The Alliance of New Mexico Chiropractors Rejects ACA's Support of "Choosing Wisely®" X-ray Guidelines
The Alliance of New Mexico Chiropractors (ANMC) has unanimously endorsed a resolution rejecting The American Chiropractic Association's (ACA) support of the American Board of Internal Medicine (ABIM) Foundation’s Choosing Wisely® campaign X-ray Guidelines.
According to Dr. Phil Uphold, President of the ANMC, "the guidelines represent nothing more than an attempt to limit the practice of subluxation based chiropractors by denying them the necessary tools for the location, analysis and correction of vertebral subluxation."
"All chiropractors who address spinal problems, regardless of their association affiliation, should reject any guidelines that deny our patients the best analysis, diagnosis, and clinical application based upon their needs and the best judgement of their doctor of chiropractic. In no way can, or should, a set of politically motivated guidelines replace the judgment, skill and experience of the chiropractor."
The ANMC resolution reads as follows:
Alliance of New Mexico Chiropractors
Resolution supporting best clinical practice with regards for radiology of patients under chiropractic care.
Whereas, the Alliance of New Mexico Chiropractors (ANMC) is a professional organization dedicated toward promotion and protection of public health through the best application of the science, art and philosophy of chiropractic.
Whereas, the ANMC believes that each individual patient deserves the best analysis, diagnosis, and clinical application based upon their needs and the best judgment of their doctor of chiropractic.
Whereas, the Statutory Chapter in New Mexico Statutes Annotated 1978, CHAPTER 61, Professional and Occupational Licenses, Article 4, Chiropractic Section 220.127.116.11, C. (1) contains the phrase “Chiropractic physicians are required to perform appropriate diagnostic procedures reasonably necessary to clinically correlate a physical examination to a diagnostic impression, … including but not limited to … conventional radiography.”
Whereas, utilization of diagnostic radiology is a scientifically proven component of the chiropractor’s clinical practice, as the role of diagnostic radiology is clinically useful in evaluating multiple aspects of human spinal anatomy, biomechanics, postural faults, misalignments, vertebral subluxation complex, and other anomalies or pathologies; and,
Whereas, the ANMC recognizes the need for scientific evidence to support chiropractic care provided by chiropractors across the state and the nation, and that the utilization of rational, evidence‐based clinical guidelines and “best practice” documents are critical ways to implement research findings into clinical practice;
Whereas, the ANMC also recognizes that clinical practice guidelines have the potential to streamline health care delivery, improve patient outcomes, and increase safety by using best available scientific evidence and broad consensus to develop appropriate care parameters;
Whereas, the ANMC further recognizes that clinical practice guidelines do not, cannot, and should not represent a “set‐in‐stone” mandate of care, as they do not take into account such critical factors as the judgment of the doctor of chiropractic and the individual circumstances and values of the patient;
Whereas, the ANMC is aware of recent publications from the American Board of Internal Medicine (ABIM) Foundation, as part of the ABIM Foundation’s Choosing Wisely® campaign, regarding the appropriateness of radiological spinal imaging for patients with low‐back pain during the six weeks after onset in the absence of red flags;
Whereas, the ANMC recognizes that entities such as insurance companies and insurance claims reviewers are using this publication to deny the use of radiographic studies to patients and deny reimbursement for such studies to doctors of chiropractic;
Whereas, the ANMC Board of Directors, while stipulating that no guideline can replace the clinical decisions made by the doctor of chiropractic during the rendering care to an individual patient, voted unanimously to support the evidence‐based science for appropriate radiologic evaluations of patients seeking chiropractic care developed by the International Chiropractors Association’s (ICA) Practicing Chiropractor’s Committee on Radiology Protocols (PCCRP);
Whereas, the ANMC Board of Directors has not been made aware of any subsequent evidence‐based radiological guidelines or protocols that would supersede or render obsolete the PCCRP’s Guidelines, including the Choosing Wisely® document from the ABIM Foundation;
Now, therefore, be it resolved
That the ANMC Board of Directors, that we re-affirm our resolution to reject the ABIM Foundation’s Choosing Wisely x-ray protocols, and instead affirm as best practices the ICA’s Practicing Chiropractors’ Committee for Radiology Protocols as published by the ICA in 2017.
Also, be it further resolved
That the ANMC Board of Directors, encourage all New Mexico doctors of chiropractic who utilize radiologic evaluations in their practice, to familiarize themselves with the PCCRP X‐ray Guidelines, which can be accessed online at www.pccrp.org.
Phil Uphold, D.C., President – Alliance of New Mexico Chiropractors
January 9, 2019
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