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ABUSED, MISQUOTED AND MISUNDERSTOOD CHIROPRACTIC STANDARDS

By Michael A. Bryant

Exposing the myths about and the misuse of chiropractic standards requires common sense, a fundamental understanding of chiropractic care, knowledge of what the client is experiencing and, last, but not least, hard work.

A solid knowledge of your client's care will provide you with the ability to respond to misguided attacks purporting to rely on chiropractic standards. Most standards and much of the literature are based on large, nonspecific study groups. Thoroughly understanding your client's injuries and the care provided will give you many ways to distinguish your individual client from those broad study groups. With that fundamental understanding of the injuries and the care provided, you will have a better opportunity to enlist the effective assistance of the treating chiropractor.

A basic understanding of chiropractic treatment can help refute arguments made by the defense. Getting at least one chiropractic adjustment yourself may help you gain that understanding. Whiplash Injuries by Stephen M. Foreman and Arthur C. Croft1 is an excellent text that provides the fundamental underpinnings of needed support. Armed with this knowledge, you can more readily anticipate the defenses and argue the issues.

Although a particular article or standard relied upon by the defense may appear to undercut your client's claim, you must examine it carefully to make sure it applies and that it is being used properly.

Use and Abuse of the Literature

There are several articles that every practitioner should be familiar with:

Abuse of the Standards

There are also several "standards" or "guidelines" every practitioner should be familiar with:

The MCA Standards of Practice9 should not be used like a schedule in the Workers' Compensation Statute. Becoming familiar with the Standards provides multiple ways where a practitioner can show that the treatments are supported under the treatment parameters. When faced with defense "pigeonhole" arguments, use the whole book.

The defense will often not look to the multiplying factors that are available under the Mercy Guidelines. Examples of multipliers include:

The defense will leave out multipliers for permanency or PRN treatment. They will overlook continued care for an individual that is permanently injured. The defense will attempt to create some ceiling on the amount of care needed, ignoring the No-Fault Act and the individual circumstances of your client.

This guideline further bolsters the proposition that there is no universal standard for a number of treatments:

Attempts have been made to identify an appropriate number and frequency of chiropractic visits based on type of conditions and degree of severity. Unfortunately, these recommendations are based mostly on consensus, and research to support these recommendations is lacking. Moreover, little to no delineation has been made in the duration of care literature base between care for specific symptomatic profiles such as low back pain, and long term subluxation-specific care.

It is the position of the Guideline Panel that individual differences in each patient and the unique circumstances of each clinical encounter precludes the formation of "cookbook" recommendations for frequency and duration of care.15

Conclusion

Don't let defense attorneys misquote the standards. The individuality and uniqueness of your client defines what is individually appropriate for their care.

The articles and literature for the most part can be very helpful. The key is making sure that each item applies to your client's individual case and that the studies are being read properly.

hroughout every one of his trial books, Gerry Spence spends a significant amount of ink on the theory that trials are won by hard work. Reading the articles, reviewing the medical records and spending the time to understand the case are what that hard work is about. In this day and age of vigorous defenses and jaundiced juries, trials are won and lost based upon the time that is put into the case. Clearly, the time put into each case will not only help make that one successful, but it will also build a foundation for many victories to follow.









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