CP 1102 Panel Dec 14, 2016


CMCC vp of external relations, chief investigator of Canadian military msk problems, will go into the division of research (health policy)

Interprofessional collaboration: 2 or more professions learn with from and about each other to improve collaboration and the quality of care. Not the same as multiprofessional education which sees things as separate and doesn’t involve an element of trust. Understanding roles and expectations, incorporate others, respect and trust (hardest part), commit to process (sustain).

-Interprofessional education is a necessary step for collaboration. System and regional differences must be considered. Different views from different angles.

-we face the same challenges but the climate is much different. Can find dc, pt and md working under one roof, reduced isolation of chiropractors.

-Towards chiropractors: favourable attitudes, functional acceptance but not full integration, incorporation is usually informal or business related.

-collaboration àworking together in absence of formal structure and processes to deliver optimal patient care. Integrationà subsumes providers under common policy, organization and structure (allied health professionals receiving pay from a hospital). Chiros w/ integration risk losing identity and business arrangements.

-critical elements of collaboration: knowledge, skills, behaviours

-primary care doctor was the gatekeeper to the patient (Predefined system).  Communication is important because we use different tools to diagnose, must learn the language. Must get consent, send clinical notes to other co-managing professionals to keep them informed. Network and take courses with other professionals. Write succinct 1 page notes, not trying to impress anybody, provide input when the patient is not responding.

-understand the impressions of behaviours of salesmen chiros. They have not gone away but they are better. Bad apples rise to the top in chiro, in medicine not so much, must be tolerant. Must have interest of better patient care, must be informed about literature, focus on the core as this is where we have best chance of integration, be tolerant because it isn’t about you It is about the patient. Don’t feel like going to war with doctor understand their uncertainties.

-learning outcomes for cp are based on bloom’s taxonomy

Devan Nambiar–LGBTQ clinical competency expert

-Transgender surgeriesà transitional, gender reassigning/confirming/affirming became part of primary care, hormones are optional so some may not use, don’t assign gender based on how they sound or look

-offer them choice of pronoun, legal sex marker, have open communication, ask open and personal questions, don’t shy away about information because it may be important for how you treat them. Male spectrum, could be chest binding to hide breasts, could cause pain/ broken ribs. Semantics are important. There are top and bottom surgery options. Must wait until healing is done before manipulation. Must be aware of healing times etc.

-types of surgeries ex hysterectomy can change hormonal profiles and have bone health implication.

-guide to caring for trans/ gender divers: http://www.rainbowhealthontario.ca/TransHealthGuide/

-Best question is what does that mean to you if you are unsure of something they say

Dr. Jessica Wong- Medical radiologist, DC, clinical sciences resident/fellow-Public Heath

-Exploring roles chiropractors can take in public health even if this type of people is not walking into your office. Health: state of complete physical and mental health not just absence of disease… public health: art and science of preventing disease prolonging life…

-Pub Health functions: assess and monitor health, support public policy, ensure access to cost effective evidence based care. Federal provincial and local public health agencies.

-Chiros in pub health: promote health, diet, exercise, strategies the promote mental and physical wellbeing to promote health of the population. Monitor obesity, and fall preventions.

-WFC has a public health committee: priority areas à opioid over use (msk conditions), healthy ageing (falls and spinal health), women and children’s health (health inequities).

-in community, educational programs, community talks, falls prevention, community exercise programs, healthy eating programs, services to address health inequities.


-Misconceptions other groups have of us? Chiros though all mds do is prescribe, mds though chiros only crack backs, need to respect bag of tools to assess and treat. Need to show mds that you have reason for treatment based on assessment tools. Physios more trained in manipulations and getting involved in research.

-Cultural competencies LGBTQ first nations? First nations, look at historical impacts, shame based trauma due to colonization. Can be heterosexual but have dual spirit (man and woman spirits) this could make them viewed as more spiritual and be a prestigious thing. To work in these communities must respect local elders. Don’t say I know what’s better for your community.

-Vaccinations, chiros considered skeptical? Vaccinations, commenting on is beyond our scope of practice, can direct to programs being provided by public health organizations.

-CMCC working with med schools to educate MDs? St. mikes hospitals, works with medical faculty to ensure chiros are part of their educational pre-licensure programs. Hospital settings, primary care focus. Working with the Canadian armed forces

-Barriers to LBGTQ receiving care? Viewed as happy homogenous community because of pride. Face discrimination because people are complicated cases and health care providers are not educated on their situation. More paperwork may be necessary and people may not want to do this. Stigma and homophobia are large barriers, every has it regardless of how liberal you are, get it as a child and try to deconstruct it as an adult.

-Why is chiropractic underrepresented in pub health? Strategies may not be accessible to all ways chiros practice, important to involve yourself in public health. We are not involved in these meetings, so focused on managing the patient we forget about the broader perspective. Get involved. Primary prevention in population level.

-Developments from research collab with Denmark? Denmark has access to database that collects outcome measures on their population. Enables more research questions. Deal with many complex cases.

-chiro identity- chronic pain, acute pain, primary prevention?  who do we see. 90-95% msk complaint, 75-80 neck back pain. This hasn’t changed since the world war. Peak year of people we see between 40-50, we are moving with the population to older. 35% of patients with chronic back pain see chiropractors. Get really good at what we do best and we will open the door, don’t be afraid of our prowess at smt, best at managing back pain and even hip pain.


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