Re: Geese, ganders and scope....... (rant)

[Guest guest]

Thanks for sharing this insiders view of the the recent OAACM meeting.  It does get me riled up big time.  I have been treating TPt's with Nimmo and ART for over 24 yrs and it is absurd for the Acupuncturists and OM docs to claim we are moving into their turf with DN work on said TPt's. 

I will be watching this situation with great interest in the future.  I am prepared to do whatever is reasonable to bring this DN technique to my patients ASAP. Schneider DCPDX

On Fri, Jan 27, 2012 at 7:05 PM, dr_tim_irving_dc <tirving@...> wrote:

 

" What's good for the goose, is good for the gander " ....????

We can't expand our scope to include modalities that acupuncturists use but they can expand theirs?

I just came back from the OAAOM meeting at NCNM. I went because they were going to address the dry needling issue and I am really trying to understand both sides of the argument.

One thing is clear, Oregon acupuncturists believe that we want to perform " acupuncture " by disguising it as dry needling. In addition, they really have no idea what we do regarding anything other than spinal manipulation. They have no idea or don't really respect our status as doctors.

Another thing I realized (I suspected this all along); many of us don't really know what they know with regards to biomedical interventions. In our defense, I don't think the acupuncture profession is clear on this either.

Then.... it happened, the handout they gave everyone states that ordering and interpreting lab results are part of their scope but the medical board is requiring an investigation to the education to do this as an acupuncturist. Wait.... they spend quite a bit of time trashing our profession for trying to increase our scope to include a modality to treat myofascial trigger points and they are actively and aggressively going after lab work to come up with western medical diagnoses???

There is irony here but also a threat to our piece of the pie as primary caregivers. Do we really need another natural and complementary profession to muddy the waters with their version of a PCP? Many DCs argue that acupuncturists are trying to invade our turf under the disguise of " Tui-Na " . While this may be the case here and there; it's apparent that OR acupuncturists are trying to expand their scope to diagnose and treat western medical illnesses.... and they're fighting us to include another modality to treat myofascial trigger points; entities that we already detect, diagnose and treat. Does anyone else see this as absurd and threatening?

One of their main counterpoints to us using DN is that we are doing it for purely monetary reasons; we are a greedy bunch. I have also heard from more than one ND that we try and be as specific as possible with our adjustments so we can see the patient more often to adjust a little each visit.... I am offended on both fronts.

Tell a recent patient of mine who has had severe myofascial pain related to TMJD and lateral pterygoid TP's, that acupuncturists are better trained at finding and treating myofascial trigger points with needles.

Despite spending thousands of dollars of her own money (she's 26 and right now has no job) on TMJD specialists, cranial work, naturopathy and chiropractic care from multiple providers, she valued my referral to an acupuncturist in Portland who claimed to do trigger point needling. I relayed to him that her lateral pterygoid may be the offending muscle, he stuck a needle right through her TMJ in addition to a few other peripheral points which didn't help at all; and he used a 30mm needle, which can't possibly reach the muscle.

She has a classic lateral pterygoid referral pattern and I have treated as much of it intraorally, that I can access with good but not complete results. She needs to have DN to the muscle (the same way I was taught by Jan Dommerholt). She is actually considering traveling to another state to get the treatment by a PT who has gone through his courses too.

I am very surprised that she continues to trust me with her care, I am able to knock back her pain significantly (more than any other treatment), but is comes back. She begged me Wednesday to perform DN on her but I can't risk it. I am actually considering flying her out to Casper, Wy for the next course with Jan just so we can treat her.

Since our board has decided that we are not allowed to perform DN; I have seen so many people who need it; many of which I have sent to various acupuncturists in Portland who claim to do myofascial TP DN with varied success and satisfaction.

Are we attempting to rebrand acupuncture as DN? Well, I don't know of any DN course that teaches us to become acupuncturists.

Is it purely for monetary gain? Them's fighting words!

Here's a question (rhetorical or not): Are we so focused on being included in medicare and Obamacare that we are going to allow another profession to stifle our ability to evolve and use modalities (DN or not) to treat things we are already adept at (experts, if you will) finding, treating and rehabbing? All the while, this profession is attempting to broaden their diagnostic scope to be relevant and more competitive in the health care market?

Can you actually see yourself recommending that a patient go see their acupuncturist to get lab work? Tui-na? Trigger point therapy? Soft-tissue work? Anything but acupuncture? If not, we need to huddle-up and realize that the DN issue is a bigger issue; it's an issue of scope, the creativity to use various modalities and create a unique package of care for our patients. One that, arguably, no one else possesses the skills to offer.

In the handout for the meeting, it states that, despite a hearing with the court of appeals in 6-8 months on the DN issue, OAAOM is claiming that they have had their first legal success nationally on said issue and that we (DCs) are all but defeated.

Rant over.....

-Tim Irving DC, MS, LMT

-- Schneider DC PDX

[Guest guest]

Go Tim! I was a punk rock girl in my teen years (still am I guess)

and I realized early on that running around the periphery screaming

rants did not work. However, keeping your head low, your grades up

and infiltrating the enemy from the inside was the way to go- muck it

up from the inside:) Way to infiltrate!!

I live in ND and DC land. The professions don't really care for one

another. It's all a turf war on all sides. I call MD's to discuss my

concurrent treatment of patients, etc- they usually blow me off (they

think ND's are a joke for trying to play PCP's). I send a patient

over to a PT or Acupuncturist and they, on occasion, change my

treatment plan and try to take over care. I know DC's who won't refer

a patient over for Prolotherapy, even though the issue is clearly a

deep joint issue, but they want to steam and cream the heck out of the

joint capsule and surrounding soft tissue bc they can get 15 visits

out of the patient's insurance company. Turf wars.

I was personally approached last year to come up with the curriculum

for the Acupuncturist's lab diagnosis course. I've been too busy or I

would have done it, seems benign enough to me. Who cares if they know

how to read a CBC? Not I. It's not really pretending to become

PCP's, I see it more as a screening tool.

And come on, how many DC's really interpret lab work on a daily

basis? Not too many. I know this bc I have a steady stream of

questions emailed to me by DC's to ask questions on their patient's

lab results., so much so that I started charging for it. The ND's are

pissed because DC's go to " Functional Lab " seminars and come out

thinking that they know how to interpret labs and charge extra for it

while the ND's have spent 4 years doing nothing but functional lab

interp, heck, we don't know how to NOT do it automatically. We never

up charge for it because it's in our veins, just like manual skills

are in your veins.

Do you see what I'm getting at? This back and forth could go on all

day:) (I wasn't dissing DC's lab skills btw, just trying to make a

point)

Let me end with this- I may be one of the few Chiropractors in Oregon

actively utilizing Dry Needling in my practice. I do so under my ND

license and I use it probably 2-3 x wk. Works well. I also refer out

to Acupuncturists 3-4 x wk. I don't pretend to know, understand or

perform Chinese Medicine. If a patient needs some muscles to melt or

some edema to dissipate out of an area, I throw some needles in and it

works. If a patient needs their Qi balanced and their Chakras

unlocked, I send them to Dr Joe in Beaverton who does the most

traditional CM I know of. I don't even pretend to be an Acupuncturist.

I am, however, a true believer that sometimes a muscle needs a needle

stuck in it! Sometimes it just won't let go with manual therapies.

Nothing like cold, hard, steel to make a change in a neuromuscular jxn:)

I'm with you all in that DN should definitely be in the DC scope.

Heck, who knows their anatomy better? No one! We can't play " he

said, she said " on this with the Acupuncturists. We need to be like

the turtle- slow and steady wins the race. Tenacity always pays off

and eventually we will wear them down. We have a bigger team:) Let

them celebrate their " win " - we can just keep on after them.

-Tyna , ND, DC

Portland, OR

[Guest guest]

Tyna,

Acupuncturists screening with lab..... Ok, but then what? What happens when a

patient has a pathology? What about a functional physiological disturbance?

Where does that fit into their paradigm? At least we are trained well in western

diagnosis and pathology; well enough to know when we are over our head

(theoretically).

The key to winning this fight is going to be making clear, concise, and

well-informed arguments. Unfortunately, this means making counter-arguments too

which tend to be made by comparing scopes, professions, paradigms. One of their

arguments against us using DN for TPs seems to contradict their argument for the

inclusion of certain other clinical skills into their scope. That's all......

Both sides are a bit misinformed but they have made some very offensive

conclusions about our knowledge, skills and moral fortitude as clinicians. It's

strange to hear these conclusions being used to buttress their legal arguments

and garner support, profession-wide.

I didn't infiltrate, the entire NCNM faculty was invited because OAAOM has an

office on campus.

-Tim Irving DC, MS, LMT

[Guest guest]

Herb, not sure about the idea falling on deaf ears.

The DN issue is tending our garden, it's expanding the number of tools with

which we can tend our garden. The beauty of our profession is that we can each

have slightly different gardens (practices) that we can nourish and grow using

a large variety of tools and skills.

Despite the idea that some have about DN just being rebranded acupuncture, it's

not, it's actually expanded TP therapy and really shouldn't be seen as being

anyone's " turf " .

-Tim Irving DC, MS, LMT