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Dynamic Chiropractic
May 20, 1994, Volume 12, Issue 11

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Video & Book Review

By Stephen Savoie, DC, DABCO

Title: "Examination of the Neurological and Musculoskeletal System" Author: Timothy D. Conwell, DC, DABCO, FICC Publisher: Clinical Advancement Plus Seminars Category: Doctor education Publication: Three-part video tape, 60 minutes each To order: See V-439 on the "Preferred Reading & Viewing List" pages 34-36.

This is a three-part video program detailing the examination of the neuromusculoskeletal system. The program is presented by Dr. Timothy Conwell. Dr. Conwell is a board-certified chiropractic orthopedist and has been an active postgraduate lecturer in the areas of documentation and examination.

In this program, Dr. Conwell presents the essential elements of examination used to assess the central nervous system, the peripheral nervous system, and the musculoskeletal system. The presentation of the material is thorough and well-organized. All examination procedures are discussed as to the performance of the procedure, the expected positive or negative result and then a demonstration on a patient of how the procedure is performed. In the demonstrations, the various procedures are grouped to make the most effective use of the examination time. Dr. Conwell also uses a timer in the corner of the screen to show that a thorough, efficient examination need not be lengthy.

The program also incorporates excellent diagrams and artwork to correlate the procedures with the relevant anatomy and physiology being tested.

Dr. Conwell's lecture style is easy to follow and understand. He also proceeds at a pace that allows the doctor viewing this series to absorb the material, yet does not move so slowly the viewer loses interest.

In the third tape of the series, there is an excellent discussion of differentiating myofascial pain syndrome from fibromyalgia, and sprain from strain injury, as well as their proper documentation.

In one part of the program, Dr. Conwell discusses charting the results of the examination just completed. This is an extremely important component of this series. Although many may perform all the examination procedures discussed, a smaller number adequately document what was done. By presenting the examination procedures and the appropriate charting techniques, Dr. Conwell has provided a much needed learning tool for the profession.

This program will be of benefit to those doctors who want to review and upgrade their exam procedures. It would also be a useful tool for recent graduates reviewing for state board examinations.

Savoie Rating: 10

Keith Innes, DC

Title: Survival Guide: Chiropractic Practice Guidelines Authors: Attorneys Richard Adler, Paul Giersch, Margaret Ennis, High Heermans Publisher: Adler Griesch, PS, attorneys at law Seattle, Washington (206) 682-0300 Category: Doctor/student education Publication: Softcover text, $95.00

Survival Guide attempts to explain the Mercy document. The authors have done a superb job in this regard. It contains 15 chapters that basically mirror the contents of the Mercy Guidelines. Almost all of the doctors of chiropractic that I have talked to about the Mercy Conference complain that the resulting document is exceedingly difficult to read and that the various rating systems are confusing, ambiguous and contradictory; that interpretations are at best subject to a multitude of misconceptions and erroneous conclusions.

Is the Mercy document an event to be recorded in history as a step in the right direction or is it a threat to the very existence of chiropractic?

The authors ask, "Did the Mercy Conference create 'guidelines' or 'standards'; Is there a difference?"

"The purpose of this book and the seminar presentation is to educate the chiropractor and the chiropractic community as to the meaning of practice guidelines, how it may be used and misused by third-party insurers, and winning strategies on how to survive under these new parameters." This is a direct quote from the text, however, I think the book does more than just what this statement says. It enables the doctor or student to get a quick and clear understanding of the Mercy document. If provides a comprehensive list of "Disclaimers" and gives the specific Mercy document page reference for further reading. It provides "Practice Tips" that are designed to keep the doctor on the straight and narrow. It provides "Malpractice Traps" that are just what they say they are, and you should be aware of them.

This text is a no nonsense hard hitting book on the reality of the Mercy document. No longer are doctors going to be able to hide behind the statement that they do not diagnose but just treat subluxations. And I quote: "The Mercy document clearly indicates that the chiropractor has the responsibility to diagnosis properly and accurately the patient's condition. No longer can a chiropractor argue otherwise. In other words, the use of terms such as "diagnosis," "clinical impression," "analysis" or "assessment" now carries the same meaning and each term carries the same ethical, moral, legal and professional responsibilities to the patient. See page 96."

For those in the chiropractic profession that either did not read the Mercy document or just plain gave up trying, this text is for you. I read the Mercy document and I am not really sure I got out of it what I should have. But when I read Survival Guide and looked up the references in the Mercy document, I did get the overall picture, and I did so in just a matter of a few hours.

Practice guidelines vs. standards of care: Is there a difference? Read Survival Guide and find out.

Chiropractic is leading the way for all the health care professions, and the combination of the Mercy document and Survival Guide is miles ahead of whatever is in second place.

Innes Rating: 10 (when used in conjunction with the Mercy document.)

Dynamic Chiropractic
May 20, 1994, Volume 12, Issue 11

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