Why "Choosing Wisely" Is A Wise Choice
Dear Editor:
The recent column [February 2018 issue] by Dr. James Edwards, "Serving Whom? Why I Will Never Sign the ACA Pledge," caught my attention. It does not surprise me that Dr. Edwards is opposed to the new ACA pledge and the "Choosing Wisely" program. After all, most of us who have been in practice for more than 40 years are resistant to change.
I do not know how many ACA leaders have served as a member of their state board, but I have served as a member of the New Mexico Board of Chiropractic Examiners, qualified as a chiropractic expert and served as an ACA delegate. In addition, I am board certified as a chiropractic orthopedist and am a tenured associate professor of clinical sciences at the University of Bridgeport College of Chiropractic, where I have taught ethics and jurisprudence. My graduate education at the University of New Mexico included an MBA, which stressed ethical and legal business behaviors. While studying psychology at UNM, I became aware of human behavior and the complicated process of learning. Thus, I feel I am qualified to respond to Dr. Edwards.
As a chiropractic faculty member for the past 13 years, I know young chiropractors want to help patients, earn the income of a professional, practice as an evidence-based and patient-centered health care provider, and become an integral member of the health care team. Newer graduates – millennials, if you will – are much more likely to accept a reasonable salary with benefits within a medical organization that provides an opportunity to be more accessible to patients in need of chiropractic services than old-timers like Dr. Edwards and me. These young doctors become really excited if they are working for a nonprofit or governmental organization that may provide student loan forgiveness.
Like Dr. Edwards (1977), I graduated from Logan College of Chiropractic (1972) and was taught to perform a radiographic examination on every patient prior to performing an adjustment. We were taught to mark full-spine, 14 x 36" films with the Gonstead marking system in order to understand how to treat the patient and to prevent malpractice. At the time, those teachings were part of the standard of care.
Today, chiropractic students are taught to make an evidence-based, clinical decision regarding the use of imaging studies, which improves quality of care, reduces unnecessary exposure to radiation and costs of care. It is not the standard of care to perform radiographic examinations on every patient prior to spinal manipulation.
It is my opinion that evidence-based, patient-centered, ethical chiropractors will be comfortable with the "Choosing Wisely" recommendations. This is not a new situation in health care. A little research indicates that the Ontario1 and Pittsburgh2 rules regarding radiographic examinations of the lower extremities reduced unnecessary radiation and costs while improving quality of care.
It is time for chiropractors to change based upon evidence and guidelines, and disregard antiquated teachings and opinions. I support the ACA for requiring chiropractors to improve quality of care with ethical behavior.
James Lehman, DC, MBA
Bridgeport, Conn.
References
- Tandeter HB, Shvartzman P. Acute knee injuries: use of decision rules for selective radiograph ordering. Am Fam Physician, 1999 Dec;60(9):2599-608.
- Sujitkumar P, Hadfield JM, Yates DW. Sprain or fracture? An analysis of 2000 ankle injuries. Arch Emerg Med, 1986 Jun;3(2):101-106.
Editor's Note: The American Chiropractic Association's response to Dr. Edwards' column also appears in this issue.
Examine Ourselves, Not Our Name
Dear Editor:
The profession of chiropractic was born and developed in its time of need. We who have graduated from a chiropractic college should be proud of our name and our abilities to provide health care services to our patients. We have the tools, and hopefully the knowledge, to refer a patient when needed. Let us not look at the medical / drug professions as health care and chiropractic as an alternative, but rather the other way around.
Concepts such asrebranding, renaming, psychology of marketing, or acceptance into the medical field should not be the goal of a chiropractor. Currently there is talk of renaming chiropractic. The market share for chiropractors is huge and waiting, and if our rhetoric does not produce results for our patients, we need only to examine ourselves – not our name.
The success of the 30-plus-year chiropractor likely is not due to branding, advertising or the name of the profession, but to results and referrals by satisfied patients. After 37 years of practice, the past 17 years of which without any third-party reimbursement, this chiropractor does not desire to change our name. Walking into the office filled with patients holding money in their outstretched hands makes me strive to meet their expectations. Results beget rewards.
Roger Bentley, DC
Delta, Colo.