Diagnosis

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There is one thing much more dangerous than failing to make a diagnosis. That is making an incorrect diagnosis. The least dangerous is to choose not to make a diagnosis and inform the practice member of that fact.

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This article has 46 comments

  1. Charles Hollensed DC 03/20/2013, 5:05 pm:

    I love it when an adjustment causes all the symptoms to disappear and the diagnosis with it.

    • Rick 03/20/2013, 5:33 pm:

      DITTO

      • Dr Rick 03/20/2013, 6:03 pm:

        I don’t diagnose. No diagnosis is needed when you don’t treat symptoms. Locating, analyzing, and correcting subluxations only, is the name of the game for me. Diagnosis is just another regulatory obstacle placed upon some chiropractors by the powers that be, in order to manipulate the profession. I simply don’t play that game.
        If you have learned to l.a.c.v.s., and you are doing something else…. Well, then you have sold out for money and/or insurance and compromised the art, science, and philosophy that you’ve been taught. Others, having not learned the same way, would not in the same way be held accountable….For they know not what they do. Their chiropractic is something else. Given, they have the right to practice as they wish…. I choose not to be part of the dilution and destruction of the art, science, and philosophy that was taught to me.

        • JStraussDC 03/20/2013, 6:16 pm:

          Dr. Rick, thanks for your input. Believe it or not there are still a few chiropractors left who don’t diagnose or treat symptoms because they believe that vertebral subluxation is the cause of all symptoms and disease rather than because the vs is in and of itself a detriment to life. Are you one of the former or the latter?

          • Dr Rick 03/20/2013, 6:54 pm:

            From my learning and experience, the body functions better in the absence of subluxations. I don’t pretend to know or understand it all. In it’s totality, the mind and body, their unseen attributes, largely remain a great and wonderful mystery. Removing a known and specific interference to the mind/body organism which we conceptually designate as subluxation, seems to enhance its function and performance. If there is any pain or discomfort present, it will usually go when subluxations are corrected, immediately, or shortly there after. The primary goal is to correct the subluxations , with attention always given to atlas and axis, as well as the rest of the spine.
            .

        • dan sevier 03/20/2013, 11:56 pm:

          re: “sold out for money” . . . I agree with Reggie’s comment on that: “If were to use therapies I would be doing it for the money” (or something similar, haven’t listened to that tape in a long time).

          • dan sevier 03/20/2013, 11:57 pm:

            “IF I WERE . . . “

          • Claude Lessard 03/23/2013, 4:44 pm:

            Dan,

            With all due respect, this is what Reggie said why HE would do it. There are others WHO would do it for different reasons, like Yves, WHO is “forced” to practice in a way that is mandated by the Quebec Board of Chiropractic. –

            – Please, let us, together without condemnation, observe what is going on… the whole reality of it. Then we can inquire, together without condemnation and “see”, that what TRULY matters, is WHO it is that YOU choose to BE regarding diagnosis.

          • Don 03/23/2013, 5:46 pm:

            Dr. Lessard,
            Assuming one is “forced” to practice in a way that is mandated by the Quebec Board of Chiropractic, what would you say the choices are with respect to diagnosis in that sort of climate?

            Do you see an alternative to the mandate of diagnosis in that province (assuming there is one) for the chiropractor that I do not see?
            I know there are other options but I can only assume changing the regulation/standard or the drastic option of leaving the profession as Reggie had done with spinology in search of a completely non-diagnostic, non-therapeutic profession. Thoughts?

          • dan sevier 03/26/2013, 10:42 pm:

            Don, it would seem to me that if the Province requires a diagnosis on file in order to be legally practicing Chiropractic in that Province, and you intend to do so, then document a diagnosis in the file, probably vertebral subluxation, and practice as you believe is correct for the person who is coming to you for your service. You probably are not required by your Province to diagnose diseases or conditions not in the Scope of Practice, so, fear not, fulfill the legal requirements and practice according to your objective.. That’s what I think.

          • dan sevier 03/27/2013, 12:31 am:

            And if you don’t like to do that, but do want to be seen as a Chiropractor and practice in that location, get political! I personally know several people who actively work to change their State law to reflect what they believe is best for the residents of that State. Patience, Persistence and Consistency pays off in many endeavors. Otherwise renounce the license, call yourself something else and do what you want.

          • dan sevier 03/26/2013, 10:49 pm:

            Yes Claude, that’s what I was trying to say. My keyboarding leaves much to be desired. I recall agreeing with Reggie when I heard him say that you can’t honestly declare another person is using therapies for the money; you can only say that “if I were to use therapies I would be doing it for the money”. (I believe this goes along with the principle that when one judges another they are first judging themselves and then comparing the other to self. “I would never do that”!) Just wanted to clear that up 🙂

          • Claude 03/26/2013, 11:22 pm:

            Dan,

            Thanks for the clarification.

    • JStraussDC 03/20/2013, 5:53 pm:

      Dr. Hollensed, The medics would argue that the symptoms (and diagnosis) could disappear even without an adjustment. How can we refute that assertion?

      • Steve 03/20/2013, 10:03 pm:

        Hey Joe,
        That doesn’t mean it did not happen. What do you say to a patient that thanks you for helping them with the condition that went away after your adjustment (adjustic thrust) was given???

        • dan sevier 03/20/2013, 11:51 pm:

          How about “You’re giving credit to the wrong guy”?

          • Steve 03/22/2013, 9:22 pm:

            Hey Dan,
            For all these years I have told them to thank Chiropractic not me. I try to explain that the adjustment allowed their body to heal and repair but I guess in OSC that is still too much of a connection, eh?

        • Tom 03/22/2013, 10:11 pm:

          Steve what do you tell them when their problem that they came to you with doesnt go away? Did chiropractic fail them???

  2. Bob Berkowitz 03/21/2013, 1:10 am:

    When a practice member takes you down the path to access their particular problematic part, it is our roll to reposition their perspective to our, or we end up in their therapeutic camp. On the other hand, I do NOT want to reprimand or insult them, I do view this as a great time to redirect that question that ultimately tells them that if they are concerned with that particular part, would their body be in a better place to heal with or without a vertebral subluxation. I may ask them; who is putting that particular part in its current state? They must learn that it is their body under their circumstance. Therefore, what makes MORE [not ‘or’] sense; address the part or improve the body? We as chiropractors improve the circumstance by addressing vertebral subluxation, thus allowing the body a better place to heal.

  3. Yves 03/21/2013, 1:29 am:

    Hi every one

    I am reading and learning a lot since I foud your blog in last september.

    I know that Dr Lessard will tell me that it’s all depend of WHO I chosse to be, but don’t be too hard on me it is my first post.

    I’m practicing in Gatineau, Quebec, Canada and not diagnosing is not only a question of money but of license. In 28 years of practice I had been visit 2 times by the regulatory board for my patient’s files information. They (Licensing Board) will take my license away if I did not have diagosis in my flies, and worse than that I will not have any malpractice insurance If I don’t have the patient singing an informed consent, and I have to explain it myself to the patient, and every time a patient come in for a new complaint I have to make a new diagnosis and a new informed consent.

    I know it is Who I choose to be but I can not choose to be a NTSOCor because I will not be allowed to practice.

    Your blog is great and keep on your good work, Dr Strauss and Dr Lessard.

    Yves

    P.S.: I know that word’s meaning are very important on this blog, I ask you to understand that I’m french speaking.

    • Claude Lessard 03/21/2013, 4:20 am:

      Yves,

      Thank you very much for your honesty. What you posted is a wake up call to ALL of us on this blog. What you are experiencing is socialism at its best. I feel sorry for your lack of freedom to CHOOSE to practice as you desire in your country. Your situation, in Canada, is slowly moving South and just about ready to cross the border with OBAMA CARE. It took Canada a little over 40 years to accomplish its socialist objective. When government regulates the “personal” health of its citizens, it gives those same citizens a FALSE sense of “security” by taking over their “personal” health responsibilities. It’s already happening with Social Security and Medicare. The “system” creates higher taxes, higher premiums, lesser quality of care, longer waits for care, lower claims payments and providers become government employees. When the system is well established, it eventually strips away little by little the freedom of its citizens under the “pretense” that it is best for them until the next revolution. –

      – Yves, je comprends ce que tu ressent et j’en suis tres desole. Je suis aussi un Quebecois d’antan qui est venu s’etablir aux Etats-Unis pour cette raison. Je crois que ce que tu as mentiones va peut-etre reveiller les lecteurs du blog. –

      – As for us, on this blog, we find ourselves confronted with a reality that exist with our brother, north of the border. While we are busy refining our glossary, there is a level of freedom we take for granted. The natives Inuits of Northern Canada THINK through any communal change into the seventh generation. If it will NOT benefit the seventh generation, they ratify the change until it is beneficial for that seventh generation or throw it out completely. –

      – Here we are, ALL of us together, with “some” freedom left and it’s the majority of chiropractors WHO choose NOT to practice the chiropractic objective. The deeper one plunges into the “disease care” system, the more one cooperates with that system and its consequences. –

      – This blog provides an on-line philosophical environment to INVESTIGATE, INQUIRE, QUESTION, DOUBT, REASON, UNLEARN and DROP our falsehoods, so a chiropractor, like Yves, will emerge from top to bottom and from inside-out, a perpetual student of the philosophy with a beginner’s mind. Despite his predicament of BEING FORCED to practice the medical objective as a chiropractor by the government of his country, Yves leaves us with a note of encouragement to carry on. ADIO.

      • Eric S. Jones 03/22/2013, 1:55 pm:

        Dr. Lessard and Yves,

        I can very well relate to this situation. I do not practice in Canada. I practice in Maryland, USA. I function solely as a NTOSC. I have a medipractor in my town that does not like nor want my way of practice in “his” town. in 10 years this DC has filed 2 board complaints against me – both in the field of diagnosis, improper exam procedures, and record keeping. By law, both times the board is required to come into my office, pull 10 random files, and take the copies back to the board for investigation. I wait on their decision. It truly is a kangaroo court. The first time was a nightmare. The second time I was fully prepared. However, BOTH times the board ruled in MY FAVOR!!! You see, as long as you have a clear and precise objective YOU ARE NOT REQUIRED TO RENDER A MEDICAL DIAGNOSIS IN THE USA. My consent for care signed by patients explains this directive. My financial policy explains this directive. Even with Medicare, if you do not have a federal contract with Medicare, and you have the proper documentation explaining this to patients before you check their spine, you are completely legal to render your services and collect payment for said services how you choose. In Maryland, I am required to provide SOAP notes on every patient, every visit. Part of the required SOAP format is the CPT / ICD.9 coding. I use the S8990 / V70.9 codes (ref. Chirocode Deskbook 2011 p. F108). These are designated and legal codes for maintenance care. They are on all of my paperwork, and the board approved. Believe it or not, there ARE LAWS in place that the NTOSC can practice under with complete confidence. We are responsible to know these laws and practice within them, and most importantly DEFEND THEM if they are challenged by our “mixer” counterparts in Washington. Yves, keep your chin up. Study your laws and look for the loophole. I’m sure if you put enough thought into the problem, a solution will rise to the surface. God Bless!!

    • Don 03/21/2013, 8:04 pm:

      Dr. Lessard and Yves,
      I find this very interesting.
      I tried to read the regulatory college of Quebec chiropractors standards of practice but noticed my french is very rusty.
      Could one of you translate the standard of practice for chiropractors in Quebec for me. I would like to see if it reads ONLY diagnosis or something different such as impression or diagnosis.
      Thank you kindly.

      • Don 03/21/2013, 8:31 pm:

        ..only the standard that relates to diagnosis.

        • Claude Lessard 03/21/2013, 10:07 pm:

          Yves,

          Tu demeure a Gatineau. Peut-tu s’il vous plait traduire pour Donald le “standard du diagnostique” pour les Chiros Quebecois? Merci. 😉

      • Yves 03/22/2013, 1:55 am:

        Hi Don

        Can you tell me where you read it ? Or send me the link so we can talk about the same rules. Because since chiropractic is taught at The university of Trois-Riviere things change often and to tell you the truth I am not always up to date with the many changes.

      • Don 03/22/2013, 8:01 pm:

        Yves and Dr. Lessard,
        I believe this is the website where the standards for chiropractic in Quebec can be found.
        http://www.ordredeschiropraticiens.qc.ca/Syndics.php?s=protection

        I am just not sure which Standard of practice makes diagnosis mandatory.

        • Yves Lanthier 03/23/2013, 12:33 am:

          Don and Dr Lessard

          When you click on the link

          Click on Lois et règlements

          then click on (C-16, r. 14)

          Règlement sur la tenu des dossiers et des cabinets de consultation de l’Ordre des chiropraticiens du Québec

          ( rules for patient’s files constitutions and chiropractic office)

          SECTION1

          TENUE DES DOSSIERS

          1.

          2.

          3.

          4.

          5.LE DIAGNOSTIC DE L’ÉTAT DU PATIENT

          I do not see it but now we are required to explain the risq (danger) of the treatment, and the alternative care,and have the patient sign the informed consent before starting care. And every time the patient come in with a new complaint we have to have another informed consent fill in.

          If you are interested in seeing a copy of it just let me know your e-mail and monday when I will be at the office I can send you one.

        • Yves 03/23/2013, 1:18 am:

          Don

          Click on the link

          Then click on

          Lois et règlements

          Then almost at the bottom you will see

          Règlements sur la tenue de dossiers et des cabinets de consultation de l’ Ordre des chiropraticiens du Québec
          (C 16 r 14)

          On this page you will see

          TENUE DE DOSSIER

          1.

          2.

          The line 5

          Le diagnostic de l’état du patient

          • Yves 03/23/2013, 1:25 am:

            Don and Dr Lessard

            Le diagnostic de l’état du patient

            I think I can translate it by

            The patient’s conditon diagnosis.

            If Dr Lessard find a better translation I will be happy to know it.

            Thank you

      • Don 03/23/2013, 4:16 am:

        Yves,
        The Chiropractic act as written on the website does not mention diagnosis but the section on documentation states that it must be in the records of a chiropractor. That seems rather interesting.
        I’ve tried to find the section that states that chiropractors are mandated to diagnose but cannot. Maybe Dr. Lessard would have better luck than I.

        Here are the fruits of my search..

        It states clearly that “SECTION IV
        PRACTICE OF CHIROPRACTIC

        6. Constitutes the practice of chiropractic any act that is intended to perform corrections of the spine, pelvis and other joints of the human body with the hands.

        1973, c. 56, a. 6.

        7. A chiropractor is authorized to determine the clinical and radiological examination of the spine, pelvis and other joints of the human body, chiropractic treatment indicated.”

        Here is the french version..

        SECTION IV
        EXERCICE DE LA CHIROPRATIQUE

        6. Constitue l’exercice de la chiropratique tout acte qui a pour objet de pratiquer des corrections de la colonne vertébrale, des os du bassin ou des autres articulations du corps humain à l’aide des mains.

        1973, c. 56, a. 6.

        7. Un chiropraticien est autorisé à déterminer, par l’examen clinique et radiologique de la colonne vertébrale, des os du bassin et des autres articulations du corps humain, l’indication du traitement chiropratique.

        No diagnosis mentioned. You may also want to call the Directrice générale Béatrice Guay-Pepper for definitive clarification on the matter.

        • Yves 03/23/2013, 5:08 am:

          Don

          You are a great mind to find thing like that.

          In 2003 if my memory is correct, we had to fight to keep the right to diagnose because the College des medecins du Québec after reviewing the curriculum that was taught at the unniversity wanted to remove our right to diagnose and our the title of Dr.

          The Ordre des chiropraticiens at the time did every thing to keep the right To diagnose because they were afraid that they will do the same thing they have done ( college des medecins) to the accuponctors, they are now under the umbrella of Coolge des medecins to be allowed to practice.

          It remind me now that it does not mention in the law but when I had my last professional inspection, every chiropractor has one at least every 10 years, the criteria for the patient’s file documentation also include the informed consent to be sign by the patient.

          Like Dr Lessard said it in his reply to my first post, Canada is a socialist country and Quebec is the worse socialist province of the country.

          There is more …

          • Yves 03/23/2013, 5:18 am:

            Don

            The diagnosis might not be in our law but every profession board of the province are under the umbrlella of l’Office des profession and it migth be there. I do not know. If something can be complicated, you can be certain the Quebec goverment will do everything to make it worse.

      • Don 03/23/2013, 5:29 pm:

        Yves,
        Obfuscation is definitely a learned skill.
        It makes getting to the bottom of things hard but not impossible ;).

        This is not a simple situation since if it is true that the regulatory colleges are making diagnosis mandatory in Quebec, how would one such as Yves, interested in practicing OSC, maintain the objective in practice yet keep her licensure?

        In other words, does socialism quash the freedom? Freedom to practice OSC?

        • Yves 03/23/2013, 8:09 pm:

          Don

          i know french is not always easy, Yves is a male first name. In your post above you wrote ” keep her licencure”. No offense, when I went to CMCC, I got used to be call Eve.

          Let say I drop my licence , I do not how I can practice correct vertebral subluxation.

          Loi sur la chiropratique C-16 r 5

          Section IV

          6. Constitue l’exrecice de la chiropratique, tout acte qui a pour objet de pratiquer des corrections de la colonne vertébrale, des os du bassin ou des autres articulations du corps humain à l’aide des mains.
          1973 C 56 a.6

          Any action aiming to correct the spine, the pelvis, or any others bone of the human body using the hands is the practice of chiropractic.

          • Don 03/23/2013, 8:41 pm:

            Yves,
            I am terribly sorry for writing she instead of he.
            Thank you for pointing that out.

            Fortunately or unfortunately the definition does not mention vertbral subluxation correction. I do not see a conflict here.
            Are there any disciplines in Quebec that correct the spine or other bones with the hands?
            I had recently had dinner with a physiotherapist who has the designation from the Canadian academy of manipulative physiotherapy. There are several others in Quebec. Is there a conflict there? Why or why not?

  4. Don 03/23/2013, 5:45 pm:

    Dr. Lessard,
    Assuming one is “forced” to practice in a way that is mandated by the Quebec Board of Chiropractic, what would you say the choices are with respect to diagnosis in that sort of climate?

    Do you see an alternative to the mandate of diagnosis in that province (assuming there is one) for the chiropractor that I do not see?
    I know there are other options but I can only assume changing the regulation/standard or the drastic option of leaving the profession as Reggie had done with spinology in search of a completely non-diagnostic, non-therapeutic profession. Thoughts?

    • Yves 03/23/2013, 10:46 pm:

      Don

      I know that the regulatory board will take action when a bonesetter manipulate the spine. The board is working for having the osteopath not treating the spine, but it is kind of tricky because many chiropractors are also practicing ostheopathy. For physiotherapist it is also an issue. For the vertebral subluxation, for having served as jury in a case of the syndic against a chiropractor, It is ” my belief” that they will not make any difference betwen ” correction de la colonne vertébrale” and correction of a vertebral subluxation. My belief based on my experience.

  5. Claude Lessard 03/24/2013, 3:14 pm:

    Don,

    An example model would be to “fulfill” the law of the land as we ALL do in North America to a certain extent, (ie, CE credits requirements, National Board requirements, State Board license requirements, etc, etc. Using myself as an example, in Pennsylvania, I am “forced” to attend 24 credit hours of “approved” CE to renew my “right to practice” every 2 years and provide the Pennsylvania State Board of Chiropractic Examiners upon their request, a certificate of completion of ALL of the 24 hours, otherwise I will get fined and the board will take away my license if those requirements are not met. In order for me to have the RIGHT to practice the chiropractic objective in Pennsylvania, it is me WHO chooses to BE in relationship with the Pennsylvania State Board of Professional License in my case and NOT the Office des Professions de Quebec at this time.

    • Don 03/24/2013, 5:00 pm:

      Dr. Lessard,
      If the Pennsylvania State Board was to mandate diagnosis the likes of Quebec, would that mean you would choose to practice in a different state?
      Would it be possible to “fulfill” the law of the land in Pennsylvania as a NTOSC?
      I am probably wrong (I am getting used to this now :)) but it doesn’t seem there is much choice in a case like this.

      • Claude Lessard 03/24/2013, 8:44 pm:

        Don,

        Are you required to obtain CE credits in your province?

        • Don 03/24/2013, 8:52 pm:

          Dr. Lessard,
          Yes.
          40 hours required over a two year period.
          20 structured (e.g. seminars) and 20 unstructured self study.

          • Claude Lessard 03/24/2013, 10:11 pm:

            Don,

            What are the mandatory subjects of study, and within those subjects, is diagnosis of musculo-skeletal conditions mandatory?

      • Don 03/24/2013, 11:44 pm:

        Dr. Lessard,
        For the CE requirements it is left up to the professional discretion of the chiropractor based on their personal self-reflection of practice and areas of need. The only requirement is structured versus unstructured and the keeping of an updated portfolio. As far as I know, the study of diagnosis of MSK conditions is not mandatory for CE requirement compliance in my province.

        • Don 03/24/2013, 11:48 pm:

          A submission of a Professional Development Log that summarizes your activities/learning is also required at the end of every two year cycle.

  6. Don 03/26/2013, 11:38 pm:

    Dan,
    That is probably the most practical approach one can take in a situation like in Quebec.
    The great minds on this blog have taught me that the problem is that if diagnosis is the realm of medicine, should a chiropractor even be documenting vs as a diagnosis?
    Then again, your point is well taken, what other option is there in a situation like Quebec for an OSC?

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