The first-line practitioner conducts a clinical examination of the patient following the basic rules of Observation, Palpation and Percussion.
This examination may also require the use of instruments such as a sphygmomanometer, a stethoscope, an eye (ophthalmoscope) ear, nose and other speculae. Obviously, in doubtful cases use can also be made of radiology, cat scan, MRI, Doppler, bone scan as well as biochemical analysis and / or the help of medical colleagues.
The possible lack of homogeneity in the results of these examinations should be noticed, just as hand writing may be either legible or not.It goes without saying that the deployment of lower quality instruments is unethical and is not to be permitted.
The latter examinations, however, constitute only “a couple of pages” of the patient's entire history. At first, patients need a non-directive approach, and it is only after the diagnosis has been well established, that a directive approach can be useful.
As a first line practitioner, as in the old days of medicine, I maintain a practice in which a close genuine relationship with the patient (preferably in their language) is retained even while making use of the evidence-based scientific and technical possibilities mentioned above.
I do not intervene in the medications that have been prescribed, but I do advise the patient to closely read the list of possible (negative) side effects, evidently: when or if published, so as to be able to take them eventually, into account.
The contact with the patient is definitely not manual in the sense of a massage or a passive manipulation.
The chiropractic treatments are mainly restricted to adjustments with the well-known Hi:Ve To / Lo: Am Fo movement, and confined to the segments that need it, all of this over a limited number of times.
The importance of the “gesture”, (dangerous in unqualified hands lacking a daily training) as well as its softness and little instrumental (hence not expensive, not painful) intervention is to be stressed.
A further major factor is the ethical aspect of refraining from treating the patient out of financial greed. A Doctor should regard his profession as a 'priestly task' rather than as a way of money grabbing. It is not because we save lives and solve socially and medically dire situations that we are permitted to take advantage.
It should be noted that the health insurance coverage for our interventions is ridiculously low and unfair.
The underprivileged do not generally know the possibilities of our art and if they do, they cannot afford it, which is also unfair.
These three aspects of Closeness, Softness, Efficacy (inexpensive) add to the dignity of our profession and are leading to its appreciation.
dr. Albert Koentges
Copyright © 12-11-10