the ethical puzzle of chiropractic stephen m. perle, d.c., m.s. associate professor of clinical...

The EthicalPuzzle of Chiropractic

Stephen M. Perle, D.C., M.S.Associate Professor of Clinical Sciences

University of BridgeportCollege of Chiropractic

(c) 2004 Stephen M. Perle, DC, MS All Rights Reserved

Three Descriptive Ethics Observations of Some DCs

QuomodocunquizeUltracrepidarianBoundary Violators


To Quomodocunquize

The desire to do

anything for money


Decreasing Market Share

1987

DC

MD

PT

Feuerstein M, Marcus SC, Huang GD. National trends in nonoperative care for nonspecific back pain. Spine J 2004;4(1):56-63.

1997

DC

MD

PT

40.48%30.63%


Cost of Chiropractic Care

At one time less expensive than medical care

May be more expensive now

Stano M, Haas M, Goldberg B, Traub PM, Nyiendo J. Chiropractic and medical care costs of low back care: Results from a practice-based observational study. Am J Manag Care 2002;8(9):802-9.


Health Care Economics

As supply increases costs increaseDue to “physician-induced” demandFuchs VR. The supply of surgeons and the demand for operations. J Hum Resour 1978;13 Suppl:35-56.

Overpopulation of DCsIncreased need for $/patient

Higher office fees

Higher PVAMCOs make this hard – W/C or PI or cash


Af-flu-en-za (n):

The bloated, sluggish and unfulfilled feeling that results from efforts to keep up with the Joneses.

An epidemic of stress, overwork, waste and indebtedness caused by dogged pursuit of the American Dream.

An unsustainable addiction to economic growth.


Ultracrepidarian

Claiming Expertise

One Does Not Possess


What Causes DCs to Be Ultracrepidarians

Natural tendencyKruger J, Dunning D. Unskilled and unaware of it: How difficulties in recognizing one's own incompetence lead to inflated self-assessments. J Pers Sociol Psychol 1999;77(6):1121-34.

Large egos and small self-esteemCan’t say I don’t know



Poorly developed C.R.A.P. (Convoluted Reasoning or Antiintellectual Pomposity) detectors

Chiropractic education that did not teach

Critical thinking

Clinical uncertainty is normal



Byproduct of the AMA boycottWe had to do it all – not now though

Doctors who proselytize their pseudo- or anti-scientific “techniques”

“Know where, when, how and why to adjust”“Practice with certainty”


Chiropractor pleads guilty to fraudOn taped call, she advised against drugs for epileptic

By Pete Shellem - July 03, 2003

A taped phone call in which a Luzerne County chiropractor assured a woman that a dying epileptic would be all right without anti-seizure medication led to a guilty plea to fraud yesterday in U.S. Middle District Court.

Joanne M. Gallagher, 43, of Hazleton, pleaded guilty to a single count of mail fraud which carries a maximum term of five years in prison. …

Strohecker died after suffering massive seizures while under the care of Gallagher, who claimed she could treat epilepsy and Down syndrome through chiropractic...Gallagher assured Schade that the seizures and vomiting were a result of Strohecker's purging her system of medication….

"Eventually you will see her just go into a peaceful sleep," Gallagher told Schade, according to a transcript of the taped conversation. "And it's going to take her brain a little while, she's going to be tired for a while, but she'll recover.“

Schade found Strohecker dead the next morning….


Ultracrepidarians ViolateEthical Duties

Credat Emptor – let the buyer have faith Hughes EC. Professions. Daedalus 1963;92(Fall):655-68.

Fidelity – duty to comply with patient’s reasonable requests

Patient’s expect us to acknowledge our limitations

Patient’s expect us to be up-to-date

Belief in truth is not enough


Boundary Violations

See Dr. Foreman’s presentation


Organizational Changes

Protect the Integrity of the Brand’s Image –The Brand Is ChiropracticPublicly denounce unethical, unscientific practices and those who practice themMake sure all publications and web sites present scientifically valid infoGrod JP, Sikorski D, Keating JC, Jr. Unsubstantiated claims in patient brochures from the largest state, provincial, and national chiropractic associations and research agencies. J Manipulative Physiol Ther 2001;24(8):514-9.


Organizational Changes

Vigorously support public health measures

Healthy People 2010

Vaccinations


Educational Changes

Increase enrollment standardsPurpose

Decrease enrollment in our collegesHelp attain cultural authority

Teach ethical problem solving skillsVigorously support public health measuresNeed to stimulate the chiropractic professorate to become scholars


Educational Changes

Make sure all publications and web sites present scientifically valid infoSikorski D, Grod JP. Unsubstantiated web site claims of chiropractic colleges in Canada and the United States. J Chiropr Ed 2003;17(2):113-19.

Hospital rotations/clerkshipsPost graduation education

Rigorous residencies e.g. DACBREnsure continuing ed presents valid infoEnsure those teaching CEs are qualifiedSpecialization is NOT board certification from every board


Educational Changes

End credulity, empiricism, anti-intellectualism and devaluing research

Stimulate critical thinking skills in students and the profession at large. Stimulate a love of knowledge i.e. real philosophyMake research part of everyday chiropractic - journal clubs.


Philosophy

Stimulate a love of knowledge i.e. real philosophy

Lose the dogma

Lose anti medicine attitude

Lose anti science attitude

Lose anti intellectual attitude


Other changes

Develop and maintain up-to-date best practices database

Stop eating our youngCreate support systems for new graduates to keep them out of the practices that train them for fraud


Oversight Changes

Not everything a chiropractor might do should he/she do

Jim Parker was wrong! Every technique does not work!Keep an open mind but not so open your brains fall outVigorous enforcement action against unethical, unscientific, unqualified, or ultracrepidarian practitioners Never forget a profession is supposed to be self-regulating

Ensure continuing ed presents valid infoEnsure those teaching CEs are qualified


Be Proactive – Enforcement

Enforce current lawsDiagnosis isn’t a crime, not diagnosing isFraud steals the professions reputation

Standards of care – not dictated by the doctor’s needs but by the patient’sSearch the web & media – they aren’t hidingInform public how and where to complainInform the profession how and where to complain


Be Proactive – Continuing Education

Critical thinkingEvidence based practiceEthics

Don’t be an ultracrepidarian – know your limitsDon’t quomodocunquize – fraud kills chiropracticBoundary issues

“The work of an intellectual is not to mold the political will of others; it is, through the analyses that he does in his own field, to re-examine evidence and assumptions, to shake up habitual ways of working and thinking.”

Michel FoucaultFrench historian and philosopher


Don’t let Kimberly Lee Stroheckerdie in vain

“Be ashamed to die until you have achieved some victory for humanity.”

Horace Mann

the ethical puzzle of chiropractic stephen m. perle, d.c., m.s. associate professor of clinical...

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