Dear Editor:
I read Dr. Miller's article regarding practical examination procedures [DC, Aug. 16, 2002] with an open mind. I compliment him on the writing of his book and the dedication to additional training evidenced by his "orthopedic diplomate" status.
Allow me to suggest another approach to patient care. The biggest roadblock to the health care of the patient is not the lack of orthopedic neurological testing, but the lack of application of chiropractic to the patient's chiropractic needs. What about the biomechanical oversights that occur because of the hour-long orthopedic exam?
A simple posture exam certainly is more objective than a Lasegue's test, or even a cervical compression test, in that the former is not compromised by subjective patient input.
Are 99 percent of the patients who come into a DC's office subluxated? Maybe they like to retain joint mobility before arthritis ensues. Is it possible people feel they don't get colds as frequently if they get adjusted more regularly?
Chiropractic has been looking for medical acceptance for over 100 years. Orthopedic and neurological tests are used by chiropractors probably more than medical doctors who, given a low back condition, simply prod a tender erector spinae muscle before prescribing a two-week regimen of muscle relaxers and anti-inflammatory meds.
Chiropractic shines with its understanding of spinal integrity, proper posture and the elimination of nerve interference. The key is to stay on purpose; do a good job; be professional. Knowing your chiropractic technique, keeping up-to-date with your training and delivering proper chiropractic care will eliminate the worry of "Did I do the right orthopedic test?" or "If I would have done a leg length exam, maybe the surgeon wouldn't have gotten him or her!"
Tim Jorgensen, DC
Enderlin, North Dakota
Questioning Chiropractic Policy in Medicare
Dear Editor:
I was perusing the November-December 2002 Medicare B News, always a fascinating read, when I was astounded to read the following policy statement:
"A treatment plan that seeks to prevent disease, promote health and prolong and enhance the quality of life, or therapy that is performed to maintain or prevent deterioration of a chronic condition is not a Medicare benefit..." This statement, of course, is found under "Maintenance Therapy" in the "chiropractic policy" section of the manual. While it is absurd that care that can provide any of those goals listed above should be denied by Medicare, they apply the rule only to chiropractic, as far as I can tell. Has anyone heard of Medicare denying diabetes drugs? I would suggest that those drugs fall under the aforementioned goals. On page 39 of the manual, under "Influenza and Pneumococcal Vaccinations," the text encourages providers to perform the service as a Medicare-Part-B-covered "preventative health care benefit."
I had hoped our services would be recognized by now as being able to improve the quality of life and prevent deterioration of a chronic condition, but it seems that policy-makers ignore what the Medicare patients tell them. Will we have better luck with a retired surgeon heading the US Senate? We may need to prepare for the pendulum to swing farther to the right regarding chiropractic inclusion in federal programs.
Les Peterson, DC
Arlington, Washington