Re: response to Jack P... long post Off topic

[Guest guest]

Dan, I just don't see the dichotomy that you describe here. A subluxation based Chiropractor can define and measure as well as a SMT Chiropractor, especially in an acute injury third party payor case. This is what the Clinical Justification Rule is about and this is all it is about.

sharron fuchs dc

From: [mailto: ] On Behalf Of D Beebe, D.C.Sent: Friday, February 24, 2006 4:15 PMJPedersenDCCc: oregondcSubject: response to Jack P... long post Off topic

Jack:Hi, and thanks.Wanted to share an opinion, like that surprises you!The warring factions are more concerning the difference between a "medical" model of sickness. ie the SMT fellows of Chiropractic who actually believe that there is no difference between SMT and an adjustment, and the Chiropractic model of wellness and the prevention of dis-ease, ie non homeostasis.So while I have no particular problem with any DC practicing SMT, by definition he/she is not practicing Chiropractic. Chiropractic has never been defined as the pain model of SMT.As you so aptly stated, there are indeed two models of health care delivery in the Chiropractic profession and it is unfortunate that there is so much animosity between the two groups. It just seems that the SMT group wants to so narrowly define Chiropractic within the scope of dbl blind studies that it is forgotten what Chiropractic really is and has been.We didn't always have the same 10% of the sick population. We all got insurance coverage and then got lazy in education of the patients. That ... gasp... the patient actually had some responsibility in their own health. That getting adjusted, eating the correct foods and exercising and attending to the spiritual portions of their lives were important aspects of maintaining homeostasis thereby preventing dis-ease. That the Chiropractic lifestyle was a reflection of the paradigm of health. After all everyone knows someone who has a spine that needs to be checked, but how many people do you personally know right at this minute that has a bad back or neck. Gee didn't you know that Chiropractor's only treat back pain and neck pain.... or was that our SMT guys selling us on the notion that we could "get them in" with the back/neck pain and then "really" educate them as to what Chiropractic does.So while I have respect for those SMT Doctor's and the good work that they do for people in terms of alleviating some/ or all of the patient's pain it is a crime to denigrate the profession by disclaiming the defined concept of the subluxation, attempting to hide behind the " it isn't proven" theory. Yes, I said theory... the subluxation has been proven, read your neurology texts... every single adjustment affects global physiology through afferent stimulation and vertebral movement that moves the body to homeostasis thereby alleviating dis-ease.If you choose to ignore neurophysiology and claim subluxation as a theory versus a fact, be my guest.. you are, however, ignoring the research that has been done. The subluxation is and has been defined in peer reviewed articles such as JMPT, and the effects/affects are known neurophysiological results of the adjustment. What we do not know ... yet... are the full components of the subluxation nor the full effects, such as vibrational components , consciousness to consciousness components, etc.The SMT Doc's, at some point are going to have to give up the notion that they are the only ones who are right. If you want to persist in the notion that there is no such thing as a subluxation, then go be a freakin physical therapist. Do not, however, denigrate the profession by being incongruent in your belief system.Jack.. sorry you opened the door.AlwaysDanno "an amorphous disorganized group of various factions?? "> Listmates:>> ....this is as close a term to Universal Basic Truth as I've ever seen> used to describe any group that has consumed as many decades struggling> to snatch defeat from the jaws of victory as chiropractic has....>> With the Big Picture hanging out of focus in our otherwise Pristine> Universe, ongoing internecine scrimmages between chiropractic factions> occupy the same niche as the fiddle-players at Nero's Roman> Extravaganza....and to the same effect....is it true we suffer a> Professional Cognitive Dissonance, a selective type of attention deficit> disorder, which tricks us into ignoring one aspect of the human> condition, while focusing on another???>> I believe we simply MUST overcome the notion EITHER:OR is 'Science'> while "BOTH:AND" is something else....modern Physics, mathematics and> the entire Silicon Lifeforms of Computer Science readily embrace both> concepts are equally useful. Why can't chiropractors do that too?>> In the development of what we can measure OR define as being an> essential part of chiropractic care, we continue to ram into the same> issues. And we can continue to serve 10% of the population with the> tools we have in place. Hardly a resounding victory in a world of> grief and affliction.>> "Crazy" is continuing to do what we have always done and complaining> about the results. "Insane" is doing what we've always done and> expecting changes to somehow spring forth. I believe it's crazy to> accept we only reach that 10%. I believe it's insane to not expect> better from my profession.>> I've been an amorphous and disorganized individual my entire life....no> wonder 'chiropractic' seems like home to me!! Personally, I feel quite> comfortable in some circumstances acting as if "That Which Can Be> Measured-orthopedic model" serves the patient best; while other> situations a more effective choice is in the ineffable "Dynamic force"> which isn't as easily documentable. And my chart notes are constructed> in a way intended to convey those various nuances.>> The requirements of OBCE to demonstrate what it is I think I'm doing> help better formulate exactly what I'm offering the afflicted patient.> Or is this note too amorphous and disorganized to understand?>> Jack Pedersen DC> Member, AmoDisVariFac>>>> OregonDCs rules:> 1. Keep correspondence professional; the purpose of the listserve is to > foster communication and collegiality. No personal attacks on listserve > members will be tolerated.> 2. Always sign your e-mails with your first and last name.> 3. The listserve is not secure; your e-mail could end up anywhere. > However, it is against the rules of the listserve to copy, print, forward, > or otherwise distribute correspondence written by another member without > his or her consent, unless all personal identifiers have been removed.>

[Guest guest]

Here in may lie the "rub"...

Subluxation practitioners typically treat (and I generalize) the physical, chemical, and emotional components of dis-ease (including toxicity's, emotions, spirit, diet, etc).

SMT practitioners typically treat (and again I generalize) physical conditions (i.e., muscle strains, ligamentous sprains, inflammation, spasm, joint hypo/hyper-mobility, degeneration, radiculitis, cephalgia, etc...).

So the dichotomy may lie in requiring a PARTS examination, which "pre-determines" that the clinical findings must be physical, musculoskeletal findings in order for the treatment to be considered "justified" or "rationalized."

I'm not saying either argument is right or wrong...

I probably shouldn't admit this on the list serve...but I treat patients who come in to get adjusted just because they "don't feel right." They are in no particular pain; they just don't feel right! On palpation, I can certainly find taught/tender muscles, myofascitis, segmental joint dysfunction, etc...(in order to justify treatment in the chart note), but is that what they really came in for...?

And, does treating a patient who does not have a particular complaint of "pain" present a problem under a strict CJ/CR rules (especially if that patient is 9-months post-MVA, and they didn't feel "not right" BEFORE the accident!)?

I'm sure no one is against "science," but I am sure no one wants to limit their scope of practice to only what "science" and "orthopedic testing" can "prove."

M. s, D.C.

"an amorphous disorganized group of various factions?? "> Listmates:>> ....this is as close a term to Universal Basic Truth as I've ever seen> used to describe any group that has consumed as many decades struggling> to snatch defeat from the jaws of victory as chiropractic has....>> With the Big Picture hanging out of focus in our otherwise Pristine> Universe, ongoing internecine scrimmages between chiropractic factions> occupy the same niche as the fiddle-players at Nero's Roman> Extravaganza....and to the same effect....is it true we suffer a> Professional Cognitive Dissonance, a selective type of attention deficit> disorder, which tricks us into ignoring one aspect of the human> condition, while focusing on another???>> I believe we simply MUST overcome the notion EITHER:OR is 'Science'> while "BOTH:AND" is something else....modern Physics, mathematics and> the entire Silicon Lifeforms of Computer Science readily embrace both> concepts are equally useful. Why can't chiropractors do that too?>> In the development of what we can measure OR define as being an> essential part of chiropractic care, we continue to ram into the same> issues. And we can continue to serve 10% of the population with the> tools we have in place. Hardly a resounding victory in a world of> grief and affliction.>> "Crazy" is continuing to do what we have always done and complaining> about the results. "Insane" is doing what we've always done and> expecting changes to somehow spring forth. I believe it's crazy to> accept we only reach that 10%. I believe it's insane to not expect> better from my profession.>> I've been an amorphous and disorganized individual my entire life....no> wonder 'chiropractic' seems like home to me!! Personally, I feel quite> comfortable in some circumstances acting as if "That Which Can Be> Measured-orthopedic model" serves the patient best; while other> situations a more effective choice is in the ineffable "Dynamic force"> which isn't as easily documentable. And my chart notes are constructed> in a way intended to convey those various nuances.>> The requirements of OBCE to demonstrate what it is I think I'm doing> help better formulate exactly what I'm offering the afflicted patient.> Or is this note too amorphous and disorganized to understand?>> Jack Pedersen DC> Member, AmoDisVariFac>>>> OregonDCs rules:> 1. Keep correspondence professional; the purpose of the listserve is to > foster communication and collegiality. No personal attacks on listserve > members will be tolerated.> 2. Always sign your e-mails with your first and last name.> 3. The listserve is not secure; your e-mail could end up anywhere. > However, it is against the rules of the listserve to copy, print, forward, > or otherwise distribute correspondence written by another member without > his or her consent, unless all personal identifiers have been removed.>

[Guest guest]

The PARTS exam delineated in the CJ is to put the IMEs (esp. the MD types) on notice that they must perform a realistic examination on any given patient. Any DC does one on an opening examination and/or on re-examination .... it is certainly not meant to be done at q visit or even at a 9 month visit....though it would seem reasonable that a partial re-examinatin would be appropriate at that length of timing.

Sunny

Sunny Kierstyn, RN DC Fibromyalgia Care Center of Oregon 2677 Willakenzie Road, 7C

Eugene, Oregon, 97401

541- 344- 0509; Fx; 541- 344- 0955

From: " s, D.C." <drbobdc@...>CC: "oregondc" < >Subject: Re: response to Jack P... long post Off topicDate: Fri, 24 Feb 2006 17:24:43 -0800

Here in may lie the "rub"...

Subluxation practitioners typically treat (and I generalize) the physical, chemical, and emotional components of dis-ease (including toxicity's, emotions, spirit, diet, etc).

SMT practitioners typically treat (and again I generalize) physical conditions (i.e., muscle strains, ligamentous sprains, inflammation, spasm, joint hypo/hyper-mobility, degeneration, radiculitis, cephalgia, etc...).

So the dichotomy may lie in requiring a PARTS examination, which "pre-determines" that the clinical findings must be physical, musculoskeletal findings in order for the treatment to be considered "justified" or "rationalized."

I'm not saying either argument is right or wrong...

I probably shouldn't admit this on the list serve...but I treat patients who come in to get adjusted just because they "don't feel right." They are in no particular pain; they just don't feel right! On palpation, I can certainly find taught/tender muscles, myofascitis, segmental joint dysfunction, etc...(in order to justify treatment in the chart note), but is that what they really came in for...?

And, does treating a patient who does not have a particular complaint of "pain" present a problem under a strict CJ/CR rules (especially if that patient is 9-months post-MVA, and they didn't feel "not right" BEFORE the accident!)?

I'm sure no one is against "science," but I am sure no one wants to limit their scope of practice to only what "science" and "orthopedic testing" can "prove."

M. s, D.C.

"an amorphous disorganized group of various factions?? "> Listmates:>> ....this is as close a term to Universal Basic Truth as I've ever seen> used to describe any group that has consumed as many decades struggling> to snatch defeat from the jaws of victory as chiropractic has....>> With the Big Picture hanging out of focus in our otherwise Pristine> Universe, ongoing internecine scrimmages between chiropractic factions> occupy the same niche as the fiddle-players at Nero's Roman> Extravaganza....and to the same effect....is it true we suffer a> Professional Cognitive Dissonance, a selective type of attention deficit> disorder, which tricks us into ignoring one aspect of the human> condition, while focusing on another???>> I believe we simply MUST overcome the notion EITHER:OR is 'Science'> while "BOTH:AND" is something else....modern Physics, mathematics and> the entire Silicon Lifeforms of Computer Science readily embrace both> concepts are equally useful. Why can't chiropractors do that too?>> In the development of what we can measure OR define as being an> essential part of chiropractic care, we continue to ram into the same> issues. And we can continue to serve 10% of the population with the> tools we have in place. Hardly a resounding victory in a world of> grief and affliction.>> "Crazy" is continuing to do what we have always done and complaining> about the results. "Insane" is doing what we've always done and> expecting changes to somehow spring forth. I believe it's crazy to> accept we only reach that 10%. I believe it's insane to not expect> better from my profession.>> I've been an amorphous and disorganized individual my entire life....no> wonder 'chiropractic' seems like home to me!! Personally, I feel quite> comfortable in some circumstances acting as if "That Which Can Be> Measured-orthopedic model" serves the patient best; while other> situations a more effective choice is in the ineffable "Dynamic force"> which isn't as easily documentable. And my chart notes are constructed> in a way intended to convey those various nuances.>> The requirements of OBCE to demonstrate what it is I think I'm doing> help better formulate exactly what I'm offering the afflicted patient.> Or is this note too amorphous and disorganized to understand?>> Jack Pedersen DC> Member, AmoDisVariFac>>>> OregonDCs rules:> 1. Keep correspondence professional; the purpose of the listserve is to > foster communication and collegiality. No personal attacks on listserve > members will be tolerated.> 2. Always sign your e-mails with your first and last name.> 3. The listserve is not secure; your e-mail could end up anywhere. > However, it is against the rules of the listserve to copy, print, forward, > or otherwise distribute correspondence written by another member without > his or her consent, unless all personal identifiers have been removed.>

[Guest guest]

Dear Sharron,

Then, why doesn't the CJ rule make that specific language, i.e. that it

applies ONLY to NMS conditions documentation and not provide for guidelines

of a wellness based model???? If it is not delineated, then it will be used

against all practioners who practice a broad scope of healthcare.

From: " Sharron Fuchs " <sharronf@...>

CC: " oregondc " < >

Subject: RE: response to Jack P... long post Off topic

Date: Fri, 24 Feb 2006 16:31:14 -0800

Dan, I just don't see the dichotomy that you describe here. A

subluxation based Chiropractor can define and measure as well as a SMT

Chiropractor, especially in an acute injury third party payor case. This

is what the Clinical Justification Rule is about and this is all it is

about.

sharron fuchs dc

________________________________

From: [mailto: ] On

Behalf Of D Beebe, D.C.

Sent: Friday, February 24, 2006 4:15 PM

JPedersenDC

Cc: oregondc

Subject: response to Jack P... long post Off topic

Jack:

Hi, and thanks.

Wanted to share an opinion, like that surprises you!

The warring factions are more concerning the difference between a

" medical "

model of sickness. ie the SMT fellows of Chiropractic who actually

believe

that there is no difference between SMT and an adjustment, and the

Chiropractic model of wellness and the prevention of dis-ease, ie non

homeostasis.

So while I have no particular problem with any DC practicing SMT, by

definition he/she is not practicing Chiropractic. Chiropractic has never

been defined as the pain model of SMT.

As you so aptly stated, there are indeed two models of health care

delivery

in the Chiropractic profession and it is unfortunate that there is so

much

animosity between the two groups. It just seems that the SMT group wants

to

so narrowly define Chiropractic within the scope of dbl blind studies

that

it is forgotten what Chiropractic really is and has been.

We didn't always have the same 10% of the sick population. We all got

insurance coverage and then got lazy in education of the patients. That

....

gasp... the patient actually had some responsibility in their own

health.

That getting adjusted, eating the correct foods and exercising and

attending to the spiritual portions of their lives were important

aspects of

maintaining homeostasis thereby preventing dis-ease. That the

Chiropractic

lifestyle was a reflection of the paradigm of health. After all everyone

knows someone who has a spine that needs to be checked, but how many

people

do you personally know right at this minute that has a bad back or neck.

Gee

didn't you know that Chiropractor's only treat back pain and neck

pain....

or was that our SMT guys selling us on the notion that we could " get

them

in " with the back/neck pain and then " really " educate them as to what

Chiropractic does.

So while I have respect for those SMT Doctor's and the good work that

they

do for people in terms of alleviating some/ or all of the patient's

pain it

is a crime to denigrate the profession by disclaiming the defined

concept of

the subluxation, attempting to hide behind the " it isn't proven "

theory.

Yes, I said theory... the subluxation has been proven, read your

neurology

texts... every single adjustment affects global physiology through

afferent

stimulation and vertebral movement that moves the body to homeostasis

thereby alleviating dis-ease.

If you choose to ignore neurophysiology and claim subluxation as a

theory

versus a fact, be my guest.. you are, however, ignoring the research

that

has been done. The subluxation is and has been defined in peer reviewed

articles such as JMPT, and the effects/affects are known

neurophysiological

results of the adjustment. What we do not know ... yet... are the full

components of the subluxation nor the full effects, such as vibrational

components , consciousness to consciousness components, etc.

The SMT Doc's, at some point are going to have to give up the notion

that

they are the only ones who are right. If you want to persist in the

notion

that there is no such thing as a subluxation, then go be a freakin

physical

therapist. Do not, however, denigrate the profession by being

incongruent in

your belief system.

Jack.. sorry you opened the door.

Always

Danno

" an amorphous disorganized group of various

factions??

"

> Listmates:

>

> ....this is as close a term to Universal Basic Truth as I've ever seen

> used to describe any group that has consumed as many decades

struggling

> to snatch defeat from the jaws of victory as chiropractic has....

>

> With the Big Picture hanging out of focus in our otherwise Pristine

> Universe, ongoing internecine scrimmages between chiropractic factions

> occupy the same niche as the fiddle-players at Nero's Roman

> Extravaganza....and to the same effect....is it true we suffer a

> Professional Cognitive Dissonance, a selective type of attention

deficit

> disorder, which tricks us into ignoring one aspect of the human

> condition, while focusing on another???

>

> I believe we simply MUST overcome the notion EITHER:OR is 'Science'

> while " BOTH:AND " is something else....modern Physics, mathematics and

> the entire Silicon Lifeforms of Computer Science readily embrace both

> concepts are equally useful. Why can't chiropractors do that too?

>

> In the development of what we can measure OR define as being an

> essential part of chiropractic care, we continue to ram into the same

> issues. And we can continue to serve 10% of the population with the

> tools we have in place. Hardly a resounding victory in a world of

> grief and affliction.

>

> " Crazy " is continuing to do what we have always done and complaining

> about the results. " Insane " is doing what we've always done and

> expecting changes to somehow spring forth. I believe it's crazy to

> accept we only reach that 10%. I believe it's insane to not expect

> better from my profession.

>

> I've been an amorphous and disorganized individual my entire

life....no

> wonder 'chiropractic' seems like home to me!! Personally, I feel

quite

> comfortable in some circumstances acting as if " That Which Can Be

> Measured-orthopedic model " serves the patient best; while other

> situations a more effective choice is in the ineffable " Dynamic force "

> which isn't as easily documentable. And my chart notes are

constructed

> in a way intended to convey those various nuances.

>

> The requirements of OBCE to demonstrate what it is I think I'm doing

> help better formulate exactly what I'm offering the afflicted patient.

> Or is this note too amorphous and disorganized to understand?

>

> Jack Pedersen DC

> Member, AmoDisVariFac

>

>

>

> OregonDCs rules:

> 1. Keep correspondence professional; the purpose of the listserve is

to

> foster communication and collegiality. No personal attacks on

listserve

> members will be tolerated.

> 2. Always sign your e-mails with your first and last name.

> 3. The listserve is not secure; your e-mail could end up anywhere.

> However, it is against the rules of the listserve to copy, print,

forward,

> or otherwise distribute correspondence written by another member

without

> his or her consent, unless all personal identifiers have been removed.

>

[Guest guest]

Hi friends,

How would improvements in ROM, muscle tonicity and subjective

evaluations be reported differently by either straights or mixers, or

by SMTers or HIOners, or NMSers or Wellnessers, or by Jews, Christians

or Muslims for that matter? I can get improvements in all these

indices with active care protocols. You can get them by what you do.

CJ sets guidelines for outcomes, not protocols. We protect all of us

by defining standards for IMEs, and by taking care of our own business

politically.

Sears

On Feb 24, 2006, at 10:48 PM, Knecht wrote:

> Dear Sharron,

>

> Then, why doesn't the CJ rule make that specific language, i.e.  that

> it

> applies ONLY to NMS conditions documentation and not provide for

> guidelines

> of a wellness based model????  If it is not delineated, then it will

> be used

> against all practioners who practice a broad scope of healthcare.

>

>

>

>

> From: " Sharron Fuchs " <sharronf@...>

> CC: " oregondc " < >

> Subject: RE: response to Jack P... long post Off topic

> Date: Fri, 24 Feb 2006 16:31:14 -0800

>

> Dan, I just don't see the dichotomy that you describe here. A

> subluxation based Chiropractor can define and measure as well as a SMT

> Chiropractor, especially in an acute injury third party payor case.

> This

> is what the Clinical Justification Rule is about and this is all it is

> about.

>

> sharron fuchs dc

>

> ________________________________

>

> From: [mailto: ] On

> Behalf Of D Beebe, D.C.

> Sent: Friday, February 24, 2006 4:15 PM

> JPedersenDC

> Cc: oregondc

> Subject: response to Jack P... long post Off topic

>

>

> Jack:

>

> Hi, and thanks.

>

> Wanted to share an opinion, like that surprises you!

>

> The warring factions are more concerning the difference between a

> " medical "

> model of sickness. ie the SMT fellows of Chiropractic who actually

> believe

> that there is no difference between SMT and an adjustment, and the

> Chiropractic model of wellness and the prevention of dis-ease, ie non

> homeostasis.

>

> So while I have no particular problem with any DC practicing SMT, by

> definition he/she is not practicing Chiropractic. Chiropractic has

> never

>

> been defined as the pain model of SMT.

>

> As you so aptly stated, there are indeed two models of health care

> delivery

> in the Chiropractic profession and it is unfortunate that there is so

> much

> animosity between the two groups. It just seems that the SMT group

> wants

> to

> so narrowly define Chiropractic within the scope of dbl blind studies

> that

> it is forgotten what Chiropractic really is and has been.

>

> We didn't always have the same 10% of the sick population. We all got

> insurance coverage and then got lazy in education of the patients.

> That

> ...

> gasp... the patient actually had some responsibility in their own

> health.

> That getting adjusted,  eating the correct foods and exercising and

> attending to the spiritual portions of their lives were important

> aspects of

> maintaining homeostasis thereby preventing dis-ease. That the

> Chiropractic

> lifestyle was a reflection of the paradigm of health. After all

> everyone

>

> knows someone who has a spine that needs to be checked, but how many

> people

> do you personally know right at this minute that has a bad back or

> neck.

> Gee

> didn't you know that Chiropractor's only treat back pain and neck

> pain....

> or was that our SMT guys selling us on the notion that we could " get

> them

> in " with the back/neck pain and then " really " educate them as to what

> Chiropractic does.

>

> So while I have respect for those SMT Doctor's and the good work that

> they

> do for people in terms of  alleviating some/ or all of the patient's

> pain it

> is a crime to denigrate the profession by disclaiming the defined

> concept of

> the subluxation, attempting to hide behind the " it isn't proven "

> theory.

> Yes, I said theory... the subluxation has been proven, read your

> neurology

> texts... every single adjustment affects global physiology through

> afferent

> stimulation and vertebral movement that moves the body to homeostasis

> thereby alleviating dis-ease.

>

> If you choose to ignore neurophysiology and claim subluxation as a

> theory

> versus a fact,  be my guest.. you are, however, ignoring the research

> that

> has been done. The subluxation is and has been defined in peer

> reviewed

> articles such as JMPT, and the effects/affects are known

> neurophysiological

> results of the adjustment. What we do not know ... yet... are the full

> components of the subluxation nor the full effects, such as

> vibrational

> components , consciousness to consciousness components, etc.

>

> The SMT Doc's, at some point are going to have to give up the notion

> that

> they are the only ones who are right. If you want to persist in the

> notion

> that there is no such thing as a subluxation,  then go be a freakin

> physical

> therapist. Do not, however, denigrate the profession by being

> incongruent in

> your belief system.

>

> Jack.. sorry you opened the door.

>

> Always

>

> Danno

>

>

>

> " an amorphous disorganized group of various

> factions??

> "

>

>

> > Listmates:

> >

> > ....this is as close a term to Universal Basic Truth as I've ever

> seen

> > used to describe any group that has consumed as many decades

> struggling

> > to snatch defeat from the jaws of victory as chiropractic has....

> >

> > With the Big Picture hanging out of focus in our otherwise Pristine

> > Universe, ongoing internecine scrimmages between chiropractic

> factions

> > occupy the same niche as the fiddle-players at Nero's Roman

> > Extravaganza....and to the same effect....is it true we suffer a

> > Professional Cognitive Dissonance, a selective type of attention

> deficit

> > disorder, which tricks us into ignoring one aspect of the human

> > condition, while focusing on another???

> >

> > I believe we simply MUST overcome the notion EITHER:OR is 'Science'

> > while " BOTH:AND " is something else....modern Physics, mathematics

> and

> > the entire Silicon Lifeforms of Computer Science readily embrace

> both

> > concepts are equally useful.  Why can't chiropractors do that too?

> >

> > In the development of what we can measure OR define as being an

> > essential part of chiropractic care, we continue to ram into the

> same

> > issues. And we can continue to  serve 10% of the population with the

> > tools we  have in place.   Hardly a resounding victory in a world of

> > grief and affliction.

> >

> > " Crazy " is continuing to do what we have always done and complaining

> > about the results.  " Insane " is doing what we've always done and

> > expecting changes to somehow spring forth.  I believe it's crazy to

> > accept we only reach that 10%.  I believe it's insane to not expect

> > better from my profession.

> >

> > I've been an amorphous and disorganized individual my entire

> life....no

> > wonder 'chiropractic' seems like home to me!!  Personally, I feel

> quite

> > comfortable in some circumstances acting as if " That Which Can Be

> > Measured-orthopedic model " serves the patient best; while other

> > situations a more effective choice is in the ineffable " Dynamic

> force "

> > which isn't as easily documentable.  And my chart notes are

> constructed

> > in a way intended to convey those various nuances.

> >

> > The requirements of OBCE to demonstrate what it is I think I'm doing

> > help better formulate exactly what I'm offering the afflicted

> patient.

> > Or is this note too amorphous and disorganized to understand?

> >

> > Jack Pedersen DC

> > Member, AmoDisVariFac

> >

> >

> >

> > OregonDCs rules:

> > 1. Keep correspondence professional; the purpose of the listserve is

> to

> > foster communication and collegiality. No personal attacks on

> listserve

> > members will be tolerated.

> > 2. Always sign your e-mails with your first and last name.

> > 3. The listserve is not secure; your e-mail could end up anywhere.

> > However, it is against the rules of the listserve to copy, print,

> forward,

> > or otherwise distribute correspondence written by another member

> without

> > his or her consent, unless all personal identifiers have been

> removed.

> >

[Guest guest]

Dear All,

I heartily agree with Dr. Sears. He more eloquently epressed my concerns.

I have no problem with outcome measures for documenting care. It not only

is the future of healthcare delivery, but also serves as good documentation

for Case Studies in the research field. My primary concern is that the

" rule " might/would be construed to limit our scope and approach to treatment

of the varied cases that present to our offices.

Does anyone out there have any validated outcome measures for HTN, Seasonal

Allergies, Hiatal Hernia, Exzema, Asthma, ADD/HD, etc. These are very

common CHIEF complaints which present to my office for care. Of course I

utilize all parameters of D.D.'s paradigm in my approach, i.e. Structure

(read vsc/SMT), Nutrition, Homeopathy, and Emotion. I would appreciate any

url links, etc.

Also, this discussion has jogged my memory of what I learned in school about

the potential impact that segmental dysfunction can have on the spinal

nerves exiting the intervertebral foramen: There are 9 functions on a

nerve, only one of them is sensory. That is why 8 out of 9 times when spinal

nerve supply is affected at such levels of segmental dysfunction in the

spine - there is absolutly no pain in the spine, however serious health

problems develope at the area of the body that is controled by that nerve.

Here are the 9 Functions

1. Motor

2. Calorific

3. Sensory

4. Secretory

5. Excretory

6. Nutritive

7. Reparative

8. Expansive

9. Reproductive

All of us, straights, mixers, smt-ers, ortho/neuro guys, HIOs, etc. see

everyday in the form of objective palpation, meansuration, observation. I

believe we sometimes forget all aspects of the underlying mechanisms

contributing to what we are observing and treating.

Yours in Health,

<html><DIV> Knecht DC </DIV>Namaste Chiropractic

<DIV></DIV>1809 NW

<DIV></DIV>Portland, OR 97209

<DIV></DIV>503-226-8010</html>

From: " dm.bones@... " <dm.bones@...>

allen@...

CC: sharronf@...,

Subject: Re: response to Jack P... long post Off topic

Date: Sat, 25 Feb 2006 00:13:58 -0800

Hi friends,

How would improvements in ROM, muscle tonicity and subjective evaluations

be reported differently by either straights or mixers, or by SMTers or

HIOners, or NMSers or Wellnessers, or by Jews, Christians or Muslims for

that matter? I can get improvements in all these indices with active care

protocols. You can get them by what you do.

CJ sets guidelines for outcomes, not protocols. We protect all of us by

defining standards for IMEs, and by taking care of our own business

politically.

Sears

On Feb 24, 2006, at 10:48 PM, Knecht wrote:

>Dear Sharron,

>

> Then, why doesn't the CJ rule make that specific language, i.e.  that

>it

> applies ONLY to NMS conditions documentation and not provide for

>guidelines

> of a wellness based model????  If it is not delineated, then it will be

>used

> against all practioners who practice a broad scope of healthcare.

>

>

>

>

> From: " Sharron Fuchs " <sharronf@...>

> CC: " oregondc " < >

> Subject: RE: response to Jack P... long post Off topic

> Date: Fri, 24 Feb 2006 16:31:14 -0800

>

> Dan, I just don't see the dichotomy that you describe here. A

> subluxation based Chiropractor can define and measure as well as a SMT

> Chiropractor, especially in an acute injury third party payor case. This

> is what the Clinical Justification Rule is about and this is all it is

> about.

>

> sharron fuchs dc

>

> ________________________________

>

> From: [mailto: ] On

> Behalf Of D Beebe, D.C.

> Sent: Friday, February 24, 2006 4:15 PM

> JPedersenDC

> Cc: oregondc

> Subject: response to Jack P... long post Off topic

>

>

> Jack:

>

> Hi, and thanks.

>

> Wanted to share an opinion, like that surprises you!

>

> The warring factions are more concerning the difference between a

> " medical "

> model of sickness. ie the SMT fellows of Chiropractic who actually

> believe

> that there is no difference between SMT and an adjustment, and the

> Chiropractic model of wellness and the prevention of dis-ease, ie non

> homeostasis.

>

> So while I have no particular problem with any DC practicing SMT, by

> definition he/she is not practicing Chiropractic. Chiropractic has never

>

> been defined as the pain model of SMT.

>

> As you so aptly stated, there are indeed two models of health care

> delivery

> in the Chiropractic profession and it is unfortunate that there is so

> much

> animosity between the two groups. It just seems that the SMT group wants

> to

> so narrowly define Chiropractic within the scope of dbl blind studies

> that

> it is forgotten what Chiropractic really is and has been.

>

> We didn't always have the same 10% of the sick population. We all got

> insurance coverage and then got lazy in education of the patients. That

> ...

> gasp... the patient actually had some responsibility in their own

> health.

> That getting adjusted,  eating the correct foods and exercising and

> attending to the spiritual portions of their lives were important

> aspects of

> maintaining homeostasis thereby preventing dis-ease. That the

> Chiropractic

> lifestyle was a reflection of the paradigm of health. After all everyone

>

> knows someone who has a spine that needs to be checked, but how many

> people

> do you personally know right at this minute that has a bad back or neck.

> Gee

> didn't you know that Chiropractor's only treat back pain and neck

> pain....

> or was that our SMT guys selling us on the notion that we could " get

> them

> in " with the back/neck pain and then " really " educate them as to what

> Chiropractic does.

>

> So while I have respect for those SMT Doctor's and the good work that

> they

> do for people in terms of  alleviating some/ or all of the patient's

> pain it

> is a crime to denigrate the profession by disclaiming the defined

> concept of

> the subluxation, attempting to hide behind the " it isn't proven "

> theory.

> Yes, I said theory... the subluxation has been proven, read your

> neurology

> texts... every single adjustment affects global physiology through

> afferent

> stimulation and vertebral movement that moves the body to homeostasis

> thereby alleviating dis-ease.

>

> If you choose to ignore neurophysiology and claim subluxation as a

> theory

> versus a fact,  be my guest.. you are, however, ignoring the research

> that

> has been done. The subluxation is and has been defined in peer reviewed

> articles such as JMPT, and the effects/affects are known

> neurophysiological

> results of the adjustment. What we do not know ... yet... are the full

> components of the subluxation nor the full effects, such as vibrational

> components , consciousness to consciousness components, etc.

>

> The SMT Doc's, at some point are going to have to give up the notion

> that

> they are the only ones who are right. If you want to persist in the

> notion

> that there is no such thing as a subluxation,  then go be a freakin

> physical

> therapist. Do not, however, denigrate the profession by being

> incongruent in

> your belief system.

>

> Jack.. sorry you opened the door.

>

> Always

>

> Danno

>

>

>

> " an amorphous disorganized group of various

> factions??

> "

>

>

> > Listmates:

> >

> > ....this is as close a term to Universal Basic Truth as I've ever seen

> > used to describe any group that has consumed as many decades

> struggling

> > to snatch defeat from the jaws of victory as chiropractic has....

> >

> > With the Big Picture hanging out of focus in our otherwise Pristine

> > Universe, ongoing internecine scrimmages between chiropractic factions

> > occupy the same niche as the fiddle-players at Nero's Roman

> > Extravaganza....and to the same effect....is it true we suffer a

> > Professional Cognitive Dissonance, a selective type of attention

> deficit

> > disorder, which tricks us into ignoring one aspect of the human

> > condition, while focusing on another???

> >

> > I believe we simply MUST overcome the notion EITHER:OR is 'Science'

> > while " BOTH:AND " is something else....modern Physics, mathematics and

> > the entire Silicon Lifeforms of Computer Science readily embrace both

> > concepts are equally useful.  Why can't chiropractors do that too?

> >

> > In the development of what we can measure OR define as being an

> > essential part of chiropractic care, we continue to ram into the same

> > issues. And we can continue to  serve 10% of the population with the

> > tools we  have in place.   Hardly a resounding victory in a world of

> > grief and affliction.

> >

> > " Crazy " is continuing to do what we have always done and complaining

> > about the results.  " Insane " is doing what we've always done and

> > expecting changes to somehow spring forth.  I believe it's crazy to

> > accept we only reach that 10%.  I believe it's insane to not expect

> > better from my profession.

> >

> > I've been an amorphous and disorganized individual my entire

> life....no

> > wonder 'chiropractic' seems like home to me!!  Personally, I feel

> quite

> > comfortable in some circumstances acting as if " That Which Can Be

> > Measured-orthopedic model " serves the patient best; while other

> > situations a more effective choice is in the ineffable " Dynamic force "

> > which isn't as easily documentable.  And my chart notes are

> constructed

> > in a way intended to convey those various nuances.

> >

> > The requirements of OBCE to demonstrate what it is I think I'm doing

> > help better formulate exactly what I'm offering the afflicted patient.

> > Or is this note too amorphous and disorganized to understand?

> >

> > Jack Pedersen DC

> > Member, AmoDisVariFac

> >

> >

> >

> > OregonDCs rules:

> > 1. Keep correspondence professional; the purpose of the listserve is

> to

> > foster communication and collegiality. No personal attacks on

> listserve

> > members will be tolerated.

> > 2. Always sign your e-mails with your first and last name.

> > 3. The listserve is not secure; your e-mail could end up anywhere.

> > However, it is against the rules of the listserve to copy, print,

> forward,

> > or otherwise distribute correspondence written by another member

> without

> > his or her consent, unless all personal identifiers have been removed.

> >

[Guest guest]

;

You make a

very good point. Would it be of value to a third party payer to misuse

the CJ rule, to draw conclusions from the language of the rule in such a way as

to say that the CJ rule implicitly states that chiropractic is intended to be

limited to NMS conditions? If you can imagine that it might be

advantageous (can anyone not imagine that???), then it is obviously important

that such a rule, be it CJ or CR, explicitly state that the rule is applicable

only to NMS conditions. It’s hard to imagine anyone arguing against

such a stipulation in the rule, unless they really did feel that chiropractic

should be exclusively and NMS based form of health care. Regardless of

the benign intentions of those who may craft a rule, if it is written in a way

that it can be misused, you can rest assured that some interested party will

find a way to misuse it.

I still

have great confusion in my mind about this CJ rule, the vigor with which it is

supported, and the strident voices that come out to pillory anyone who wants to

amend problem language in the rule. I don’t buy the argument about controlling

disreputable IMEs for reasons that I’ve already posted here. In

short, that including required pieces into an examination does nothing to prevent

a biased IME from writing a biased report. I trained with Brad

years ago and have written a fair number of IMEs over the years, which I

strived to make fair and balanced. My experience with that process tells

me that if I were not committed to being fair, and if the proposed CJ rule were

in effect, that I could write a biased report that met the letter of the law

without much of a stretch.

The second argument

supporting the CJ rule is that is would prevent overutilization and put teeth

into regulation of bandito chiros. Well, maybe this is a big issue.

Maybe there is so much blatant overutilization and padding of bills that we are

at a crisis point and need to implement strong rules to address this. How

could we tell if this were true? I guess we would take a look at the

statistics that the OBCE keeps of various complaints and disciplinary

actions. That should tell us if we have an immanent problem, should it

not? Last week Dr. Schmidt kindly sent me a compilation for the past

several years of those very OBCE statistics. I was startled! What I

saw was that there were 9 cases in all of the state of Oregon last year of complaints to the OBCE about

overbilling. Zowie! Nine; is that so? How do we get from the

fact of 9 such complaints covering hundreds of thousands of cases for the year

for over a thousand chiropractors in Oregon to the fevered exhortations to roll

forward with the CJ rule as a sacrosanct product of a “consensus” process

that has been well criticized on this forum?

S.

Feinberg, D.C.

From:

[mailto: ] On Behalf Of Knecht

Sent: Friday, February 24, 2006

10:48 PM

sharronf@...

Cc:

Subject: RE: response

to Jack P... long post Off topic

Dear Sharron,

Then, why doesn't the CJ rule make that specific

language, i.e. that it

applies ONLY to NMS conditions documentation and

not provide for guidelines

of a wellness based model???? If it is not

delineated, then it will be used

against all practioners who practice a broad scope

of healthcare.

From: " Sharron Fuchs "

<sharronf@...>

CC: " oregondc "

< >

Subject: RE: response to Jack P...

long post Off topic

Date: Fri, 24 Feb 2006 16:31:14 -0800

Dan, I just don't see the dichotomy that you

describe here. A

subluxation based Chiropractor can define and

measure as well as a SMT

Chiropractor, especially in an acute injury third

party payor case. This

is what the Clinical Justification Rule is about

and this is all it is

about.

sharron fuchs dc

________________________________

From:

[mailto: ] On

Behalf Of D Beebe, D.C.

Sent: Friday, February 24, 2006 4:15 PM

JPedersenDC

Cc: oregondc

Subject: response to Jack P... long

post Off topic

Jack:

Hi, and thanks.

Wanted to share an opinion, like that surprises

you!

The warring factions are more concerning the

difference between a

" medical "

model of sickness. ie the SMT fellows of

Chiropractic who actually

believe

that there is no difference between SMT and an

adjustment, and the

Chiropractic model of wellness and the prevention

of dis-ease, ie non

homeostasis.

So while I have no particular problem with any DC

practicing SMT, by

definition he/she is not practicing Chiropractic.

Chiropractic has never

been defined as the pain model of SMT.

As you so aptly stated, there are indeed two

models of health care

delivery

in the Chiropractic profession and it is

unfortunate that there is so

much

animosity between the two groups. It just seems

that the SMT group wants

to

so narrowly define Chiropractic within the scope

of dbl blind studies

that

it is forgotten what Chiropractic really is and

has been.

We didn't always have the same 10% of the sick

population. We all got

insurance coverage and then got lazy in education

of the patients. That

....

gasp... the patient actually had some

responsibility in their own

health.

That getting adjusted, eating the correct

foods and exercising and

attending to the spiritual portions of their lives

were important

aspects of

maintaining homeostasis thereby preventing

dis-ease. That the

Chiropractic

lifestyle was a reflection of the paradigm of

health. After all everyone

knows someone who has a spine that needs to be

checked, but how many

people

do you personally know right at this minute that

has a bad back or neck.

Gee

didn't you know that Chiropractor's only treat

back pain and neck

pain....

or was that our SMT guys selling us on the notion

that we could " get

them

in " with the back/neck pain and then

" really " educate them as to what

Chiropractic does.

So while I have respect for those SMT Doctor's and

the good work that

they

do for people in terms of alleviating some/

or all of the patient's

pain it

is a crime to denigrate the profession by

disclaiming the defined

concept of

the subluxation, attempting to hide behind the

" it isn't proven "

theory.

Yes, I said theory... the subluxation has been

proven, read your

neurology

texts... every single adjustment affects global

physiology through

afferent

stimulation and vertebral movement that moves the

body to homeostasis

thereby alleviating dis-ease.

If you choose to ignore neurophysiology and claim

subluxation as a

theory

versus a fact, be my guest.. you are,

however, ignoring the research

that

has been done. The subluxation is and has been

defined in peer reviewed

articles such as JMPT, and the effects/affects are

known

neurophysiological

results of the adjustment. What we do not know ...

yet... are the full

components of the subluxation nor the full

effects, such as vibrational

components , consciousness to consciousness

components, etc.

The SMT Doc's, at some point are going to have to

give up the notion

that

they are the only ones who are right. If you want

to persist in the

notion

that there is no such thing as a

subluxation, then go be a freakin

physical

therapist. Do not, however, denigrate the

profession by being

incongruent in

your belief system.

Jack.. sorry you opened the door.

Always

Danno

" an amorphous

disorganized group of various

factions??

"

> Listmates:

>

> ....this is as close a term to Universal

Basic Truth as I've ever seen

> used to describe any group that has consumed

as many decades

struggling

> to snatch defeat from the jaws of victory as

chiropractic has....

>

> With the Big Picture hanging out of focus in

our otherwise Pristine

> Universe, ongoing internecine scrimmages

between chiropractic factions

> occupy the same niche as the fiddle-players

at Nero's Roman

> Extravaganza....and to the same effect....is

it true we suffer a

> Professional Cognitive Dissonance, a

selective type of attention

deficit

> disorder, which tricks us into ignoring one

aspect of the human

> condition, while focusing on another???

>

> I believe we simply MUST overcome the notion

EITHER:OR is 'Science'

> while " BOTH:AND " is something

else....modern Physics, mathematics and

> the entire Silicon Lifeforms of Computer

Science readily embrace both

> concepts are equally useful. Why can't

chiropractors do that too?

>

> In the development of what we can measure OR

define as being an

> essential part of chiropractic care, we

continue to ram into the same

> issues. And we can continue to serve

10% of the population with the

> tools we have in place.

Hardly a resounding victory in a world of

> grief and affliction.

>

> " Crazy " is continuing to do what we

have always done and complaining

> about the results. " Insane "

is doing what we've always done and

> expecting changes to somehow spring

forth. I believe it's crazy to

> accept we only reach that 10%. I

believe it's insane to not expect

> better from my profession.

>

> I've been an amorphous and disorganized

individual my entire

life....no

> wonder 'chiropractic' seems like home to

me!! Personally, I feel

quite

> comfortable in some circumstances acting as

if " That Which Can Be

> Measured-orthopedic model " serves the

patient best; while other

> situations a more effective choice is in the

ineffable " Dynamic force "

> which isn't as easily documentable. And

my chart notes are

constructed

> in a way intended to convey those various

nuances.

>

> The requirements of OBCE to demonstrate what

it is I think I'm doing

> help better formulate exactly what I'm

offering the afflicted patient.

> Or is this note too amorphous and

disorganized to understand?

>

> Jack Pedersen DC

> Member, AmoDisVariFac

>

>

>

> OregonDCs rules:

> 1. Keep correspondence professional; the

purpose of the listserve is

to

> foster communication and collegiality. No

personal attacks on

listserve

> members will be tolerated.

> 2. Always sign your e-mails with your first

and last name.

> 3. The listserve is not secure; your e-mail

could end up anywhere.

> However, it is against the rules of the

listserve to copy, print,

forward,

> or otherwise distribute correspondence

written by another member

without

> his or her consent, unless all personal

identifiers have been removed.

>

[Guest guest]

Les,

You make some very good points. I believe the CJ rule should be scrutinzed

carefully and rewritten with the true consensus of the profession and the

board. The profession has had time to digest the CJ rule and now is a good time

to refine or dramaticly rewrite it with the advantage of better perspective and

a wider consensus.

I agree with Les and many other listserve members that the current CJ rule could

be used by ruthless third party payers and IME docs to discredit and otherwise

hurt reputable chiropractors in Oregon. We must do this thing right for the

good of our profession and our own survival.

Schneider

Portland

----- " an amorphous disorganized group of various

>factions??

> "

>

>

>> Listmates:

>>

>> ....this is as close a term to Universal Basic Truth as I've ever seen

>> used to describe any group that has consumed as many decades

>struggling

>> to snatch defeat from the jaws of victory as chiropractic has....

>>

>> With the Big Picture hanging out of focus in our otherwise Pristine

>> Universe, ongoing internecine scrimmages between chiropractic factions

>> occupy the same niche as the fiddle-players at Nero's Roman

>> Extravaganza....and to the same effect....is it true we suffer a

>> Professional Cognitive Dissonance, a selective type of attention

>deficit

>> disorder, which tricks us into ignoring one aspect of the human

>> condition, while focusing on another???

>>

>> I believe we simply MUST overcome the notion EITHER:OR is 'Science'

>> while " BOTH:AND " is something else....modern Physics, mathematics and

>> the entire Silicon Lifeforms of Computer Science readily embrace both

>> concepts are equally useful. Why can't chiropractors do that too?

>>

>> In the development of what we can measure OR define as being an

>> essential part of chiropractic care, we continue to ram into the same

>> issues. And we can continue to serve 10% of the population with the

>> tools we have in place. Hardly a resounding victory in a world of

>> grief and affliction.

>>

>> " Crazy " is continuing to do what we have always done and complaining

>> about the results. " Insane " is doing what we've always done and

>> expecting changes to somehow spring forth. I believe it's crazy to

>> accept we only reach that 10%. I believe it's insane to not expect

>> better from my profession.

>>

>> I've been an amorphous and disorganized individual my entire

>life....no

>> wonder 'chiropractic' seems like home to me!! Personally, I feel

>quite

>> comfortable in some circumstances acting as if " That Which Can Be

>> Measured-orthopedic model " serves the patient best; while other

>> situations a more effective choice is in the ineffable " Dynamic force "

>> which isn't as easily documentable. And my chart notes are

>constructed

>> in a way intended to convey those various nuances.

>>

>> The requirements of OBCE to demonstrate what it is I think I'm doing

>> help better formulate exactly what I'm offering the afflicted patient.

>> Or is this note too amorphous and disorganized to understand?

>>

>> Jack Pedersen DC

>> Member, AmoDisVariFac

>>

>>

>>

>> OregonDCs rules:

>> 1. Keep correspondence professional; the purpose of the listserve is

>to

>> foster communication and collegiality. No personal attacks on

>listserve

>> members will be tolerated.

>> 2. Always sign your e-mails with your first and last name.

>> 3. The listserve is not secure; your e-mail could end up anywhere.

>> However, it is against the rules of the listserve to copy, print,

>forward,

>> or otherwise distribute correspondence written by another member

>without

>> his or her consent, unless all personal identifiers have been removed.

>>

[Guest guest]

So, .....how do you suggest it read? Sunny

Sunny Kierstyn, RN DC Fibromyalgia Care Center of Oregon 2677 Willakenzie Road, 7C

Eugene, Oregon, 97401

541- 344- 0509; Fx; 541- 344- 0955

From: "schneider@..." <schneider@...>Reply-<schneider@...><allen@...>, <sharronf@...>, " S. Feinberg, D.C." <feinberg@...>CC: < >Subject: RE: response to Jack P... long post Off topicDate: Sat, 25 Feb 2006 12:40:55 -0800Les,You make some very good points. I believe the CJ rule should be scrutinzed carefully and rewritten with the true consensus of the profession and the board. The profession has had time to digest the CJ rule and now is a good time to refine or dramaticly rewrite it with the advantage of better perspective and a wider consensus.I agree with Les and many other listserve members that the current CJ rule could be used by ruthless third party payers and IME docs to discredit and otherwise hurt reputable chiropractors in Oregon. We must do this thing right for the good of our profession and our own survival. SchneiderPortland----- "an amorphous disorganized group of various>factions??>">>>> Listmates:>>>> ....this is as close a term to Universal Basic Truth as I've ever seen>> used to describe any group that has consumed as many decades>struggling>> to snatch defeat from the jaws of victory as chiropractic has....>>>> With the Big Picture hanging out of focus in our otherwise Pristine>> Universe, ongoing internecine scrimmages between chiropractic factions>> occupy the same niche as the fiddle-players at Nero's Roman>> Extravaganza....and to the same effect....is it true we suffer a>> Professional Cognitive Dissonance, a selective type of attention>deficit>> disorder, which tricks us into ignoring one aspect of the human>> condition, while focusing on another???>>>> I believe we simply MUST overcome the notion EITHER:OR is 'Science'>> while "BOTH:AND" is something else....modern Physics, mathematics and>> the entire Silicon Lifeforms of Computer Science readily embrace both>> concepts are equally useful. Why can't chiropractors do that too?>>>> In the development of what we can measure OR define as being an>> essential part of chiropractic care, we continue to ram into the same>> issues. And we can continue to serve 10% of the population with the>> tools we have in place. Hardly a resounding victory in a world of>> grief and affliction.>>>> "Crazy" is continuing to do what we have always done and complaining>> about the results. "Insane" is doing what we've always done and>> expecting changes to somehow spring forth. I believe it's crazy to>> accept we only reach that 10%. I believe it's insane to not expect>> better from my profession.>>>> I've been an amorphous and disorganized individual my entire>life....no>> wonder 'chiropractic' seems like home to me!! Personally, I feel>quite>> comfortable in some circumstances acting as if "That Which Can Be>> Measured-orthopedic model" serves the patient best; while other>> situations a more effective choice is in the ineffable "Dynamic force">> which isn't as easily documentable. And my chart notes are>constructed>> in a way intended to convey those various nuances.>>>> The requirements of OBCE to demonstrate what it is I think I'm doing>> help better formulate exactly what I'm offering the afflicted patient.>> Or is this note too amorphous and disorganized to understand?>>>> Jack Pedersen DC>> Member, AmoDisVariFac>>>>>>>> OregonDCs rules:>> 1. Keep correspondence professional; the purpose of the listserve is>to>> foster communication and collegiality. No personal attacks on>listserve>> members will be tolerated.>> 2. Always sign your e-mails with your first and last name.>> 3. The listserve is not secure; your e-mail could end up anywhere.>> However, it is against the rules of the listserve to copy, print,>forward,>> or otherwise distribute correspondence written by another member>without>> his or her consent, unless all personal identifiers have been removed.>>

[Guest guest]

On Feb 24, 2006, at 5:24 PM, s, D.C. wrote:

> I probably shouldn't admit this on the list serve...but I treat

> patients who come in to get adjusted just because they " don't feel

> right. "   They are in no particular pain; they just don't feel right! 

> On palpation, I can certainly find taught/tender muscles,

> myofascitis, segmental joint dysfunction, etc...(in order to justify

> treatment in the chart note), but is that what they really came in

> for...?

>  

makes a very good point, " ... what (did) they really come in

for...? " if they are in no particular pain. This is not an isolated

observation; we all know exactly what 's speaking about. Not

everyone we treat is in pain: muscles are not in spasm, segmental

motion is not sore on palpatory challenge, functional measurements are

relatively unremarkable, subjective complaints are ambiguous, but

something's not right.... They know that our attention to such

complaints are helpful in some way, but what is it that we're

addressing? If we don't know, how can we expect to inform third party

payers? Further, how can we expect to define ourselves publicly if

we're unsure? How can we support guidelines if we're not sure they

address everything we do?

This confusion has hindered unity within the profession for decades,

and continues to do so in our CJ consultations. What we do is not

solely mechanical and measurable, nor is it solely subtle and ethereal.

Further, we have the legal demands brought by our movement into

mainstream health care, that we be defined in such a way that the

public and the payers can understand who we are and what we do.

These are the natural growing pains of a profession coming of age and

how we deal with it is important. Given external circumstances, I see

the profession moving toward an NMS orientation within the health care

industry, backed by evidence that restoring motion to the axial and

appendicular skeletal system and it's associated neuromuscular

components is beneficial. That basis is expressed in a PARTS

examination and report. Does that fully describe the territory of

chiropractic? No. But, it does give those who pay for our treatments

of injury to others a handle on who and what we can be expected to do.

It also gives the public a handle on who and what we do.

We are forced by circumstances to address the efforts of third party

payers who seek to gain more control over payment for NMS related

treatment. Our guideline, CJ, is a general NMS statement which puts

responsibility on the profession for self-regulation, allowing us to

avoid definition by others with less friendly intent. It's the process

of us defining ourself that must be preserved in a politically charged

arena. If we can continue to define ourselves, then we won't be

subjected to a list of " 100 mandated regulations " such as those being

foisted on the AMA at present, for example. If CJ is inappropriate for

us, or being misused by others, then we are still free to change the

guideline. If someone else is doing the defining, then we have less

control over our own destiny. This is the minutia of mainstream health

care and the only thing standing in the way of our unity in the face of

third party payer efforts at control is our reactive fear of taking a

stand.

Of greater long range importance is our ability to define ourself to

the general public, for it is chiropractic's place in the public's eye

that has more power to drive political pressures on us. We need to

give the public a simple chiropractic story of who we are and what we

can do for them if we are ever to gain more than the fabled 10-15% of

the population. That story will be a NMS story for the most part, but

needn't be the total story. We can also offer a handle on how to

engage subtle innate capacities for healing currently outside of

mainstream American health care. This would encompass stress

reduction, improved cardiovascular health, improved digestive

functioning, improved oxidizing reparation of all cells, simple foods

and nutrients as sources of health, and other still mysterious ways

that our innate continues to reveal itself to us as we work with these

potentials every day. All of the multiple functions of the human nerve

that Knecht brought forward are real, in spite of our attention

currently at the motor and sensory levels.

The public handle on chiropractic might be something like, " Motion is

life; chiropractic keeps you moving. " Such a slogan doesn't define the

profession, but it suggests simply who and what we do for the most

part. We bring life back to immobile parts of the body.

Realistically, in our practices, that life is usually biomechanical.

But it may also be psychological to a mind fixated and stuck around

unhealthy aspects. That life may be cathartic to an emotionally bound

experience. It may be an inner relaxation from chronically held

compensation for pain or earlier injury no longer sore, but still " not

right. " It begins to answer 's important question of what they

are coming for and what we are giving: motion! We keep people moving,

on a whole lot of levels. This is just a suggestion, with the intent

of bringing this thread to a larger recognition of our potential place

in a rapidly changing America. If we are able to see ourself as

purveyors of an innate human capacity for self-healing that is evolving

on more than just mechanical levels, then we can rightly take our place

as the leaders of natural health. This, it seems, is the direction for

a secure future for the profession, and for a maximally potentiated

citizenry.

If we go forward on assumptions based in fear, we severely limit

ourself. If we go forward on a vision of what we can do together for

the greater benefit of all, we are on a sustainable path. For the

benefit of all, we need unity in diversity.

With respect for all,

Sears

[Guest guest]

Les, , Colleagues,

These were the "anticipated," supposedly "possible" negative occurrences that would happen if the Clinical Justification Rule was adopted...that we heard from Dr. Boothby and Cafferty during the year period of time the rule was adopted. We specifically and repeatedly already addressed these concerns in Rules Advisory Committee and in front of the Board multiple times. Though the majority felt this was not a valid concern we nonetheless inserted a "sunset clause" just in case so we could amend or eliminate the rule easily.....it's not going to happen.

To date there has not been a single example given of a colleague's scope of practice being impacted by this rule nor a restriction on the types of procedures or treatments they can use.

As I've said so many times if we do not act from within the profession, those outside the profession will. ...and what I've also said repeatedly is that the real danger is not the CJ rule which we can use to our advantage (proactive) but what's just around the corner that being "Evidence Based Best Practices!" This is the very danger Drs. Boothby and Cafferty, you, and are concerned with. We need to leave the CJ rule in place it's a good rule and now in a collaborative way address "Best Practices."

Our current CJ rule with it's Evidence Based Outcomes as the determinate of when to end curative care will keep us from being boxed into canned numbers of treatments. Our "ratings of the evidence" document produced a number of years ago nexuses to the ESTPD rule will keep others (third party payers) from outside the profession from raising the evidence bar to high as per what procedures will be reimbursed and which will not.

As I stated in Pendleton we must always leave the door open for new innovative techniques and procedures but if we are not proactive others outside the profession will restrict reimbursement for treatments and procedures that don't have their (the outsiders) sufficient "level of evidence" supporting that procedure's effectiveness.

Vern Saboe

"an amorphous disorganized group of variousfactions??"> Listmates:>> ....this is as close a term to Universal Basic Truth as I've ever seen> used to describe any group that has consumed as many decadesstruggling> to snatch defeat from the jaws of victory as chiropractic has....>> With the Big Picture hanging out of focus in our otherwise Pristine> Universe, ongoing internecine scrimmages between chiropractic factions> occupy the same niche as the fiddle-players at Nero's Roman> Extravaganza....and to the same effect....is it true we suffer a> Professional Cognitive Dissonance, a selective type of attentiondeficit> disorder, which tricks us into ignoring one aspect of the human> condition, while focusing on another???>> I believe we simply MUST overcome the notion EITHER:OR is 'Science'> while "BOTH:AND" is something else....modern Physics, mathematics and> the entire Silicon Lifeforms of Computer Science readily embrace both> concepts are equally useful. Why can't chiropractors do that too?>> In the development of what we can measure OR define as being an> essential part of chiropractic care, we continue to ram into the same> issues. And we can continue to serve 10% of the population with the> tools we have in place. Hardly a resounding victory in a world of> grief and affliction.>> "Crazy" is continuing to do what we have always done and complaining> about the results. "Insane" is doing what we've always done and> expecting changes to somehow spring forth. I believe it's crazy to> accept we only reach that 10%. I believe it's insane to not expect> better from my profession.>> I've been an amorphous and disorganized individual my entirelife....no> wonder 'chiropractic' seems like home to me!! Personally, I feelquite> comfortable in some circumstances acting as if "That Which Can Be> Measured-orthopedic model" serves the patient best; while other> situations a more effective choice is in the ineffable "Dynamic force"> which isn't as easily documentable. And my chart notes areconstructed> in a way intended to convey those various nuances.>> The requirements of OBCE to demonstrate what it is I think I'm doing> help better formulate exactly what I'm offering the afflicted patient.> Or is this note too amorphous and disorganized to understand?>> Jack Pedersen DC> Member, AmoDisVariFac>>>> OregonDCs rules:> 1. Keep correspondence professional; the purpose of the listserve isto> foster communication and collegiality. No personal attacks onlistserve> members will be tolerated.> 2. Always sign your e-mails with your first and last name.> 3. The listserve is not secure; your e-mail could end up anywhere.> However, it is against the rules of the listserve to copy, print,forward,> or otherwise distribute correspondence written by another memberwithout> his or her consent, unless all personal identifiers have been removed.>

[Guest guest]

Dr. Knecht said,

" Does anyone out there have any validated outcome measures for HTN, Seasonal

Allergies, Hiatal Hernia, Exzema, Asthma, ADD/HD, etc. These are very

common CHIEF complaints which present to my office for care. Of course I

utilize all parameters of D.D.'s paradigm in my approach, i.e. Structure

(read vsc/SMT), Nutrition, Homeopathy, and Emotion. I would appreciate any

url links, etc "

This is the difficulty inherent in CJ. However, we must remember that we

don't treat these conditions. We treat subluxations. These subluxations may

be the direct cause or an aggravating factor etc., but it is important to

realize that our responsibility ends at clearing the subluxation. If the

disease will not relent even after clearing the subluxation then it is our

mandate to REFER or co manage. So, it is going to be very difficult to see

any outcome measures for these diseases as far as chiropractic is concerned.

I for one would be very reluctant to let a case of Eczema or Asthma go for

very long without referral. There are some good meds out there for it.

Musculoskelatal conditions are a bit different. Unless it's a surgery case

there are very few options for the patient other than what we can do for

them.Again though, if we don't get results,eventually we have to re think

what we are doing and whether or not to discharge.

Dr. ph Medlin D.C.

Spine Tree Chiropractic

1627 NE Alberta St. #6

Portland, OR 97211

Ph: 503-788-6800

c: 503-889-6204

" an amorphous disorganized group of various

>> factions??

>> "

>>

>>

>> > Listmates:

>> >

>> > ....this is as close a term to Universal Basic Truth as I've ever

>> seen

>> > used to describe any group that has consumed as many decades

>> struggling

>> > to snatch defeat from the jaws of victory as chiropractic has....

>> >

>> > With the Big Picture hanging out of focus in our otherwise Pristine

>> > Universe, ongoing internecine scrimmages between chiropractic

>> factions

>> > occupy the same niche as the fiddle-players at Nero's Roman

>> > Extravaganza....and to the same effect....is it true we suffer a

>> > Professional Cognitive Dissonance, a selective type of attention

>> deficit

>> > disorder, which tricks us into ignoring one aspect of the human

>> > condition, while focusing on another???

>> >

>> > I believe we simply MUST overcome the notion EITHER:OR is 'Science'

>> > while " BOTH:AND " is something else....modern Physics, mathematics and

>> > the entire Silicon Lifeforms of Computer Science readily embrace both

>> > concepts are equally useful. Why can't chiropractors do that too?

>> >

>> > In the development of what we can measure OR define as being an

>> > essential part of chiropractic care, we continue to ram into the same

>> > issues. And we can continue to serve 10% of the population with the

>> > tools we have in place.  Hardly a resounding victory in a world of

>> > grief and affliction.

>> >

>> > " Crazy " is continuing to do what we have always done and complaining

>> > about the results. " Insane " is doing what we've always done and

>> > expecting changes to somehow spring forth. I believe it's crazy to

>> > accept we only reach that 10%. I believe it's insane to not expect

>> > better from my profession.

>> >

>> > I've been an amorphous and disorganized individual my entire

>> life....no

>> > wonder 'chiropractic' seems like home to me!! Personally, I feel

>> quite

>> > comfortable in some circumstances acting as if " That Which Can Be

>> > Measured-orthopedic model " serves the patient best; while other

>> > situations a more effective choice is in the ineffable " Dynamic

>> force "

>> > which isn't as easily documentable. And my chart notes are

>> constructed

>> > in a way intended to convey those various nuances.

>> >

>> > The requirements of OBCE to demonstrate what it is I think I'm doing

>> > help better formulate exactly what I'm offering the afflicted

>> patient.

>> > Or is this note too amorphous and disorganized to understand?

>> >

>> > Jack Pedersen DC

>> > Member, AmoDisVariFac

>> >

>> >

>> >

>> > OregonDCs rules:

>> > 1. Keep correspondence professional; the purpose of the listserve is

>> to

>> > foster communication and collegiality. No personal attacks on

>> listserve

>> > members will be tolerated.

>> > 2. Always sign your e-mails with your first and last name.

>> > 3. The listserve is not secure; your e-mail could end up anywhere.

>> > However, it is against the rules of the listserve to copy, print,

>> forward,

>> > or otherwise distribute correspondence written by another member

>> without

>> > his or her consent, unless all personal identifiers have been

>> removed.

>> >

[Guest guest]

Dear Joe,

In all professional respect, It appears that you have missed the point. Treating the subluxation as a primary cause involves treating all nine aspects (see prior post) of the nerve function being affected by said subluxation. In fact, in my clinic and I know for a FACT that in several of my colleagues clinics, these conditions that I referenced (see prior post to which you have just responded to) do in fact respond wonderfully to this type of care without the need for referral to the medical profession which involves mainly prescription drug therapy with attendant side effects.

For example, I do refer out to surgical oncologists for tumors which the body doesn't have the strength to deal with. We then work on building up the immune system and PREVENT further such episodes. We use CMT, nutrition, homeopathy and stress release as our mode of addressing the underlying subluxations that you so correctly pointed out as being the root cause and effect.

Your error, in my humble opinion, is that the subluxation can only be treated with CMT instead of all aspects of Dr. D.D. Palmer´s original paradigm as outlined above. Your proposal you just presented paints us into strictly spinal manipulators (1/4 of the puzzle) so to speak.Humbly yours,

Knecht DC Namaste Chiropractic

1809 NW

Portland, OR 97209

503-226-8010

From: "deadmed" <deadmed@...><allen@...>,<dm.bones@...>CC: <sharronf@...>,< >Subject: Re: response to Jack P... long post Off topicDate: Tue, 28 Feb 2006 08:53:58 -0800Dr. Knecht said,"Does anyone out there have any validated outcome measures for HTN, SeasonalAllergies, Hiatal Hernia, Exzema, Asthma, ADD/HD, etc. These are verycommon CHIEF complaints which present to my office for care. Of course Iutilize all parameters of D.D.'s paradigm in my approach, i.e. Structure(read vsc/SMT), Nutrition, Homeopathy, and Emotion. I would appreciate anyurl links, etc"This is the difficulty inherent in CJ. However, we must remember that we don't treat these conditions. We treat subluxations. These subluxations may be the direct cause or an aggravating factor etc., but it is important to realize that our responsibility ends at clearing the subluxation. If the disease will not relent even after clearing the subluxation then it is our mandate to REFER or co manage. So, it is going to be very difficult to see any outcome measures for these diseases as far as chiropractic is concerned. I for one would be very reluctant to let a case of Eczema or Asthma go for very long without referral. There are some good meds out there for it.Musculoskelatal conditions are a bit different. Unless it's a surgery case there are very few options for the patient other than what we can do for them.Again though, if we don't get results,eventually we have to re think what we are doing and whether or not to discharge.Dr. ph Medlin D.C.Spine Tree Chiropractic1627 NE Alberta St. #6Portland, OR 97211Ph: 503-788-6800c: 503-889-6204 "an amorphous disorganized group of various>> factions??>> ">>>>>> > Listmates:>> >>> > ....this is as close a term to Universal Basic Truth as I've ever >> seen>> > used to describe any group that has consumed as many decades>> struggling>> > to snatch defeat from the jaws of victory as chiropractic has....>> >>> > With the Big Picture hanging out of focus in our otherwise Pristine>> > Universe, ongoing internecine scrimmages between chiropractic >> factions>> > occupy the same niche as the fiddle-players at Nero's Roman>> > Extravaganza....and to the same effect....is it true we suffer a>> > Professional Cognitive Dissonance, a selective type of attention>> deficit>> > disorder, which tricks us into ignoring one aspect of the human>> > condition, while focusing on another???>> >>> > I believe we simply MUST overcome the notion EITHER:OR is 'Science'>> > while "BOTH:AND" is something else....modern Physics, mathematics and>> > the entire Silicon Lifeforms of Computer Science readily embrace both>> > concepts are equally useful. Why can't chiropractors do that too?>> >>> > In the development of what we can measure OR define as being an>> > essential part of chiropractic care, we continue to ram into the same>> > issues. And we can continue to serve 10% of the population with the>> > tools we have in place.  Hardly a resounding victory in a world of>> > grief and affliction.>> >>> > "Crazy" is continuing to do what we have always done and complaining>> > about the results. "Insane" is doing what we've always done and>> > expecting changes to somehow spring forth. I believe it's crazy to>> > accept we only reach that 10%. I believe it's insane to not expect>> > better from my profession.>> >>> > I've been an amorphous and disorganized individual my entire>> life....no>> > wonder 'chiropractic' seems like home to me!! Personally, I feel>> quite>> > comfortable in some circumstances acting as if "That Which Can Be>> > Measured-orthopedic model" serves the patient best; while other>> > situations a more effective choice is in the ineffable "Dynamic >> force">> > which isn't as easily documentable. And my chart notes are>> constructed>> > in a way intended to convey those various nuances.>> >>> > The requirements of OBCE to demonstrate what it is I think I'm doing>> > help better formulate exactly what I'm offering the afflicted >> patient.>> > Or is this note too amorphous and disorganized to understand?>> >>> > Jack Pedersen DC>> > Member, AmoDisVariFac>> >>> >>> >>> > OregonDCs rules:>> > 1. Keep correspondence professional; the purpose of the listserve is>> to>> > foster communication and collegiality. No personal attacks on>> listserve>> > members will be tolerated.>> > 2. Always sign your e-mails with your first and last name.>> > 3. The listserve is not secure; your e-mail could end up anywhere.>> > However, it is against the rules of the listserve to copy, print,>> forward,>> > or otherwise distribute correspondence written by another member>> without>> > his or her consent, unless all personal identifiers have been >> removed.>> >

[Guest guest]

Nice Post , well thought out and sums up the present situation well.

Knecht DC Namaste Chiropractic

1809 NW

Portland, OR 97209

503-226-8010

From: "dm.bones@..." <dm.bones@...>" s, D.C." <drbobdc@...>CC: oregondc < >Subject: Re: response to Jack P... long post Off topicDate: Sun, 26 Feb 2006 11:25:31 -0800On Feb 24, 2006, at 5:24 PM, s, D.C. wrote:> I probably shouldn't admit this on the list serve...but I treat > patients who come in to get adjusted just because they "don't feel > right." They are in no particular pain; they just don't feel right! > On palpation, I can certainly find taught/tender muscles, > myofascitis, segmental joint dysfunction, etc...(in order to justify > treatment in the chart note), but is that what they really came in > for...?> makes a very good point, "... what (did) they really come in for...?" if they are in no particular pain. This is not an isolated observation; we all know exactly what 's speaking about. Not everyone we treat is in pain: muscles are not in spasm, segmental motion is not sore on palpatory challenge, functional measurements are relatively unremarkable, subjective complaints are ambiguous, but something's not right.... They know that our attention to such complaints are helpful in some way, but what is it that we're addressing? If we don't know, how can we expect to inform third party payers? Further, how can we expect to define ourselves publicly if we're unsure? How can we support guidelines if we're not sure they address everything we do?This confusion has hindered unity within the profession for decades, and continues to do so in our CJ consultations. What we do is not solely mechanical and measurable, nor is it solely subtle and ethereal. Further, we have the legal demands brought by our movement into mainstream health care, that we be defined in such a way that the public and the payers can understand who we are and what we do.These are the natural growing pains of a profession coming of age and how we deal with it is important. Given external circumstances, I see the profession moving toward an NMS orientation within the health care industry, backed by evidence that restoring motion to the axial and appendicular skeletal system and it's associated neuromuscular components is beneficial. That basis is expressed in a PARTS examination and report. Does that fully describe the territory of chiropractic? No. But, it does give those who pay for our treatments of injury to others a handle on who and what we can be expected to do. It also gives the public a handle on who and what we do.We are forced by circumstances to address the efforts of third party payers who seek to gain more control over payment for NMS related treatment. Our guideline, CJ, is a general NMS statement which puts responsibility on the profession for self-regulation, allowing us to avoid definition by others with less friendly intent. It's the process of us defining ourself that must be preserved in a politically charged arena. If we can continue to define ourselves, then we won't be subjected to a list of "100 mandated regulations" such as those being foisted on the AMA at present, for example. If CJ is inappropriate for us, or being misused by others, then we are still free to change the guideline. If someone else is doing the defining, then we have less control over our own destiny. This is the minutia of mainstream health care and the only thing standing in the way of our unity in the face of third party payer efforts at control is our reactive fear of taking a stand.Of greater long range importance is our ability to define ourself to the general public, for it is chiropractic's place in the public's eye that has more power to drive political pressures on us. We need to give the public a simple chiropractic story of who we are and what we can do for them if we are ever to gain more than the fabled 10-15% of the population. That story will be a NMS story for the most part, but needn't be the total story. We can also offer a handle on how to engage subtle innate capacities for healing currently outside of mainstream American health care. This would encompass stress reduction, improved cardiovascular health, improved digestive functioning, improved oxidizing reparation of all cells, simple foods and nutrients as sources of health, and other still mysterious ways that our innate continues to reveal itself to us as we work with these potentials every day. All of the multiple functions of the human nerve that Knecht brought forward are real, in spite of our attention currently at the motor and sensory levels.The public handle on chiropractic might be something like, "Motion is life; chiropractic keeps you moving." Such a slogan doesn't define the profession, but it suggests simply who and what we do for the most part. We bring life back to immobile parts of the body. Realistically, in our practices, that life is usually biomechanical. But it may also be psychological to a mind fixated and stuck around unhealthy aspects. That life may be cathartic to an emotionally bound experience. It may be an inner relaxation from chronically held compensation for pain or earlier injury no longer sore, but still "not right." It begins to answer 's important question of what they are coming for and what we are giving: motion! We keep people moving, on a whole lot of levels. This is just a suggestion, with the intent of bringing this thread to a larger recognition of our potential place in a rapidly changing America. If we are able to see ourself as purveyors of an innate human capacity for self-healing that is evolving on more than just mechanical levels, then we can rightly take our place as the leaders of natural health. This, it seems, is the direction for a secure future for the profession, and for a maximally potentiated citizenry.If we go forward on assumptions based in fear, we severely limit ourself. If we go forward on a vision of what we can do together for the greater benefit of all, we are on a sustainable path. For the benefit of all, we need unity in diversity.With respect for all, SearsOregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

[Guest guest]

I think

this is what Dr. Tannenbaum was talking about in the quote I referenced from

the journal in which he described the false premises and limitations to the

rationality of the “Evidence based medicine” movement. Once

you have a poorly written rule in place, one that does nothing to state that it

refers only to NMT conditions and that chiropractic is more than that, and once

the insurance companies have a few meetings to see how they can exploit and

twist the rule to their advantage, then we’ll all be stuck. The

example that gives, “I treat patients who come in to

get adjusted just because they " don't feel right. " , is a good case in

point. The CJ rule would require, as I understand it, that EVERY

examination – and remember that there is an examination component to

every chiropractor/patient encounter – include the specified CJ

examination criteria to “justify” the decision to treat on that

date. Absent such “evidence” in a case such as

mentions, I suspect that it is arguable that such a visit should not be paid,

by insurance or by the patient.

Without

clarifying language in any CJ/CR rule to explicitly state things such as the

rule is limited to the NMS arena only and some tip of the hat to the idea that

everything in a doctor/patient relationship can not be reduced to a check list

of orthopedic/neurologic tests, the CJ/CR rule carries with it the risk of

unanticipated adverse consequence to the profession. Protests of

supporters of the rule that they have thought of everything are as reassuring as

similar assurances about the Dubai Ports deal. Maybe its OK, but you know

what, maybe it isn’t.

S.

Feinberg, D.C.

From:

[mailto: ] On Behalf

Of Knecht

Sent: Wednesday, March 01, 2006

6:37 AM

dm.bones@...;

drbobdc@...

Cc:

Subject: Re: response

to Jack P... long post Off topic

Nice Post

, well thought out and sums up the present situation well.

Knecht DC

Namaste Chiropractic

1809 NW

Portland,

OR 97209

503-226-8010

From: " dm.bones@... " <dm.bones@...>

" s, D.C. "

<drbobdc@...>

CC: oregondc

< >

Subject: Re: response to Jack

P... long post Off topic

Date: Sun, 26 Feb 2006 11:25:31 -0800

On Feb 24, 2006, at 5:24 PM, s, D.C.

wrote:

> I probably shouldn't admit this on the list

serve...but I treat

> patients who come in to get adjusted

just because they " don't feel

> right. " They are in no

particular pain; they just don't feel right!

> On palpation, I can certainly

find taught/tender muscles,

> myofascitis, segmental joint

dysfunction, etc...(in order to justify

> treatment in the chart note), but is that

what they really came in

> for...?

>

makes a very good point, " ... what

(did) they really come in

for...? " if they are in no particular

pain. This is not an isolated

observation; we all know exactly what 's

speaking about. Not

everyone we treat is in pain: muscles are not in

spasm, segmental

motion is not sore on palpatory challenge,

functional measurements are

relatively unremarkable, subjective complaints are

ambiguous, but

something's not right.... They know that our

attention to such

complaints are helpful in some way, but what is it

that we're

addressing? If we don't know, how can we

expect to inform third party

payers? Further, how can we expect to define

ourselves publicly if

we're unsure? How can we support guidelines

if we're not sure they

address everything we do?

This confusion has hindered unity within the

profession for decades,

and continues to do so in our CJ

consultations. What we do is not

solely mechanical and measurable, nor is it solely

subtle and ethereal.

Further, we have the legal demands brought

by our movement into

mainstream health care, that we be defined in such

a way that the

public and the payers can understand who we are

and what we do.

These are the natural growing pains of a

profession coming of age and

how we deal with it is important. Given external

circumstances, I see

the profession moving toward an NMS orientation

within the health care

industry, backed by evidence that restoring motion

to the axial and

appendicular skeletal system and it's associated

neuromuscular

components is beneficial. That basis is

expressed in a PARTS

examination and report. Does that fully

describe the territory of

chiropractic? No. But, it does give those

who pay for our treatments

of injury to others a handle on who and what we

can be expected to do.

It also gives the public a handle on who and what

we do.

We are forced by circumstances to address the

efforts of third party

payers who seek to gain more control over payment

for NMS related

treatment. Our guideline, CJ, is a general

NMS statement which puts

responsibility on the profession for

self-regulation, allowing us to

avoid definition by others with less friendly

intent. It's the process

of us defining ourself that must be preserved in a

politically charged

arena. If we can continue to define

ourselves, then we won't be

subjected to a list of " 100 mandated

regulations " such as those being

foisted on the AMA at present, for example.

If CJ is inappropriate for

us, or being misused by others, then we are still

free to change the

guideline. If someone else is doing the

defining, then we have less

control over our own destiny. This is the

minutia of mainstream health

care and the only thing standing in the way of our

unity in the face of

third party payer efforts at control is our

reactive fear of taking a

stand.

Of greater long range importance is our ability to

define ourself to

the general public, for it is chiropractic's place

in the public's eye

that has more power to drive political pressures

on us. We need to

give the public a simple chiropractic story of who

we are and what we

can do for them if we are ever to gain more than

the fabled 10-15% of

the population. That story will be a NMS

story for the most part, but

needn't be the total story. We can also

offer a handle on how to

engage subtle innate capacities for healing

currently outside of

mainstream American health care. This would

encompass stress

reduction, improved cardiovascular health,

improved digestive

functioning, improved oxidizing reparation of all

cells, simple foods

and nutrients as sources of health, and other

still mysterious ways

that our innate continues to reveal itself to us

as we work with these

potentials every day. All of the multiple

functions of the human nerve

that Knecht brought forward are real, in

spite of our attention

currently at the motor and sensory levels.

The public handle on chiropractic might be

something like, " Motion is

life; chiropractic keeps you moving. "

Such a slogan doesn't define the

profession, but it suggests simply who and what we

do for the most

part. We bring life back to immobile parts

of the body.

Realistically, in our practices, that life is

usually biomechanical.

But it may also be psychological to a mind fixated

and stuck around

unhealthy aspects. That life may be

cathartic to an emotionally bound

experience. It may be an inner relaxation

from chronically held

compensation for pain or earlier injury no longer

sore, but still " not

right. " It begins to answer 's

important question of what they

are coming for and what we are giving:

motion! We keep people moving,

on a whole lot of levels. This is just a

suggestion, with the intent

of bringing this thread to a larger recognition of

our potential place

in a rapidly changing America. If we are able to

see ourself as

purveyors of an innate human capacity for

self-healing that is evolving

on more than just mechanical levels, then we can

rightly take our place

as the leaders of natural health. This, it

seems, is the direction for

a secure future for the profession, and for a

maximally potentiated

citizenry.

If we go forward on assumptions based in fear, we

severely limit

ourself. If we go forward on a vision of

what we can do together for

the greater benefit of all, we are on a

sustainable path. For the

benefit of all, we need unity in diversity.

With respect for all,

Sears

OregonDCs

rules:

1. Keep correspondence professional; the purpose

of the listserve is to foster communication and collegiality. No personal

attacks on listserve members will be tolerated.

2. Always sign your e-mails with your first and

last name.

3. The listserve is not secure; your e-mail could

end up anywhere. However, it is against the rules of the listserve to copy,

print, forward, or otherwise distribute correspondence written by another

member without his or her consent, unless all personal identifiers have been

removed.

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[Guest guest]

Les, colleagues,

If indeed this has occurred please provide that example, just one will do. If indeed this happens then we can immediately amend or remove (by true consensus) the rule. Also considering why the rule was developed in the first place I don't see a problem with it only applying to neuromuscular trauma cases (NMT?). In fact the very first raw draft written by yours truly specifically stated that the rule referred to "casualty insurance" cases. However in a true consensus building manner the 18 member rules advisory committee determined that having the rule only apply to casualty insurance was inappropriate so that language was removed.

Give the thing a chance, I'm telling you it made a huge difference at the capitol last session, and it will be critical this coming 2007 session.

Vern

Re: response to Jack P... long post Off topicDate: Sun, 26 Feb 2006 11:25:31 -0800On Feb 24, 2006, at 5:24 PM, s, D.C. wrote:> I probably shouldn't admit this on the list serve...but I treat > patients who come in to get adjusted just because they "don't feel > right." They are in no particular pain; they just don't feel right! > On palpation, I can certainly find taught/tender muscles, > myofascitis, segmental joint dysfunction, etc...(in order to justify > treatment in the chart note), but is that what they really came in > for...?> makes a very good point, "... what (did) they really come in for...?" if they are in no particular pain. This is not an isolated observation; we all know exactly what 's speaking about. Not everyone we treat is in pain: muscles are not in spasm, segmental motion is not sore on palpatory challenge, functional measurements are relatively unremarkable, subjective complaints are ambiguous, but something's not right.... They know that our attention to such complaints are helpful in some way, but what is it that we're addressing? If we don't know, how can we expect to inform third party payers? Further, how can we expect to define ourselves publicly if we're unsure? How can we support guidelines if we're not sure they address everything we do?This confusion has hindered unity within the profession for decades, and continues to do so in our CJ consultations. What we do is not solely mechanical and measurable, nor is it solely subtle and ethereal. Further, we have the legal demands brought by our movement into mainstream health care, that we be defined in such a way that the public and the payers can understand who we are and what we do.These are the natural growing pains of a profession coming of age and how we deal with it is important. Given external circumstances, I see the profession moving toward an NMS orientation within the health care industry, backed by evidence that restoring motion to the axial and appendicular skeletal system and it's associated neuromuscular components is beneficial. That basis is expressed in a PARTS examination and report. Does that fully describe the territory of chiropractic? No. But, it does give those who pay for our treatments of injury to others a handle on who and what we can be expected to do. It also gives the public a handle on who and what we do.We are forced by circumstances to address the efforts of third party payers who seek to gain more control over payment for NMS related treatment. Our guideline, CJ, is a general NMS statement which puts responsibility on the profession for self-regulation, allowing us to avoid definition by others with less friendly intent. It's the process of us defining ourself that must be preserved in a politically charged arena. If we can continue to define ourselves, then we won't be subjected to a list of "100 mandated regulations" such as those being foisted on the AMA at present, for example. If CJ is inappropriate for us, or being misused by others, then we are still free to change the guideline. If someone else is doing the defining, then we have less control over our own destiny. This is the minutia of mainstream health care and the only thing standing in the way of our unity in the face of third party payer efforts at control is our reactive fear of taking a stand.Of greater long range importance is our ability to define ourself to the general public, for it is chiropractic's place in the public's eye that has more power to drive political pressures on us. We need to give the public a simple chiropractic story of who we are and what we can do for them if we are ever to gain more than the fabled 10-15% of the population. That story will be a NMS story for the most part, but needn't be the total story. We can also offer a handle on how to engage subtle innate capacities for healing currently outside of mainstream American health care. This would encompass stress reduction, improved cardiovascular health, improved digestive functioning, improved oxidizing reparation of all cells, simple foods and nutrients as sources of health, and other still mysterious ways that our innate continues to reveal itself to us as we work with these potentials every day. All of the multiple functions of the human nerve that Knecht brought forward are real, in spite of our attention currently at the motor and sensory levels.The public handle on chiropractic might be something like, "Motion is life; chiropractic keeps you moving." Such a slogan doesn't define the profession, but it suggests simply who and what we do for the most part. We bring life back to immobile parts of the body. Realistically, in our practices, that life is usually biomechanical. But it may also be psychological to a mind fixated and stuck around unhealthy aspects. That life may be cathartic to an emotionally bound experience. It may be an inner relaxation from chronically held compensation for pain or earlier injury no longer sore, but still "not right." It begins to answer 's important question of what they are coming for and what we are giving: motion! We keep people moving, on a whole lot of levels. This is just a suggestion, with the intent of bringing this thread to a larger recognition of our potential place in a rapidly changing America. If we are able to see ourself as purveyors of an innate human capacity for self-healing that is evolving on more than just mechanical levels, then we can rightly take our place as the leaders of natural health. This, it seems, is the direction for a secure future for the profession, and for a maximally potentiated citizenry.If we go forward on assumptions based in fear, we severely limit ourself. If we go forward on a vision of what we can do together for the greater benefit of all, we are on a sustainable path. For the benefit of all, we need unity in diversity.With respect for all, SearsOregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

[Guest guest]

Wait a minute Dr. Knecht, i never intended to insenuate nor did i say outright that CMT is the only method of treatment for subluxation, although I think you will agree that CMT is a necessary component. Indeed I use much of DD's paradigm myself.

My point was that treating subluxations is our scope of practice, not treating eczema asthma etc. and therefore it would be difficult to aquire VALIDATED OUTCOME MEASURES of such diseases. Some DC's may have outcome measures, but VALIDATED??? I'd love to see it. Now thats not to say that we can't help patients with these conditions, and in some cases "cure" them of them, but just try advertising or telling your patients that you can treat eczema in 4-6 visits or ADD in 9.

Perhaps you were requesting the info for your own use as a way to guage the progress of the patient and have a better idea when to refer out. If so, thats where i missed the point.

I think we agree here mostly however.

Yours in Chiro,

Dr. ph Medlin D.C.Spine Tree Chiropractic1627 NE Alberta St. #6Portland, OR 97211Ph: 503-788-6800c: 503-889-6204

"an amorphous disorganized group of various>> factions??>> ">>>>>> > Listmates:>> >>> > ....this is as close a term to Universal Basic Truth as I've ever >> seen>> > used to describe any group that has consumed as many decades>> struggling>> > to snatch defeat from the jaws of victory as chiropractic has....>> >>> > With the Big Picture hanging out of focus in our otherwise Pristine>> > Universe, ongoing internecine scrimmages between chiropractic >> factions>> > occupy the same niche as the fiddle-players at Nero's Roman>> > Extravaganza....and to the same effect....is it true we suffer a>> > Professional Cognitive Dissonance, a selective type of attention>> deficit>> > disorder, which tricks us into ignoring one aspect of the human>> > condition, while focusing on another???>> >>> > I believe we simply MUST overcome the notion EITHER:OR is 'Science'>> > while "BOTH:AND" is something else....modern Physics, mathematics and>> > the entire Silicon Lifeforms of Computer Science readily embrace both>> > concepts are equally useful. Why can't chiropractors do that too?>> >>> > In the development of what we can measure OR define as being an>> > essential part of chiropractic care, we continue to ram into the same>> > issues. And we can continue to serve 10% of the population with the>> > tools we have in place.  Hardly a resounding victory in a world of>> > grief and affliction.>> >>> > "Crazy" is continuing to do what we have always done and complaining>> > about the results. "Insane" is doing what we've always done and>> > expecting changes to somehow spring forth. I believe it's crazy to>> > accept we only reach that 10%. I believe it's insane to not expect>> > better from my profession.>> >>> > I've been an amorphous and disorganized individual my entire>> life....no>> > wonder 'chiropractic' seems like home to me!! Personally, I feel>> quite>> > comfortable in some circumstances acting as if "That Which Can Be>> > Measured-orthopedic model" serves the patient best; while other>> > situations a more effective choice is in the ineffable "Dynamic >> force">> > which isn't as easily documentable. And my chart notes are>> constructed>> > in a way intended to convey those various nuances.>> >>> > The requirements of OBCE to demonstrate what it is I think I'm doing>> > help better formulate exactly what I'm offering the afflicted >> patient.>> > Or is this note too amorphous and disorganized to understand?>> >>> > Jack Pedersen DC>> > Member, AmoDisVariFac>> >>> >>> >>> > OregonDCs rules:>> > 1. Keep correspondence professional; the purpose of the listserve is>> to>> > foster communication and collegiality. No personal attacks on>> listserve>> > members will be tolerated.>> > 2. Always sign your e-mails with your first and last name.>> > 3. The listserve is not secure; your e-mail could end up anywhere.>> > However, it is against the rules of the listserve to copy, print,>> forward,>> > or otherwise distribute correspondence written by another member>> without>> > his or her consent, unless all personal identifiers have been >> removed.>> >

[Guest guest]

Yes, you got it right, I was sincerely asking for outcome measures to apply in these type of cases. One of the techniques that I utilize does in fact have documented and published studies in peer reviewed journals including JMPT, and ongoing studies including a newly launched RCT.

And also, we do not advertise directly for these type of cases. Our practice is mostly by word of mouth referral based upon results achieved. My patients are duly informed that we treat the underlying causes of any condition and cannot guarantee any specific result.

I knew we had common ground, this is an example of the greatness of discussion on this forum

Knecht DC Namaste Chiropractic

1809 NW

Portland, OR 97209

503-226-8010

From: "deadmed" <deadmed@...><allen@...>,< >Subject: Re: response to Jack P... long post Off topicDate: Wed, 1 Mar 2006 12:50:03 -0800

Wait a minute Dr. Knecht, i never intended to insenuate nor did i say outright that CMT is the only method of treatment for subluxation, although I think you will agree that CMT is a necessary component. Indeed I use much of DD's paradigm myself.

My point was that treating subluxations is our scope of practice, not treating eczema asthma etc. and therefore it would be difficult to aquire VALIDATED OUTCOME MEASURES of such diseases. Some DC's may have outcome measures, but VALIDATED??? I'd love to see it. Now thats not to say that we can't help patients with these conditions, and in some cases "cure" them of them, but just try advertising or telling your patients that you can treat eczema in 4-6 visits or ADD in 9.

Perhaps you were requesting the info for your own use as a way to guage the progress of the patient and have a better idea when to refer out. If so, thats where i missed the point.

I think we agree here mostly however.

Yours in Chiro,

Dr. ph Medlin D.C.Spine Tree Chiropractic1627 NE Alberta St. #6Portland, OR 97211Ph: 503-788-6800c: 503-889-6204

"an amorphous disorganized group of various>> factions??>> ">>>>>> > Listmates:>> >>> > ....this is as close a term to Universal Basic Truth as I've ever >> seen>> > used to describe any group that has consumed as many decades>> struggling>> > to snatch defeat from the jaws of victory as chiropractic has....>> >>> > With the Big Picture hanging out of focus in our otherwise Pristine>> > Universe, ongoing internecine scrimmages between chiropractic >> factions>> > occupy the same niche as the fiddle-players at Nero's Roman>> > Extravaganza....and to the same effect....is it true we suffer a>> > Professional Cognitive Dissonance, a selective type of attention>> deficit>> > disorder, which tricks us into ignoring one aspect of the human>> > condition, while focusing on another???>> >>> > I believe we simply MUST overcome the notion EITHER:OR is 'Science'>> > while "BOTH:AND" is something else....modern Physics, mathematics and>> > the entire Silicon Lifeforms of Computer Science readily embrace both>> > concepts are equally useful. Why can't chiropractors do that too?>> >>> > In the development of what we can measure OR define as being an>> > essential part of chiropractic care, we continue to ram into the same>> > issues. And we can continue to serve 10% of the population with the>> > tools we have in place.  Hardly a resounding victory in a world of>> > grief and affliction.>> >>> > "Crazy" is continuing to do what we have always done and complaining>> > about the results. "Insane" is doing what we've always done and>> > expecting changes to somehow spring forth. I believe it's crazy to>> > accept we only reach that 10%. I believe it's insane to not expect>> > better from my profession.>> >>> > I've been an amorphous and disorganized individual my entire>> life....no>> > wonder 'chiropractic' seems like home to me!! Personally, I feel>> quite>> > comfortable in some circumstances acting as if "That Which Can Be>> > Measured-orthopedic model" serves the patient best; while other>> > situations a more effective choice is in the ineffable "Dynamic >> force">> > which isn't as easily documentable. And my chart notes are>> constructed>> > in a way intended to convey those various nuances.>> >>> > The requirements of OBCE to demonstrate what it is I think I'm doing>> > help better formulate exactly what I'm offering the afflicted >> patient.>> > Or is this note too amorphous and disorganized to understand?>> >>> > Jack Pedersen DC>> > Member, AmoDisVariFac>> >>> >>> >>> > OregonDCs rules:>> > 1. Keep correspondence professional; the purpose of the listserve is>> to>> > foster communication and collegiality. No personal attacks on>> listserve>> > members will be tolerated.>> > 2. Always sign your e-mails with your first and last name.>> > 3. The listserve is not secure; your e-mail could end up anywhere.>> > However, it is against the rules of the listserve to copy, print,>> forward,>> > or otherwise distribute correspondence written by another member>> without>> > his or her consent, unless all personal identifiers have been >> removed.>> >