings tell our intelligence what’s going on with that person. When we couple that information with other things we learned, like reading films (I prefer flexion and extension, since that reveals what moves, and what doesn’t), leg checks, static palpation, and the educated observation of that patient in motion…all that directs the chiropractor within.

      I agree that there *could* be a different way to teach students. We had 3 “major” anatomy classes (all 5 credit) in 2 gross anatomy (year 1 muscles, year 2 organs and nervous system) and the third focused on spine. Considering we received close to 300 credits overall, I don’t begrudge 15 (or 5%) of it to anatomy.

      Many are called. Less will “get it” completely. At least 10% of my class dropped out by 5th tri, unable to handle the grind of constant learning. I have no idea what percentage dropped out once they hit clinic and realized that knowledge didn’t turn them into clinicians…by that point I wasn’t concerned whether some of them failed…I was already enraptured by my experience. And guess what…I am still enraptured.

      The big problem on our Planet is that it is filled with frail, imperfect humans. The saving grace of our Planet is that many of us learn to accept, sympathize and cooperate with each other. Our schools are no more perfect than our Government or any one of us. We’ve all muddled through somehow, and every day we get another chance to let our light shine on others. Who could ask for more?

      All your ideas…it’s not debate…it’s creative criticism from your own point of view. If you truly have suggestions your school could benefit from, make yourself heard at your school. I can’t change if for you.

      When I was in clinic, I convinced several of my friends to revisit our Spinal Anatomy lab, so we could reassess what we learned as beginners, and to re-integrate that into a higher plane of understanding. I approached Chip and convinced him to take us on a tour, and to answer all our questions. Truthfully, it shocked him to see we cared enough to come back…and our questions surprised him, both by being profound as well as demonstrating some things we had failed to grasp because we were only 2nd semester kids when we took his class.

      I KNOW we rocked his thinking, and I am sure (to some extent) that he learned from us about things he could change, to make his next class more useful to his students. IN the ideal world we all hunger for, who could ask for more?

      Have a great night, my friend. Let your dissatisfaction accomplish something by reaching out to make a change. You’ll be glad you did!

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