aware of this. There will be attorneys that will think this is the next big thing. This is the next asbestos or this is the next tobacco or whatever the case might be, and they'll get on board with that. Then in time it will drop back off to the background level that it would historically have, simply, those people that in the process of dissection cross paths with us because of the presence of neck pain and headache. Nonetheless, we need to be diligent and we need to, as you say, you can't over- document your care in these environments. To what you're referring, there was an association of attorneys up in Michigan, and I know you recall this, that had a whole article on dealing with chiropractors with stroke patients. We did respond to that article. The doctors, I had a doctor apply for coverage with us, and my team came to me because the doctor said they do not document their patient care. We didn't accept this person, because we called them and said, "You must be making a mistake. It's not only a responsibility, but it's the law based on your responsibilities to your licensing board." They said, "But I just adjust people, and I'm not going to document." "Okay." These are situations that as a profession we need to move beyond that being okay. It's an unfortunate situation, but we do. Number one, as you've said, informed consent is an expected, appropriate and responsible activity on the part of the practitioner to provide to the patient, number one. Number two, double-check, make sure your examination, it should be your history procedures are correct. Do you have a question on there about the presence or the possibility of stroke or aneurysm or dissection in that person's life or in their immediate family? Do you get into the questions about whether or not there's any history of any collagen disorders, Marfan's Syndrome, osteogenesis imperfecta, Ehlers-Danlos Syndrome, medial cystic degeneration, things of that nature, now known as fibromuscular degeneration? Those kinds of questions to get into the case history as potential signals. When a person's had a familial history of aneurysm or dissection, there's a 5% likelihood that the next generation will experience that. We need that heads-up at that point. We need to be alert to the possibility that neck pain is more than simple neck pain. It's easy to dismiss. It's something we see all the time, and it's something we can take as routine, but we need to avoid that temptation to take it as routine, be appropriate and be complete. Do your basic exam in terms of your intake activities. Make sure you've got vitals. Make sure you've got basic neurologic exam so you've got good baseline information, and then monitor your care as you go along and respond to the care. If you have patients that present tomorrow morning and say, "Hey, I don't want you to adjust my neck," I wouldn't suggest that you try and talk them out of that. I'd suggest you give them the information. You give them the reality. We're talking about the significance of an accident that is one in two million adjustments is the number that it is commonly used in the profession that's associated with this problem. It's rare. What are the takeaways from all of this?
Dr. Hoffman:
Dr. Clum:
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