Some time ago, my wife and I (she is also a chiropractic physician) decided to explore the exciting underwater sport of scuba diving. Knowing full well that the adventures seen on the television series "Sea Hunt" and the escapades of Captain Jacques Cousteau didn't just happen, we decided to research the various types of educational programs leading to certification.
Our study led us to believe that while certifying agencies are basically the same, the programs offered by the YMCA and the National Association of Underwater Instructors (NAUI) had more "pool" time, more formal classroom hours, and 20 minute minimums on check-out dives in the ocean or in a lake. This piqued our interest even more, so there we were.
We had selected a dive shop with an excellent reputation for instruction, paid our tuition, and had nothing but great expectations for the lectures and dives which were forthcoming. On the first evening, a gentleman by the name of Ruben (who was to be our instructor) handed out the usual release of liability forms anticipated in any contact or high adventure sport. One form, however, drove me absolutely up the proverbial wall: a medical certification form which had to be signed by an allopathic or osteopathic physician. Reluctantly succumbing to this intimidating form, I quietly began corresponding with the National YMCA Scuba Program, in Georgia, questioning the rules pertaining to physical examinations and "locked-in" health care providers. I had learned from a close friend named Paula Robinson (who is a National YMCA scuba instructor) that the YMCA was a progressive organization, and if they were presented with the concept of chiropractors doing examinations, and if I could validate clinical expertise, my pleadings would probably have a favorable outcome.
Diligence, persistence, and subtle tenacity led to my receipt of a letter from the National YMCA headquarters on July 25, 1990, which contained only two paragraphs:
"Dear Dr. Stern: Your material was reviewed at the Y.M.C.A. National Advisory Committee meeting and it was agreed upon that chiropractic physical examinations are acceptable. ...
"Thank you for the information and patience in waiting for our clarification. ..."
A clear and decisive decision by the National YMCA, in this dubious area, has led to a change in their manual of instruction to include physical examinations given by doctors of chiropractic. Diving is a unique sport designed for those who want to appreciate the wonders and beauty of the world below the surfaces of the oceans, lakes, and rivers of the world. The sport is safe when one follows the rules, regulations, and precautions taught by the various certifying agencies. Now doctors of chiropractic will have to make decisions as to the physical ability of people to participate in this demanding recreational activity.
The profiles of the diving examination include a wide variety of system evaluation, which will be discussed in an upcoming article. It may now be you that opens or closes the door to diving instruction for your patients. The responsibility is great. However, I firmly believe that the courses of instruction at accredited chiropractic colleges are sufficient in depth to undertake and accept this unique responsibility.
Watch for a future article in this series titled "Conducting the Diving Candidate's Examination."
Neil Stern, D.C., F.A.C.C.
Arlington, Texas
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
Spearheaded by burgeoning scientific and clinical research literature, psychedelics have reached a level of media coverage and popular interest that has not been seen for over half a century. By “psychedelics,” we are referring to the unique class of substances that includes psilocybin (the active compound found in so-called “magic mushrooms”), LSD, dimethyltryptamine (DMT), ayahuasca, 5-MeO-DMT, and mescaline – each of which occurs in the natural world (except for LSD, which is a semi-synthetic compound).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
