Integrated doesn’t mean equal

In recent years, the “integrated practice” has been a hot topic. The idea of having medical doctors work side by side with chiropractors, acupuncturists, nutritionists, or other alternative health and wellness professionals is alluring. The problem, however, is that these integrated practices end up being dominated by the MDs, who reluctantly (if ever) dole out very limited access to non-medical practitioners.

This isn’t surprising since, behind the scenes, organized medicine continues to fight to restrict chiropractic to musculoskeletal “treatment” of chronic low-back pain in adults. While I’ve always opposed expanding the chiropractic scope of practice into medical areas, I’ve spent my career trying to make sure we have the legal right to provide care to ALL people, regardless of age or symptomology.

Since I view chiropractic as a holistic and neurologically based approach — one that allows the body to better address all health issues — I’m actually a “broad scope” proponent in the widest meaning of that term. Yes, I draw the line at any kind of medical procedures (i.e., drugs, surgery, differential full-body diagnosis, etc.) but I definitely don’t want chiropractic limited to the role of pain relief for back pain.

American Medical Association logoFor those who feel we’re ready to join forces with the medical profession, I suggest a review of how the American Medical Association (AMA) and other elements of organized medicine continue to fight the expansion of all CAM approaches into what they see as their “turf.”

For instance, an article Amy Lynn Sorrel published in the Jan 25, 2010, issue of American Medical News noted with a touch of braggadocio that “in 2009, physicians fought a blitz of scope-of-practice expansions by other health professionals on legislative, legal and regulatory fronts. Organized medicine defeated attempts by naturopaths to seek licensure, prevented chiropractors from being able to perform invasive procedures and achieved further regulation of lay midwives. The efforts were among more than 300 scope-related bills the American Medical Association tracked last year.”

Sorrel added that “Physicians don’t expect the battles to let up, and with patient safety on the line, they are countering such efforts with some fresh tactics.”

Among their efforts will be to make it illegal for anyone but medical doctors to use the term “doctor,” establish state MD-dominated review panels to evaluate plans by non-medical health professionals to expand their practice, and mandate that non-medical doctors wear badges identifying their credentials. Let’s hope they aren’t suggesting badges with yellow stars.

Among the health professionals in the crosshairs for the AMA are nurses, podiatrists, naturopaths, optometrists, and — of course — chiropractors, all of whom appear to threaten the AMA.

A case in point was the Texas regulation that permitted DCs to perform manipulation under anesthesia and needle electromyography. Because of efforts by the AMA, the court overturned the Board’s decision and barred those procedures. The AMA and its allies also won a partial victory in Texas over whether the word “diagnose” could be used instead of “analyze, examine or evaluate” (which is permitted in the Texas Chiropractic Act). On Aug. 17, the court decided that DCs may “diagnose” — within limits. The final decision is up in the air and no one knows, at this time, exactly what it all means.

As I mentioned above, I disagree with some of the suggested scope expansions promoted by chiropractors, but it’s because they tend to make the profession more medically oriented rather than broaden their scope to include more people.

What I do know is that no matter what we see as chiropractic progress — whether it’s to become more ‘medical’ or, as I hope, to become less medical and address a full slate of neurological as well as musculoskeletal issues — we need to understand that organized medicine is NOT a friend of chiropractic or any other non-medical health approach.

As patients continue to join in the mass exodus away from allopathic medicine, the backlash against alternatives will continue and I strongly urge DCs to be careful when establishing “alliances” with medical professionals. Exceptions do exist and I know several MDs who are truly interested more in their patients’ well-being than they are in protecting their turf, but these ARE the exceptions, not the rule. Let’s move as far as possible away from the medical paradigm and allow them to stomp on their own grounds while we claim more fertile territories.

SOURCE: “Organized medicine pushes back on expansions of scope of practice” AMA News, Jan. 18. 2010.

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Comments

I for one agree that the Chiropractor should not be perscribing drugs. I feel it is a mixed message to offer drugs and an alternative way of healing. The patient needs to ‘get’ that their body can heal itself with no interference and without masking symptoms.
Also, I, as a patient mostly, like the idea of prices staying where they are! If Chiropractic Practices get into the same odds as those who perscribe medicine I don’t want to have to pay my bill! Of course the price will go up to pay for insurance!

You do need to admire the medical profession. Despite all their problems all the unnecessary pain and misery they cause, (yes they also do a lot of good) they still have the energy to systematically attack or seek to control other professions. Chiropractic will continue to vulnerable until there is a united view on what chiropractic is. Until that happens the medical profession will be able to undermine the profession by chipping away at the cracks in the profession.

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