CP 1102 Panel Nov 7, 2016 Reflection

CCPA CEO- Dr. Greg Dunn

-incident management, what to do if you do get into trouble, how to avoid getting into trouble, defense if you do get into trouble

-road map to care: process of steps to take to avoid incidents when things go wrong (things can cause harm when they shouldn’t), things will go wrong despite your intentions. In practice you get comfortable with the status quo, patient your treating always gets better, comes back in same thing I need to get back to work, comes back next day, night pain trouble walking, dr does same treatment didn’t re-eval thought he needs more not different. Next day, vascular ischemia fo the lower leg, immediate below the knee amputation. If dr had taken even a moment to look at that leg, palpate, check circulation. Always be vigilant and promote proper communication and dialogue.

OCA CEO- Dr. Haig

-advocacy organization (promote interests of profession with other bodies with influence), ministry of health low back pain initiative. Association is a group of individuals that come together to accomplish something that they can’t do themselves. No membership fee. Long term strategies. Public promotion, member support.

-Patient decision (media, other healthcare, friends, insurance, family): oca tries to interact with all influences.6-8 full adds in the medical post, non-pharmaceutical approach to pain, neck lbp adds. Describing profession in a manner that resonates with people. National position statement/ brand position statement (imbed in portfolio).

-Advocacy objectives: inclusion in family health care teams and funding for positions, PCLBP pilots and LBP strategy, access to advanced diagnostics, access to x-ray.

-Eric Hoskins minister of health who is a physician said chiropractic saved my life

WFC- Dr. Richard Brown

-striving to be relevant and meaningful, represents 88 countries over the world. International voice of the profession, people can come to if they are in trouble and can come to for information about other countries. Advocate on a global level, help achieve legislation, get chiropractors to see patients. 4 pillars, support (and supply with information), empowerment, promotion and unity. Puerto rico advocated against treating children with chiropractic being illegal. Brazil recognized chiropractic as its own independent profession from physiotherapy. Uganda only 6 chiros but government support for hospital based teams. WHO has 200 non-governmental organization, WFC has been one of them since 1997. Nurse with crippling back pain began taking opioids from her GP, began prescribing them to herself, imprisoned due to this addiction. More people died in the US because of opioids than car accidents. Back pain is not boring.

Q and A

Dr. Dunn

-how are services provided? CCPA people on the ground in each region who are familure with local regulations and procedures to offer advice and guidance.

-Gray areas faced when defending chiropractic? Drs get in their own way. If records (informed consent), ethics and good procedures are adhered to when they get into trouble they don’t have proof of due diligence. Forged entries into files from memory. Must do due diligence at the time so you have confidence in time of need to stand by your action. Huge asset is experience of CCPA members.

-Technique systems create problems in defenses? Chiros given large latitude, not the system but user of the system that get people in trouble. Some fringe systems are harder to defend because it is hard to find experts. Ethical approach is most important. Patient affection lasts as long as they feel like they can trust you, as soon as they think you over bill, act not in their interest and they prosecute you.

-financial concerns will associate because you have to, you are subject to their bad habits/ shortcuts/ practice management systems. You always have a choice to act ethically, can’t compromise.

Dr. Haig

-how do bodies work together? OCA and CCA and other provincial organizations worked together on the video for chiropractic promotion

-Record keeping is extremely important but one of the easiest things to let slip because of workload. Coroner subpoenaed at request of neurologist his records because patient died of stroke 12 hrs after being treated but he had written do not treat neck. Assumption out there that he as a chiropractor had hurt this patient.

-Chiropractic inclusion in OHIP? Moving towards capitated payment not fee for service payment (perverse incentives). OHIP will not include chiropractic. Actively working on funding for chiropractic being included in Ontario coverage, very likely, has happened on a limited basis. Working on initiative to include chiropractic funding in multi-disciplinary teams from same sources as other practitioners. Want flow of patients from publically funded system to chiros in the private system (already happens on a limited basis). It will never be everybody, chiros will always have to collaborate ethically, to thrive and delivering best quality care.

-technique systems? Interaction with politicians- government relations consultations, cabinet minister said my wife went to a chiropractor and he was like a used car salesman, other agreed and complained about paying for 80 sessions as a block. These systems lead to short term monitory gains but undermine the professional image. Now we are small and vulnerable and much smaller than we should be, every action affects us, don’t tolerate it in your colleagues. Seen from outside as why does the profession let these things happen. Doesn’t help to promote view in the public eye when we are actively doing damaging things.

Dr. Brown

-biggest issues chiro is facing? Popular answer persecution from governing bodies. When profession is pressured it turns inwards and argues within itself philosophy of practice, need to focus on tenants of patient centered care. Promote unity, things that bind not divide.

-“Canada best place to practice chiropractic in the world”

-World spine care: time? How to get involved? Finances? Not directly linked to WFC but WFC supports and endorses it. Botswana 1 part time chiro and one spine care surgeon, have to have reference letters and qualifications, you fund transport and lodgings, and your time commitment are taken into consideration when applying. Some stay up to 12 mo some stay as short as 4 weeks. Dominican Republic is another location of this outreach.

-technique systems? one of the biggest cancers in this profession is practice management systems that offer to enhance your income. Tempted because of your debt. Use your techniques taught in good faith to abuse the trust of your patients. Destroys credibility and reputability of the profession.

-cognitive dissonance: doing something you know to be wrong. Small profession so the responsibility falls to all of us.

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