low back that's painless could indicate a fusion like ankylosing spondyliDs, severe degeneraDve joint disease, it could indict a transiDonal lumbosacral segment, like a sacralizaDon or lumbarizaDon, block vertebra. All of these condiDons can be asymptomaDc. They could cause low back pain but they could also be asymptomaDc. One of my points is that adjusDng those segments could possibly injure the paDent. I had occasion to see two x-rays recently, both had a leh convex lumbar scoliosis. On one case the congenital anomaly was on the convexity and there was evidence of increased compression, and sclerosis, and degeneraDve change on the concavity. It occurred to me that if we followed the general chiropracDc rule that you contact on the convex side of the curve and adjust the paDent we would only be compressing that segment more, we'd be compressing those areas of degeneraDve change more an in that way maybe hurt the paDent. Almost the next case there was a leh convex lumbar sclerosis that had degeneraDve change, segmental rotaDon, it was the classic example of how we would contact the convexity to improve the result. I don't see how without x-ray you could differenDate those two paDents. My point is the doctor has to be able to make the decision on their own. They can't be pigeonholed or their hands can't be Ded by a guideline that says you only have to think this way. They've got to be able to make a decision, think outside the box, and decide in those instances whether they want to x-ray or not. These shows we do for the doctors, but quite frankly I always learn from them and this was another example of that. I really appreciate it because one of the things that I got from what you just shared is a reminder that each and every one of the doctors out there that is in acDve pracDce and seeing paDents they need to remember that they need to become a master of their skills no maSer what technique that they're uDlizing. Their diagnosDc skills go along with their adjusDng skills. That was a good reminder for me as well. You also lightened up a liSle bit in terms of that the guidelines can be a good thing because they do give you some consistency and something to go by. But I think the most important thing that I heard was that the doctors need to do what they think it best whether or not, you didn't say this, I'm adding to it, whether or not insurance is paying or not paying, whether the ACA likes it or doesn't like it, whether the ICA likes it or doesn't like it, et cetera. It's really all about the paDent and what you as the doctor think is in the best interest of the paDent. Is that a fair read? Absolutely, it is all about the paDent. I think what we need to understand in this day and age the paDents are becoming more intelligent. They're looking at the internet, they're searching the parDcular condiDon that they have, they come in to the doctor with more informaDon someDmes than iniDally what the doctor would have. It's good to communicate with the paDent, it's good to discuss these things with the paDent, and involve the paDent in the process of their care. I did appreciate your senDments about Life ChiropracDc West, by the way. As ChiroSecure we ensure the insDtuDon and I've always supported Life
Dr. Hoffman:
Dr. GaSerman:
Dr. Hoffman:
Chiropractor Malpractice Insurance - ACA X-ray Guideline 3 Drs. Clum, ...
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