Would you turn in an incompetent colleague?

A recent report published in the Journal of the American Medical Association (JAMA) revealed that many medical doctors have direct, personal knowledge of an impaired or incompetent physician in their workplaces but won’t report them.

Doctor thinkingThe researchers, led by Catherine DesRoches of Harvard Medical School, surveyed 1,891 practicing US doctors in order to “understand physicians’ beliefs, preparedness, and actual experiences related to colleagues who are impaired or incompetent to practice medicine.”

A majority of the doctors surveyed (64%) said they agreed that it was important to report other MDs who were “significantly impaired or otherwise incompetent to practice.” But just 69% said they were prepared to really do anything about the situation if it came up in their practice.

More shocking was the revelation that 17% of the doctors had direct personal knowledge of a physician colleague who was incompetent to practice medicine in their hospital, group, or practice. But of those, a full one third (33%) had not reported the colleague to the relevant authority.

The reasons they gave for their silence were the belief that someone else would take care of the problem (19%), the belief that nothing would happen as a result of the report (15%) and fear of retribution (12%).

The actual numbers might be even higher since, of the 2,938 physicians contacted, only 1,891 agreed to take the survey — the other 36% might have decided the questions were a bit too delicate to answer.

As bad as this sounds, I wonder how it differs from the chiropractic profession (or any health care profession). Granted, an incompetent chiropractor is far less of a threat to a patient’s well being than an incompetent MD, but what do we do when we realize a fellow DC is significantly impaired? If we know a colleague is drinking or using drugs during work, or is otherwise unfit to care for patients, do we report him or her to the board?

I realize that there have been many (far too many) cases where chiropractors have “tattled” on their competition for the most trivial infractions of the rules, but that’s a far cry from accusing another practitioner of being incompetent.

This is one of those grey areas that require soul searching and total honesty. If we truly believe that a colleague might do any harm to patients or to the profession as a whole, we owe it to those patients and chiropractic to take a courageous stand. We might try approaching the doctor and discussing the situation with him or her, offering to assist in getting the person proper help overcoming the problem. If that doesn’t work, we may have no choice but to file a complaint with the state board.

SOURCE: “Physicians’ Perceptions, Preparedness for Reporting, and Experiences Related to Impaired and Incompetent Colleagues,” JAMA. 2010;304(2):187-193. doi:10.1001/jama.2010.921

The power of our touch

Power of touchWhen DD Palmer called our profession “chiropractic” — combining the Greek words cheir (hand) and praxis (action) — he couldn’t have chosen a better name. While there are a few doctors who substitute mechanical devices for their hands, even those practitioners have some hands-on work with patients — palpation, adjusting or just placing the hands on affected areas.

We, and our patients, have always known that the success of chiropractic has a great deal to do with the “personal touch” we provide (metaphorically as well as literally). Surveys on patient satisfaction almost always emphasize the influence of our personal involvement with those under our care, particularly when compared to the cold, impersonal treatment received from many medical providers.

A recent research study, sponsored by the National Cancer Institute and presented at the 6th International Conference of the Society for Integrative Oncology, reinforces our understanding of the importance of true “by hand” practice, whether it’s provided by a health care practitioner or a caretaker.

Researchers found that touch — particularly massage — administered by care partners significantly reduces the effects of cancer and the side-effects from its treatment while providing comfort and improvement in the quality of life.

In the study, 97 family caregivers learned touch and massage techniques from a 78-minute instructional DVD, called “Touch, Caring, and Cancer: Simple Instruction for Family and Friends.” They then used these touch techniques to safely care for people living with cancer. “The magnitude of the impact of family members was unexpected. Our research found significant reductions of pain, anxiety, fatigue, depression and nausea when massage was routinely administered at home by family and caregivers,” lead researcher William Collinge, PhD, revealed.

The study found massage by family members reduced stress/anxiety (44% reduction), pain (34%), fatigue (32%), depression (31%), and nausea (29%).

“The discovery that family members can learn and administer simple massage techniques that can consistently reduce stress is significant. Stress is a constant that negatively impacts the lives and wellbeing of cancer patients,” Collinge wrote. “Both cancer patients and caregivers benefit because massage appears to strengthen the relationship bond. Massage provides the caregiver a way to make a difference.”

This research not only reminds us of the significance of personal touch between doctor and patient, but might be a good incentive to bring a massage therapist into your practice. The synergistic effect of the two disciplines would no doubt benefit many patients and might increase patient volume.

You may even want to provide certain patients with the video used to train the participants in the study (it’s available from Amazon.com). I believe strongly that the “hands on” approach works for all people, regardless of the state of their health. Since it reduces stress — the primary cause of most health issues — it would be effective on most people, not just those with cancer.

Welcome News: Study Confirms Chiropractic Benefits

As most of my readers know, I regularly point out biased claims from organized medicine (often parroted by the mainstream press) that chiropractic is not supported by research. That’s why it’s always welcome news when studies are published that DO point out research proving the effectiveness of chiropractic.

Maurice Jones-Drew
Jaguars Running Back Maurice Jones-Drew relies on chiropractic to put him on top of his game.

The latest, a report published by Australia’s Cochrane Collaboration, confirms what may seem obviously to chiropractors and their patients — that chiropractic can be effective in helping people overcome low-back pain.

The research, led by Bruce Walker, DC, of the Murdoch University School of Chiropractic and Sports Science in Australia, analyzed a number of different techniques provided by chiropractors. Walker and his colleagues at Murdoch studied 12 randomized controlled trials that included 2,887 participants. Each trial compared combined chiropractic interventions to some other therapeutic approach to low-back pain.

The result: in the short-term (within one month after the study began), pain improved in patients treated both with chiropractic and comparison treatments. Benefits were somewhat greater in the chiropractic group , although the difference was not considered “clinically significant,” the study’s authors wrote.

“If consumers have acute or subacute back pain they can have some confidence that if they go to the chiropractor they’ll see some improvement,” Dr. Walker reported.

References: Walker BF, et al. Combined chiropractic interventions for low-back pain (Review). Cochrane Database of Systematic Reviews. Issue 4, 2010.

About the Author – Terry A. Rondberg, DC
Dr. Terry Rondberg is an outspoken supporter for research on chiropractic care for not just back pain, but total body wellness. He is founder and CEO of the World Chiropractic Alliance, and is a much sought-after speaker worldwide on the issue of drug-free chiropractic.

Chiropractic Instrumentation – Terry A. Rondberg, DC

Dr. Terry Rondberg
Terry Rondberg

Chiropractic Instrumentation

Not long ago, the only “instrumentation” chiropractors needed was their own hands. We palpated for subluxations, conducted relatively simple range-of-motion or leg length exams, and detected subluxations and corrected them.  Later, we obtained X-Ray machines that helped verify our visual and manual findings, although we never relied solely on this machine and still remained confident in our sense of touch and sight. That, however, was before outcome measurements, evidence-based practices, reliance on third-party payers, and an appreciation for the science as well as the art and philosophy of chiropractic.

Over the years there have been several developments in instrumentation for chiropractic use: weight scales, postural measuring, galvanic skin response measurements, para-spinal thermal devises etc. Although much of the instrumentation has provided valuable information for Chiropractic, it has been rated as scientifically unacceptable and has given non-reproducible results.

Earlier chiropractic instrumentation was bulky, awkward, and hard to use. I often wonder how many doctors and staff members gave up trying to learn about their new equipment and how much of that equipment is now sitting in a corner. I have seen some classified ads on popular Internet websites.  Here are some of the actual descriptions for sEMG machines on sale:

  • “Brand-new condition; rarely used.”
  • “Unit is like brand new, Less than 2 years old and used only about a dozen times.”
  • “All in great condition, dynamic SEMG never used.”
  • “Great condition — rarely used.”


“Today, in order to deliver the safest and most effective chiropractic care to our patients, and satisfy the more stringent requirements of the insurance industry, the government, and the courts, we must go beyond just feeling for subluxations.” – Terry A. Rondberg, DC

Thanks to computerized techniques, we now gather a wide range of data for neurological activity, leading to a better understanding of normal/ideal functional levels.  Surface electromyography (sEMG) and para-spinal thermal scans made a huge contribution about 12 to 15 years ago. While these seemed to support the chiropractic position of spinal care and joint mechanics, one must question if this deals with cause?  Furthermore, X-Rays, sEMG and thermal scans offer a static view of a dynamic being.  To base any care on a single static view is questionable. These instruments have served their purpose, which demonstrates the value of objective measurements in replacing the anecdotal foundations of chiropractic. It is better to move towards objective evidence than just sharing our philosophy and telling the chiropractic story.

In addition to sEMG, inclinometry and infrared temperature evaluations, instrumentation provides the ability to perform stress assessments and neurofeedback.  Much of this was developed by doctors of chiropractic Richard Barwell and Ken Vinton; it translates all data into detailed neurological reports that validate and document all clinical findings and guide health care decisions. This equates to the survival of modern chiropractic practice and plays an important role in case of a lawsuit or board complaint. Another reason to choose the NeuroInfiniti Instrumentation is that it is currently the only reliable system that allows field doctors to participate in a global research project that will prove the effects of how correcting vertebral subluxation impacts the autonomic nervous system while proving the real value of chiropractic care. The ultimate goal is to accumulate and analyze objective data from all the doctors who use the NeuroInfiniti to demonstrate the efficacy of chiropractic, to elevate our professions acceptance insure our rightful place in the health care professions.

We need powerful instrumentation that not only aids us in detecting subluxations, but provides an accurate outcome assessment system which correlates the value of what we do. Since chiropractic is the largest natural health care system in the world, we need the highest quality instrumentation. Let’s not settle for less.

We are working with state-of-the-art instrumentation developed for chiropractic that will transform chiropractic offices into the most effective, health care resources ever offered to the public.  A scientific evidence based practice will act as a patient magnet, drawing families into your office so you can provide the finest chiropractic care.

We do not often have the opportunity to revolutionize our offices, dramatically increase our patient volume and revenue, help more people lead healthier lives, and contribute to research validating what DD and BJ represented.  Chiropractic is a fast-moving profession.  Physicians can either join the frontrunners or be left in the dust.  They can either create the practice and the profession of their dreams today or they can continue to do nothing.

About the Author – Terry A. Rondberg, DC.
As CEO of the World Chiropractic Alliance, Dr. Terry Rondberg is the author of myriad, thought-provoking articles in the wellness field. He is the author of several best-selling books on the subject of chiropractic, and is a sought-after speaker at medical events worldwide.

Neurological Activity (Part Three) – By Terry A. Rondberg, DC

Part Three of three articles.

In a previous Journal article, although medical authorities acknowledge neurological complications may occur as a result of subluxation, classical chiropractic definitions mandate the presence of a neurological component.  Researcher, Charles Lantz, PhD, DC, writes, “Common to all concepts of subluxation are some form of kinesiological dysfunction and some form of neurological involvement.”

Nevertheless, we’re often ignoring that neurological involvement.  As a result, we are known as back-pain doctors and used the same way as aspirin or exercise equipment: to relieve musculoskeletal stiffness and pain.  One reason is we were sold a bill of goods to find a “niche” market. Back pain, we were told, was a lucrative market, with nearly eight of every ten adults suffering from it at one time or another. We thought the medical profession would allow us to treat back pain as long as we did not invade their territory.

It was also less complicated to describe how chiropractic could ease back pain than it was to explain the entire vitalistic philosophy.  It was also easier to advertise.  All we had to do was show a person with red lightning bolts radiating from his or her back or neck and we were in business!

The final reason we ignored the neurological component was that we didn’t have the scientific research to prove what we knew from clinical experience.  As Dr. Davila says, “We need to show a neurological connection to the subluxation so we have the proof we have talked about over the years and then tie that connection to functional improvement.”
Why then is so much of our current research focused on back pain and similar musculoskeletal conditions?  Here, for instance, is the complete list of all the projects funded by FCER last year:

  • “Chiropractic Dosage for Lumbar Stenosis”
  • “Chiropractic and Acute Neck Pain: A Practice-Based Study”
  • “Preventive Care of Chronic Cervical Pain and Disabilities: Comparison of Spinal Manipulative Therapy and Individualized Home Exercise Programs”
  • “Does Chiropractic Care Decrease Fall Risk in Older Adults?”  (The grant description notes that: “It is proposed that balance, the risk factor for falls, is adversely affected by both musculoskeletal function and low back and lower extremity pain — which have been found to be responsive in previous studies to chiropractic intervention.”)


Do you see the pattern here?  Instead of locking our profession in the miniscule musculoskeletal box, we need to reclaim the missing component of subluxation: neurological involvement. The World Chiropractic Alliance is dedicated to this mission.  We must discuss with our patients and members of the community, integrating it in our patient education programs. It is also necessary to redesign our advertising so we are not reinforcing the old, erroneous idea of back pain doctors. Furthermore, we should demand that our colleges and research institutions stop plucking the low-hanging fruit by examining the connection between chiropractic and back pain! Field doctors need to start using the NeuroInfiniti instrumentation to accurately measure a patient’s neurological response before and after subluxation correction, and learn to document vital information for use not only in research but for the government and all insurance companies.

In the hundred-plus years since DD Palmer discovered chiropractic, we’ve lost much of the spirit and substance of chiropractic. If we lose the neurological component of the subluxation, we will lose our original identity and possibly, our future.

I don’t want to wait until someday for chiropractic validation. Certainly, you do not wish to wait to transform your office into a smooth-running and modern, scientific evidence-based practice, with easy-to-use technology that maximizes your patient outcomes AND your bottom line! However, we do not need to wait until that elusive someday.  We can have it all NOW.

About the Author – Terry A. Rondberg, DC.
As CEO of the World Chiropractic Alliance, Dr. Terry Rondberg is known worldwide as one of the chiropractic profession’s leading proponents. After receiving his Doctor of Chiropractic (DC) Dr. Rondberg began publishing The Chiropractic Journal, a leading publication in the field. In addition to publishing the Journal—which continues to be an authoritative reference for chiropractic practitioners and professionals —Dr. Terry Rondberg has written a number of best-selling books on the subject of chiropractic.