ChiropracDc College West as well. That's where we got in touch with Doctor Clum over here. I think he is a familiar face to that campus and what a legacy he leh for everybody else over there. Doctor Clum, I just want to come back to you to just bring it back around one more Dme. Both Doctor Jennifer and Doctor Bryan they both had really important things that I wasn't sure I was expecDng this morning. Anything you want to address, or add, or even ask? Thanks Stu. I appreciate it. There is. One of the things that I did when this whole issue came up is I went and visited the ACA's website and I reviewed what they had posted a couple months ago now relaDve to the Choose Wisely program and do the recommendaDons that they were pu^ng forward. There is an introductory statement and an explanaDon for this that was wriSen by Doctor Goertz who is the Director of Research at Palmer. ChrisDne Goertz, a brilliant woman. Very accomplished as a scienDst and as a chiropractor, holds her PhD as well as her DC degree, authored a statement that's on the website and I'd like to read a couple sentences from it. This is "Every chiropractor in pracDce for more than a few weeks has run across a paDent with subpathological findings that could potenDally impact treatment decisions." Now the reality here that we're talking about is that Jennifer and Bryan have both given a couple examples of potenDal problems that can be there that the pracDDoner needs to be aware of. We're at a point where we are pu^ng a thrust into the spine whether it's one technique or another doesn't maSer, but let's just assume and talk for a moment about just a high velocity, low amplitude adjustment, a diversified adjustment, or a Gonstead adjustment, something of that nature. We're pu^ng a thrust into the spine and it doesn't seem beyond the pale that we need to know about the quality of the bone that's underneath our hands, we need to know the geometry of the structure that's underneath our hands, and we need to know how that is going to react to the force that we apply. That doesn't miDgate our responsibility relaDve to having done a neurologic exam, having done an orthopedic exam, having done a good case history, done a good physical. We can do all of those things and sDll have gaps in our understanding of what's going on with that paDent. Then Doctor Goertz went on to write and she talks about "Good clinical pracDce involves juxtaposiDon between benefits and the risks of progressively more advanced and basic diagnosDc procedures as we assess each individual paDent." We agree completely. She also goes on to talk about the responsibiliDes of the pracDDoner under a perspecDve of evidence informed care. One of the concerns that I have that I think Bryan and Jennifer both spoke to in this is that when people talk about evidence enforced care or evidence based pracDce they immediately default to the literature. If we go back to David SackeS, the grandfather, godfather, father, origin point of the concept of evidence based care, SackeS said there were three things involved, the published literature, the a^tude and perspecDve of the paDent, and the clinical experience of the pracDDoner. Now all too ohen when we get into this evidence informed pracDce
Dr. Clum:
Chiropractor Malpractice Insurance - ACA X-ray Guideline 3 Drs. Clum, ...
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