portal of entry, primary care...

August 18, 2001

,

I think that your "purging" was well thought out and made very good sense. I know that I do not feel like I could read an ECG, identify the location and type of a murmur based on a stethoscopic exam, or figure out what to do with a pulse oximetry reading of 72 in a diabetic in ketoacidosis.

I don't mean to say that DCs are uneducable, just poorly educated in some of the essential areas of primary care.

D Freeman Mailing address: 2480 Liberty Street NE Suite 180Salem, Oregon 97303phone 503 763-3528fax 503 763-3530pager 888 501-7328

portal of entry, primary care...

Hello-

I've been stewing about this issue for a long time, so I thought I would purge and feel better.

Do we see patients with a wide variety of health complaints/issues? Of course we do. Do these patients present to the chiropractor for assessment and management of all of their health problems? Generally not. Should we be able to recognize problems other than musculoskeletal complaints and treat, refer or co-manage as needed. Sure. This makes us portal of entry physicians. But are we qualified as primary care physicians. This depends on the definition and the individual chiropractor. If primary care means "see all, treat what we can and make the appropriate referral when needed" we should be able to function as primary care. But because of historical prejudice and the perpetuation of chiropractors outside of the general healthcare community we have a problem. We need education in proper interdisciplinary referral protocols. We need continuing education that reviews internal diagnosis. We need to learn better communication skills. Call me a mixer, but my own philosophy does not allow me to believe that manipulation alone can effectively manage, cure or correct systemic disease. This doesn't mean you shouldn't adjust what needs adjusting, but if the chiropractor is going to treat problems (which may be currently out of scope in our state, someone could address this point) such as chronic fatigue, irritable bowel, cardiovascular disease etc. he/she needs more ammunition. This doesn't mean pharmaceuticals but it may mean herbs, supplements, dietary modification, exercise therapy... and adjusting.

Forget for a minute the MD's (PCP's) do a crappy job of managing musculoskeletal complaints. These folks graduate with an MD, and instead of jumping into private practice they enter a residency in which they see a wide variety of nasty complaints. They get good at diagnosis. Their treatment of course is usually meds because that is what they were taught. The treatment may be a cannon instead of a pea shooter but at least they know what they are shooting at.

We on the other hand jump into practice with a good foundation but little practical experience. By the nature of the beast we see lots of patients (hopefully) who present with neck and back complaints. We become good adjusters, but unless we are personally motivated our other clinical/diagnostic skills fade (how long has it been since you used that scope you bought in school.... yea I know a few of you use it daily but you are an exception). We become NMS experts, but can we still function as PCP's?

Seitz, DCTuality Physicians730-D SE Oak StHillsboro, OR 97123

August 18, 2001

I submit to you and every DC in practice that if you cannot recognize and support the body's recovery from systemic dysfunction you cannot adjust a subluxation. You can provide, at best, palliative care.

If you are not acting as a primary care provider you cannot address subluxation becasue subluxation IS NOT simply a musculoskeletal condition. It is neural.

Neural tissue requires optimum blood flow, blood oxygen and sugar balance; hormonal axis stability, and so on. If you ignore these things then you ignore subluxation and are adjusting without giving a dot about prevention. Certainly, anything less is what the public expects of a chiropractor, but this most certainly is not what you are trained to provide. If you do not know about oximetry, ECG, auscultation and such then I suggest you change your shingle to read "chiropractic physical therapy", because that is the level of care you are giving. This is why we are even in today defending the subluxation from care by PT's. Our very own profession is highly trained, yet spends its time discounting chiropractic training and fabricates unscientific excuses for their inability to grasp the importance of preventing and adjusting the spinal subluxation.

Go back to D.D. Palmer and focus on the big picture. The atlas is governed by the nervous system and that means primary care is essential to care for the person. Give up the idea that PCP means treating the dying patients, it means identifying the physical trends that lead to illness by first identifying the presence of subluxation, adjusting it, and importantly PREVENTING it from recurring. Prevention may be through diet (guided by blood sugar tests for insulin resistant sympathetic alarm), respiratory training (guided by oximetry and chemistries roe respiratory neural alkalosis), treatment of anemias (adequate gas exchange for the CNS and PNS), exercise training (to assure circulation to the spinal nervous system --make sure you have a good ECG and HArvard Step TEst first), recognition of hormonal deficiencies, et ad board exam infinitum ...

I am weary of this professions constant pampering of "chiropractic physical therapists" when we need to grow up as a profession and take responsibility for what we know works. We need to stop hiding befind the dogmas of our sick society that delegate all illness to medication and surgical care and leave the sore backs to chirorpactors after they are medicated and PT'ed until their insurance runs out.

If you do not by now realize that the body can heal itself once subluxation is adjsuted and prevented, visit a friend at the hospital and feel their spines. You will understand. The spine shows the state of the nervous system long before the blood pressure cuff and the blood chemistry.

WE do not need any more ( medical) ammunition than the body's natural recuperative powers to do our job well. When the body has the disease we can make sure everything is done to regain full health (including medical referral if it is the patient's wish or in their best interest). When the disease has the body, we can comfort the dying and refer the patient (let the medics keep the dying alive if that is the patient's or the attorney's wish), we can sign death certificates. When the body is maimed or broken, we can support the recovery after the medical repairs are made. Certainly, medicine has a very important place in primary care, but that does not mean we must limit ourselves to be PT's.

WE HAVE ALREADY won the legal rights to practice full scope in Oregon and we can tackle the responsibilities as a profession. Every time we narrow our logical or theoretical scope to musculoskeletal conditions it is a scientific absurdity. The MS system does not exist as two chapters in the body! The body is fully integrated with multiple levels of reduplicative neurological and biochemical hierarchies. To limit our assesment to the MS system is scientifically impossible and thank God that our CCE has been wise enough to keep chiropractic education at the fine level it is.

Some say they have no experience to act as primary care providers. To them I say, "GO GET SOME EXPERIENCE!"

We are paving the way for the PT's to take our profession, because we have narrowed our historic scope to what can be done in 3 minutes or less with an adjusting instrument, a spinal thrust, or a drop table headpiece, or worse: a paper IME report. This is a travesty, but it is still quite profitable. This is an idiopathic plague for the profession, it leaves us in a pleasant and endless conundrum - a nauseating mixture of apathy and renegadery made palatable by a thick syrup of medical snake oil backed by flashy insurance approved diagnostic technology.

Adjustment of subluxation must follow identification of the same, prevention must grow from the board certified knowledge each of us possess -- the chemistry, the ECG reading, etc. If you were treating sick people and you would stay up nights studying every aspect of your training until you can see the anwers in the dark. If you have shut away you knowledge in a carton of notes, you have also shut away the source of your professional courage and skill (politics, unfortunately, does not require either of these). I implore you as a friend, musculoskeletal chiropractic is a noble knowledge base, but it is not chiropractic, it is the tool but not the job.

We are more than that. How much more depends upon your ability to understand how the subluxation is caused and how to prevent it. Can you imagine a world without blood pressure cuffs? Consider that the subluxation precedes the neural milleau of every known form of hypertension. An ECG is no big deal. You read it as normal or abnormal. Look at the waveform. It is either hypertrophied heart or pacemaker damage. Both affect the spinal tone which can be influenced by same diet, relaxation, and exercise known to benefit the heart. I could, as I have , write for hours on this primary care discussion.

Remember that primary care medicine, many in our profession place on a pedistal high above chiropractic, is devoid of one drop of respect for spinal or neurological chiroporactic science. It is diagnostically aneural, yet its medications are decidedly neural modulators. Primary care chiropractic is absolutely neural based in both assessment and care. Chiropractic is the logical choice, at least until medicine incorporates the nervous system into its every diagnosis.

Please, excuse my intensity and let me close with the critical importance of recognizing the premise of all chiropractic:

"life is the expression of tone" (D.D. Palmer)

This is chiropractic.

Willard

portal of entry, primary care...

Hello-

I've been stewing about this issue for a long time, so I thought I would purge and feel better.

Do we see patients with a wide variety of health complaints/issues? Of course we do. Do these patients present to the chiropractor for assessment and management of all of their health problems? Generally not. Should we be able to recognize problems other than musculoskeletal complaints and treat, refer or co-manage as needed. Sure. This makes us portal of entry physicians. But are we qualified as primary care physicians. This depends on the definition and the individual chiropractor. If primary care means "see all, treat what we can and make the appropriate referral when needed" we should be able to function as primary care. But because of historical prejudice and the perpetuation of chiropractor! s outside of the general healthcare community we have a problem. We need education in proper interdisciplinary referral protocols. We need continuing education that reviews internal diagnosis. We need to learn better communication skills. Call me a mixer, but my own philosophy does not allow me to believe that manipulation alone can effectively manage, cure or correct systemic disease. This doesn't mean you shouldn't adjust what needs adjusting, but if the chiropractor is going to treat problems (which may be currently out of scope in our state, someone could address this point) such as chronic fatigue, irritable bowel, cardiovascular disease etc. he/she needs more ammunition. This doesn't mean pharmaceuticals but it may mean herbs, supplements, dietary modification, exercise therapy... and adjusting.

Forget for a minute the MD's (PCP's) do a crappy job of managing musculoskeletal complaints. These folks ! graduate with an MD, and instead of jumping into private practice they enter a residency in which they see a wide variety of nasty complaints. They get good at diagnosis. Their treatment of course is usually meds because that is what they were taught. The treatment may be a cannon instead of a pea shooter but at least they know what they are shooting at.

We on the other hand jump into practice with a good foundation but little practical experience. By the nature of the beast we see lots of patients (hopefully) who present with neck and back complaints. We become good adjusters, but unless we are personally motivated our other clinical/diagnostic skills fade (how long has it been since you used that scope you bought in school.... yea I know a few of you use it daily but you are an exception). We become NMS experts, but can we still function as PCP's?

Seitz, DCTuali! ty Physicians730-D SE Oak StHillsboro, OR 97123

August 19, 2001

Willard,

I love your passion for our profession - your comments below reflect a great deal of critical thought about how chiropractors can function as PCPs because of the power of the chiropractic adjustment.

Having said that, I also have to say that I disagree with you on several points.

Reading an ECG is not a big deal if you have been taught to do so; DCs are not. Managing CHF or diabetes is relatively straightforward, but DCs don't know how to do it, and, regardless of the power of the adjustment to correct subluxation, these folks need ACE inhibitors, beta blockers, and diuretics to prolong the life of their heart.

You have taken the time to learn more about primary care issues, but few DCs will do this, and there is a very good reason why, in my opinion. While the chiropractic adjustment can help some folks with hypertension, many kids with bed wetting, and the occasional individual with psoriasis, there is no question in my mind that what we are best at doing is alleviating pain.

I don't consider it an ignoble pursuit to improve the mechanics of the human frame so that pain is relieved or eradicated. You may believe that this makes me a "chiropractic PT" but I disagree. I think this makes me a chiropractor who recognizes what it is that he does best. If I can show that I do it the best then the PTs cannot take over my job, and if I don't do it the best then maybe they should.

I have been studying primary care for the past 9 months and learning things that I never heard about in chiropractic school. The educational process has taught me a tremendous amount of respect for the folks who do primary care well, and also shown me that practicing as I do, specializing in the diagnosis and treatment of musculoskeletal pain (this is not the same thing as a sore back doc, BTW) is a heck of a lot more enjoyable than primary care. I wouldn't practice primary care for anything.

That's not to say that a well educated DC can't or shouldn't practice in a more general manner as you do, just that it's not my preference. Hopefully we agree that there is room under the Oregon practice act for more than one method of delivering chiropractic care to the public.

D Freeman

Mailing address: 2480 Liberty Street NE Suite 180Salem, Oregon 97303phone 503 763-3528fax 503 763-3530pager 888 501-7328

portal of entry, primary care...

Hello-

I've been stewing about this issue for a long time, so I thought I would purge and feel better.

Do we see patients with a wide variety of health complaints/issues? Of course we do. Do these patients present to the chiropractor for assessment and management of all of their health problems? Generally not. Should we be able to recognize problems other than musculoskeletal complaints and treat, refer or co-manage as needed. Sure. This makes us portal of entry physicians. But are we qualified as primary care physicians. This depends on the definition and the individual chiropractor. If primary care means "see all, treat what we can and make the appropriate referral when needed" we should be able to function as primary care. But because of historical prejudice and the perpetuation of chiropractor! s outside of the general healthcare community we have a problem. We need education in proper interdisciplinary referral protocols. We need continuing education that reviews internal diagnosis. We need to learn better communication skills. Call me a mixer, but my own philosophy does not allow me to believe that manipulation alone can effectively manage, cure or correct systemic disease. This doesn't mean you shouldn't adjust what needs adjusting, but if the chiropractor is going to treat problems (which may be currently out of scope in our state, someone could address this point) such as chronic fatigue, irritable bowel, cardiovascular disease etc. he/she needs more ammunition. This doesn't mean pharmaceuticals but it may mean herbs, supplements, dietary modification, exercise therapy... and adjusting.

Forget for a minute the MD's (PCP's) do a crappy job of managing musculoskeletal complaints. These folks ! graduate with an MD, and instead of jumping into private practice they enter a residency in which they see a wide variety of nasty complaints. They get good at diagnosis. Their treatment of course is usually meds because that is what they were taught. The treatment may be a cannon instead of a pea shooter but at least they know what they are shooting at.

We on the other hand jump into practice with a good foundation but little practical experience. By the nature of the beast we see lots of patients (hopefully) who present with neck and back complaints. We become good adjusters, but unless we are personally motivated our other clinical/diagnostic skills fade (how long has it been since you used that scope you bought in school.... yea I know a few of you use it daily but you are an exception). We become NMS experts, but can we still function as PCP's?

Seitz, DCTuali! ty Physicians730-D SE Oak StHillsboro, OR 97123

August 19, 2001

Thank yoy for your response Willard. I always enjoy reading your posts and

your articles long ago in DC. I believe you practice what you preach.

Regarding your response, I too believe in the ability of the body to heal

itself (vitalism, homeostasis). The neurological component is part of the

picture, and a very important part, but so is the biochemical, structural

and other components. I think I remember a triangle with subluxations the

result of chemical, mental and physical causes. So if this is true, and

subluxation is the result of such insult how do you determine the level of

subluxation? (And what is your definition of subluxation). With

auscultation? I determine the mechanical component of subluxation wia motion

palpation, after all, no matter how good you are, none of us directly

adjusts the nervous system! Manipulation directly affects joint dynamics,

which has a secondary effect on the nervous system primarily through the

excitement of mechanoreceptors, and later by the abscence of noxious

stimulation. Although the body strives for homeostasis sometimes it cannot

achieve such balance without help, such as adjustment, change in diet, rest,

and sometimes drugs. Sometimes balance can never be achieved. People need

maintenance, either chiropractic or pharmaceutical. And in time organisms

die, no matter what the intervention, and to prolong the inevitable may be

cruel (another topic).

My original point is that while I believe we are portal of entry, most of us

do not practice primary care nor should we without some continuing

education. BTW, I don't believe care of the dying is a big part of primary

care, there is a growing specialty related to the

the care of the dying.

Seitz, DC

Tuality Physicians

730-D SE Oak St

Hillsboro, OR 97123

>From: " Willard Bertrand " <healthstar@...>

> " Oregon DCs Listserve (E-mail) " < >

>Subject: RE: portal of entry, primary care...

>Date: Sat, 18 Aug 2001 22:45:05 -0700

>

>I submit to you and every DC in practice that if you cannot recognize and

>support the body's recovery from systemic dysfunction you cannot adjust a

>subluxation. You can provide, at best, palliative care.

>

>If you are not acting as a primary care provider you cannot address

>subluxation becasue subluxation IS NOT simply a musculoskeletal condition.

>It is neural.

>

>Neural tissue requires optimum blood flow, blood oxygen and sugar balance;

>hormonal axis stability, and so on. If you ignore these things then you

>ignore subluxation and are adjusting without giving a dot about prevention.

>Certainly, anything less is what the public expects of a chiropractor, but

>this most certainly is not what you are trained to provide. If you do not

>know about oximetry, ECG, auscultation and such then I suggest you change

>your shingle to read " chiropractic physical therapy " , because that is the

>level of care you are giving. This is why we are even in today defending

>the

>subluxation from care by PT's. Our very own profession is highly trained,

>yet spends its time discounting chiropractic training and fabricates

>unscientific excuses for their inability to grasp the importance of

>preventing and adjusting the spinal subluxation.

>

>Go back to D.D. Palmer and focus on the big picture. The atlas is governed

>by the nervous system and that means primary care is essential to care for

>the person. Give up the idea that PCP means treating the dying patients, it

>means identifying the physical trends that lead to illness by first

>identifying the presence of subluxation, adjusting it, and importantly

>PREVENTING it from recurring. Prevention may be through diet (guided by

>blood sugar tests for insulin resistant sympathetic alarm), respiratory

>training (guided by oximetry and chemistries roe respiratory neural

>alkalosis), treatment of anemias (adequate gas exchange for the CNS and

>PNS), exercise training (to assure circulation to the spinal nervous

>system --make sure you have a good ECG and HArvard Step TEst first),

>recognition of hormonal deficiencies, et ad board exam infinitum ...

>

>I am weary of this professions constant pampering of " chiropractic physical

>therapists " when we need to grow up as a profession and take responsibility

>for what we know works. We need to stop hiding befind the dogmas of our

>sick

>society that delegate all illness to medication and surgical care and leave

>the sore backs to chirorpactors after they are medicated and PT'ed until

>their insurance runs out.

>

>If you do not by now realize that the body can heal itself once subluxation

>is adjsuted and prevented, visit a friend at the hospital and feel their

>spines. You will understand. The spine shows the state of the nervous

>system

>long before the blood pressure cuff and the blood chemistry.

>

>WE do not need any more ( medical) ammunition than the body's natural

>recuperative powers to do our job well. When the body has the disease we

>can

>make sure everything is done to regain full health (including medical

>referral if it is the patient's wish or in their best interest). When the

>disease has the body, we can comfort the dying and refer the patient (let

>the medics keep the dying alive if that is the patient's or the attorney's

>wish), we can sign death certificates. When the body is maimed or broken,

>we

>can support the recovery after the medical repairs are made. Certainly,

>medicine has a very important place in primary care, but that does not mean

>we must limit ourselves to be PT's.

>

>WE HAVE ALREADY won the legal rights to practice full scope in Oregon and

>we

>can tackle the responsibilities as a profession. Every time we narrow our

>logical or theoretical scope to musculoskeletal conditions it is a

>scientific absurdity. The MS system does not exist as two chapters in the

>body! The body is fully integrated with multiple levels of reduplicative

>neurological and biochemical hierarchies. To limit our assesment to the MS

>system is scientifically impossible and thank God that our CCE has been

>wise

>enough to keep chiropractic education at the fine level it is.

>

>Some say they have no experience to act as primary care providers. To them

>I

>say, " GO GET SOME EXPERIENCE! "

>

>We are paving the way for the PT's to take our profession, because we have

>narrowed our historic scope to what can be done in 3 minutes or less with

>an

>adjusting instrument, a spinal thrust, or a drop table headpiece, or worse:

>a paper IME report. This is a travesty, but it is still quite profitable.

>This is an idiopathic plague for the profession, it leaves us in a pleasant

>and endless conundrum - a nauseating mixture of apathy and renegadery made

>palatable by a thick syrup of medical snake oil backed by flashy insurance

>approved diagnostic technology.

>

>Adjustment of subluxation must follow identification of the same,

>prevention

>must grow from the board certified knowledge each of us possess -- the

>chemistry, the ECG reading, etc. If you were treating sick people and you

>would stay up nights studying every aspect of your training until you can

>see the anwers in the dark. If you have shut away you knowledge in a carton

>of notes, you have also shut away the source of your professional courage

>and skill (politics, unfortunately, does not require either of these). I

>implore you as a friend, musculoskeletal chiropractic is a noble knowledge

>base, but it is not chiropractic, it is the tool but not the job.

>

>We are more than that. How much more depends upon your ability to

>understand

>how the subluxation is caused and how to prevent it. Can you imagine a

>world

>without blood pressure cuffs? Consider that the subluxation precedes the

>neural milleau of every known form of hypertension. An ECG is no big deal.

>You read it as normal or abnormal. Look at the waveform. It is either

>hypertrophied heart or pacemaker damage. Both affect the spinal tone which

>can be influenced by same diet, relaxation, and exercise known to benefit

>the heart. I could, as I have , write for hours on this primary care

>discussion.

>

>Remember that primary care medicine, many in our profession place on a

>pedistal high above chiropractic, is devoid of one drop of respect for

>spinal or neurological chiroporactic science. It is diagnostically aneural,

>yet its medications are decidedly neural modulators. Primary care

>chiropractic is absolutely neural based in both assessment and care.

>Chiropractic is the logical choice, at least until medicine incorporates

>the

>nervous system into its every diagnosis.

>

>Please, excuse my intensity and let me close with the critical importance

>of

>recognizing the premise of all chiropractic:

>

> " life is the expression of tone " (D.D. Palmer)

>

>This is chiropractic.

>

>Willard

>

> portal of entry, primary care...

>

>Hello-

>

>I've been stewing about this issue for a long time, so I thought I would

>purge and feel better.

>

>Do we see patients with a wide variety of health complaints/issues? Of

>course we do. Do these patients present to the chiropractor for assessment

>and management of all of their health problems? Generally not. Should we

>be able to recognize problems other than musculoskeletal complaints and

>treat, refer or co-manage as needed. Sure. This makes us portal of entry

>physicians. But are we qualified as primary care physicians. This depends

>on the definition and the individual chiropractor. If primary care means

> " see all, treat what we can and make the appropriate referral when needed "

>we should be able to function as primary care. But because of historical

>prejudice and the perpetuation of chiropractor! s outside of the general

>healthcare community we have a problem. We need education in proper

>interdisciplinary referral protocols. We need continuing education that

>reviews internal diagnosis. We need to learn better communication skills.

>Call me a mixer, but my own philosophy does not allow me to believe that

>manipulation alone can effectively manage, cure or correct systemic

>disease.

>This doesn't mean you shouldn't adjust what needs adjusting, but if the

>chiropractor is going to treat problems (which may be currently out of

>scope

>in our state, someone could address this point) such as chronic fatigue,

>irritable bowel, cardiovascular disease etc. he/she needs more ammunition.

>This doesn't mean pharmaceuticals but it may mean herbs, supplements,

>dietary modification, exercise therapy... and adjusting.

>

>Forget for a minute the MD's (PCP's) do a crappy job of managing

>musculoskeletal complaints. These folks ! graduate with an MD, and instead

>of jumping into private practice they enter a residency in which they see a

>wide variety of nasty complaints. They get good at diagnosis. Their

>treatment of course is usually meds because that is what they were taught.

>The treatment may be a cannon instead of a pea shooter but at least they

>know what they are shooting at.

>

>We on the other hand jump into practice with a good foundation but little

>practical experience. By the nature of the beast we see lots of patients

>(hopefully) who present with neck and back complaints. We become good

>adjusters, but unless we are personally motivated our other

>clinical/diagnostic skills fade (how long has it been since you used that

>scope you bought in school.... yea I know a few of you use it daily but you

>are an exception). We become NMS experts, but can we still function as

>PCP's?

>

> Seitz, DC

>Tuali! ty Physicians

>730-D SE Oak St

>Hillsboro, OR 97123

>

August 20, 2001

I wonder how many GPs know how to read ECG's. I'll bet very few. MDs refer to specialists.

I also wonder how many chiropractors refer to DACNs, DACBOs, etc.

DeSiena

----- Forwarded Message -----

From: "Willard Bertrand" <healthstar@...>

"Oregon DCs Listserve (E-mail)" < >

Date: Mon, 20 Aug 2001 08:11:41 -0700

Subject: FW: portal of entry, primary care...

Message-ID: <NEBBLMOKGLPEAIFHIPHFAEAKCCAA.healthstar@...>

:

Your statement "but DCs don't know how to do it" should have stated "DC's do not know how to read ECG's at the level of an MD". there is a difference here. Every DC has passed a test on what a p wave or a QRS wave represents (the actions of the atrium and the ventricles). This does not make them cardiologists, but this certainly makes them able to recognize normal or abnormal heart function.

Your sweeping statements denigrating your educational backround in the name of academic honesty and professional integrity are misplaced.

You state "there is no question in my mind that what we are best at doing is alleviating pain". Pain is a neurobiologic expression. This neural response is no different than the neural respons of a cough, of a heart arrythmia, of a bowel spasm, etc. You are best at restoring normal neural tone, with pain as your only observed skill. Perhaps you might observe that the same techniques that alleviate pain might affect other neurobiological mechanisms, but of course this would require that you make the observations:

"If a tree falls in the woods and no one is there to hear it does it still make a noise?"

I submit to your scientific educated mind what your innate mind already knows: you cannot address subluxations without the added responsibility of addressing the rest of the body. This responsibility is like that of a marriage; you can’t just take the bedroom without the rest. You can’t pick and choose what part of the body you are responsible to understand any more than you can pick what part of the marriage you prefer. Sure a marriage based upon just one aspect can survive, but it will never thrive. This inseparability is both logical and scientific, it is the epitomy of the academic integrity you hoist up with each e-mail posting.

Pay attention to the ECG example. Every CCE school required you to learn to read an ECG, not to diagnose Wolf-Parkinson White syndrome 100% of the time, but to recognize the state of the tone of the cardiovascular system and to know when the patient’s well-being would be served best by a cardiological consult. The ECG waveform is either normal or abnormal: too much tone or not enough tone. Manage the tone, not the ECG! You are mistaking naming the disorder with observing the patient; you are confusing the skill of the adjustor with the innate of the body; you are mistaking the need for beta blockers of the very few for the need for chiropractic care of the absolute majority – too many for this profession to care for in all of our lifetimes of practice. (Note: You do not need an ECG to practice chiropractic, I have rarely seen an abnormal ECG unless there is audible and palpable cardiovasculr instability. But, you will never see an ECG return to normal from your adjustments unless you get one before you start. Furthermore, if you do not know that the person has cardiovascular disease you will never understand why your adjustments are not "holding".)

Can the MS system can be professionally treated seperately from the rest of the body? Yes, by a physical therapist, upon referral from a primary care practitioner. As a chirorpactor you are licensed as a primary care practitioner. You may abdicate this postition on paper, but the "marriage" is still in force. The scientific reality : there is ONE integrated body inseparable from the MS system. Sure you have a specialty of chiropractic, but you might choose to define your profession in larger, tonal terms. Look to the entire body to find the underpinnings of every subluxations and you will find a lifetime of study. At OHSU you are at Oregon's absolute Mecca of medical knowledge, and yet you are uncertain as to whether you will take a drink! Integrating this knowledge into your practical skill as a chiropractor is the essence of taking the art closer to the science.

Instead of talking in terms of limiting your practice, consider ideas of expanding your knowledge and application of your professional skills, as did those who preceded you. I commend your efforts and wish you a favorable outcome that will satisfy your every intellectual curiosity as a chiropractor . There is room as you say "for more than one method of delivering chiropractic care to the public" but alas there is only one body that accepts this diversity of methods. By observing only the MS system you may miss the plot, but still enjoy the story.

Willard

August 20, 2001

Hi Willard,

I don't want to respond to everything that you have written below other than to say that our interpretation of chiropractic results and why they occur differs somewhat. I would say that your training in reading ECGs was far more comprehensive than mine in chiropractic school - I had one 2 hour class on the subject, and didn't learn anything from it, really.

D Freeman Mailing address: 2480 Liberty Street NE Suite 180Salem, Oregon 97303phone 503 763-3528fax 503 763-3530pager 888 501-7328

FW: portal of entry, primary care...