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Dynamic Chiropractic – August 15, 1995, Vol. 13, Issue 17

Science of Caring

By Arnold Cianciulli, BS,DC,MS,FICC,FACC
The second year national medical board examinations revealed that female medical students do not do as well as men, nor Hispanics and Afro-Americans as well as Whites, according to a recent issue of JAMA. To mitigate the expected dismay, the authors explained that these examinations have little to do with the success of a clinician.1 The Flexner report of 1910 proposed that laboratory training and basic science were more important for medical schools than any "practical studies." The NIH agrees excessively with this Flexnerian premise and funds projects based on this. Clinicians may find fault at the irrelevance of much of what is taught in the preclinical years, but faculties funded by research grants largely ignore the clinicians who say that too large a focus on research and basic science could distort the mission of medical schools to train doctors.

Members of the allopathic profession have gone along with this charade because they have risen from middle-class income to celestial levels, largely because of new diagnostic tools which they can use and charge for. Medical practice becomes technology dependent and the public increases its homage of their toys. Frank Davidoff of the American College of Physicians recently expressed surprise at a Dutch study which suggested that basic science is not all that important to clinical practice.2 These findings appear to indicate that basic sciences are learned and then "encapsulated" in the unconscious and are available for use when automatic response does not help in making a diagnosis. Further, this study says that too much basic science "actually slows clinical learning and even interferes with it."3

Do these findings mean we should abandon the basic sciences? No, absolutely not! However, select the "best DCs" in practice and give them a basic science exam and see how many of them will pass. Their predictable failure demonstrates how little this knowledge relates to clinical excellence and, at best, is merely embellishment. The selection of medical students least prepared for treating patients is due to the bias of medical schools toward "hard science" applicants. It is claimed that 80 percent of complaints in a doctor's office stem from social, economic, and psychological origins. If this is true, then primary care providers need to understand sociology and anthropology as much as any other science, and maybe even more. The conviction that medicine is a science has caused overtraining and overintellectualizing. It was used to bolster the mystery of medicine.

The emphasis toward primary care has academics worried. How many neurosurgeons will agree to be recycled to treat tension headaches? What does this all mean to the profession of chiropractic? First, we should improve our training on the "caring" aspect. Patient contact and touch must be encouraged. We need to emphasize cognitive skills, those skills which allow us to help the patient decide on the right course of action for their illness. We must devalue the centrality of disease management, and increase our caring for the patient's illness. Regular ongoing chiropractic management will help patients deal with the many everyday clinical problems as well as assuring them of our capacity to refer them to another professional when necessity demands prompt attention. Bad lifestyle habits have more to do with the loss of health than all the missed checkups. The chiropractic profession must not buy into the nonsense that only a person trained to the level of a general internist can distinguish serious disease from innocent complaints. The chiropractic physician doesn't need a general internist gatekeeper acting like a second lieutenant, leading us like a bunch of army privates.

It is time for the chiropractic profession to stand up for our patients. We must decide what are good chiropractic guidelines, we must decide what are good chiropractic standards, and we must fight all managed care companies who want to impose their business standards on us. Yes, science is part of our chiropractic culture. It is fun to learn, it uplifts our daily routines. Science helps us understand ourselves, and how things work but science is subservient to caring, helping and assisting the sick patient. Chiropractic must support the needs of patients and not fall prey to the blind obedience of science, which after time is tomorrow's fiction.

References

  1. Dawson B, et al. Performance on the National Board of Medical Examiners Part I examination by men and women of different race and ethnicity. JAMA 272:674-679, September 7, 1994.

     

  2. Davidoff F. Is basic science necessary? Clinical teaching faces a conundrum. ACP Observer, July/August 1994, page 16.

     

  3. Ibid.

Arnold Cianciulli, DC
Bayonne, New Jersey

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