Guidelines

[Guest guest]

Dear ODOC and OBCE critics:

Your intellectual integrity and courage are in the spotlight:

answer Dr. Pedersen's commentary or risk becoming irrelevant.

Dr. Abrahamson, D.C.

From: " chirodoc " <chirodoc@...>

Reply- " chirodoc " <chirodoc@...>

Date: Thu, 10 Apr 2003 23:04:56 -0700

" Dr. Willard Bertrand, D.C. " <willard@...>, " Oregon DCs " < >

Subject: guidelines

Dr. Bertrand:

I share your general notions, and appreciate your recent comments.

RE: my own thoughts on a portion of these comments regarding " specific time frames for chiropractic care " and " fraudulent claims " . This relates directly to the guidelines you mention.

Somewhere along the line, I got the idea there is a beginning to chiropractic care, based on that stuff I had to learn in school; that people should improve because of what I did to help their innate express itself better; there is a middle point where they might still need care but maybe not so much or maybe a different application; and eventually there might be an endpoint where we would all be happy with unsubluxated spines........and they wouldn't need my help every day after all........

what a relief it was to learn someone had actually invented a kind of Rosetta Stone to help me determine what those points might be........only this was called " Oregon Chiropractic Practice Utilization Guidelines " .......specifically NOT the " Oregon Chiropractic Ten Commandments " ........

Let us just ask what kind of chiropractor would treat anyone 'many many many many many' times, without charting significant exam findings clarifying why such a course of treatment were required; without notation of patient response or lack thereof; without any changes in types of care provided; without further testing or examination to evaluate whether the patient was improving or not........did I mention many many many treatments..........and did the exact same thing to each and every patient, just as long as there was a third party paying the bill.........perhaps this Rosetta Stone could help interpret just what kind of chiropractic care the patient was getting......

Having worked extensively for some time with the gritty details of OCPUG and other documents guiding the musings of our OBCE, I found how difficult it is to identify what a " fraudulent claim " might be without some notion of 'guidelines.' As unsatisfying as it might be to some, at least for slow learners like myself, there arises at least some kind of prehensile order from OCPUG......and when taken in conjunction with " Administrative Rules " and " Oregon Revised Statutes " we have the beginnings of a Rational Health Care protocol.

Those Guidelines don't demand anything other than using what we learned in chiropractic college; nor does it require a particular philosophical position; nor does it establish the dogma of only a certain kind of technique. It does require we accept our responsibility as a thinking chiropractor.

In review of this material, some find it astonishing to discover what they didn't previously understand: that as long as our chart notes demonstrate objective clinical findings, a rational treatment plan that is related to the patient complaint as well as the physical findings, and provision of health care is based on abnormalities of physiology, anatomy, etc, we satisfy the scientific aspect of chiropractic. Our chart notes should convey at least a semblance of thought process about understanding and improving the patient's condition.

If the patient doesn't improve, does the DC make further evaluation to determine why? If the patient improves, does that justify a change of treatment plan? Rational care is based on some kind of findings, don't you think so?

OCPUG recognizes variation in conditions, patient response, complicating factors, just as we all must judge in our ongoing care of each patient. The guidelines define themselves as such, no more, no less. They too are a tool that helps us make the best clinical decision for our patient.

Thus, the " specific time frame " and type of care grows from the data our chart notes demonstrates was needed in a particular situation.

It is up to the individual chiropractor to apply his understanding of the Art and Philosophy in conjunction with what our Chiropractic Science has elaborated, to ensure the best care for our patient.

Some argue with the details contained therein; let us sit down and agree what changes best represent our Science, Art and Philosophy. And let us hold our standard up to the best of critical thought and current research too, please.

I'm sure you would be welcome to join those who at this very moment are laboring to improve that tool for the benefit of the entire chiropractic family.

yours in health,

Jack Pedersen, DC

[Guest guest]

Dear Dr.

Pedersen:

Well

stated points. Are you are stating that the purpose of the guidelines is to

enable to board to find the overutilizers who do not have chart notes to

support their overutilization? This whole idea that the board must identify the

overutilizers is at the heart of the OPUG. Basically, I think this is more the

job of the CCE than the OBCE. Perhaps we might encourage more non-governmental

consensus documents like the Mercy Guidelines and use them as guidelines rather

than create our own. Where Mercy fails, we can look to joint ODOC, CAO, WSCC

guidelines to chart our course. Leave the guidelines development separate from

the OBCE and I think all will be happy. I am not in favor of abandoning

consensus guidelines. And, I understand that SOMEONE has to take the initiative

here. I just do not think that it should be the OBCE. I would be happy to help

separate the guidelines totally from the government. We would all be better off.

Willard

-----Original

Message-----

From: chirodoc

[mailto:chirodoc@...]

Sent: Thursday, April 10, 2003

11:05 PM

Dr. Willard Bertrand, D.C.;

Oregon DCs

Subject: guidelines

Dr. Bertrand:

I share your general notions, and appreciate your recent comments.

RE: my own thoughts on a portion of these comments regarding

" specific time frames for

chiropractic care " and " fraudulent claims " . This relates

directly to the guidelines you mention.

Somewhere along the line, I got the idea there is a beginning to

chiropractic care, based on that stuff I had to learn in school; that people

should improve because of what I did to help their innate express itself

better; there is a middle point where they might still need care

but maybe not so much or maybe a different application;

and eventually there might be an endpoint where we would all be

happy with unsubluxated spines........and they wouldn't need my help

every day after all........

what a relief it was to learn someone had actually invented a kind

of Rosetta Stone to help me determine what those points might be........only

this was called " Oregon Chiropractic Practice Utilization

Guidelines " .......specifically NOT the " Oregon Chiropractic Ten

Commandments " ........

Let us just ask what kind of chiropractor would treat anyone 'many

many many many many' times, without charting significant exam

findings clarifying why such a course of treatment were required; without

notation of patient response or lack thereof; without any changes in types

of care provided; without further testing or examination to evaluate

whether the patient was improving or not........did I mention many many

many treatments..........and did the exact same thing to each and every

patient, just as long as there was a third party paying the

bill.........perhaps this Rosetta Stone could help interpret just what kind of

chiropractic care the patient was getting......

Having worked extensively for some time with the gritty details of

OCPUG and other documents guiding the musings of our OBCE, I found how

difficult it is to identify what a " fraudulent claim " might be

without some notion of 'guidelines.' As unsatisfying as it might be to

some, at least for slow learners like myself, there arises at

least some kind of prehensile order from OCPUG......and when taken in

conjunction with " Administrative Rules " and " Oregon Revised

Statutes " we have the beginnings of a Rational Health Care protocol.

Those Guidelines don't demand anything other than using what we

learned in chiropractic college; nor does it require a particular

philosophical position; nor does it establish the dogma of only a

certain kind of technique. It does require we accept our responsibility

as a thinking chiropractor.

In review of this material, some find it astonishing

to discover what they didn't previously understand: that as long as our

chart notes demonstrate objective clinical findings, a rational treatment plan

that is related to the patient complaint as well as the physical findings, and

provision of health care is based on abnormalities of physiology,

anatomy, etc, we satisfy the scientific aspect of chiropractic. Our chart

notes should convey at least a semblance of thought process

about understanding and improving the patient's condition.

If the patient doesn't improve, does the DC make further evaluation

to determine why? If the patient improves, does that justify a change of

treatment plan? Rational care is based on some kind of findings, don't

you think so?

OCPUG recognizes variation in conditions, patient response,

complicating factors, just as we all must judge in our ongoing care of each

patient. The guidelines define themselves as such, no more, no

less. They too are a tool that helps us make the best clinical decision

for our patient.

Thus, the " specific time frame " and type of

care grows from the data our chart notes demonstrates was needed in a

particular situation.

It is up to the individual chiropractor to apply his understanding

of the Art and Philosophy in conjunction with what our Chiropractic

Science has elaborated, to ensure the best care for our patient.

Some argue with the details contained therein; let us sit down and

agree what changes best represent our Science, Art and Philosophy.

And let us hold our standard up to the best of critical thought and current

research too, please.

I'm sure you would be welcome to join those who at this very moment

are laboring to improve that tool for the benefit of the entire chiropractic

family.

yours in health,

Jack Pedersen, DC

OregonDCs rules:

1. Keep correspondence professional; the purpose of the listserve is to foster

communication and collegiality. No personal attacks on listserve members will

be tolerated.

2. Always sign your e-mails with your first and last name.

3. The listserve is not secure; your e-mail could end up anywhere. However,

it is against the rules of the listserve to copy, print, forward, or otherwise

distribute correspondence written by another member without his or her consent,

unless all personal identifiers have been removed.

Your use of

is subject to the

Terms of Service.

[Guest guest]

Dr. B:

The OCPUG were the first attempt of any entity to clarify practice parameters. It was produced by a broad cross-section of Oregon Chiropractors and Chiropractic Physicians over a year's time. We met in person at least 15 times and by phone and fax fore often in our various subcommittees. We were all volunteers to the OBCE but not of the OBCE. We represented the profession in Oregon and devbeloped a good product. Can it be improved? Of course. And the improvement is still in process with an even greater cross section of the profession, in greater numbers and with better science. The various interst groups you mentioned all have been represented, if they wanted to and were willing to work.

Art

===============================================

guidelines

Dr. Bertrand:

I share your general notions, and appreciate your recent comments.

RE: my own thoughts on a portion of these comments regarding "specific time frames for chiropractic care" and "fraudulent claims". This relates directly to the guidelines you mention.

Somewhere along the line, I got the idea there is a beginning to chiropractic care, based on that stuff I had to learn in school; that people should improve because of what I did to help their innate express itself better; there is a middle point where they might still need care but maybe not so much or maybe a different application; and eventually there might be an endpoint where we would all be happy with unsubluxated spines........and they wouldn't need my help every day after all........

what a relief it was to learn someone had actually invented a kind of Rosetta Stone to help me determine what those points might be........only this was called "Oregon Chiropractic Practice Utilization Guidelines".......specifically NOT the "Oregon Chiropractic Ten Commandments"........

Let us just ask what kind of chiropractor would treat anyone 'many many many many many' times, without charting significant exam findings clarifying why such a course of treatment were required; without notation of patient response or lack thereof; without any changes in types of care provided; without further testing or examination to evaluate whether the patient was improving or not........did I mention many many many treatments..........and did the exact same thing to each and every patient, just as long as there was a third party paying the bill.........perhaps this Rosetta Stone could help interpret just what kind of chiropractic care the patient was getting......

Having worked extensively for some time with the gritty details of OCPUG and other documents guiding the musings of our OBCE, I found how difficult it is to identify what a "fraudulent claim" might be without some notion of 'guidelines.' As unsatisfying as it might be to some, at least for slow learners like myself, there arises at least some kind of prehensile order from OCPUG......and when taken in conjunction with "Administrative Rules" and "Oregon Revised Statutes" we have the beginnings of a Rational Health Care protocol.

Those Guidelines don't demand anything other than using what we learned in chiropractic college; nor does it require a particular philosophical position; nor does it establish the dogma of only a certain kind of technique. It does require we accept our responsibility as a thinking chiropractor.

In review of this material, some find it astonishing to discover what they didn't previously understand: that as long as our chart notes demonstrate objective clinical findings, a rational treatment plan that is related to the patient complaint as well as the physical findings, and provision of health care is based on abnormalities of physiology, anatomy, etc, we satisfy the scientific aspect of chiropractic. Our chart notes should convey at least a semblance of thought process about understanding and improving the patient's condition.

If the patient doesn't improve, does the DC make further evaluation to determine why? If the patient improves, does that justify a change of treatment plan? Rational care is based on some kind of findings, don't you think so?

OCPUG recognizes variation in conditions, patient response, complicating factors, just as we all must judge in our ongoing care of each patient. The guidelines define themselves as such, no more, no less. They too are a tool that helps us make the best clinical decision for our patient.

Thus, the "specific time frame" and type of care grows from the data our chart notes demonstrates was needed in a particular situation.

It is up to the individual chiropractor to apply his understanding of the Art and Philosophy in conjunction with what our Chiropractic Science has elaborated, to ensure the best care for our patient.

Some argue with the details contained therein; let us sit down and agree what changes best represent our Science, Art and Philosophy. And let us hold our standard up to the best of critical thought and current research too, please.

I'm sure you would be welcome to join those who at this very moment are laboring to improve that tool for the benefit of the entire chiropractic family.

yours in health,

Jack Pedersen, DC

OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed.

[Guest guest]

Once again, Willard, the OBCE is supporting the cost, not dictating the course of the educational manual. Please join us for the next Nominal panel session and see for yourself. Sunny ;'-)))

PS The Mercy guidelines were not a 'consensus' document. ;'-)

guidelinesDr. Bertrand:I share your general notions, and appreciate your recent comments.RE: my own thoughts on a portion of these comments regarding "specific timeframes for chiropractic care" and "fraudulent claims". This relatesdirectly to the guidelines you mention.Somewhere along the line, I got the idea there is a beginning tochiropractic care, based on that stuff I had to learn in school; that peopleshould improve because of what I did to help their innate express itselfbetter; there is a middle point where they might still need care but maybenot so much or maybe a different application; and eventually there might bean endpoint where we would all be happy with unsubluxated spines........andthey wouldn't need my help every day after all........what a relief it was to learn someone had actually invented a kind ofRosetta Stone to help me determine what those points might be........onlythis was called "Oregon Chiropractic Practice UtilizationGuidelines".......specifically NOT the "Oregon Chiropractic TenCommandments"........Let us just ask what kind of chiropractor would treat anyone 'many many manymany many' times, without charting significant exam findings clarifying whysuch a course of treatment were required; without notation of patientresponse or lack thereof; without any changes in types of care provided;without further testing or examination to evaluate whether the patient wasimproving or not........did I mention many many many treatments..........anddid the exact same thing to each and every patient, just as long as therewas a third party paying the bill.........perhaps this Rosetta Stone couldhelp interpret just what kind of chiropractic care the patient wasgetting......Having worked extensively for some time with the gritty details of OCPUG andother documents guiding the musings of our OBCE, I found how difficult it isto identify what a "fraudulent claim" might be without some notion of'guidelines.' As unsatisfying as it might be to some, at least for slowlearners like myself, there arises at least some kind of prehensile orderfrom OCPUG......and when taken in conjunction with "Administrative Rules"and "Oregon Revised Statutes" we have the beginnings of a Rational HealthCare protocol.Those Guidelines don't demand anything other than using what we learned inchiropractic college; nor does it require a particular philosophicalposition; nor does it establish the dogma of only a certain kind oftechnique. It does require we accept our responsibility as a thinkingchiropractor.In review of this material, some find it astonishing to discover what theydidn't previously understand: that as long as our chart notes demonstrateobjective clinical findings, a rational treatment plan that is related tothe patient complaint as well as the physical findings, and provision ofhealth care is based on abnormalities of physiology, anatomy, etc, wesatisfy the scientific aspect of chiropractic. Our chart notes shouldconvey at least a semblance of thought process about understanding andimproving the patient's condition.If the patient doesn't improve, does the DC make further evaluation todetermine why? If the patient improves, does that justify a change oftreatment plan? Rational care is based on some kind of findings, don't youthink so?OCPUG recognizes variation in conditions, patient response, complicatingfactors, just as we all must judge in our ongoing care of each patient. Theguidelines define themselves as such, no more, no less. They too are a toolthat helps us make the best clinical decision for our patient.Thus, the "specific time frame" and type of care grows from the data ourchart notes demonstrates was needed in a particular situation.It is up to the individual chiropractor to apply his understanding of theArt and Philosophy in conjunction with what our Chiropractic Science haselaborated, to ensure the best care for our patient.Some argue with the details contained therein; let us sit down and agreewhat changes best represent our Science, Art and Philosophy. And let ushold our standard up to the best of critical thought and current researchtoo, please.I'm sure you would be welcome to join those who at this very moment arelaboring to improve that tool for the benefit of the entire chiropracticfamily.yours in health,Jack Pedersen, DC

[Guest guest]

The piper

plays for those who pay. Would the OBCE pay for a set of PUG’s that left the

practice of chiropractic undefined? The question of creating a document that

would leave the issue undefined is unavailable within the parameters of a

government agency paying to define them.

Willard

-----Original

Message-----

From: sunny kristyn

[mailto:skrndc1@...]

Sent: Friday, April 11, 2003 7:54

PM

Oregon DCs; Dr. Willard

Bertrand, D.C.

Subject: Re:

guidelines

Once

again, Willard, the OBCE is supporting the cost, not dictating the course

of the educational manual. Please join us for the next Nominal panel

session and see for yourself. Sunny ;'-)))

PS

The Mercy guidelines were not a 'consensus' document. ;'-)

-----

Original Message -----

From: Dr. Willard

Bertrand, D.C.

Oregon

DCs

Sent: Friday, April 11, 2003

4:05 PM

Subject: RE:

guidelines

Dear

Dr. Pedersen:

Well stated points. Are you are stating that the purpose of the guidelines

is to enable to board to find the overutilizers who do not have chart notes

to support their overutilization? This whole idea that the board must

identify the overutilizers is at the heart of the OPUG. Basically, I think

this is more the job of the CCE than the OBCE. Perhaps we might encourage

more non-governmental consensus documents like the Mercy Guidelines and use

them as guidelines rather than create our own. Where Mercy fails, we can

look to joint ODOC, CAO, WSCC guidelines to chart our course. Leave the

guidelines development separate from the OBCE and I think all will be happy.

I am not in favor of abandoning consensus guidelines. And, I understand that

SOMEONE has to take the initiative here. I just do not think that it should

be the OBCE. I would be happy to help separate the guidelines totally from

the government. We would all be better off.

Willard

guidelines

Dr. Bertrand:

I share your general notions, and appreciate your recent comments.

RE: my own thoughts on a portion of these comments regarding " specific

time

frames for chiropractic care " and " fraudulent claims " .

This relates

directly to the guidelines you mention.

Somewhere along the line, I got the idea there is a beginning to

chiropractic care, based on that stuff I had to learn in school; that people

should improve because of what I did to help their innate express itself

better; there is a middle point where they might still need care but maybe

not so much or maybe a different application; and eventually there might

be

an endpoint where we would all be happy with unsubluxated

spines........and

they wouldn't need my help every day after all........

what a relief it was to learn someone had actually invented a kind of

Rosetta Stone to help me determine what those points might be........only

this was called " Oregon Chiropractic Practice Utilization

Guidelines " .......specifically NOT the " Oregon Chiropractic Ten

Commandments " ........

Let us just ask what kind of chiropractor would treat anyone 'many many many

many many' times, without charting significant exam findings clarifying

why

such a course of treatment were required; without notation of patient

response or lack thereof; without any changes in types of care provided;

without further testing or examination to evaluate whether the patient was

improving or not........did I mention many many many treatments..........and

did the exact same thing to each and every patient, just as long as there

was a third party paying the bill.........perhaps this Rosetta Stone could

help interpret just what kind of chiropractic care the patient was

getting......

Having worked extensively for some time with the gritty details of OCPUG and

other documents guiding the musings of our OBCE, I found how difficult it is

to identify what a " fraudulent claim " might be without some notion of

'guidelines.' As unsatisfying as it might be to some, at least for slow

learners like myself, there arises at least some kind of prehensile order

from OCPUG......and when taken in conjunction with " Administrative

Rules "

and " Oregon Revised Statutes " we have the beginnings of a Rational

Health

Care protocol.

Those Guidelines don't demand anything other than using what we learned in

chiropractic college; nor does it require a particular philosophical

position; nor does it establish the dogma of only a certain kind of

technique. It does require we accept our responsibility as a thinking

chiropractor.

In review of this material, some find it astonishing to discover what they

didn't previously understand: that as long as our chart notes demonstrate

objective clinical findings, a rational treatment plan that is related to

the patient complaint as well as the physical findings, and provision of

health care is based on abnormalities of physiology, anatomy, etc, we

satisfy the scientific aspect of chiropractic. Our chart notes should

convey at least a semblance of thought process about understanding and

improving the patient's condition.

If the patient doesn't improve, does the DC make further evaluation to

determine why? If the patient improves, does that justify a change of

treatment plan? Rational care is based on some kind of findings, don't

you

think so?

OCPUG recognizes variation in conditions, patient response, complicating

factors, just as we all must judge in our ongoing care of each patient.

The

guidelines define themselves as such, no more, no less. They too are a

tool

that helps us make the best clinical decision for our patient.

Thus, the " specific time frame " and type of care grows from the data

our

chart notes demonstrates was needed in a particular situation.

It is up to the individual chiropractor to apply his understanding of the

Art and Philosophy in conjunction with what our Chiropractic Science has

elaborated, to ensure the best care for our patient.

Some argue with the details contained therein; let us sit down and agree

what changes best represent our Science, Art and Philosophy. And

let us

hold our standard up to the best of critical thought and current research

too, please.

I'm sure you would be welcome to join those who at this very moment are

laboring to improve that tool for the benefit of the entire chiropractic

family.

yours in health,

Jack Pedersen, DC

[Guest guest]

Hello Art:

I see the PUG’s as needless duplication of the information taught in CCE

approved chiropractic schools. The schools set the PUG’s in the classroom where

every condition is evaluated in detail, each student is tested on knowledge of

the condition, and the national board reconfirms the uniformity of this

knowledge. Why then should the OBCE feel compelled to attempt to redefine this

in a tiny document a few pages long? Certainly, I have volumes of information

in my library from 20 years of practice and education that is impossibly beyond

the compilation into a single tome. To attempt to do so would take more than a

decade I can see from the long effort spent on the development of PUG’s in

Oregon. This might be a clue that the task is impossible.

This might underlie why there will always be some statewide organization

(or nonorganization) that has refused to participate in PUG development. If

such a document proceeded without them, then the document created was never truly

a consensus document. Instead, it would be an attempted consensus and should be

labeled as such.

Consensus in Oregon? Which part of the state is that located in? Is

there a good hotel there? The OPUG that was published is so exclusively NMS

that it is, at best, a document that represents the practice of a group of

technicians. The fact that no effort has been successful in addressing the role

of chiropractic in the management of the top 60 conditions presenting in a

general practice combined with the publication of a set of NMS guidelines a

decade ago implies that there is a less important need for chiropractors to address

problems outside of the NMS. As such, we cannot arrive at consensus on the

practice of chiropractic, which I am under the impression is not a treatment

for any condition, but an adjustment and prevention of the subluxation.

Subluxation is defined by the ACA, the WCA, the ICA, WSCC, the CCE, ad

infinitum. OBCE simply should adopt the word subluxation – as it has – and leave

the consensus at that. By continually attempting to arrive at a consensus for

sprains, strains, and entrapments, it leaves us all to a confusing state as to

what is left out and leads to the idea that subluxation adjustment is most

commonly defined as a strain, sprain, or entrapment, which I think would leave

out about 9/10ths of our education. I for one, would like to think that I did

not spend thousands of hours studying material that was irrelevant to the practice

of chiropractic in Oregon. Therefore, again I suggest that we relay the PUG’s to the educational institutions who have

the breadth and depth of thousands of hours to transfer the knowledge to

students and leave the OBCE with responsibilities that can be properly and

economically administered by a governmental agency. Should the OBCE need PUG’s

to facilitate its prosecution of wrongdoers it should seek such clarification

from the instructors and CCE approved blueprints for that subject. I am certain

that the level of detail will be more complete than the present PUG’s and the

odds that consensus is reached will be in the favor of common sense. To do

otherwise weakens the credibility of the chiropractic education and the quality

of the board’s ability to screen poorly trained chiropractors from practice in

Oregon. I do not believe this is possible given the state of chiropractic

education, the strength of the OBCE licensing examination, and the integrity of

chiropractors in the field. Where the field doctor deviates from this position

the OBCE must rely upon the knowledge truly broad knowledge base that created the

chiropractors in the first place, not use a minimal subset of that knowledge that

exists solely in the state of Oregon’s committee of 15 or so willing providers

meagerly funded by the OBCE. How many millions of dollars have been spent to

create the chiropractic blueprint of the CCE as taught in chiropractic schools

across the nation? How many thousands on the Oregon PUG’s. You decide which of

these rings you would wear on your hand.

Now, PUG committee members, I know how hard you have worked to create

the OPUG’s. You are rightfully proud of your accomplishments and should send

your work to the CCE and the colleges that send applicants to your state with

the suggestion that these areas need to be clarified in their educational

blueprints so that the OBCE and other state boards can better administrate their

authority. That is sufficient yield for you labors. The OBCE should let the sun

set on the present PUG’s and move toward adoption of the blueprint of CCE

approved colleges with special emphasis on that of the WSCC.

I welcome your reply and would be glad to be on the committee as long as

I was free to move in the directions that I have outlined here. Somehow, I do

not think those directions may find much wind behind them, so I have dropped my

sails in this matter, and have raised my flag as you see it here.

Willard

-----Original

Message-----

From: Art

[mailto:spine@...]

Sent: Friday, April 11, 2003 7:45

PM

Dr. Willard Bertrand, D.C.;

Oregon DCs

Subject: RE:

guidelines

Dr. B:

The OCPUG were the first

attempt of any entity to clarify practice parameters. It

was produced by a broad cross-section of Oregon Chiropractors and Chiropractic

Physicians over a year's time. We met in person at least 15 times and by

phone and fax fore often in our various subcommittees. We were all

volunteers to the OBCE but not of the

OBCE. We represented the profession in Oregon and devbeloped a good

product. Can it be improved? Of course. And the improvement is

still in process with an even greater cross section of the profession, in

greater numbers and with better science. The various interst groups you

mentioned all have been represented, if they wanted to and were willing to

work.

Art

===============================================

-----Original

Message-----

From: Dr. Willard Bertrand, D.C.

[mailto:mail@...]

Sent: Friday, April 11, 2003 4:06

PM

Oregon DCs

Subject: RE:

guidelines

Dear Dr. Pedersen:

Well stated points. Are you are stating that the

purpose of the guidelines is to enable to board to find the overutilizers who

do not have chart notes to support their overutilization? This whole idea that

the board must identify the overutilizers is at the heart of the OPUG.

Basically, I think this is more the job of the CCE than the OBCE. Perhaps we

might encourage more non-governmental consensus documents like the Mercy

Guidelines and use them as guidelines rather than create our own. Where Mercy

fails, we can look to joint ODOC, CAO, WSCC guidelines to chart our course.

Leave the guidelines development separate from the OBCE and I think all will be

happy. I am not in favor of abandoning consensus guidelines. And, I understand

that SOMEONE has to take the initiative here. I just do not think that it

should be the OBCE. I would be happy to help separate the guidelines totally

from the government. We would all

be better off.

Willard

-----Original

Message-----

From: chirodoc

[mailto:chirodoc@...]

Sent: Thursday, April 10, 2003

11:05 PM

Dr. Willard Bertrand, D.C.;

Oregon DCs

Subject: guidelines

Dr. Bertrand:

I share your general notions, and appreciate your recent comments.

RE: my own thoughts on a portion of these comments regarding

" specific time frames for

chiropractic care " and " fraudulent claims " . This relates

directly to the guidelines you mention.

Somewhere along the line, I got the idea there is a beginning to

chiropractic care, based on that stuff I had to learn in school; that people

should improve because of what I did to help their innate express itself

better; there is a middle point where they might still need care

but maybe not so much or maybe a different application;

and eventually there might be an endpoint where we would all be

happy with unsubluxated spines........and they wouldn't need my help

every day after all........

what a relief it was to learn someone had actually invented a kind

of Rosetta Stone to help me determine what those points might be........only

this was called " Oregon Chiropractic Practice Utilization

Guidelines " .......specifically NOT the " Oregon Chiropractic Ten

Commandments " ........

Let us just ask what kind of chiropractor would treat anyone 'many

many many many many' times, without charting significant exam

findings clarifying why such a course of treatment were required; without

notation of patient response or lack thereof; without any changes in types

of care provided; without further testing or examination to evaluate

whether the patient was improving or not........did I mention many many

many treatments..........and did the exact same thing to each and every patient,

just as long as there was a third party paying the bill.........perhaps this

Rosetta Stone could help interpret just what kind of chiropractic care the

patient was getting......

Having worked extensively for some time with the gritty details of

OCPUG and other documents guiding the musings of our OBCE, I found how

difficult it is to identify what a " fraudulent claim " might be

without some notion of 'guidelines.' As unsatisfying as it might be to

some, at least for slow learners like myself, there arises at

least some kind of prehensile order from OCPUG......and when taken in

conjunction with " Administrative Rules " and " Oregon Revised

Statutes " we have the beginnings of a Rational Health Care protocol.

Those Guidelines don't demand anything other than using what we

learned in chiropractic college; nor does it require a particular

philosophical position; nor does it establish the dogma of only a

certain kind of technique. It does require we accept our responsibility

as a thinking chiropractor.

In review of this material, some find it astonishing

to discover what they didn't previously understand: that as long as our

chart notes demonstrate objective clinical findings, a rational treatment plan

that is related to the patient complaint as well as the physical findings, and

provision of health care is based on abnormalities of physiology,

anatomy, etc, we satisfy the scientific aspect of chiropractic. Our chart

notes should convey at least a semblance of thought process

about understanding and improving the patient's condition.

If the patient doesn't improve, does the DC make further evaluation

to determine why? If the patient improves, does that justify a change of

treatment plan? Rational care is based on some kind of findings, don't

you think so?

OCPUG recognizes variation in conditions, patient response,

complicating factors, just as we all must judge in our ongoing care of each

patient. The guidelines define themselves as such, no more, no

less. They too are a tool that helps us make the best clinical decision

for our patient.

Thus, the " specific time frame " and type of

care grows from the data our chart notes demonstrates was needed in a

particular situation.

It is up to the individual chiropractor to apply his

understanding of the Art and Philosophy in conjunction with what our

Chiropractic Science has elaborated, to ensure the best care for our patient.

Some argue with the details contained therein; let us sit down and

agree what changes best represent our Science, Art and Philosophy.

And let us hold our standard up to the best of critical thought and current

research too, please.

I'm sure you would be welcome to join those who at this very moment

are laboring to improve that tool for the benefit of the entire chiropractic

family.

yours in health,

Jack Pedersen, DC

OregonDCs rules:

1. Keep correspondence professional; the purpose of the listserve is to

foster communication and collegiality. No personal attacks on listserve members

will be tolerated.

2. Always sign your e-mails with your first and last name.

3. The listserve is not secure; your e-mail could end up anywhere. However,

it is against the rules of the listserve to copy, print, forward, or otherwise

distribute correspondence written by another member without his or her consent,

unless all personal identifiers have been removed.

Your use of

is subject to the

Terms of Service.

OregonDCs rules:

1. Keep correspondence professional; the purpose of the listserve is to

foster communication and collegiality. No personal attacks on listserve members

will be tolerated.

2. Always sign your e-mails with your first and last name.

3. The listserve is not secure; your e-mail could end up anywhere. However,

it is against the rules of the listserve to copy, print, forward, or otherwise

distribute correspondence written by another member without his or her consent,

unless all personal identifiers have been removed.

Your use of

is subject to the

Terms of Service.

[Guest guest]

I am certainly glad you are all engaging in conversation about something of real meaning. Since Dr Abrahamson enjoys my run on sentences and enjoys engaging in lengthy, colorful descriptions so much I will collect all this, give it some thought for a while and reply. Sorry , but I would prefer to give my reply a bit of responsible contemplation.

Sunny and Jack, thankyou for your less colorful but well thought out replies. Willard, thank you for your support.

[Guest guest]

HI Willard,

Just received your last three posts.

What you seem not to be considering was pointed out by Jack: If we don't define ourselves, someone (in our current atmosphere of insurances defining what they will fund) will do it for us….and that is not something with which I chose to reside. The Educational Manual is something that our DC population will be able to use as a guide for themselves to see what is actually going on out there in literature and consensus.

The OBCE is showing remarkable foresight to the continuance of chiropractic practice in Oregon (the way we doctors want it) by supporting the production of this document.

It is also (and more importantly) being written as a guide to the public, both professional and lay public, to learn about our wonderful profession: what we do, how we do it, how we learn it; to learn what we expect of ourselves and our patients; to learn the extent of our considerations in our diagnoses and actions and therapeutics and assessments; to learn how we as a profession respond to our internal transgressions. Some of it is specific and some of it is vague due to there being so many variables. All of it is consensus by those who sit around the table in the Seed panels and Nominal panels and those who participate in the Delphi panels.

And as far as not attending one or many of our production gatherings: when someone doesn't attend, it seems to me they give up the right to Monday-morning quarterbacking. When something has not be observed and/or experienced, opinions are just that and are worth the paper on which they aren't written.

Putting your body where your mouth/fingers are will allow us to have a realistic conversation. The next gathering of the Seed Panel for the Record Keeping chapter is May 8th at 9 in Salem. Mind you it is a production meeting, not a debate society…meaning that we need to stay on topic. There is considerable debate about the topic. We are well past the debate on the philosophical matters…too bad you weren't, those debates lasted for many hours and were fascinating.

What the colleges do is educate our students; the Educational Manual is intended to educate the public and provide a guide for our doctors in the field….not dictate anything to anybody.

Sunny

guidelinesDr. Bertrand:I share your general notions, and appreciate your recent comments.RE: my own thoughts on a portion of these comments regarding "specific timeframes for chiropractic care" and "fraudulent claims". This relatesdirectly to the guidelines you mention.Somewhere along the line, I got the idea there is a beginning tochiropractic care, based on that stuff I had to learn in school; that peopleshould improve because of what I did to help their innate express itselfbetter; there is a middle point where they might still need care but maybenot so much or maybe a different application; and eventually there might bean endpoint where we would all be happy with unsubluxated spines........andthey wouldn't need my help every day after all........what a relief it was to learn someone had actually invented a kind ofRosetta Stone to help me determine what those points might be........onlythis was called "Oregon Chiropractic Practice UtilizationGuidelines".......specifically NOT the "Oregon Chiropractic TenCommandments"........Let us just ask what kind of chiropractor would treat anyone 'many many manymany many' times, without charting significant exam findings clarifying whysuch a course of treatment were required; without notation of patientresponse or lack thereof; without any changes in types of care provided;without further testing or examination to evaluate whether the patient wasimproving or not........did I mention many many many treatments..........anddid the exact same thing to each and every patient, just as long as therewas a third party paying the bill.........perhaps this Rosetta Stone couldhelp interpret just what kind of chiropractic care the patient wasgetting......Having worked extensively for some time with the gritty details of OCPUG andother documents guiding the musings of our OBCE, I found how difficult it isto identify what a "fraudulent claim" might be without some notion of'guidelines.' As unsatisfying as it might be to some, at least for slowlearners like myself, there arises at least some kind of prehensile orderfrom OCPUG......and when taken in conjunction with "Administrative Rules"and "Oregon Revised Statutes" we have the beginnings of a Rational HealthCare protocol.Those Guidelines don't demand anything other than using what we learned inchiropractic college; nor does it require a particular philosophicalposition; nor does it establish the dogma of only a certain kind oftechnique. It does require we accept our responsibility as a thinkingchiropractor.In review of this material, some find it astonishing to discover what theydidn't previously understand: that as long as our chart notes demonstrateobjective clinical findings, a rational treatment plan that is related tothe patient complaint as well as the physical findings, and provision ofhealth care is based on abnormalities of physiology, anatomy, etc, wesatisfy the scientific aspect of chiropractic. Our chart notes shouldconvey at least a semblance of thought process about understanding andimproving the patient's condition.If the patient doesn't improve, does the DC make further evaluation todetermine why? If the patient improves, does that justify a change oftreatment plan? Rational care is based on some kind of findings, don't youthink so?OCPUG recognizes variation in conditions, patient response, complicatingfactors, just as we all must judge in our ongoing care of each patient. Theguidelines define themselves as such, no more, no less. They too are a toolthat helps us make the best clinical decision for our patient.Thus, the "specific time frame" and type of care grows from the data ourchart notes demonstrates was needed in a particular situation.It is up to the individual chiropractor to apply his understanding of theArt and Philosophy in conjunction with what our Chiropractic Science haselaborated, to ensure the best care for our patient.Some argue with the details contained therein; let us sit down and agreewhat changes best represent our Science, Art and Philosophy. And let ushold our standard up to the best of critical thought and current researchtoo, please.I'm sure you would be welcome to join those who at this very moment arelaboring to improve that tool for the benefit of the entire chiropracticfamily.yours in health,Jack Pedersen, DCOregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is tofoster communication and collegiality. No personal attacks on listservemembers will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However,it is against the rules of the listserve to copy, print, forward, orotherwise distribute correspondence written by another member without his orher consent, unless all personal identifiers have been removed.

[Guest guest]

The definition thing:

Our collective

alma maters must be chagrined to discover that after several thousand hours of

education, carefully crafted national board tests, legally implacable state

licensing examinations and over 100 years of clinical practice joined tightly together

with 50 state laws and several federal laws defining chiropractic that any reasonable

agent could believe that chiropractic

is not yet suitably defined.

Some

people are never satisfied. Apparently they have all gone into the insurance

business. Some people are never going to get the point that insurance companies

and our political adversaries will never accept chiropractic in any form. It is

not our fault. The profession or the OBCE does not have to rectify their

intentional confusion. They cannot define our profession any more than I can

define the insurance industry or the medical industry. I don’t see them sending

our profession any definitions in the mail about what they mean by insurance or

medicine. Hey, lawyers in the list

serve, would you please define law to us? Ministers in the list serve would you

please define religion? And so on. This is just a ploy that only works as long

as we keep taking the bait. Where there is an attack on the profession, we

should send our best efforts forward. I don’t mean to insult the OBCE, but your

agency is not the best we have. And furthermore, by pretending to be needed to

fight the battle you are making us look weaker than we truly are. Leave that battle

to the agencies noted above. The job

of the OBCE is not public education, it is administration of the state law.

Sunny, as

far as attendance of a OPUG meeting goes, refer again to my previous post. It

is inserted again here:

The old adage that criticism of a committee must be

preceded by membership in the committee requires that one would become a member

of every committee with which one might disagree, a daunting task for the

individual and a perpetual protection from criticism for the committee.

Obviously, this is not a practical nor is it a constructive mode of disallowing

an objective view of a committee’s work, that, by the very definition of

objective, must come from outside of the committee itself. By that stroke of

logic, all of the committee members should disqualify their support of the

committee’s work, and leave its discussion to those not connected to the

committee. This, of course, is also not practical. Therefore, I suggest that

membership in the committee not be considered a germane prerequisite for

further discussion, and we stick to the facts of what the committee has produced

and may produce in the future, viz., PUG’s.

I am

surprised at your labeling me as a quarterback, since I am not interested in

that position, nor that sport. I like the halfback position on a soccer field

much better. If you create public actions you MUST accept public criticism. You

may not hide behind the guise of a “good citizen” and merely by meeting attendance

secure your opinions against criticism.

You have

somehow earned the ability of using the royal “we” when you say

“The OBCE is showing remarkable foresight to the

continuance of chiropractic practice in Oregon (the way we doctors want it) by

supporting the production of this document.”

I don’t

think “we” is the right word here. As I am remember it “we” has a different

definition, one that predates the OPUG’s, unless you have somehow been

commissioned to redefine “we” -- as well as chiropractic.

Also, the foresight

you have such value for may become a dangerous thing if it causes you to trip

over the obvious in the present. The obvious here is that chiropractic is

already defined and our adversaries will never accept our definitions, even

though they originate from every corner of chiropractic as noted above in the first

paragraph.

Your

invitation to come to the OPUG committee sounds a lot like an invitation to

become part of the formation of a rubber stamp of approval. I will reiterate that

my objective is to have the sun set on OPUG’s. The OBCE should merely point insurers

and the public to the chiropractic institutions capable of providing them. The

OBCE and the OPUG committee is woefully under funded and the nation’s breadth

of chiropractic expert representation is inadequate, which plays perfectly into

the hands of our adversaries.

You sound

like you are past the point of changing your course and so I withdraw from

further attempts to redirect your energies to other pressing OBCE missions, as

it appears to do so might inadvertently annoy you.

Still, I

am not concerned with the outcome of this discussion. Deep-rooted policy changes,

of the nature we have discussed here, that take several years to develop because

of internal complexities beyond the scope of the group’s grasp, are subject to

collapse of its own goodwill.

I continue

to appreciate your efforts to improve the profession. I am particularly glad

that you are expending so much of your time on behalf of the public; and I am chiefly

impressed with your promise to avoid dictating your outcome to the profession.

Thank you very

much for the invitation, however I will not attend the meeting in May. If you

send out a copy of your work so far, I will gladly WRITE OUT my opinions on the

matter and publish them here where all may view, if they wish. Meetings represent

12 hours of travel and several hours of turmoil whenever opinions diverge. That

is why endless meetings tame the individual spirit to “get the job done and go home.” Writing

opinions of the topics on the other hand is instantly individual and not

subject to the same level of willingness to “move on”; writing creates a permanent

record, and writing is easily separated from the fatigue of interaction which

so permeates the hundreds of public meetings I have attended. I am certain that

with a minimal amount of reflection you could recognize that if you are writing

guidelines, the meetings should be very well served with an interchange of

written opinions rather than a secretarial summary of verbalizations. My

fingers pose ready to serve.

Sincerely,

Willard

-----Original

Message-----

From: sunny kristyn

[mailto:skrndc1@...]

Sent: Saturday, April 12, 2003

9:38 AM

Art ; Oregon DCs; Dr.

Willard Bertrand, D.C.

Subject: Re:

guidelines

HI

Willard,

Just

received your last three posts.

What

you seem not to be considering was pointed out by Jack: If we don't define

ourselves, someone (in our current atmosphere of insurances defining what they

will fund) will do it for us….and that is not something with which I chose to

reside. The Educational Manual is something that our DC population will

be able to use as a guide for themselves to see what is actually going on out there

in literature and consensus.

The

OBCE is showing remarkable foresight to the continuance of chiropractic

practice in Oregon (the way we doctors want it) by supporting the production of

this document.

It

is also (and more importantly) being written as a guide to the

public, both professional and lay public, to learn about our wonderful

profession: what we do, how we do it, how we learn it; to learn

what we expect of ourselves and our patients; to learn the extent of our

considerations in our diagnoses and actions and therapeutics and assessments;

to learn how we as a profession respond to our internal transgressions.

Some of it is specific and some of it is vague due to there being so many

variables. All of it is consensus by those who sit around the table in

the Seed panels and Nominal panels and those who participate in the Delphi

panels.

And

as far as not attending one or many of our production gatherings: when someone

doesn't attend, it seems to me they give up the right to Monday-morning

quarterbacking. When something has not be observed and/or

experienced, opinions are just that and are worth the paper on which they

aren't written.

Putting

your body where your mouth/fingers are will allow us to have a realistic

conversation. The next gathering of the Seed Panel for the Record

Keeping chapter is May 8th at 9 in Salem. Mind you it is a

production meeting, not a debate society…meaning that we need to stay on

topic. There is considerable debate about the topic. We are

well past the debate on the philosophical matters…too bad you weren't, those

debates lasted for many hours and were fascinating.

What

the colleges do is educate our students; the Educational Manual is intended to

educate the public and provide a guide for our doctors in the field….not

dictate anything to anybody.

Sunny

[Guest guest]

Well said Jack, well said...

J. Holzapfel DCAlbany

-- JPedersenDC <chirodoc1@...> wrote:Listmates:1) I support the notion our OBCE should be the party that develops guidelines, as the schools and various organizations have failed to produce a document they can all agree upon. It is required by Legislative mandate via ORS that the OBCE license DCs in the first place. If OBCE is responsible for such a task in the first place, then it is reasonable they develop those professional guidelines applicable within the state.2) Whatever parameters or guidelines our licensing body recognizes as appropriate and necessary to make diagnostic and therapeutic decisions, there must be a body of academic evidence supporting the inclusion of those parameters. It is the OBCE to which we all must be able to demonstrate upon what our clinical reasoning is based. Our chart notes must contain sufficient information to make that determination. Neither the schools nor the professional organizations have the legal authority or responsibility to determine what constitutes the practice of Chiropractic in Oregon. Only the OBCE has the mechanism to enforce remedy of violation of those guidelines.3) DCs have been performing services for well over a century, and for all too long with little to no documentation to support our clinical claims. It's time we stipulate methods to demonstrate HOW we measure results of chiropractic care. 4) It's time we focus on honing what DCs can prove we do for the good of the patient. Our efforts to remodel the 'health care system' will strengthen as we provide AS A PROFESSION undeniable quality of service and a set of performance protocols that can not be ignored or dismissed. We must focus on what CHIROPRACTORS do;we must FOCUS on what CHIROPRACTORS do;we MUST FOCUS on what CHIROPRACTORS do;WE MUST FOCUS on what CHIROPRACTORS DO....J. Pedersen DCSweet Home

[Guest guest]

why am i not finding them???

guidelines

Thanks for reminding us . I honestly don't know how many years I have

been on this list, but it has been that long since I reviewed the guidelines.

Sharon H.

Mom to , (15, DS) and , (11)

South Carolina

" Be kinder than necessary, for everyone you meet is fighting some kind of

battle. "

[Guest guest]

> why am i not finding them???

Angie - you have to log in under your ID to the Upsndowns site. Once

you are there, look at the left side of the window. You will see a list of

things like messages, photos, files, etc. Click on files and then a page

will pop up with all the files that has been posted there.

Karla - one of my biggest pet peeves are the short messages that should be

sent privately. I set up the reply and reply to all function to help

eliminate that (well one reason). It use to be alot worse.

[Guest guest]

Hi allDoes anyone know a website which has the all new guidelines we need for the exam? Thank you in advance Ayham Sbahi

[Guest guest]

Dear Ayham,

here is the link for the updatesd guidelines for ore2.

http://www.orepart2.org.uk/guidance

Regards

From: Ayham Sbahi <ayhamsbahi@...>" " < > Sent: Friday, 23 March 2012, 12:29Subject: Guidelines

Hi all

Does anyone know a website which has the all new guidelines we need for the exam?

Thank you in advance

Ayham Sbahi

[Guest guest]

Tessy thank you so muchbut i meant the clinical guidelines regarding what should we do and what we shouldn't in term of dental treatment options.example: if the INR is more than 4 ,then we should refer the patient to a specialist to adjust it.and another things (patient recall,x-rays,infection control)etc.......do you know any website available to get them straight away,exept of googling each thing seperately?Thank you againAyham Sbahi From: Tessy Al-Khalidi <hott_ice17@...> " " < > Sent: Friday, 23 March 2012, 13:17 Subject: Re: Guidelines

Dear Ayham,

here is the link for the updatesd guidelines for ore2.

http://www.orepart2.org.uk/guidance

Regards

From: Ayham Sbahi <ayhamsbahi@...>" " < > Sent: Friday, 23 March 2012, 12:29Subject: Guidelines

Hi all

Does anyone know a website which has the all new guidelines we need for the exam?

Thank you in advance

Ayham Sbahi

[Guest guest]

I found just one guideliness on referrals- google DENTAL REFERRAL INFORMATION - NHS Eastern and CoastalFrom: Ayham Sbahi <ayhamsbahi@...>Subject: Re: Guidelines" " < >Date: Friday, 23 March, 2012, 16:34

Tessy thank you so muchbut i meant the clinical guidelines regarding what should we do and what we shouldn't in term of dental treatment options.example: if the INR is more than 4 ,then we should refer the patient to a specialist to adjust it.and another things (patient recall,x-rays,infection control)etc.......do you know any website available to get them straight away,exept of googling each thing seperately?Thank you againAyham Sbahi From: Tessy Al-Khalidi <hott_ice17@...> " " < > Sent: Friday, 23 March 2012, 13:17 Subject: Re: Guidelines

Dear Ayham,

here is the link for the updatesd guidelines for ore2.

http://www.orepart2.org.uk/guidance

Regards

From: Ayham Sbahi <ayhamsbahi@...>" " < > Sent: Friday, 23 March 2012, 12:29Subject: Guidelines

Hi all

Does anyone know a website which has the all new guidelines we need for the exam?

Thank you in advance

Ayham Sbahi

[Guest guest]

Thank you so muchAyham Sbahi From: <arleydiaz@...> Sent: Friday, 23 March 2012, 17:54 Subject: Re:

Guidelines

I found just one guideliness on referrals- google DENTAL REFERRAL INFORMATION - NHS Eastern and CoastalFrom: Ayham Sbahi <ayhamsbahi@...>Subject: Re: Guidelines" " < >Date: Friday, 23 March, 2012, 16:34

Tessy thank you so muchbut i meant the clinical guidelines regarding what should we do and what we shouldn't in term of dental treatment options.example: if the INR is more than 4 ,then we should refer the patient to a specialist to adjust it.and another things (patient recall,x-rays,infection control)etc.......do you know any website available to get them straight away,exept of googling each thing seperately?Thank you againAyham Sbahi From: Tessy Al-Khalidi <hott_ice17@...> " " < > Sent: Friday, 23 March 2012, 13:17 Subject: Re: Guidelines

Dear Ayham,

here is the link for the updatesd guidelines for ore2.

http://www.orepart2.org.uk/guidance

Regards

From: Ayham Sbahi <ayhamsbahi@...>" " < > Sent: Friday, 23 March 2012, 12:29Subject: Guidelines

Hi all

Does anyone know a website which has the all new guidelines we need for the exam?

Thank you in advance

Ayham Sbahi

[Guest guest]

also here you find more...

http://www.sdcep.org.uk/index.aspx?o=2269 --- On Fri, 23/3/12, Ayham Sbahi <ayhamsbahi@...> wrote:From: Ayham Sbahi <ayhamsbahi@...>Subject: Re: Guidelines" " < >Date: Friday, 23 March, 2012, 18:07

Thank you so muchAyham Sbahi From: <arleydiaz@...> Sent: Friday, 23 March 2012, 17:54 Subject: Re:

Guidelines

I found just one guideliness on referrals- google DENTAL REFERRAL INFORMATION - NHS Eastern and Coastal From: Ayham Sbahi <ayhamsbahi@...>Subject: Re: Guidelines" " < >Date: Friday, 23 March, 2012, 16:34

Tessy thank you so muchbut i meant the clinical guidelines regarding what should we do and what we shouldn't in term of dental treatment options.example: if the INR is more than 4 ,then we should refer the patient to a specialist to adjust it.and another things (patient recall,x-rays,infection control)etc.......do you know any website available to get them straight away,exept of googling each thing seperately?Thank you againAyham Sbahi From: Tessy Al-Khalidi <hott_ice17@...> " " < > Sent: Friday, 23 March 2012, 13:17 Subject: Re: Guidelines

Dear Ayham,

here is the link for the updatesd guidelines for ore2.

http://www.orepart2.org.uk/guidance

Regards

From: Ayham Sbahi <ayhamsbahi@...>" " < > Sent: Friday, 23 March 2012, 12:29Subject: Guidelines

Hi all

Does anyone know a website which has the all new guidelines we need for the exam?

Thank you in advance

Ayham Sbahi

[Guest guest]

Oooops sorry I thought thats what you wanted...

There are certain sources that are best to learn the guidelines from, google is not always the best place. But I dont know a certain website that has everything...

Regarding x-rays guidelines, the best source is a small book titled :selection criteria for dental radiography. It was also recommended to us in royal college course aroung 100 times, very important. Other subjects , will try to search if i have any files relevant to send to you, just bear with me... Regards,Tessy

From: Ayham Sbahi <ayhamsbahi@...>" " < > Sent: Friday, 23 March 2012, 16:34Subject: Re: Guidelines

Tessy thank you so much

but i meant the clinical guidelines regarding what should we do and what we shouldn't in term of dental treatment options.example: if the INR is more than 4 ,then we should refer the patient to a specialist to adjust it.and another things (patient recall,x-rays,infection control)etc.......do you know any website available to get them straight away,exept of googling each thing seperately?

Thank you again

Ayham Sbahi

From: Tessy Al-Khalidi <hott_ice17@...>" " < > Sent: Friday, 23 March 2012, 13:17Subject: Re: Guidelines

Dear Ayham,

here is the link for the updatesd guidelines for ore2.

http://www.orepart2.org.uk/guidance

Regards

From: Ayham Sbahi <ayhamsbahi@...>" " < > Sent: Friday, 23 March 2012, 12:29Subject: Guidelines

Hi all

Does anyone know a website which has the all new guidelines we need for the exam?

Thank you in advance

Ayham Sbahi

[Guest guest]

Thank you for your help.Ayham sbahi From: <arleydiaz@...> Sent: Friday, 23 March 2012, 18:11 Subject: Re:

Guidelines

also here you find more...

http://www.sdcep.org.uk/index.aspx?o=2269 --- On Fri, 23/3/12, Ayham Sbahi <ayhamsbahi@...> wrote:From: Ayham Sbahi <ayhamsbahi@...>Subject: Re: Guidelines" " < >Date: Friday, 23 March, 2012, 18:07

Thank you so muchAyham Sbahi From: <arleydiaz@...> Sent: Friday, 23 March 2012, 17:54 Subject: Re:

Guidelines

I found just one guideliness on referrals- google DENTAL REFERRAL INFORMATION - NHS Eastern and Coastal From: Ayham Sbahi <ayhamsbahi@...>Subject: Re: Guidelines" " < >Date: Friday, 23 March, 2012, 16:34

Tessy thank you so muchbut i meant the clinical guidelines regarding what should we do and what we shouldn't in term of dental treatment options.example: if the INR is more than 4 ,then we should refer the patient to a specialist to adjust it.and another things (patient recall,x-rays,infection control)etc.......do you know any website available to get them straight away,exept of googling each thing seperately?Thank you againAyham Sbahi From: Tessy Al-Khalidi <hott_ice17@...> " " < > Sent: Friday, 23 March 2012, 13:17 Subject: Re: Guidelines

Dear Ayham,

here is the link for the updatesd guidelines for ore2.

http://www.orepart2.org.uk/guidance

Regards

From: Ayham Sbahi <ayhamsbahi@...>" " < > Sent: Friday, 23 March 2012, 12:29Subject: Guidelines

Hi all

Does anyone know a website which has the all new guidelines we need for the exam?

Thank you in advance

Ayham Sbahi

[Guest guest]

Thank you Tessy for your help.Ayham Sbahi From: Tessy Al-Khalidi <hott_ice17@...> " " < > Sent: Friday, 23 March 2012, 18:15 Subject: Re: Guidelines

Oooops sorry I thought thats what you wanted...

There are certain sources that are best to learn the guidelines from, google is not always the best place. But I dont know a certain website that has everything...

Regarding x-rays guidelines, the best source is a small book titled :selection criteria for dental radiography. It was also recommended to us in royal college course aroung 100 times, very important. Other subjects , will try to search if i have any files relevant to send to you, just bear with me... Regards,Tessy

From: Ayham Sbahi <ayhamsbahi@...>" " < > Sent: Friday, 23 March 2012, 16:34Subject: Re: Guidelines

Tessy thank you so much

but i meant the clinical guidelines regarding what should we do and what we shouldn't in term of dental treatment options.example: if the INR is more than 4 ,then we should refer the patient to a specialist to adjust it.and another things (patient recall,x-rays,infection control)etc.......do you know any website available to get them straight away,exept of googling each thing seperately?

Thank you again

Ayham Sbahi

From: Tessy Al-Khalidi <hott_ice17@...>" " < > Sent: Friday, 23 March 2012, 13:17Subject: Re: Guidelines

Dear Ayham,

here is the link for the updatesd guidelines for ore2.

http://www.orepart2.org.uk/guidance

Regards

From: Ayham Sbahi <ayhamsbahi@...>" " < > Sent: Friday, 23 March 2012, 12:29Subject: Guidelines

Hi all

Does anyone know a website which has the all new guidelines we need for the exam?

Thank you in advance

Ayham Sbahi