Informed Consent

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(4th Friday Philosophy-a week late)
“Informed Consent” is an important and necessary aspect of objective straight chiropractic care, however, we understand the term in a different way than most. Medically speaking, “informed consent” means that even if I do everything correctly, there are some possible negative results, i.e., “Do you understand there are possible negative results as a result of my care and are you willing to receive care in spite of them. Please sign this form.” The most obvious negative medical example is the too often used phrase….“the operation was a success but the patient died.” It does not happen with objective straight chiropractic care. An adjustment enables the innate forces of the body to be expressed more fully. The adjustment cannot cause death or any other negative result. “Adjustment” means to make right. Death might occur in spite of the adjustment. You are not practicing objective straight chiropractic if you are adjusting a practice member for a medical condition. Rather, you are practicing chiropractic medicine (therapeutic chiropractic) which many chiropractors, even those who adjust only, by hand only, are doing. If you are adjusting someone with, but not for, a medical condition, he/she may die as a result of the medical condition. Their death, then, would be as coincidental to your care as if they walked out of the office and were hit by a passing car as they crossed the street. “Informed consent” does not include malpractice. Malpractice does not involve wrong “intent.” No doctor intends to do wrong. Accidents do happen and the best intention sometimes results in malpractice. The conservative care of chiropractors makes it less common than medical care but it is possible. Having malpractice insurance is recommended even if not required in your particular state. The practice member, his/her attorney or family members may not know or understand your non-therapeutic “informed consent.” You must be clear. “Informed consent” involves the practice member or the potential practice member understanding what they can expect in your office and what they cannot expect from objective straight chiropractic care. The article below entitled “Making Decisions Regarding Your Health” is taken from a 4-color booklet that we gave our new practice members on their first visit. The booklet is now out of print but we may print it again in the future. Meanwhile, we would like to put the information into your hands. If you would like to reproduce this information to aid in the education of your practice members, feel free to do so. Please note that the material from this booklet is copyrighted, so it should not be sold.

Making Decisions Regarding Your Health

Every individual experiencing symptoms, whether diagnosed as a disease, or undiagnosed, is faced with four options. Since everyone, at some time in his or her life, experiences symptoms, it is important for you to understand these options and the ramifications of each in order to make a more intelligent decision. It is vital to understand that no option is fixed in stone. Every person has the freedom to change his or her mind at any time and pursue another option. The following is an explanation of those four options.

1. Ignore the symptoms or the disease.

At first this does not appear to be a very intelligent option and most of the time it is not. If your arm is bleeding profusely, you would be foolish to ignore it! Ignoring a compound fracture of the leg would also be unwise. Simply doing nothing about a disease or symptom may be a poor choice. Yet we all do it more often than we realize. Many people suffering from the common cold just ignore it, confident that in a few days or a week it will go away. People have aches and pains all the time which they ignore. Often the symptoms disappear and do not return. The rationale behind this option is the knowledge that the body has the ability to heal itself and normalize function often without any assistance. A cut finger, a headache, or a sore back are other conditions which people often choose to ignore and that often heal or go away in a short time. So this approach is much more common than would first appear. There are sometimes potentially harmful consequences, however. In this particular option, for example, ignoring a symptom or a disease, doing nothing about it, may allow the condition to become worse. If and when another option is pursued it may be too late to receive help. A compound fracture of the leg could become gangrenous if ignored long enough. This is an extreme example, but it makes a point. A lingering headache may be an example closer to home. That headache may be a symptom of a serious, underlying brain dysfunction such as a tumor. It would seem that ignoring the problem is an option, but most often is a poor choice. In fact, unless you are convinced you are doing everything you can to be healthy (proper rest, diet, exercise, hygiene, good nerve supply, etc.), it is always a poor choice.

2. Treat it medically or therapeutically.

This is the most often chosen option. It may range from taking a simple over-the-counter drug such as aspirin, or putting iodine on a cut finger, to major surgery. The possible ramifications are numerous, both negative and positive. On the negative side, the treatment may be covering up the symptom while neglecting the cause and allowing it to get worse. Taking aspirin to relieve the symptoms of a brain tumor demonstrates this possibility. Secondly, the treatment may be worse than the disease itself. People die from so-called minor surgery. On the other hand, this option may do nothing to promote healing but may relieve the symptoms while the body is healing itself. Pain relievers are the most common example. Another positive possibility would be that the procedure did something to remove an interference to the body’s ability to heal itself. The iodine on a cut finger may kill off microorganisms that would interfere with the healing process. It should be noted in both these examples that it may be impossible to know whether the treatment is relieving the symptoms while the body is healing itself or relieving the symptoms while the condition is getting worse. It is also impossible to know whether the procedure, such as the application of iodine to a cut finger, while destroying the microorganisms, may be having an even greater effect in damaging healthy tissue or reducing the body’s ability to heal.

What then, can we conclude regarding this option? Most of the time we do not know whether the medical procedure, whatever it might be, is doing good, doing harm, or doing nothing at all. Because of the individuality of the human organism, the best that you can do, in choosing this option, is utilize the expertise of the most competent of therapists, usually the medical doctor, and hope for the best. This option is not available in this office.

3. Choose chiropractic care.

Chiropractic does not pretend to be a treatment for symptoms or disease. A chiropractor only corrects vertebral subluxations so that the body’s nervous system is free of interference and thus the body is able to function in a more efficient manner. When this is accomplished, the body will have a greater capacity to heal itself, perhaps a capacity that it did not have before the utilization of chiropractic care. If you choose this option, you, in effect, are saying “I am going to have my spine adjusted and see if my body has the ability to heal itself.” There are three very important points to bear in mind here.

First, the body is limited in its ability to heal itself by the factors of time and matter. It may take a longer time for your body to heal itself than you are willing to give it. This is particularly true with longstanding conditions. The damage done may be of such a severe nature that your body will never heal itself. That is a limitation of your particular body.

Secondly, the chiropractor is not able to determine whether you have passed that point. It is questionable whether anyone is able to make that judgment. Many have gotten well after the finest of physicians has told them that the condition was chronic, terminal, or incurable. However, the chiropractor is definitely not going to make that judgment, because it involves a symptom or condition which is of a medical nature. Chiropractors do not make medical judgments.

The third point to remember in choosing chiropractic care is that you, not the chiropractor, are responsible for all your choices. You may choose to begin chiropractic care and allow your body an opportunity to heal itself. Or you may choose another option, when you believe your body has passed the point of limitations of time and matter. Remember, chiropractic is not a treatment or cure for your condition or symptom. This is not a nullification of responsibility by the chiropractor. It is merely ascribing to him/her the responsibility that is his/hers, which is the correction of vertebral subluxation only. Your responsibility is then to make your own decisions regarding life and health. Because your body is a fantastic organism, it has the ability to heal itself of the vast majority of conditions and symptoms, most of the time. But there are people under chiropractic care who do not get better. They may even continue to worsen. These people must be aware of what is happening in their bodies and be prepared to exercise another option if they so choose. It is important for you to understand the four options and to realize that at any point you may choose to exercise any option. It is your health and your life. The chiropractor wants to make sure that you make an informed decision.

4. Choose medical care and chiropractic care.

Since chiropractic care and medical care have different objectives, it is entirely possible for you to be under the care of an M.D. and a D.C. at the same time. The M.D. fulfills his objective by treating the symptoms or condition. The chiropractor makes sure the body has a good nerve supply so that it can more effectively heal itself.

You actually have this fourth option open to you at all times. Some people choose to be treated medically at the beginning of their chiropractic care because they need continued, immediate relief. Some give their bodies what they feel is sufficient time to heal and then resort to treating their problem medically, all the while continuing chiropractic adjustments to keep the body working at increased efficiency. Some people, having been under medical care, will continue with their medical doctor after beginning chiropractic care until their body normalizes function. The only problem with taking this option is that medical care often interferes with the body’s ability to heal itself. Medications for example, place a foreign substance into the body which often decreases the body’s recuperative ability. However, here again we have an example of why the practice member must make the choice. No doctor knows what symptoms you may be experiencing and how necessary relief is for you. The only person able to make the judgment is you. You must be willing to experience the consequences, whatever they might be.

Options in Health…

With regard to health, the options are much more limited than with disease. In fact, there are only two options. The first option is best summed up in a bumper sticker slogan: “Ignore your health and it will go away.”

1. You may choose to ignore doing the things necessary to maintain and promote your health. However, if you do, you will most likely be faced at some time with symptoms that will cause you to choose one of the four options previously discussed. Many people ignore their health. Unfortunately, the first symptom of disease can sometimes be death! Ignoring your health is never an intelligent decision.

2. The second option is to do everything necessary to be healthy. That includes good eating habits, nutritious food in the right quantity and quality, getting the proper rest, exercising regularly and maintaining a good mental attitude. It also necessitates good hygiene and maintaining the spine free of subluxations so that the body has a good nerve supply. This is done through regular chiropractic care. You need to make efforts in all the above areas. You cannot choose two from column A and one from column B. You should not do extra exercise so that you may ignore eating properly. Rest does not take the place of receiving regular chiropractic adjustments. All should be done and should be done regularly. If one area is ignored, your health potential is decreased by that much. If your health potential is seriously decreased, disease is the inevitable result. Ignoring or being haphazard in any area is like playing Russian roulette. You may get away with it for a while, but the results may be disastrous.

For most people, the idea of having to actively pursue health by doing all those things necessary, and doing them regularly, is not appealing. It is not the most enjoyable expenditure of time, money, and energy. However, it is much better than being faced with the options of disease.

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This article has 70 comments

  1. Don 05/30/2014, 9:13 pm:

    Great post Joe!

    I feel the statement that stood out the most for me was “it is their health and life, the goal of the chiropractor is to make sure you ( aka. invite you? make an elegant choice?) to make an informed choice.”.

    I agree by definition that an adjustment cannot cause death.

    Can the introduction of forces as applied by the chiropractor cause death or any other negative?

    After all, the chiropractor introduces forces, that doesn’t suggest that they will always be used by ii.

    Joe, in your opinion, what do you say about the need for an informed consent for the introduction of forces into the spine to explain the possible negative events like an MD?
    Why or why not?

    Thanks.

    • Joe Strauss 05/31/2014, 2:17 pm:

      Don, as I mentioned in the cover letter … a chiropractor does not intend to introduce an eif, that not only will not be able to be utilized by the PM’s innate intelligence but will be of such magnitude to cause injury. IOW no doctor of any kind, informs a patient “this is what may happen if I make a mistake”. No doctor assumes that he will mal-practice. But we are imperfect human beings and make mistakes. Fortunately our chiropractic procedures and techniques enable us to introduce so little force that “chiropractic malpractice” is highly unlikely and very rare. Most malpractice claims, and I have consulted on dozens for the defense, are because the chiropractor has claimed to be a straight chiropractor but was really addressing a medical problem or the more common reason is that the PM or family did not know/understand the OSC objective. That’s a reason why a chiropractic Terms of Acceptance, (not an informed consent) is recommended. The biggest problem in chiropractic is that most chiropractors are practicing the medical objective under the guise of chiropractic and many who are not are inadequately explaining the difference to the people who come into their office.

    • Joe Strauss 05/31/2014, 2:30 pm:

      Don, a P.S. Thank you for your kind comment and its good to hear from you even if its only a short interruption from the Claude Lessard/David Suskin Show. (Only kidding. I appreciate Dave’s inquisitive mind and Claude’s patient willingness to dialogue).

      • Don 05/31/2014, 5:21 pm:

        Joe, a reply to your P.S. Thank you for replying to my comments. I know it can be challenging to keep up with all the posts from your astute participants on this blog (Dave, Claude and Steve to name a few) and I appreciate you getting back to my personal post.

        I wish I could participate more regularly but know that I read often. Admittedly, I often find myself looking for look for your responses because they are easy to find as they show up in bold type face but I wonder if there is an easier way.
        Whatever the answer, I understand that some things get lost in communication. It is the nature of blogging and not conversing face to face. Cheers.

    • Don 05/31/2014, 5:07 pm:

      Joe,
      I didn’t know you have consulted on many cases of malpractice. I can see how practicing in a way that is not congruent with what is said can lead to conflict (in many ways).

      I feel we agree that there are probably very few doctors who assume the intent to mal-practice in practice. (0r at least I should hope their aren’t …YIKES!)

      I also get the sense that you are saying “chiropractic malpractice” is either highly unlikely/very rare.
      I also get the sense that you are saying “chiropractic malpractice” does not exist in an OSC practice.

      I would like to explore the process of informed consent in the context of an OSC practice. I don’t imagine I have a firm enough grasp of OSC and informed consent to do that.
      Thankfully I have you and this blog for the former and websites like this for the latter.
      http://www.chirocolleges.org/informed_consent.html

      Maybe with your help I can explore it more fully and completely Thanks again for this great post and I look forward to your reply!
      -Don

      • Don 06/05/2014, 8:34 pm:

        Understandably, Joe may be busy with some other projects.
        I noticed I addressed my last post to Joe so I’ll correct that…If anyone else would like to share their view of consent, please feel free to jump in.

  2. Don 06/08/2014, 6:07 pm:

    To Joe, Dr. Lessard, Steve and Tom (Because you are the only four OSCors i know 🙂

    I need some help with an aspect of the OSC practice I don’t fully understand.

    I understand that the ii of the body produces an adjustment. I also understand that the EIF is the educated force applied by the chiropractor using his analysis of the vs with the intent that the ii will adapt this force in order to correct the vs.

    If we look at these in steps. Analysis, determination of vs presence, introduction of EIF, ii adapting EIF.

    Should the procedure of introducing an EIF (note: assumption here is it carries some material risk requiring disclosure) be preceded by an informed consent process?

    Thanks everyone!

    Excerpt taken from the link on informed consent in this thread….
    Recognizing that all care including diagnostic studies and chiropractic care have some potential for causing injury to a patient, it is the recommendation of the Association of Chiropractic Colleges that, prior to performing diagnostic testing and prior to implementing chiropractic procedures, the patient should be informed about the material and inherent risks and common options to the recommended care and the associated risks, including the risk of refusing care. If the patient wishes to continue he/she should give his/her consent. The Doctor should have a record in his/her clinical file documentation which confirms that consent was given by the patient to the diagnostic testing and/or the chiropractic procedure.

    • Don 06/08/2014, 6:09 pm:

      ** correction **
      Chiropractor introduces an EIF with the intent and the understanding that only the ii of the body makes the adjustment. 8)

      • Claude Lessard 06/08/2014, 9:13 pm:

        Don,

        As per glossary you mean EUF (educated universal force). Correct?

        • Steve 06/10/2014, 2:55 pm:

          Don,
          What it really comes down to is, what does your state/provincial law say you must do.
          Personally I like Joe’s “Terms of Acceptance”. Within that document, after explaining our unique perspective, goal, mission, approach and/or Raison d’être, you may include what you expect of the patient (attendance at lectures, following the recommended schedule, payments, referrals, missed visits,etc). This would also include a waiver of liability for the unknown/unknowable responses to analysis and care.
          Two other things you say in this thread concern me. One, even an OSC can be sued for malpractice, because let’s face it, shit happens. Two, please do not put me up with Joe, Claude, and Tom for the truth the light and the way of all things OC, as I have repeatedly stated, I am a neophyte in this transitional movement toward a purification of chiropractic.

    • Joe Strauss 06/10/2014, 7:49 pm:

      Don, sorry to take so long to respond…had to get my thoughts together. As you will see, I do not agree with the ACC’s position. I am having dinner with the ACC’s new President before the summer is over. He was a student of mine and an OSCor when he was in practice. Hope the following helps:
      Medical Informed Consent covers a situation (actually every situation) in which the educated brain of the doctor is limited in his knowledge of the limitations of matter (LOM) of the patient’s body. If the md’s educated brain wholly knew the LOM of the patient’s body he would not need an IC. He would never perform a procedure in which the “procedure was a success but the patient died”. He would know that the patient’s body could not handle that procedure. Sometimes they do know (or educatedly think they know) and don’t recommend or refuse to perform a procedure. He chooses to “just keep the patient comfortable”. Signing an IC form is, in effect, saying you understand that because of the doctor’s limited knowledge of the patient’s body’s LOM he cannot guarantee a positive outcome but I want him to go ahead with the procedure anyway.
      Medical malpractice is making a mistake, one that the average doctor under the same circumstances would not make. It is up to the plaintiff to prove that. The doctor is innocent until proven guilty. IC does not exonerate a doctor from malpractice.
      Chiropractic Informed Consent is not needed because the adjustment is done by the P.M’s body’s innate intelligence. It (the ii) would never do anything to harm the tissues in which it resides. The outcome of non-therapeutic chiropractic care is the correction of the VS, the chiropractic objective. The OSC must inform the PM that he is not addressing any medical outcome and says so in his terms of acceptance (TOA) , which the PM signs attesting to his understanding of that.
      Chiropractic malpractice is the introduction of an EIF that is of such a magnitude or delivered in a such a manner so as to cause injury or harm. An IC or TOA does not exonerate a chiropractor from malpractice so IC is not an issue in OSC but a TOA is.

      • Claude Lessard 06/11/2014, 11:40 am:

        Don,

        I was suspecting that WHEN Joseph would get around to answer your question, it would have a PERIOD at the end. Well… it does. PERIOD. 😉

        • Claude 06/11/2014, 3:13 pm:

          … in other words, there is nothing to add to Joseph’s answer regarding the distinction between “informed consent” and “terms of acceptance” from a chiropractic objective point of view. –

          – PS: Page 182 of CASE MANAGEMENT FOR STRAIGHT CHIROPRACTORS has the form. 😉

      • Don 06/13/2014, 12:43 am:

        Joe,
        Glad to hear that the new ACC President was a student of yours. I hope his view of chiropractic has not varied from his OSC roots in practice. I assume you will find that out during the dinner. 🙂

        Thank you for describing TOA and IC from your perspective.

        There are many points I understand in your post and a few that you may need to help me understand a little better.

        I understand…
        -the IC does not exonerate a doctor from malpractice.
        -the adjustment is done by the P.M’s body’s ii –the educated brain of the doctor covers (every) situation in which the brain of the doctor is limited in his knowledge of the LOM of the patient’s body.
        -Sometimes they do know (or educatedly think they know) and don’t recommend or refuse to perform a procedure.

        Maybe you can help me understand these 2 questions
        -Is the OUTCOME of an adjustic thrust with the OSC objective ALWAYS and ONLY correction of VS? If not, what else is possible?

        I see IC ( 😉 sorry)… I couldn’t resist.
        I regard IC as similar to but also different than malpractice and risk management. Then again you do have the malpractice experience here. 🙂 So I will ask a question…
        Could an OSc not deliver/introduce an EIF that is of such a magnitude or delivered in a such a manner so as to cause injury or harm?
        Sorry about not getting on this blog often enough. I will keep checking back as often as I can for your answer. Thanks for answering my questions Dr. Strauss! 🙂

        • Don 06/19/2014, 8:23 pm:

          Joe and Dr. Lessard,
          I think my question was lost in the exchanges seen on the blog lately.
          Please let me know your individual thoughts on this question.

          Could an OSc not deliver/introduce an EIF that is of such a magnitude or delivered in a such a manner so as to cause injury or harm?

          See above if you need the preamble/context of this question.
          Thanks.

          • Claude Lessard 06/19/2014, 8:57 pm:

            Don,

            Are talking about yourself being concerned about introducing an adjustic thrust that would cause injury or harm? Or are you talking about some Canadian agencies making informed consent part of the law?

          • Joe Strauss 06/20/2014, 10:10 pm:

            Don, your question of 6/13/2014 (Could an OSc not deliver/introduce an EIF that is of such a magnitude or delivered in a such a manner so as to cause injury or harm?) was not lost. You asked if I could help you understand your question. I could not understand the question myself so I was waiting for someone else to explain to you what your question meant. But since you asked it again without further explaining it, I will try to answer it even though I still do not understand the question. The answer is YES. More than once I’ve asked questions on a exam that did not make sense, so don’t feel bad. I usually recognized my vague/poorly worded question when a confused student would raise his/ her hand and say “what the #@%* does that question say?” I gave credit for the question when I reread it and say to myself, what was I thinking when I made up that question. I tried to answer yours as best I could (I did reread it again and again for context but that did not seem to help). I hope you will give me credit if the answer is unresponsive… or perhaps you could rephrase the question more clearly and I promise to give a more complete answer. If the answer “yes” is correct or incorrect, don’t put too much reliance upon it, not understanding the question, it was only a guess rather than an intelligent, deductive response.

        • Steve 06/20/2014, 5:24 pm:

          Don, The goal is always the same. To offer an educated universal force that Innate Intelligence may adapt to correct a subluxation. The outcome of the adjustic thrust however, has three possibilities. 1. insufficient force for adaptation and no correction occurs, what our instructors called a kiss adjustment. Actually, without a correction it was just a manipulation. 2. sufficient force (amount, location, direction) for II to adapt and a correction occurs. 3. excessive force, II adapts what it can/is able, the rest is absorbed by the body. Excessive force can damage the body, such as fracture ribs. These are not philosophical principles, they are physiological realities.

      • Don 06/21/2014, 3:27 am:

        Steve,
        Thank you for the reply.
        Joe,
        Thanks for the kind reply. I write something. Often it makes sense in my head when I read it….occasionally it will make sense to someone else. I learn to try again. 🙂
        I will try again….”Please let me know your individual thoughts on this question.
        Could an OSc not deliver/introduce an EIF that is of such a magnitude or delivered in a such a manner so as to cause injury or harm?”

        My second attempt (let’s hope this is better): An adjustic thrust is a univesal force delivered by a chiropractor that is adapted by the innate intelligence of the body for the correction of a vertebral subluxation.
        After analysis the chiropractor then prepares to deliver the adjustic thrust (EUF). He/she then delivers a their EUF that the ii of the body adapts and ALWAYS corrects a VS? SOMETIMES uses to correct the VS? This is where I have trouble so then my question…

        In your opinion, could a OSCor/OCor deliver/introduce an EUF into the body that is of such a magnitude (or manner) that causes injury or harm?

        If the answer is YES, is the recipient/PM/patient informed of that risk before the introduction of force through the terms of acceptance?

        Dr. Lessard,
        Just as all chiropractors want what is best for the people they provide their services for, I too strive to take care in delivering gentle, refined applied forces to recipients. I always exercise caution. Someone wise once said “if you are in doubt: Don’t” 😉

        I am not sure Canadian agencies have made a “law” so I cannot comment on that. I can say that I do have an interest in learning more about the TOA and OSC view of the adjustic thrust delivery. Thanks for the questions.

        Steve,
        Your responses were great. Thank you for the concise reply and the term “physiological realities”. I think that term may help me communicate my question better. Care to explain a little more what you mean by that term? Thanks.

        • Joe Strauss 06/21/2014, 12:03 pm:

          Don, I got it now! Dropping the 4th word of the question, “not”, made all the difference in the world. You would think after communicating with Claude for 37 years I would understand “Canadian” by now. The answer to your question is still YES. Informed consent is intended to apprise the patient of dangers inherent in the delivery of care, not of the possibility of the doctor doing something wrong. The md has a patient sign the form understanding that there are certain inherent risks to a procedure. Unbeknownst to the doctor (or anyone else), a patient’s heart may be so weak as to not be able to handle the open heart surgery. That is the purpose of IC. It is not to exonerate the surgeon from “nicking” an artery in the process. That is malpractice, obviously an accident but still malpractice never the less, and covered by malpractice insurance. Here is a chiropractic scenario: A chiropractic adjustment means “to make right” so there is no inherent risk. I had an associate once (not Claude), who was a “heavy” adjustor. We used to call him, jokingly, “Dr. Iron Hands”. His humorous response was “you’ve got to break a few eggs to make an omelet!” To my knowledge he never cracked a rib but if he had, that would have been malpractice and his response would probably not have satisfied a jury because in the normal, natural, common course of a chiropractor introducing an educated EIF, it is not necessary to break ribs. (in the course of open heart surgery, it might be and a surgical IC would cover that.) The only way IC would be possible/necessary and useful here would be if the chiropractor told every PM, “in the course of introducing an EIF to enable your body to make the adjustment it may be necessary to break a few ribs.” I’m not sure that even that would prevent a malpractice suit but that is what juries are for. I sure would not want to be the expert witness for the defense in that case. Again, the short answer is yes. The long answer is yes but it is a “bad EIUF”. IC is for side-effects that might commonly occur in the course of care. Malpractice covers events that are abnormal in the course of care and would not ordinarily result from most doctors’ care. Juries are to determine the difference. Hope that helps and my misunderstanding of your question entitles you to ask a bonus question of your choosing.

          • Don 06/21/2014, 8:22 pm:

            Joe,
            I can’t be sure my poor grammar can be called a new language but I do recognize that my questions have the potential to be poorly worded.

            I believe we are in agreement that an OSCor/OCor could potentially deliver an EIF with a sufficient force to injure or harm. I guess the possibility with some (ol’ iron hands) may be higher. No arguing that.

            I think my question is regarding the application of material risk in an OSC practice. I have copied and pasted a definition of material risk below.

            The material effects, risks and side- effects of the procedure. One court has described a material risk in the following way: a risk is thus material when a reason- able person in what the [chiropractor] knows or ought to know to be the patient’s position would be likely to attach significance to the risk or cluster of risks in determining whether or not to undergo the proposed therapy. Thus, remote risks that are a mere possibility usually need not be disclosed unless the consequence is sig- nificant (e.g., death, paralysis, stroke).

            I understand that this definition uses the term therapy and OC is not a therapy, however, I think the introduction of an EIF could be viewed as a procedure that requires informed consent. What do you think? ( this isn’t my bonus question 😉 )

            Lastly, I believe I am highlighting EIF introduction as the focus of my questions. I do recognize there are other areas that informed consent is required. For instance whenever a chiropractor touches a person for analysis more formal steps usually take place.

            My bonus question: (sorry, I only get one so I chose a difficult one 🙁
            Is there a material risk of stroke, paralysis or death from the introduction of an EIF from an OSCor/OCor and should the member/recipient/patient be made aware of this prior to its application? why or why not?

            I am really looking forward on your response and I trust this post is clearer. 🙂

            Cheers,
            Don

          • Don 06/26/2014, 8:45 pm:

            I know I put the reply button around here somewhere. 🙂

            Did anyone see the reply button to my last post above 06/21/2014, 8:22 pm?
            😉

          • Joe Strauss 06/30/2014, 11:09 pm:

            Don, I was out of town last week. I hope my response today answered you question.

        • Joe Strauss 06/30/2014, 11:05 pm:

          Don, there is such a thing as a good EUF and a bad EUF. The latter at times may cause injury or harm. I don’t believe any doctor is expected to apprise the patient of the unexpected results of improper care, (delivering a bad EUF).

          • Don 07/01/2014, 2:47 am:

            Joe,
            I believe that it must be my wording i am not aware of again and it seems there is an understanding injuries result from improper or bad care only. Also, this is malpractice and the only time an injury may occur.

            I tend to think that even if the practitioner asks all the right questions, there is a possibility an injury may still occur (e.g. unsuspected poor bone quality, other conditions already in progress, etc.).
            Am I wrong to assume this?

          • Joe Strauss 07/02/2014, 6:05 pm:

            Don, this past weekend I was with an 81 year old, still practicing, upper cervical chiropractor who has been practicing since 1957. He told me during his career he found 15 cases of fracture of the anterior arch of Atlas in 70,000 Base Posterior views (I think I have my figures correct. We were driving through the Colorado mountains and I didn’t write the numbers down.) That being the case, I undoubtedly adjusted a number of people with that condition without incident. My adjusting technique was obviously gentle enough to correct the VS and cause no harm in the .00002142 percent of the people coming into the office with that fracture. A case history will catch most of those cases. When in doubt don’t adjust or don’t adjust in the area will probably prevent the rest. When the likelihood of being injured from chiropractic care is less than the likelihood of being struck by lightening on the way to the chiropractor, I don’t think an IC is necessary. If the state/province requires it then I would tell people the odds of injury demonstrate how safe it is. Despite all this can injury occur? Yes, thatdoes mean we should worry about it? No. Does that mean we should be prepared with malpractice insurance? Yes.

      • Don 07/03/2014, 2:44 am:

        Joe,
        81 years old and since 1957. How many years was/is his practice career now?
        That is very impressive.

        I agree with your points and I can’t argue with you.
        I do submit that it ultimately will be decided not in the practice of a chiropractor but by a governing agency.
        I can think of 2 states with mandatory informed consent laws for chiropractors. California and Conneticut. There may be others but I cannot recall at the moment.

        The question then is, if an OSCor is in a IC mandated state/region, does the TOA and IC conflict?
        And How is that situation best handled/explained?

        • Don 07/13/2014, 6:20 pm:

          Hey Joe,
          I am still curious on your perspective on how to handle OSC TOA/IC conflict in a IC mandated state. Thanks.

          • Joe Strauss 07/14/2014, 8:17 pm:

            Don, give me an example of a state’s regulation and I will explain how I would answer it in keeping with the OSC philosophy.

      • Don 07/15/2014, 7:51 pm:

        Joe,
        Here is one example I could find on the internet. This one relates to California regulations. This one seems consistent with others I have read. I will post others if I find them.
        I appreciate you looking into this and giving me the OSC perspective.
        Thanks.

      • Don 07/15/2014, 10:18 pm:

        Joe, Sorry my fault. I forgot to copy the link.
        Here it is:
        http://www.chiro.ca.gov/laws_regs/consent_notice.pdf
        Thanks again.

        • Joe Strauss 08/05/2014, 11:39 pm:

          Don, in reading the CA regulation, I can see no material (inherent) risk to a chiropractic adjustment. I think, I would perhaps say that in a written statement, explaining why there is not inherent risk. An adjustment means to make right. There is no negative result from making something right. I could not in good conscience say otherwise (such as “the possibility of stroke”). I would be willing to say that to the state board and I believe the onus would be on them to prove otherwise. Someone should ask them to supply what those “material risks” include and the documentation for them.

          • Don 08/06/2014, 3:02 am:

            Thank you Joe.
            There are theories about the material risks and various numbers are presented.
            The way I see it, the plausibility of those theories will ultimately decide how the policymakers (CA board of examiners) will limit or expand the definition of chiropractic care in that state.
            The same can be said about supplanting the terms: analysis with diagnosis, chiropractor with physician or subluxation with any number of other terms we have come across purported to be a synonym for it.
            Language counts! Especially when it comes to rules and regs.

            Lastly, and maybe you or Tom, or Glen Allen can fill me in.
            Spinology recognizes that the correction is from the wisdom of the body and the Spinologiat merely offers refined forces.
            With regard to absence of material risks, could the same not be said for Spinology?
            Whether NTOSC/OC or possibly even spinology, Is it the practice of delivering of the EIF’s (IOW’s the application of technique) that carries with it the inherent risks?
            Thanks for answering my endless stream of questions. 🙂

      • Don 07/18/2014, 9:48 pm:

        Joe,
        Did you get that link I re-posted?

        • Joe Strauss 07/19/2014, 2:08 am:

          Yes Don, I did. Thank you. I analyzed the CA regulation, gave my take on it, posted my response, deleted my working draft, and went to dinner. While eating the post disappeared. I will rewrite it for you ASAP. Sorry!

      • Don 07/21/2014, 8:45 pm:

        Joe, Spaghetti and Meatballs I assume?
        Not a problem. I have the same difficulty. There is little I can do when dinner is on my mind. It is completely understandable. 🙂

        I still look forward to your post.
        Thanks again.

      • Don 07/29/2014, 3:50 am:

        Joe,
        Were you able to find that post you wrote about the CA reg.’s?

      • Don 08/03/2014, 2:52 pm:

        Anybody else have a way of addressing this query?
        I imagine Joe hasn’t had a chance to repost.
        Thanks.

  3. Don 06/08/2014, 10:40 pm:

    Dr. Lessard,
    Thank you for clarifying. I used EIF for Educated Invasive Force. It was incorrect EUF.
    Adjustic thrust is correct.

    29.) Adjustic thrust: An adjustic thrust is a specific educated universal force introduced into a subluxated vertebra of a living person by a chiropractor with the intent that the innate intelligence of the body of that person will produce a vertebral adjustment.

    • Don 06/08/2014, 10:48 pm:

      EUF is what I meant by EIF. Adjustic thrust would probably be a better term since I am referring specifically to what a chiropractor introduces into a living person.

      (Note: I refrain from saying into a subluxated vertebra because (and I could be wrong here) I think there are some techniques do not apply the force directly into a subluxation (NSA comes to mind)). Hope this doesn’t sidetrack the discussion. 😉

      • Claude 06/09/2014, 8:09 pm:

        Don,

        I am not forgetting your question. I’m giving a chance to everyone to answer it! 😉

  4. Claude Lessard 06/27/2014, 6:45 pm:

    Don,

    I think what Joseph posted sums it up pretty well: “IC is for side-effects that might commonly occur in the course of care. Malpractice covers events that are abnormal in the course of care and would not ordinarily result from most doctors’ care. Juries are to determine the difference.”

  5. Don 06/27/2014, 9:16 pm:

    Dr. Lessard,
    I am not well versed in legalese and am not sure if all malpractice cases are abnormal. My understanding is that informed consent is not limited to commonly occurring events. I could be wrong.

    This is why I ask about material risk.
    Benefits and risks of standard course of care in an OSCor’s office is not something I am familiar with and am curious to learn more..

    Joe has the experience with court system and juries. I wouldn’t have the faintest clue on how they determine the difference what is normal from what is not.

    I know it isn’t a pleasant topic but I am looking forward to the responses from anyone who can help explain how the legal defintions and OSC/OC mesh. Thanks.

    • Claude Lessard 06/29/2014, 9:50 pm:

      Don,

      Let’s say you have a friend from college WHO choose to come to visit you for the first time since graduation. After greeting each other at the airport, you both walk to your car. Before, you enter the car, do you inform your friend of the possibility that you may have an accident on your way to your house and that he could sustain injury? Of course not! Unless… YOU KNOW FOR SURE that your car is unsafe for your friend, and then your car would also be unsafe for your children. I AM SURE that it is you WHO would choose not drive an unsafe car with your children in it or anyone else for that matter since you already mentioned that: “Just as all chiropractors want what is best for the people they provide their services for, I too strive to take care in delivering gentle, refined applied forces to recipients. I always exercise caution. Someone wise once said “if you are in doubt: Don’t” 😉 ” –

      – The chiropractic objective does NOT mesh with any legal definitions. Yet, wherever you practice, as a citizen of that province, if you want to legally practice the chiropractic objective, you must follow the law. Therefore since you mentioned before that your province does NOT require IC… then WHAT would be your rationale to have an IC unless you know that your technique is unsafe?

  6. Don 06/29/2014, 11:43 pm:

    Dr. Lessard,
    Thank you for your example. I can agree that the informed consent process can certainly be taken too far. I think there are instances of implied consent. Would you say this is what is going on in the example you provided? Is it implied consent in the office of the OSCor?

    I can certainly agree with your friend that said “if you are in doubt: Don’t” and I would add that that that is great advice.

    As for the chiropractic objective NOT meshing with any legal definition, I may need you to explain that further.

    The rationale to have an IC in a state/province that does not require one would depend on the chiropractor. If they see it as a necessary part of the encounter with recipients or a limitation to providing care.
    I guess it depends on perspective, “is it the responsibility of the rational patient to provide consent or is it the role of the chiropractor to seek it?” (taken from A Gotlib)

    Lastly, I believe regardless of technique all chiropractors discuss the benefits and course of care in their office. These are parts of the process of gaining informed consent.
    You bring up a great question, are there any techniques that are 100% safe all of the time? If not, what are the risks and should the person be made aware before participating?

    • Don 06/29/2014, 11:46 pm:

      Sorry that was disjointed and brief. I am in a rush and wanted to get back to you promptly.

      Also, if you get a chance please respond to the questions I posed to Joe. I am interested in as many perspectives as possible on the OSCor view of this. Thanks.

      • Claude Lessard 06/30/2014, 10:57 am:

        Don,

        From a philosophical point of view, the educated brain is ALWAYS less than 100% due to the limitation of its e/matter. Therefore, together without condemnation, we can conclude, through rational logic, that the answer to your question “are there any techniques that are 100% safe all of the time?” is NO!

        • Claude Lessard 06/30/2014, 2:16 pm:

          Don,

          … that is WHY in the lexicon, it is called an EDUCATED universal force.

  7. Tom 08/06/2014, 1:25 pm:

    Don 08/06/2014, 3:02 am:
    Thank you Joe.
    There are theories about the material risks and various numbers are presented.
    The way I see it, the plausibility of those theories will ultimately decide how the policymakers (CA board of examiners) will limit or expand the definition of chiropractic care in that state.
    The same can be said about supplanting the terms: analysis with diagnosis, chiropractor with physician or subluxation with any number of other terms we have come across purported to be a synonym for it.
    Language counts! Especially when it comes to rules and regs.

    Lastly, and maybe you or Tom, or Glen Allen can fill me in.
    Spinology recognizes that the correction is from the wisdom of the body and the Spinologiat merely offers refined forces.
    With regard to absence of material risks, could the same not be said for Spinology?
    Whether NTOSC/OC or possibly even spinology, Is it the practice of delivering of the EIF’s (IOW’s the application of technique) that carries with it the inherent risks?
    Thanks for answering my endless stream of questions.

    Yes, Don, I agree, language DOES count which is why NTOSC is such a stickler for its terminology. The chiropractic adjustment as defined in NTOSC is not something that the chiropractor performs but as you have pointed out, something that the body (ii) does with a properly supplied force. As Joe pointed out, that is always a positive and can never have a negative result. The negative however, can possibly come from an improperly delivered force from the chiropractor or spinologist.

    There was a time when I was young and stupid, rather younger and more stupid, that whenever I was out and about and saw a chiropractic office I would stop in, introduce myself and if I felt comfortable would ask them to check my spine. HA. While I met some very nice folks over the years, I also ended up getting hurt on more than one occasion. Now granted, the first time we check anyone’s spine is usually the worst application of technique we will ever do with any one person as we know the least about that spine at that particular time. So I do cut them some slack on that. I say all that to simply say yes Don, I agree with your last sentence, “Is it the practice of delivering of the EIF’s (IOW’s the application of technique) that carries with it the inherent risks?”. Any improperly delivered force, from a chiro, spino or otherwise, carries with it the possibility of a negative outcome. This is just one reason why an NTOSCor or spinologist is always looking to deliver forces that are minimally invasive but usable by the ii to correct a vs.

    • Joe Strauss 08/06/2014, 4:16 pm:

      Tom, I think I understand your and Don’s point. I guess my only argument is with the term “material” or “inherent”. There is no inherent or material danger to the adjustment inasmuch as it is done by the ii of the body. There is a danger to the eif of the thrust but that is not the intent of that regulation. The CA board IMO is trying to copy medical practice and since medical practice by its intent does harm, even when it is trying to do ultimate good (cutting out a tumor, side effects of administering a drug). The second point is that there is a mechanism for addressing the effect of harmful eifs. It is called malpractice. Again the CA Board was not addressing that In your “young and stupid” days, someone committed malpractice on you. (I hope I was not one of those chiropractors. Since you have asked me to check your spine on a number of occasions, I assume I was not. That would really have been stupid on your part. It was kind and gracious of you to not sue those chiropractors. You did what most people would do, just not return. I guess the closest a chiropractor can come to the issue we are discussing is to correct a vs but the eif coincidently alsodoes harm. In that case the adjustment had no inherent harm but the uf introduced did. That would be chiropractic care andmalpractice.

      • Tom 08/06/2014, 5:35 pm:

        It absolutely was NOT you Joe! On more than one occasion I’ve driven the 3 hours to come see you, get my spine checked by you, hang out there at the office with you for a bit and drive back home 3+ hours. It was WELL worth the trip! 🙂

    • Don 08/07/2014, 1:09 pm:

      Joe and Tom thank you for your responses. I was beginning to think I was going crazy and no one share my thinking. That wouldn’t be the first. Lol!
      I guess the issue at hand is if the EIF carries the possibility of a negative outcome.
      I think we all agree that an improperly delivered force coincidently or otherwise does harm.
      The EIF being a universal force is defined as such. Universal forces are destructive to matter. 11.) Invasive Forces: Invasive Forces are Universal Forces which force the effects upon tissue in spite of Innate’s resistance; or in case the resistance is lowered.

      I would ask if we can all consider malpractice/informed consent aside for the moment and consider that we are discussing the educated application of a force and that educated is fallible, what conclusion(s) can we make here?
      Is the EIF application from a chiropractor (or anyone for that matter attempting the same) destructive toward matter?
      Does the EIF as it is delivered carry a risk of negative outcome?
      Is this predictable?
      Thanks.

  8. Steve 08/08/2014, 5:30 pm:

    Don,
    As I said before, Informed Consent is defined by law not philosophical orientation. In most parts of the world the chiropractor makes/gives an “adjustment” to the patient. Call it what you will, adjustment, adjustic thrust, EUF, applied technique, manipulation, racking of the vertebrae, or vector sensitive-speed conscious-predetermined depth concussion, when you put your hands on someone there are issues to be considered.
    I do recall hearing that some microtrauma accompanies every adjustment which is why BJ demanded bed rest after every one he gave. This allowed time for the damaged fibers or rather the tissue and chemicals of healing to “set up and gel”. Obviously the miniscule amount of damage is outweighed by the advantages gained when a subluxation is corrected (by innate). This is somewhat substantiated by the findings that “exercise ache” is due to eccentric contraction tearing and the release of intracellular chemicals of muscle fibers not lactic acid.

    • David Suskin 08/08/2014, 5:57 pm:

      Steve,
      How come I can observe a physical-chemical-physiological analysis of the repercussions of EIF exceeding IRForces, but when ever I ask ANYONE about the relationship of II >> IForce >> Coordination or Active Organization of Matter to Matter (Physiology, cellular biology, biochemistry) >> Everyone, I mean Everyone goes BRAIN-DEAD?

      • Steve 08/08/2014, 10:38 pm:

        David,
        I can’t speak for anyone but myself but I think you’re going beyond the philosophy, which stops at coordination. Physiology or patho-physiology can indeed be linked to traditional chiropractic but is outside the scope of OC. As has been said here before, we have no way of knowing whether some sign or symptom is an adaptive or maladaptive (exceeding LOM) occurrence. Dis-ease and disease are not the same. I might add that cellular biology is outside the scope as there is no subluxation within a cell (as far as we know).

  9. David Suskin 08/09/2014, 12:05 am:

    Steve,
    I’m confused. We talk about the 33 principles passionately. This entire blog, that is almost 30 years archived is basically discussions, debates, inquiries, into The Law of Life. Innate intelligence. I’m not talking about symptoms or no symptoms. Physiology and pathophysiology Outside the Scope of what we deduce? Deductions that the matter which contains the physiology, the workings of the process of pathophysiology, the cells and their integration into this matter MINUS the innate intelligence of the body and what do you have? DEATH!

    We talk about chiropractic adjustments removing interference to the intent and wishes of the mental impulse and if there is NO LIMITATION OF MATTER, which I know is impossible but if true or close to true then ther is optimal health, performance, interpersonal relationship, mental capacity, stress reduction,enjoyment of life, etc??? And this all because of coordination??? That’s it? And that’s TC? Not OC?

    Something doesn’t make sense. Maybe I’m not making sense.

    I know dis-ease isn’t disease.
    I have a slogan
    Get coordinated – get adjusted!!!!! Good? What? No good? Am I missing something here? Adio? What?

    Live an Adio life? For coordination? What? You’ll be approaching death very very soon and begging, BEGGING for some good ole OI drugs to control your physiology because coordination just ain’t gonna do it!

    I’m confused. Very confused. And sarcastic. But mostly, and it’s probably my own fault, misunderstood.

    • Steve 08/11/2014, 2:33 pm:

      David,
      I don’t think you are misunderstood, but I do think you are confused. Chiropractic is about three things, Intelligence, Force and Matter. Optimal health, performance, interpersonal relationship, mental capacity, stress reduction,enjoyment of life, etc are all aspects of life and may or may not be directly related to IFM. Regardless, we have one goal, to facilitate the correction of subluxations because they are a detriment to life(IFM). It is not so much about the Matter as it is the connection to the Matter. It doesn’t have to be about anything else, unless you make it so. If we are helping to get I to M we are doing our JOB.
      Yes the public is concerned with the matter, it is our duty to teach them about and help them focus on the connection, the transmission of intelligent force. Intelligence and Matter are out of our hands.(yes the pun was intended)

      • David Suskin 08/11/2014, 2:52 pm:

        Along the same LIne Steve,
        The public is THINKING WAAAAAAY over here
        And I want to Introduce them to Innate Force.
        How to do that in a relatively Scripted Dialogue that would be my One Minute Message, (or your 1 minute message), if you don’t mind…

        Go Ahead….Make My Day 😉

  10. Steve 08/11/2014, 3:27 pm:

    OK David,
    For the rest of the day tell every patient, “your body always works better with a clear nerve system”, then shut up. See how they respond.

    • David Suskin 08/11/2014, 3:34 pm:

      OK Steve,
      Thanx 🙂

      ps >> I like the shut up part 🙂 (It’s called flinching)

      • Steve 08/11/2014, 4:53 pm:

        David,
        It’s not flinching, it’s innate waiting for a response before making an intellectual adaptation and forming another MI. That’s why I detest scripts. Their response tells you where in the (educational)process they are so you can fine tune your instructive information.

        • David Suskin 08/11/2014, 5:16 pm:

          Not to get off track, but I thought and intellectual adaptation was:
          Intellectual Adaptation: The mental process of Innate Intelligence to plan ways and means of using or circumventing universal forces.

          This is me, waiting for my educated to navigate thru a response from another person, with an ultimate objective to accomplish LACVS and fully communicated, educate someone on the objective of OSC.

          Explain your using an analysis of how innate overcomes a universal force is applicable to this situation. Is the universal force a Resistant Communication, or Another persons inaccurate assessment on what it is that truly differentiates Chiropractic from anything else, distinguishing it as an ADIO offering, vs confusing it with something OI?

          Explain?

  11. Steve 08/11/2014, 7:01 pm:

    David,
    Scripts are OI (from someone else’s educated) .
    The PM’s answer (impression of vibrations) would be a UF because it was not created inside you, your response (reception/interpretation followed by ideation/intellectual adaptation) would be a gathering of principles, assembled to meet the needs of the situation(mental impulses).
    When you communicate on their level you are truly in harmony.

    • Claude Lessard 08/11/2014, 7:22 pm:

      Steve,

      For clarification’s sake, the mental impulse you alluded to in your last post.. is “tinctured” with a special “code” for so called voluntary functions in order to communicate with the PM. Correct?

      • Steve 08/11/2014, 8:17 pm:

        Hey Claude,
        It was only an analogy but if you think it should be tainted then it is, for you.

        • Claude Lessard 08/11/2014, 9:08 pm:

          Steve,

          Thanks for the analogy. 😉

    • David Suskin 08/11/2014, 7:40 pm:

      Steve,
      Are we not moving into the Innate Thots area which can be a bone (no pun- or pun) of contention?

      and
      So anything, ANYTHING from the outside is a UF, hmmmm, makes sense, even a loving kiss, or gentle touch. What about a glance? Guess that becomes more of a perceptual interpretation which can be a new or stirred up tincture.

      Interesting…
      Communication as UF’s that Mental Impulse has a chance to deliver it’s Life connection from Innate Int to Matter >> rendering an expression of Innate Intelligence, and be an ADIO process, but not necessarily an OSC. Something else.

      Since LACVS IS the objective of NTOSC, I wonder where or in what object the effective education of ADIO to a PM lies

      • Steve 08/11/2014, 8:22 pm:

        David,
        In this analogy you are II and the patient is Matter, as in chiropractic it is the communication we are discussing. Don’t get distracted.
        PS Are you hitting on me? (loving kiss, or gentle touch. What about a glance)

        • David Suskin 08/11/2014, 9:25 pm:

          Hysterical. No hit but I got something on my mind. That is for sure. Hmmmmm.
          I told my wife this morn. Honey. I need lots of love. Lots. So there you go. I where it on my sleeve. What’s up with me?
          So it’s analogy? That’s cool. The triune paradigm pervades. Adio?

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