College of Chiropractor's of Ontario - October 2001 Chiropractice Newsletter ExcerptsThe following excerpts are from a recent newsletter from Allan Gotlib, former president of the College of Chiropractors of Ontario. This was circulated to licensed chiropractors.
By Dr. Allan Gotlib
In the CCO 2000 Annual Report (which by the way is still not on their own web site), I spoke as president of how "acting beyond the scope of practice" without the patient being fully informed has continued to cloud professional growth and brought pressure to the concepts of public safety and protection.
While the public recognizes the diversity in our profession, they want assurances that the chiropractic care we deliver is both competent and ethical, and frankly, so do I.
Letter to Ms. Jo-Ann WillsonDear Ms. Willson:
I would like to formalize my gratitude and appreciation for your extensive response to my query of eligibility of chiropractic to order diagnostic tests in the hospital setting.
The report has pulled together and summarized many of the questions about document and legislative references, which I had. It offers more clarity for our organization to now move forward and develop our own internal directives for handling this issue.
As per our telephone conversation, I too, would be pleased if you would share this information with the Ministry of Health and Long-Term Care, College of Physicians and Surgeons, and the College of Medical Radiation Technologists of Ontario. I agree that across the varying legislative bodies and within their own directives exist many inconsistencies. It is my hope that by sharing this formal inquiry with the varying governing bodies that future due attention will be drawn to this issue as deserved.
In the memorandum enclosed with this newsletter, you will see that we are consulting with the profession, the public and other stakeholders on two standards for the purpose of further protecting this public interest. The proposed standards of practice are designed to raise the level of enforceability. They emphasize and reinforce the importance of chiropractors operating within the scope of practice of this profesion.
Our scope of practice statement is not a license. It is a description setting out an explanation to the public about what we commonly do and what they may expect when attending a chiropractor. What is licensed are the controlled acts. The area in-between a monopoly (the old system) and the licensed controlled acts (new syste), where all health professionals practice their profession, must be set out in policies, guidelines, and standards of practice. Each self-governing profession must determine those policies, guidelines and standards within their statutory mandate and then articulate them to the profession and the public.
However, many of the services in this in-between area may be provided in the public domain by unregulated professionals or even non-professional practitioners. This system error, common to all regulated health professionals in Ontario, has created confusion for patients and regulated health professionals. Regulated professionals may provide services that are not usual and customary for their particular profession, yet the public assumes they are receiving competent, ethical services from a regulated professional.
This provision of health services falls within the public domain if it does not involve a controlled act. Even when a practitioner has his/her certificate of registration revoked, he /she is still able to provide health services to the public services that are in the public domain. This is particularly frustrating to regulatory boards and to those patients who have engaged in the disciplinary process.
When we are not clear with our patients and the public at large, there is confusion and complaints emerge from patients, the public or other health care professionals.
The issue of informed consent is well settled in our existing requirements set out in the professional misconduct regulation, many of our standards of practice, policies and guidelines as well as in case law.
To insure consent is fully informed and voluntarily given, chiropractors must clearly explain the following to their patients:
Current data suggest that approximately 95 percent of patients interactions relate to the treatment of conditions commonly referred to as neuro-musculoskeletal, while only 5 percent relate to non-neuromusculoskeletal conditions.
Confusion arises when patients with serious conditions, such as allergies, cancer or AIDS, believe they are being treated for those particular conditions when, in fact, the treatment focuses on concurrent secondary neuro-musculoskeletal problems. There is a clear distinction in treating a patient for a condition as opposed to treating a patient with a condition.
The treatment by chiropractors of various pain syndromes (headache, neck pain, back pain) is now well established in the scientific literature. However, the treatment of pediatric conditions, such as colic, enuresis, asthma, otitis media, attention deficit hyperactivity disorder, commonly referred to as non-neuro-musculoskeletal, has yet to be based on unequivocal cogent evidence beyond the expert clinical opinion or case report levels. Also, characterizing some of these conditions as non-neuro-musculoskeletal as opposed to neuro-musculoskeletal is in dispute. These academic arguments are not relevant to the patient - what is relevant is safety and competent, ethical chiropractic care.
Clearly, the scope of practice statement does not restrict or limit us to only musculoskeletal conditions. The purpose of the Regulated Health Professions Act (RHPA), was to provide for the evolution in the role that all regulated professionals, including chiropractors, play in the health care system.
However, in the same breath, the public must be assured about public safety and ethical competent care. How can we address this issue in language that meets the needs of the profession, the public and all other stakeholders while allowing our evolutionary role to benefit the health care system?
The Health Professions Regulatory Advisory Council (HPRAC), an advisory body to the Minister of Health and Long-Term Care, is addressing some of the challenge relating to the regulation of health care professionals who provide services in the public domain.
The CCO looks forward to offering input into recommendations relating to the difficult issues surrounding health care services that do not fit neatly into current controlled act/public domain model of the RHPA. In the interim, I invite the entire profession to provide feedback to Council in formulating standards of practice that address the needs of the public and other stakeholders in addressing chiropractors who act beyond the scope of chiropractic practice. The public and other health professionals are also stakeholders and we will be seeking their input as well. The final language must have provisions that will accomodate the evolution of the profession and allow for new research and knowledge to be transferred into the clinical setting.
You should review the documents through the eyes of the public - what does the public need to need to know in forms of efficacy and safety! We need to be absolutely clear with the patient.
Imposing your personal veiws is not acceptable. It is not about you, it is about the patient. Patients expect safe and effective treatment and their views may not be congruent with what you want. It is not your choice, it is the patient's choice and you should respect that choice.
There are 2,800 chiropractors in this jurisdiction. We must all interact and collaborate with the Ministry of Health and Long-Term Care, the health care system and the other health professions to the benefit of the jointly shared consumers of our services. Chiropractors can no longer remain isolated or marginalized. We must take up our duties in support of the core businesses of our Ministry of Health related to public health, health promotion and wellness, health policy and integrated health care programs.
Chiropractors must be in concert with the Ministry committments and strategies.
You should not be defensive about this accountability measure. You should view this as providing a more professional service in the best interest of your consumer. You are not the only one providing services to the patient, whether they are acute care services, chronic care, wellness care or preventative care. All regulated practitioners provide these - we must collaborate and make the sytem work better.
It is up to our profession to set standards of practice that provide for competent and ethical care and at the same time assure public safety and protection.
The fax lines are open.
CCO would like to take the opportunity to set the record straight on a number of issues that have arisen and may be causing concerns to some members:
CCO is not out to get subluxation-based chiropractors
CCO does not like treatments plans (i.e., putting patients on long-term care).
CCO is against block fees
CCO does not like specialties (e.g. pediatrics)
(I don't think that Dr. Gotlib has read his own web site that says that the CCO does not regulate, but does approve of only 3 specialties. Pediatrics is NOT one of them.
Here are comments about pediatrics from the CANOE.CA web site.)
Here are comments about pediatrics from the CANOE.CA web site.)
Executive Dr. Keith Thomson, Chair Dr. Allan Gotlib, Vice Chair Ms Regina Willmann, Treasurer Ms Gail Diamond Mr. Calvin MacPherson Dr. Drew Potter Dr. Donald Viggiani Complaints Dr. Keith Thomson, Chair Dr. Elizabeth Anderson-Peacock, non-Council member Dr. Gilles Lamarche Ms Regina Willmann Ms Ruth Mabee, alternate Discipline Dr. Lynda Montgomery, Chair Dr. Richard Bray, non-Council member Dr. Douglas Brown, non-Council member Ms Gail Diamond Ms Helen Foster Dr. Jacques Laquerre Ms Ruth Mabee, alternate Ms Jane Ann McLachlan, alternate Fitness to Practice Dr. Brian Schut, Chair Ms Clarissa D'Cunha Dr. Drew Potter Patient Relations Dr. Gilles Lamarche, Chair Ms Gail Diamond Ms Helen Foster Dr. Brian Kleinberg, non-Council member Dr. Janit Porter, non-Council member Quality Assurance Dr. Donald Viggiani, Chair Ms Gail Diamond Dr. Jacques Laquerre Dr. Jeffrey Lustig, non-Council member Ms Regina Willmann Registration Mr. Calvin MacPherson, Chair Dr. David Leprich Dr. Lynda Montgomery non-Statutory Committee Advertising Dr. Drew Potter, Chair Dr. Peter Amlinger, non-Council member Ms Helen Foster Dr. David Leprich
CommentsMissing from this newsletter was any mention of the following: