Dr. Kirk Andrew, BHSc (Hon), CSCS, DC 105 Fifth St. E. Cornwall, ON K6H 2L6 613-933-7884 www.CornwallWellness.com drkandrew@gmail.com
Member of the National Strength and Conditioning Association (NSCA)
Active Release Techniques (ART) Certified
Low Level Laser Therapy
So, as far as logic is concerned, the thought experiment that preceded this discussion demonstrates that with a toothache, we invariably seek the advice and care of experts in that particular field- a Dentist, or DDS. We know that they are trained and have the experience when dealing with teeth. We typically do not see a Medical Doctor (MD), unless there is a financial issue or other extenuating circumstance like an Emergency. Dentists are specifically trained to diagnose and treat conditions of the mouth, gums, teeth and jaw. Conversely, we would not seek the care of a Dentist should be have abdominal cramps! Logic! We’d see our Medical Doctor, as they are trained in diagnosis and treatment of visceral disorders such as those that affect the abdomen. Logic!
Digital Gait Scan Technology
It is well established that as human beings, we typically fear the unknown. Without the proper information on a subject, it may typically fall under the category of the “unknown”. Thus, we may fear it. Or at the very least, not understand it. Worse still, our fear is compounded when we hear 'negative information' regarding the unknown item or topic . Especially when that information comes from someone we are indoctrinated to implicitly trust, and to respect their expertise without question (but that is a topic for another time).
Physical Therapy, Strength Training
When one has an electrical problem, one doesn't typically call a Plumber. We call the expert in that particular field- the Electrician. It's only logical. However, Logic is a funny thing, because it isn’t always applied consistently to all situations. Sometimes it is merely because we do not have the proper information to make an informed and thus logical decision. Sometimes this lack of knowledge is because we have yet to learn something. Sadly, sometimes it is because this information is not freely available to us, or some other person or group keeps us ignorant to it, for one reason or another (see "Who killed the Electric Car").
X-Ray Facilities
SEEKING THE APPROPRIATE CARE
Holistic Health Care Chiropractic Care versus Medical Care
CHIROPRACTIC EDUCATION Please review the training of a Doctor of Chiropractic: Chiropractic Curriculum (Please read on to compare courses and focus to the MD curriculum) Admission to which is based on performance and completion of 3-4 years of University (7-8 years minimum total). Year 1: http://www.cmcc.ca/Page.aspx?pid=311 Year 2: http://www.cmcc.ca/Page.aspx?pid=312 Year 3: http://www.cmcc.ca/Page.aspx?pid=313 Year 4: http://www.cmcc.ca/Page.aspx?pid=314 Notice the intense concentration and training in Neuroanatomy, Neurophysiolgy, Orthopedics, Musculoskeletal anatomy, Biomechanics, Radiology, and Rehabilitation! Notice how these topics are conspicuously absent from the MD curriculum! Furthermore, this training is highly scientifically intensive, rigorous, and thus analogous to that of your Medical Doctor in terms of course load, demands, and topics: A recent study described U.S. Chiropractic curricula as an average of 4820 classroom and clinical hours, with about 30% spent in the basic sciences and 70% in clinical sciences and internship[vi]. Medical school curricula average about 4670 hours with a similar breakdown. Compared with medical students, chiropractic students spend more hours in anatomy and physiology but fewer in public health and pharmacology [vii]. Both programs have similar hours in biochemistry, microbiology, and pathology[viii].
EXPERTISE IN RESPECTIVE FIELDS
THE FOUR STAGES OF COMPETENCY
NEUROMUSCULOSKELETAL EXPERTS
When one analyses the training of each profession, we clearly see that our logic is sound:
However, Medical Doctors invariably treat these NMSK conditions! Why? Does that seem logical? Several reasons exist that are relevant to explain why MD's attempt to treat things they have no adequate training in, some more concerning and pervasive than others. For simplicity sake, we'll keep this discussion related to logic and the methods of human knowledge accumulation and realization. Therefore, one has to look at the four phases of competency proposed by Maslow to fully understand this phenomenon. These four stages are typically how human beings progress from complete ignorance and inexperience concerning a subject or skill to informed knowledgeable expertise of said subject or skill. The stages are:
This is why when you see your MD for your back problem, you’ll be prescribed Non-Steroidal AntiInflammatory Drugs, and sent home. Or told Arthritis is a "natural part of aging". At worst, your MD will give you advice that is plain wrong, and your condition will worsen or merely return some months or years later, typically worse than it was initially. If you’re lucky, you’ll get a referral to a physiotherapist. A better option, however it can still fall short as far as a comprehensive and clinically sound solution, depending on the condition. Ultimately, complexity of the human body often necessitates a multidisciplinary approach. Again, a topic for another time, as it is beyond the scope of this discussion.
Dental Curriculum: http://www.utoronto.ca/ dentistry/admissions/undergraduatecurriculum.html Medical School Curriculum: http://www.uottawa.ca/ academic/info/regist/calendars/programs/845.html Upon analyzing the curriculum of each profession, it is evident that Dentists are highly trained in oral clinical matters, reflected in their specific course topics and material. Conversely, Medical Doctors are highly trained in endocrinology, pathology, microbiology, pharmacology and visceral anatomy and physiology. Thus, for infections, severe trauma, and matters of the visceral systems, MD’s are your clear choice. Logically.
1. 2.
However, when one looks at Neuromusculoskeletal (NMSK) training, we clearly see a major deficiency in the general Medical School (MD) Curriculum. There are no courses on the anatomy of the lumbar spine, cervical spine, thoracic spine, knee, shoulder, elbow, foot, etc. There is no mention of Biomechanics, a profoundly large and relevant scientific field dealing with the physics and forces of the human body concerning each specific joint in the body, tissue tolerances, and how these forces affect them, and how they relate to injury. There is no training in physical rehabilitation. No mention of manual therapy. No mention of muscular, tendinous and ligamentous anatomy and physiology. Little to no mention of Orthopedics, nor skeletal Radiology! Nor sports training. Nor Ergonomics. The list goes on! This is why you'll go to your Medical Doctor and hear things like; "Sorry, you have Osteoarthritis, and there is nothing we can do but give you an anti-inflammatory" or "You'll just have to live with this" or "Arthritis is a natural part of getting old". Why is there no mention of the aforementioned highly critical topics essential for proper treatment of the human body in Medical Education? Because there are no specific courses nor any adequate or relevant focus on these topics! As a matter of fact, if one considers training and education as a foundation for scope of practice, MD’s are not well equipped to diagnose and treat NMSK conditions pertaining to your back, neck, knee, hip and shoulder pain, among others! NOT IN THE LEAST! Much the same as your MD isn’t the primary clinician to seek for your tooth-ache!
3. 4.
Unconscious Incompetence (you aren’t aware that you don't know) Conscious Incompetence (you are now aware that you don't know) Conscious Competence (you are aware and you now also have skill pertaining to the topic) Unconscious Competence (you have so much skill and knowledge to the topic that the awareness is now 'automatic')
The initial stage of the learning cycle is called unconscious incompetence. This takes place when you don't know that you don't know. At this point, you have yet to realize that there is something more that you need to learn. Your Plumber is at phase two of Maslow's stages of competence concerning Electrical technical issues, but is probably at phase three or four concerning Plumbing technical issues, depending on his or her experience level. Thus, your Plumber would probably tell you to call the Electrician if your lights were not functioning. Medical training does not even attempt to address biomechanics, little in terms of orthopaedics, nor a more detailed role of the importance of NMSK anatomy, physiology and pathology. Medical Doctors also receive very little, if any, education concerning other fields of health care, nor other theories, fields, science, research, and models of the functioning of the human body. This is because the Medical Model is considered by Medical Practitioners and researchers to be the only model or paradigm. Similar to assuming Freudian Theory is the only field in Psychology! Thus, this clearly falls under the category of Unconscious Incompetence!
When it comes to Dentistry, MD’s have progressed to phase 2 of Maslow’s stages of competency. They are typically Conscious Incompetent. Thus, MD’s do not do fillings or Root Canals! Plumbers don't do wiring. Electricians don't do plumbing. When it comes to your teeth, Dentists are typically in phase 3 or 4, depending on experience. They are trained, educated and have the expertise to deal with conditions of the oral cavity. And, when it comes to your back, neck, knees, shoulders and NMSK conditions, Chiropractors are in phase 3 or 4, compared to your MD’s phase 1 status (or occasionally phase 2 in particular cases). It is for this reason, in addition to some more troubling political and economic reasons, you will likely not receive a referral to a Chiropractor from your MD. In fact, when pressed, many will suggest that you don't see a Chiropractor. This is simply ignorance and subsequent fear (of a mongering type) at work. Your MD's uninformed advice is not doing you any favors; it is merely ignorance and not your best interest that is the motivation for your non-referral. At worst, as noted above, anything unknown (which is the situation in phase 1) is typically feared. It is often human nature. Thus, as noted, sometimes you’ll get a stern warning from your MD that Chiropractors do this or that, which may negatively affect you somehow. Again, sadly these dubious claims are mere ignorance. Ignored or simply unknown is the plethora of scientific research concerning safety, effectiveness, and efficiency or Chiropractic. Ironic, since this is an example of a double-standard at it's finest, as MD's often claim to be purely evidence based, and have historically criticized other fields of health care for not being evidence based.