At the first of the year, many of us are evaluating the successes and failures of 1994 and planning and making this evaluation of ourselves and our practices, number of patient visits, patient referrals, net and gross income, etc. Perhaps the most important component of a successful practice, the doctor's clinical competence, rarely if ever gets evaluated. Although we all took a state and/or national board examination when we first obtained licensure, it is unlikely that many have had a general competency test since that time. So to help you make this most important evaluation of yourself, I have included a brief 10-question clinical competency test. The exam questions have been developed based on a few simple suppositions. We need to continue to learn new information about prevention, diagnosis, and treatment to stay informed and maintain a high level of clinical competence. To assimilate relevant new information, we must have skills that permit us to access the literature and have critical reading skills to understand what we have read. Most of the questions relate to primary care issues with emphasis on neuromusculoskeletal conditions with a couple of questions designed to test information retrieval and comprehension skills.
Competency Exam
Most of the self-evaluation questions as you no doubt have noted, were derived from the literature published in 1993 and 1994. These questions exemplify that you cannot rely on textbooks or other sources of information for what can only be found in the primary journal literature. It also gives you a feel for how much new information is produced each year that should be integrated in your daily practice in order to remain clinically competent. This is particularly true if you are functioning in the capacity of a primary care provider.
Most of us want to have a good, solid command of clinical information. We want to be able to develop good narratives, make proper referrals, intelligently rebut insurance denials, protect ourselves from malpractice, provide quality consulting, etc. However, a far more important issue is the ability to provide the best care possible to our patients. So, if you fared poorly on the mini competency exam above, take some of the following action steps in 1995:
ANSWERS TO EXAM: 1.(b), 2.(c), 3.(d), 4.(a), 5.(c), 6.(a), 7.(a), 8.(a), 9.(c), 10.(a)
Journal subscription phone numbers:
Chiropractic Technique 800-638-6423
Chiropractic Sports Medicine 800-638-6423
European Journal of Chiropractic (01865)791155
Journal of Chiropractic History 319-326-8450
JMPT 800-638-6423
Journal of Neuromusculoskeletal System 800-342-0454
Journal of Australian Chiropractors' Assoc. +61 69 213238
Journal of Canadian Chiropractic Assoc. 416-781-5656
Spine 800-638-3030
Topics in Clinical Chiropractic 800-638-8437
Ronald Rupert, MS, DC
Denton, 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.
