Guest guest Posted January 22, 2005 Report Share Posted January 22, 2005 It is interesting to consider a little history in the flap over the CA acu board's continued existence and related issues such as the right to order lab tests and make western dx. One of the points that has been here and elsewhere is that failure to do physical exam and order subsequent lab tests creates a major liability issue for the px. However when the same issue arose after the legislature expanded Oregon's scope of practice, the arguments heard were quite different. I remember there was an open meeting in Portland in the local Quaker's meeting house. The legislature had given the board an opportunity to to grant broad rights regarding western dx to LAc. Arguments ranged from those who felt we should only be practicing nei jing style acupuncture to the usual doctor wannabes that dot the CA political landscape these days. It was only after the lawyers spoke that cooler heads prevailed. When one has the right to make western dx and order lab tests, one is required by law to be able to do this competently. Failure to order proper tests when indicated would be grounds for sanction or loss of license or a malpractice claim. If the scope does not include this right, one is not liable for failing to do the tests or make the dx (whichever is applicable). In Oregon, one needs to recognize ominous signs as reported by the patient and make a referral, but is is prohibited from doing any physical exam or lab tests towards that end. Thus, the patient reporting things like high fever, severe pain, bleeding, any persistent undiagnosed symptoms, recent unexplained weight loss and other obvious red flags are considered the justifications for referral. Because this list includes persistent undiagnosed symptoms as one category for which you should refer, there is really no reason for an LAc to ever listen to the chest with a stethoscope or look in the eyes with an opthalmoscope. If there is an obvious emergency, you call 911. If there is just an undiagnosed but nonurgent problem, you make a referral. the likelihood of making the correct dx of nonurgent cases is unlikely due to severe training limitations necessary in order that the students may learn TCM. So it would hazardous to make any decision on a half assed physical exam, whether urgent or nonurgent. For example,in any of the cases described above, a referral would be indicated regardless of the outcome of a physical exam by an LAc, IMO. there is only one reason for Lac to do physical exams. In order to be minidocs. I have not read a single word here in 6 years that has changed my mind one iota on this point. No clinical advantage and lots more liability and risk, for you and your patients. But oh those precious insurance codes. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 22, 2005 Report Share Posted January 22, 2005 On 23/01/2005, at 12:38 PM, wrote: > Thus, the patient reporting things like high fever, severe pain, > bleeding, any > persistent undiagnosed symptoms, recent unexplained weight loss and > other obvious red > flags are considered the justifications for referral. > > Because this list includes persistent undiagnosed symptoms as one > category for which you > should refer, there is really no reason for an LAc to ever listen to > the chest with a > stethoscope or look in the eyes with an opthalmoscope. If there is an > obvious emergency, > you call 911. If there is just an undiagnosed but nonurgent problem, > you make a referral. > the likelihood of making the correct dx of nonurgent cases is unlikely > due to severe > training limitations necessary in order that the students may learn > TCM..... > Hi Could you explain your belief that " any persistent undiagnosed symptoms " should be referred into the WM system? Are you only referring to " persistent " in terms of non-improvement during TCM treatment? Or are you suggesting that we can't treat any symptom at all that has lasted beyond what would be considered acute (personally I think acute is the area more suited to WM diagnosis) without a previous WM diagnosis? At this point, from the wording of you post; you seem to be saying that TCM treatment should only be used after diagnosis from an MD of some sort. I would be interested to here if you believe there is ANY symptom a patient can be treated for without a MD's signature beyond an acute onset of a runny nose;-). Best WIshes, Steve Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 22, 2005 Report Share Posted January 22, 2005 , Steven Slater <laozhongyi@m...> wrote: > > Hi > > Could you explain your belief that " any persistent undiagnosed > symptoms " should be referred into the WM system? > I said that was what a quorum at a meeting years ago in Oregon decided (my ideas were not yet formed at the time). I do not believe it has resulted in any hardship for patients and has prevented some harm. I have also seen those who have ignored this common sense have some serious problems such as the time a chronic pain case turned out to be multiple myeloma, which if diagnosed 1.5 years earlier would have resulted in a completely different prognosis for this young mother. So yes, if one has symptoms that could be a serious illness with a terminal prognosis, as most symptoms persistent enough to warrant a doctor's visit might be in a worst case scenario, then a WM dx is necessary for informed consent by the patient. Keep in mind, that persistent means those that persist after reasonable TCM treatment. Unless there is imminent harm from delay, we should ply our trade. But how long do you wait with no results before a referral for a cough or a breast lump or chest pain, etc? I have seen the waiting go on so long in some such cases that it most definitely resulted in the patient's untimely demise. If the general rule of thumb in such cases was to refer, then it is likely some harm would have been avoided, IMO. Experience tends to feed belief. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 22, 2005 Report Share Posted January 22, 2005 On 23/01/2005, at 4:21 PM, wrote: > , Steven Slater > <laozhongyi@m...> wrote: > >> >> Hi >> >> Could you explain your belief that " any persistent undiagnosed >> symptoms " should be referred into the WM system? >> > > I said that was what a quorum at a meeting years ago in Oregon decided > (my ideas were > not yet formed at the time). I do not believe it has resulted in any > hardship for patients > and has prevented some harm. I have also seen those who have ignored > this common > sense have some serious problems such as the time a chronic pain case > turned out to be > multiple myeloma, which if diagnosed 1.5 years earlier would have > resulted in a > completely different prognosis for this young mother. So yes, if one > has symptoms that > could be a serious illness with a terminal prognosis, as most symptoms > persistent enough > to warrant a doctor's visit might be in a worst case scenario, then a > WM dx is necessary for > informed consent by the patient. Keep in mind, that persistent means > those that persist > after reasonable TCM treatment. Unless there is imminent harm from > delay, we should ply > our trade. This I agree with. Your previous post left out this detail which prompted me to ask for further clarification. Personally I always refer if a condition does not readily respond to treatment in a " reasonable " period of time, regardless of previous diagnosis as I am not helping the patient and perhaps someone else could. WM dx is not foolproof by any means, and a 2nd, 3rd or 4th opinion is often necessary before anything approaching a patients real condition is determined. A recent case of prostate cancer was a good example to me of the uselessness of relying on WM diagnostic practices to rule out (or in for that matter) any condition in a patient. Specificity and sensitivity are often forgotten basic laws in WM dx and people often hold the belief that a WM diagnosis is real and accurate when no such thing exists for most conditions today. This includes terminal conditions like late stage prostate cancer which went undiagnosed until it reached a late stage regardless of all the WM tests being performed. The real facts are often more a matter of 70% of patients with such-and-such a condition show raised XXX, 34% show.......blah blah. Is such reliability of any real use in most long-term or chronic conditions apart from allowing them to put a label of questionable probability next to a patients name while they prescribe the same drugs to address the branch regardless of the label? I vote for smoke and mirrors to disguise the fact they really have no clue but which results in all roads leading to Rome (Rome being the drug cartels). WM dx may be of use in some cases of long-term symptoms (eg. cancer), but in most it just results in a label being attached to a patient for a period of time. A label which will change depending on how the condition progresses or who else is consulted. WM dx results in a label and too frequently no real answers or helpful treatment. I am not saying that WM dx is useless or not appropriate in SOME cases; but lets not get carried away with the need to refer everything out of fear of failing to place a label on a patients condition for the sake of liability to some infallible WM standard that does not exist. Personally, the double-talk about how patients have the freedom to choose any treatment they like, and have access to alternative medicine etc..........which is then qualified by statements that the majority of cases must be referred out for WM diagnosis in the guise of " informed consent " is crap. This just amounts to asking big daddy WM to take the responsibility of our patient so if something goes awry we can say " but Daddy said it was OK " or " Daddy was the doctor, I just helped the patients general health " . We are not WM doctors, our position must be clarified. Saying we must know when to refer for WM diagnosis is already expecting a certain level of WM diagnosis. Then saying we can not perform any physical examination or send for lab tests prevents us from approaching this standard. THis is ALL double talk and double standards and can not be accomplished no matter what our intentions. I don't have a solution for this catch-22, but if we wish to be able to practice our trade free of liability for not recognising and referring out when " red-flags " appear without being WM diagnosticians of some sort in the current climate, then we will have to only get our patients via referral from said WM diagnosticians. I often hear how there are certain " red flags " that should be referred, and I agree there are. However, I really don't think anybody has ever given an exact presentation of what these are and why (including our schools), especially without performing some form of WM diagnosis practice to determine this (which is not in our scope of practice). This results in some of us being overly cautious and referring almost everything out of fear of the great US law machine and some of us hardly ever referring at all to the detriment to our patients health. For a true standard of red flags to exist; first we need a list of diagnoses that are best managed by WM either alone or in combination with TCM. Without such evidence it is impossible to provide " informed consent " to our patients. At any rate, I don't see the majority or MD's referring out even in cases where WM has no real treatment beyond giving drugs to suppress branch symptoms which are harmful to the patients general health; despite the known benefits which are available via alternative methods. Is WM providing informed consent here? NO! How can we be liable for failing to refer a patient under suspicion of a WM condition that must be referred to WM if we can't legally perform said diagnosis? Where is it written in law what the red flags are? And where is it written that such a red flag means we must refer? Or does liability fall into the realm of fear of " Daddy " rather than a legal requirement? Currently I don't think such data exists; so how can we truly know when to refer? As referral requires a certain suspicion of a certain WM condition which requires SOME examination that falls outside our scope of practice. I am really tired of WM holding us to standards they refuse to hold themselves; it is even more irritating when some in our own profession jump on the WM bandwagon and demand this also. Evidence, safety etc.............the very things WM has a dismal record in according to freely available statistics. I am really rambling now, so I think it is best I leave it here without any answers and only the convoluted requirements of our current practice swirling in my mind. Best Wishes, Steve Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 23, 2005 Report Share Posted January 23, 2005 what I still don't get is why (beyond economics) a doctor's script is needed at all for a patient to get a lab test. A big reason that I order tests is that in many cases it's obvious that that test will be needed for a Western diagnosis no matter who is making it. Me requesting it just allows the patient to go down the street and get a test without making another appointment with an MD. For example, I have a number of people coming in worried about Hep C exposure... I'm not evaluating a liver biopsy just the numbers indicating infection or not. Again, I don't know why my consent is needed for the patient to get these tests. doug , Steven Slater <laozhongyi@m...> wrote: > > On 23/01/2005, at 4:21 PM, wrote: > > , Steven Slater > > <laozhongyi@m...> wrote: > > > >> > >> Hi > >> > >> Could you explain your belief that " any persistent undiagnosed > >> symptoms " should be referred into the WM system? > >> > > > > I said that was what a quorum at a meeting years ago in Oregon decided > > (my ideas were > > not yet formed at the time). I do not believe it has resulted in any > > hardship for patients > > and has prevented some harm. I have also seen those who have ignored > > this common > > sense have some serious problems such as the time a chronic pain case > > turned out to be > > multiple myeloma, which if diagnosed 1.5 years earlier would have > > resulted in a > > completely different prognosis for this young mother. So yes, if one > > has symptoms that > > could be a serious illness with a terminal prognosis, as most symptoms > > persistent enough > > to warrant a doctor's visit might be in a worst case scenario, then a > > WM dx is necessary for > > informed consent by the patient. Keep in mind, that persistent means > > those that persist > > after reasonable TCM treatment. Unless there is imminent harm from > > delay, we should ply > > our trade. > > > This I agree with. Your previous post left out this detail which > prompted me to ask for further clarification. Personally I always refer > if a condition does not readily respond to treatment in a " reasonable " > period of time, regardless of previous diagnosis as I am not helping > the patient and perhaps someone else could. > > WM dx is not foolproof by any means, and a 2nd, 3rd or 4th opinion is > often necessary before anything approaching a patients real condition > is determined. A recent case of prostate cancer was a good example to > me of the uselessness of relying on WM diagnostic practices to rule out > (or in for that matter) any condition in a patient. > > Specificity and sensitivity are often forgotten basic laws in WM dx and > people often hold the belief that a WM diagnosis is real and accurate > when no such thing exists for most conditions today. This includes > terminal conditions like late stage prostate cancer which went > undiagnosed until it reached a late stage regardless of all the WM > tests being performed. > > The real facts are often more a matter of 70% of patients with > such-and-such a condition show raised XXX, 34% show.......blah blah. Is > such reliability of any real use in most long-term or chronic > conditions apart from allowing them to put a label of questionable > probability next to a patients name while they prescribe the same drugs > to address the branch regardless of the label? I vote for smoke and > mirrors to disguise the fact they really have no clue but which results > in all roads leading to Rome (Rome being the drug cartels). > > WM dx may be of use in some cases of long-term symptoms (eg. cancer), > but in most it just results in a label being attached to a patient for > a period of time. A label which will change depending on how the > condition progresses or who else is consulted. WM dx results in a label > and too frequently no real answers or helpful treatment. > > I am not saying that WM dx is useless or not appropriate in SOME cases; > but lets not get carried away with the need to refer everything out of > fear of failing to place a label on a patients condition for the sake > of liability to some infallible WM standard that does not exist. > > Personally, the double-talk about how patients have the freedom to > choose any treatment they like, and have access to alternative medicine > etc..........which is then qualified by statements that the majority of > cases must be referred out for WM diagnosis in the guise of " informed > consent " is crap. This just amounts to asking big daddy WM to take the > responsibility of our patient so if something goes awry we can say " but > Daddy said it was OK " or " Daddy was the doctor, I just helped the > patients general health " . > > We are not WM doctors, our position must be clarified. Saying we must > know when to refer for WM diagnosis is already expecting a certain > level of WM diagnosis. Then saying we can not perform any physical > examination or send for lab tests prevents us from approaching this > standard. THis is ALL double talk and double standards and can not be > accomplished no matter what our intentions. > > I don't have a solution for this catch-22, but if we wish to be able to > practice our trade free of liability for not recognising and referring > out when " red-flags " appear without being WM diagnosticians of some > sort in the current climate, then we will have to only get our patients > via referral from said WM diagnosticians. > > I often hear how there are certain " red flags " that should be referred, > and I agree there are. However, I really don't think anybody has ever > given an exact presentation of what these are and why (including our > schools), especially without performing some form of WM diagnosis > practice to determine this (which is not in our scope of practice). > This results in some of us being overly cautious and referring almost > everything out of fear of the great US law machine and some of us > hardly ever referring at all to the detriment to our patients health. > > For a true standard of red flags to exist; first we need a list of > diagnoses that are best managed by WM either alone or in combination > with TCM. Without such evidence it is impossible to provide " informed > consent " to our patients. At any rate, I don't see the majority or MD's > referring out even in cases where WM has no real treatment beyond > giving drugs to suppress branch symptoms which are harmful to the > patients general health; despite the known benefits which are available > via alternative methods. Is WM providing informed consent here? NO! > > How can we be liable for failing to refer a patient under suspicion of > a WM condition that must be referred to WM if we can't legally perform > said diagnosis? Where is it written in law what the red flags are? And > where is it written that such a red flag means we must refer? Or does > liability fall into the realm of fear of " Daddy " rather than a legal > requirement? > > Currently I don't think such data exists; so how can we truly know when > to refer? As referral requires a certain suspicion of a certain WM > condition which requires SOME examination that falls outside our scope > of practice. > > I am really tired of WM holding us to standards they refuse to hold > themselves; it is even more irritating when some in our own profession > jump on the WM bandwagon and demand this also. Evidence, safety > etc.............the very things WM has a dismal record in according to > freely available statistics. > > > I am really rambling now, so I think it is best I leave it here without > any answers and only the convoluted requirements of our current > practice swirling in my mind. > > Best Wishes, > > Steve Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 23, 2005 Report Share Posted January 23, 2005 At 1:38 AM +0000 1/23/05, wrote: >For example,in any of the cases described above, a referral would be >indicated regardless of the outcome of a physical exam by an LAc, >IMO. there is only one reason for Lac to do physical exams. In >order to be minidocs. I have not read a single word here in 6 years >that has changed my mind one iota on this point. No clinical >advantage and lots more liability and risk, for you and your >patients. But oh those precious insurance codes. -- I have to say that I am completely unmotivated by insurance codes, and for the most part refuse to do insurance billing other than signing the simplest of receipts. My interest in doing PE, ortho-neuro exam, and ordering lab has to do with patient care, for which I find these skills useful. Most of our Chinese trained colleagues are trained to function as Western docs. Including this right in our license might be empowering for them. You don't seem to have included their interest in your argument. Having the right to order lab does not place an obligation on the practitioner to do so. I know Western docs who always refer out to a colleague for even the simplest lab, and they have not been sanctioned for this practice. It would place an added responsibility on us to refer out, but that seems like a good thing to me, something we should be doing anyway. The main problems with this idea are education, assessing competency, and deciding limits. Most of our US based schools would have to upgrade their science requirements, include extra classes, and most importantly include these practices consistently in the clinical training. This would mean ensuring that clinic supervisors are competent in these skills, which most US trained supervisors are probably not. We would have to be retrained and have our competency tested. I believe we should have the right in our licenses to include these practices, but for those already licensed to do so, I think we should have to demonstrate training and competency, and be independently certified. Only those truly motivated would undertake the training and testing required. Rory -- Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 23, 2005 Report Share Posted January 23, 2005 WM dx is not foolproof by any means, and a 2nd, 3rd or 4th opinion is often necessary before anything approaching a patients real condition is determined. A recent case of prostate cancer was a good example to me of the uselessness of relying on WM diagnostic practices to rule out (or in for that matter) any condition in a patient. >>>>Actually the fact that we spend a much longer time with a patient gives us more opportunities to figure out what is the diagnosis (when trained). I have picked out missed diagnosis many times in my practice. While Todd may think that some of us are want to be " MD alike, " I would suggest that if we had the minimal training in WM as done in china (which is by no means comprehensive) we would be often in a better position than the patient's MD to actually pick up on the medical condition. At the same time; however, if one is not comfortable with the patient's diagnosis, he/she should refer out the patient to someone that may clarify it. This is what should be done by an MD as well as many conditions are outside one's specialty. What we are talking about here is diverse visions of what we should be as a profession. Those of us that have seen the benefit of integrative knowledge and those of us that want to keep the profession in one dimension regardless of the limitations in legal practice rights, safety to patients as well as clinical benefit. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 23, 2005 Report Share Posted January 23, 2005 Hi et al: I have been reading this thread for a long time and think about this issue quite a bit. I think it is rather complex. I want to speak about this personally for a moment. I use laboratory tests for very specific reasons including helping to prevent life- threatening complications of Western medication which can require serious Western intervention if not treated ealrly enough (sometimes it does anyway but that is another issue). This is primarily related to the complicated pathway (red tape) of making sure the doctor orders the test, that the lab does the right test and that they send it to me in a timely (sometimes necessary within one day) fashion. This is relatively rare but in some cases must be done. An example of this is a person who is on interferon treatment--in these cases the gold standard is to have a CBC with differential done at week 1,2,3 and 4--the hepatologists I work with mostly do this as a regular routine however some university doctors and those at the nameless HMO refuse--this can lead to life-threatening consequences of severe neutropenia or frank anemia. So by ordering and reading the CBC in a timely fashion, I can alert the client to see their Western physician on an emergency basis if necessary and I can also help prevent the use of Neupogen or erythropoetin by intervening with herbs (a Western use of herbs to some degree but a successful strategy)--this relieves the life- threatening issue as well as prevents the use of hormone-based medications for which the side-effects are pretty nasty and for which we have no studies of long-term effects. More usual is that I order tests because the client is having a very difficult time getting their doctor (often within the un-nameless HMO system are prevented from) to order certain tests and the client have no other (simple/inexpensive) recourse. This includes using labs that Western doctors often do not use for parasite testing. I cannot tell you how many times I have been able to have those tests done and have the client who has had digestive problems for years go get treated with antibiotics along with Chinese medicine and be cured within two to three weeks (using a test that the doctor refused to order). It also ultimately means I order less of these tests because these medical doctors become aware of the tests as valid and useful. And, in this case, I can often rule our parasites and bacterial infections that respond only to using a combination of (primarily) Western medicine along with adjunctive Chinese medicine, and am able to focus on pure Chinese medicine treatment with differential diagnosis. I never order a lab that I cannot read and I always ask the client to cc their Western practitioners--this is something that I teach in all my classes as well. I also only order labs and the clients pay the labs directly so I make nothing from lab tests (although I do need to use diagnostic codes to order labs--another can of woms, huh?) My goal is to never have to use a lab test if I can have Western practitioner order the test and I have access to it easily for my purposes through being a " consulting practitioner " or having direct access to the lab databases such as UCSF (if we are not allowed to order labs we could probably be refused that access--a conjecture not a definite on my part). And, then of course is the issue of adequate training which I alluded to above--I believe that Todd is correct in that Chinese medicine folks are NOT adequately trained in Western lab reading, etc. In our certification courses, we are trying to correct some of this in particular areas by training people in our classes to read and understand Western tests (not to diagnose)--it comes up all the time and is truly scary to me. However, I say if you can't do it, don't do it--which, at this point, does not deal with the scope of practice issue. This needs a whole lot more discussion. Rory has said some wise words--please note his last two paragraphs. My two cents. Yours, Misha Cohen In , Rory Kerr <rorykerr@o...> wrote: > At 1:38 AM +0000 1/23/05, wrote: > >For example,in any of the cases described above, a referral would be > >indicated regardless of the outcome of a physical exam by an LAc, > >IMO. there is only one reason for Lac to do physical exams. In > >order to be minidocs. I have not read a single word here in 6 years > >that has changed my mind one iota on this point. No clinical > >advantage and lots more liability and risk, for you and your > >patients. But oh those precious insurance codes. > > I have to say that I am completely unmotivated by insurance codes, > and for the most part refuse to do insurance billing other than > signing the simplest of receipts. My interest in doing PE, > ortho-neuro exam, and ordering lab has to do with patient care, for > which I find these skills useful. > Most of our Chinese trained colleagues are trained to function as > Western docs. Including this right in our license might be empowering > for them. You don't seem to have included their interest in your > argument. > Having the right to order lab does not place an obligation on the > practitioner to do so. I know Western docs who always refer out to a > colleague for even the simplest lab, and they have not been > sanctioned for this practice. It would place an added responsibility > on us to refer out, but that seems like a good thing to me, something > we should be doing anyway. > > The main problems with this idea are education, assessing competency, > and deciding limits. Most of our US based schools would have to > upgrade their science requirements, include extra classes, and most > importantly include these practices consistently in the clinical > training. This would mean ensuring that clinic supervisors are > competent in these skills, which most US trained supervisors are > probably not. We would have to be retrained and have our competency > tested. > > I believe we should have the right in our licenses to include these > practices, but for those already licensed to do so, I think we should > have to demonstrate training and competency, and be independently > certified. Only those truly motivated would undertake the training > and testing required. > > Rory > -- > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 26, 2005 Report Share Posted January 26, 2005 In a message dated 1/22/05 8:39:38 PM, writes: > For example,in any of the cases described above, a referral would be > indicated regardless of the outcome of a physical exam by an LAc, IMO. > there is only one > reason for Lac to do physical exams. In order to be minidocs. I have not > read a single > word here in 6 years that has changed my mind one iota on this point. No > clinical > advantage and lots more liability and risk, for you and your patients. But > oh those > precious insurance codes. > > A referral would also be necessary for a DC as well, and an ND in most states. Face it, if we don't have access to basic lab tests, we can't tell if an herb is causing mayhem in a specific patient if we believe it might be possible that it is happening. Does everyone have access to a a doc who we can ask for a lab test from to see if we are poisoning a patient, even if that is what they do every day? Do we have less responsibility if we have to refer out for those lab tests? No. Do we, in reality, have any less liability if we do not have access to lab tests? No. We merely need to convince a patient, who may not like the MD model of medicine, that they need to go see a MD without any realistic proof, which may be seen in a lab test. Having access to lab testing iis not about insurance, especially since we only get insurance for physical medicine problems now, generally, anyway. One's patients need to have your availability to have access to lab testing because we have different views of how testing is done and read, perhaps, plus also in many places in this country, we may be the only " holistic " doc around to interpret specific tests needed. I guess it comes down to wondering if it is better to have one hand tied behind our back so that we can pursue dogma or somehow believing that it is in our patients best intersts if we remain paritally blind. Is anyone under the impression that the ancient OM docs would not be using lab tests in order to avoid liability if they had access to them? Why does it always come down to how badly our colleges dumb down our education when we are talking about scope and the ability to practice medicine without restriction to our patients best utility in the OM format? Why do these things have to be taught in colleges before licensing? Why can't we merely put together post grad " colleges " or specialties of such things and require training and examination processes, and let our boards know these things exist for their use, like in New Mexico? If you don't want to do testing, don't take the responsibility of learning it, I guess. And why is it when someone wants to use other fields tools in the best interests of their patients and to observe OM phonomena or results from the use of OM perspectives of treatment, like they can and will use ours, we call people wannabe MD's? It is nothing like that at all, and I wonder sometimes what dogmatic or financial strains or programming on ones subconsiousness could cause such things to leak out. I can't imagine it is a consious choice to restrict our field of medicine to the barefoot and pregnant aspect of our healthcare system in this way. It is not even about health insurance, but about doing what is best for our patients to our best ability. There is no doubt that some may like to avoid learning such things for whatever reasons, and that is ok, but at the same time to work against people who choose to do so is anti-diversity! David Molony 101 Bridge Street Catasauqua, PA 18032 Phone (610)264-2755 Fax (610) 264-7292 **********Confidentiality Notice ********** This electronic transmission and any attached documents or other writings are confidential and are for the sole use of the intended recipient(s) identified above. This message may contain information that is privileged, confidential or otherwise protected from disclosure under applicable law, including the FTC Safeguard Rule and U.S.-EU Safe Harbor Principles. If you are the intended recipient, you are responsible for establishing appropriate safeguards to maintain data integrity and security. If the receiver of this information is not the intended recipient, or the employee, or agent responsible for delivering the information to the intended recipient, you are hereby notified that any use, reading, dissemination, distribution, copying or storage of this information is strictly prohibited. If you have received this information in error, please notify the sender by return email and delete the electronic transmission, including all attachments from your system. Quote Link to comment Share on other sites More sharing options...
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