Academy of Chiropractic Personal Injury & Primary Spine Care Program
Quickie Consult 1017
LAWYERS and MEDICAL SPECIALISTS MEETINGS-COMMUNICATIONS 58 L
"Doctor...Why didn't you send the patient to their primary care MD first?"
Dr. Eric Lee from Utah, a Trauma Team member, and a Fellow Candidate shared that defense lawyers are now asking why he (the chiropractor) didn’t refer the accident case to the family MD first and wanted my version of the best answer. This answer is about the easiest topic to handle because the literature backs up our “real life” experiences in dealing with MD primary care providers and spine.
The short answer is “MD primary care providers have little to no education on either anatomical or mechanical spine issues (no fracture, tumor or infection), which has contributed significantly to the opioid crisis in our country.”
The literature-based support is as follows:
Day Et. Al. (2007) Reported that only 26% of fourth-year Harvard medical students had a cognitive mastery of physical medicine (pg. 452). Schmale (2005) reported “Incoming interns at the University of Pennsylvania took an exam of musculoskeletal aptitude and competence, which was validated by a survey of more than 100 orthopedic program chairpersons across the country. Eighty-two percent of students tested failed to show basic competency. Perhaps the poor knowledge base resulted from inadequate and disproportionately low numbers of hours devoted to musculoskeletal medicine education during the undergraduate medical school years. Less than 1⁄2 of 122 US medical schools require a preclinical course in musculoskeletal medicine, less than 1⁄4 require a clinical course, and nearly 1⁄2 have no required preclinical or clinical course. In Canadian medical schools, just more than 2% of the curricular time is spent on musculoskeletal medicine, even though approximately 20% of primary care practice is devoted to the care of patients with musculoskeletal problems. Various authors have described shortcomings in medical student training in fracture care, arthritis, and rheumatology, and basic physical examination of the musculoskeletal system (pg. 251).
A 2005 study by DeVocht, Pickar, & Wilder concluded through objective electrodiagnostic studies (neurological testing) that 87% of chiropractic patients exhibited decreased muscle spasms. This study validates the reasoning behind the later study that people with severe muscle spasms in the low back respond well to chiropractic care and this prevents future problems and disabilities. It also dictates that care should not be delayed or ignored due to a risk of complications.
The above statistic indicates that while medicine cannot conclude an accurate diagnosis in 85% of their back pain patients, chiropractic has already helped 87% of the same population. We also know that chiropractic is one of the safest treatments currently available in healthcare for spinal treatment and when there is a treatment where the potential for benefits far outweighs any risk, it deserves serious consideration. Whedon, Mackenzie, Phillips, and Lurie(2015) based their study on 6,669,603 subjects after the unqualified subjects had been removed from the study and accounted for 24,068,808 office visits. They concluded, “No mechanism by which SM [spinal manipulation] induces injury into normal healthy tissues has been identified”(p. 5).
The citations for the above are found on the US Chiropractic Directory (as with almost every piece of evidence we need) at:
Mark Studin DC, FASBE(C), DAAPM, DAAMLP
Adjunct Associate Professor of Chiropractic, University of Bridgeport, College of Chiropractic
Adjunct Post Graduate Faculty, Cleveland University-Kansas City, College of Chiropractic
Adjunct Professor, Division of Clinical Sciences, Texas Chiropractic College
Graduate Medical Educational Presenter, Accreditation Council for Continuing Medical Education Joint Partnership with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences
Academy of Chiropractic
US Chiropractic Directory