wri`en carefully that it affects anybody, doesn't ma`er what technique, doesn't ma`er what your philosophy is, it is general, it's not an ACA versus an ICA. These guidelines were put together for the general doctor of chiropracDc and if we have to look at it you know staDsDcally or logically, there's the majority of chiropractors don't belong to associaDons. Maybe their state associaDon where they pracDce, which is very important, but when you talk about guidelines from one organizaDon or another, those should not impede anybody in their actual pracDce in my opinion as how to take care of the paDent. The paDent is the primary concern all the Dme. I'm in total agreement with you and my concern is that what the ACA is pukng out there is not only pukng the doctor at risk, but it's also pukng the paDent at risk because if the doctor doesn't have the appropriate informaDon, then the paDent ulDmately suffers and that's always a concern you know to me. I come from the malpracDce risk management perspecDve, but you know, like you said and we agree, you know it's ulDmately about the paDent and I don't understand why anyone would put out something that doesn't really address what's in the best interest of the paDent. What could possibly be a raDonal to not take an x- ray. We know that there's no business incenDve to not take it, there's not real radiaDon consideraDon when every Dme you sniffle you go to the hospital and they'll take an MRI or a CAT scan or whatever, we're talking a basic, simple, chiropracDc x-ray here. I don't see any risk versus all the reward. I have a couple I guess ideas or couple of hypotheses. First I want to say that I know people in the ICA, I know people in the ACA, I know people that don't belong to any chiropracDc organizaDon and I know, there are good people in everything. The ACA, I've had conversaDons with a number of ACA people in the last few days, including some of their officers, not everybody in the ACA is happy with these guidelines. There's good people all over. I think one of the quesDons you brought up is the reason or how this came about again, I don't know if this is gonna be proven to be fact, but this is my general hypotheses. Again, we have to turn the magic prism. First of all, many new doctors, the millennials coming out have high student loans. So in some cases, it actually prohibits them from having x-ray in their office right away. But that's where the referrals come in like you menDoned. The other thing is that a lot of the millennials have these different pracDce management groups that talk about you have to now in order to survive, you have to have an integraDve pracDce. Well, these guidelines coming from the American Board of Internal Medicine is sort of a precursor to having the DCs and MDs in one locaDon. It's an integraDve type of pracDce and I've seen modern chiropracDc offices. I was just at one not too many weeks ago where the chiropracDc office, if you walk right across the hall, you're into the vein clinic. You went right down the hall, you're into the neurosurgery clinic. It's all under one roof.
Dr. Hoffman:
Dr. Murkowski:
Again, for a new pracDDoner, I think that's very appeDzing. I think that they think that's the way to go in the future. I'm not saying it isn't, but I'm saying that the most important thing again, I keep hammering is what's good for the paDent. Chiropractor Malpractice Insurance Dr. Ken Murkowski The ACA X-ray Gui... Page ! of ! 5 9
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