CF 153: Some Chiropractors Could Be Better Today we’re going to talk about chiropractors, the subluxation – vitalistic group in our profession and we’ll probably make some grumpy vitalistic enemies out of these chiropractors in the process. But first, here’s that sweet sweet bumper music
OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. If you haven’t yet I have a few things you should do.
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You have found yourself smack dab in the middle of Episode #153 Now if you missed last week’s episode , we talked about spinal instability clinical pearls and we tal ked about degeneration and the facets. That was some good stuff you need to to have in your back pocket. Make sure you don’t miss that info. Keep up with the class. While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function
On the personal end of things…..
I’m doing hte same stuff you’re doing for the most part. I’m just struggling through this second wave of COVID. Trying to stay smart and trying to stay healthy. I wish I could say the same for everyone around me. For example, I just had a staff member start this week off by telling me she started working a part time job on the weekends because she got an apartment she thought she could afford but it’s not as easy as she thought. Anyway, at this part time job, her buddy drank out of her drink. She’s like, oh well, it’s just my friend. No big deal. Yeah, no big deal friend called her today…..2 days after that…..and is feeling bad and going to get tested. Now, does that mean my girl has it? Of course not. The friend wasn’t even symptomatic so the chances are low she has it in the first place and if she does have it now, the chances she was shedding the virus then are low.
Still…..come on man. Be smart. My daughter goes to school with 1000 plus kids every day and I don’t let her take a sip of my drink or anything like that. Much less a buddy at my part time job. Hell no. hell no. So those are the things we get to battle with, right? We can control everything about what we personally do but we can’t control our kids at school with their friends. We can’t control my other kid at college and his behavior. We can’t control our staff when they’re not here at work. We just do our best, keep our fingers crossed, and keep working diligently. And hopefully safely. Not because I’m necessarily scared of getting it. Mostly because I don’t want to shut my practice down for 2 weeks minimum. Who can afford that? So let’s get on with pissing people off, shall we?
If you don’t understand by this point that there is a divide in our profession that simply cannot be healed, tied together, or unified, well….I don’t know what to do for you. You just need to pay more attention. If at any point you have thought the two groups could come together, you are fooling yourself. This profession either needs to be split into two completely different degrees and entities or the vitalists need to practice their minimal practice and sit in the back seat and shut the hell up. Yep….shots fired. I know. I’ll explain more as we go. Every now and then I get fired up and this is one of those times. I’m triggered. I’m the grumpy old ‘get the hell off of my lawn’ guy. More specifically, I’m ‘raise your damn game and quit actiing like fools’ guy.
I should tell you why I’m triggered first. As our listeners are well-aware, I am a member of lots of Facebook groups but the most notable would be the Forward Thinking Chiropractic Alliance. Most friends and family would classify me as conservative in finances and life in general but when it comes to my profession, I’m all about progressive change and forward momentum. So this group fits me very well. Anyway, one of the members posted a screenshot of a doctor – trust me – I use that ‘doctor’ term extremely loosely here – it was a post of this guy claiming that with one table, by himself, he treated 99 chiropractic patients and 9 new patient exams all in 3 hours. I did the math for you all. That’s right at 2 minutes per patient.
Well, for many of us, that’s not too far off of the mark for established patients. Some of you are boutique practices and spend 30 minutes to an hour with each patient and charge out the wazoo for that. But, for most of us, we are adjusting, passing off to our staff for therapy and rehab and moving on to the next patient. I want to be fair here. My face to face time is typically 3-5 mintues with an established just depending on what questions I have to answer, if there’s a new complaint popping up that needs evaluated, new patient education, and things like that. Some slightly less than 3 mintues, some quite a bit longer than 5 minutes.
Now, my patients’ whole visit will clock in on average around 20-30 minutes after therapy and/or rehab but that is delegated to the staff. Here’s the real kicker for me on this joke. The new patients. I can not get past the new patients. Now I’ve seen 7 or 8 new patients in a day while juggling another 50 or more established patients. But damn man…that’s over the course of a 7 hour day. And, while I don’t think it makes me particulary any more special than anyone else, I have a Fellowship in neuromusculoskeletal medicine. I can come to a diagnosis somewhat quickly when compared to others. Still, my exam, unless it’s a simple rib complaint or something easy like that, it’s going to take 30-45 mintues. Easy. And that’s with staff doing their history and intake part.
Them filling out OATS takes time on top of that. Plus, I recorded a 7 minute, ‘Welcome to our practice’ video they all watch. Look, there’s no damn way on this damn planet anyone calling themselves doctor works that many new patients through in 3 hours while juggling 99 established patients and claims they’re doing a good job. No way now how. Nope, no, negatory, NO! Worst of all, he’s a vitalist, practice management guru so he’s offering to show other, impressionable knuckleheads how to mistreat patients all on their own.
Solo crappery if you will. Crappy treatment all by themselves. With his crappy guidance. What a crappy deal. I have 34 mutual friends with this person and that’s just disappointing. It truly is. Many of you know who I’m referring to but I see no point in mentioning names because the last thing I want is to bring him even more attention. Especially when I don’t see the reason even one person would pay him any at all. I have no way of knowing how long they’re spending with new patients but let’s just agree that it’s not 30-45 minutes.
There’s no way. I know this because if he spent 30 minutes with each of the 9 new patients, that would be about 4 and a half hours. Much more than the 3 hours he talked about in the post. We are forced to assume it is much less than that. So let’s play with the math. Three hours is 180 minutes. I think we can all agree on that. A former attendee to one of his seminars said he bragged in the seminar that he could adjust a patient top to bottom in just 30 seconds. As a sidenote, he taught how to have the trash can right next to the door so that he could tear the face paper and grap the door knob in one smooth motion so as to have the door open and showing the person out before they’re even off of the table. That way, you don’t have to talk to them. So you don’t have to talk to the patient……you get that?
Good Lord, can you imagine a doctor having to speak to their patient after treatment is provided? The horrors!!! Anyway, let’s say 30 seconds is his record but it actually takes one minute on average per patient. If 30 seconds is the fastest, can’t we assume there will at least be some greeting involved in the appointment? Some questions from time to time? There may be some 30 second appointments in there but there may be some minute and a half and some two minute appointments as well. I think that’s fair.
So, if each of the 99 established takes an average of one minute, which is stillsubstandard care by the way, if they all average one minute, then that leaves 81 minutes to examine and evaluate 9 new patients. That means he has roughly 10-15 minutes for each new patient to do the following if he’s going to adequately assess the patient and have a specific diagnosis outside of subluxation slaying and spine whispering. He’s got to:
- Review the history taken by the staff before he came in
- Review the range of motion if taken in advance by the staff
- Review the vitals
- Meet the patient and listen to their story
- Assess gait
- Assess standing posture
- Check yellow flags and discuss any that are present with the patient
- Check for red flags – not everyone needs x-rays
- Check reflexes
- Check dermatomes
- Check muscle strength (not freaking AK)
- Check neurodynamic positions for radiculopathy
- Assess for Ehler-Danlos and hypermobility
- Check orthos
- Check neuro testing
- Check for extension/flexion bias positions in some cases
- Come up with an accurate diagnosis
- Educate the patient on their diagnosis
- If chronic pain is part of the case, he has to educate on CNS upregulation and the biopsychosocial aspect of pain which is at least a 5 mintues conversation.
- Teach proper movement and biomechancis to remove the daily pain triggers
- He has to answer questions the patient may have
Hell, I wonder if he’s ever had someone lay on their stomachs propped on their elbows for 3 minutes to see if they can identify a home self management strategy for their low back pain? Hell no. Three minutes wouldn’t fit into this doctor-centered model. I have no way of knowing but I’m guessing the exam consists of ‘checking subluxation’ and telling them to lay down.
Pop, pop, pop, the ridiculous power is on, see you tomorrow for you next life-saving adjustment. It’s silly. And it’s insane. And it’s not evidence-based. And it’s not patient-centered. It’s not special. It doesn’t take talent other than being able to sell targets garbage. It’s the lowest common denominator and nothing more.
The point being made here is that one cannot do an adequate, responsible, and appropriate exam in this amount of time. And assuming they average only one minute per patient face to face, that’s substandard as hell. Would you want your kid or brother or sister or mom or dad shuttled through an office like a bullet from a gun? Or would you want them to go to someone that cares, connects with them, slows down a tad and takes their time to listen and work with them? The answer is obvious and if you tell me you’d rather your family go to this guy or anyone like them, then you’re just being obstinate and disagreeable.
It’s obvious which style is superior in healthcare. Maybe working on an assembly line you’d like to see fast, efficient, and little attention given to the specifics. But not in healthcare. This model, I’m sorry to be blunt here….this model is garbage when we are working with the breathing, ever-changing human body. And….oh this guy loves him some of him. Oh my goodness. If someone likes to look in the mirror every morning, it’s probably this guy. Now, he’s selling his unique brand of BS to others. He’s doing a good job of it too. He’s got sycophants all over now learning how to shuttle them out of the office without having to speak to them.
They’re in the comments section of this post proclaiming him a rock star! BS. Rock on! I can’t wait to do this when I get out of school! You’re an inspiration. How awesome!!! Blahditty freaking blah. BS, BS, BS. I would comment, “What an embarrassment to our chiropractic community! What a fool! What about exercise and rehab? What about quality over quantity? You give our profession a bad name. You’re one of the reasons we have zero cultural authority and can’t pass a bill in the legislature because you and your followers are irresponsible!!!” You know….things like that. Now, I’ve been asked why I talk bad about other chiropractors.
Running them down and such. I don’t call it that at all. I call it policing our own and calling out BS when it’s right under your nose. I don’t know about you but I don’t want BS under my nose. It stinks. And not only can I smell it, but everyone else I come into contact with smells it as well. So, basically, these people’s actions reflect on me, my business, and my livelihood. And yours as well. So if you’ve been going along to get along thinking it doesn’t matter, it does matter. It matters to your bottom line.
Can you imagine if we were to have more cultural authority and more integration into a regular healthcare protocol…..can you imagine how full our offices would be? Low back pain is the number one reason for disability globally folks. Yet we only see 10% of the damn population. It’s obvious why and the Palmer Gallup poll laid it out. The biggest reason people don’t go to chiropractors is because they don’t freaking trust us. Because of fools like this. Lots of high volume clinics like this slay subluxations non-stop for weeks and weeks. Some see people every week for life. Think about a self-adjuster. The more they did it, the easier it got to the point they created instability in their neck, they have consistent chronic pain, and now they’re a mess.
Can we see this happen in patients that are adjusted too often for too long? Of course we can!! These spine whipering TORs are many times creating instability and causing chronic pain. Which is the damn thing the knuckleheads are supposed to be treating in the first place. But they were too lazy to get educated beyond college and some continuing education each year about proper documentation and how to adjust an elbow. What if they have a hypermobile EDS patient that really needs weight training but they just keep hammering away at what they call subluxations? This is low quality garbage for people that aren’t taking the time to properly evaluate their patients in the new patient exam. In one of his videos he says, “The patient doesn’t care about anything other than does the doctor care and can he help me?” Again, I use that doctor term exceedingly loosely. I have to just say that he is 100% wrong. Yes, patients do care about those two things but you know what else they care about?
They also care that their doctor is smart. Is on top of his game. Is making decisions in the best interest of the patient and not the clinic or the doctor’s wallet. They care about proper biomechanics so they don’t re-injure their back. They care that if they’re hyper mobile, maybe they shouldn’t be adjusted and should focus on weight training instead. They care that a slight decrease in neck curvature isn’t really the harbinger of death and disease some chiros act like it is. They want to know their doctor is making decisions on their care based on accurate diagnoses. Is making decisions on their care based on research and not philosophy. Trust me, they care about a hell of a lot more than How incredibly arrogant of this supposed doctor to think he has the only answer to what patients care about. They’re not freaking sheep with little to no thought processes.
They’re smart as hell in many cases and they absolutely care about a whole lot of stuff is missing. Saying they don’t is selling them short and it’s unfortunate that he’s going around teaching that. One more example of him being doctor-centered rather than patient-centered. “I….the doctor….knows what the patient really wants and cares about. They can’t think for themselves.” Garbage. Of course patients don’t care about the biopsychosocial aspects of pain. They don’t even know what the hell that is. But we as professionals should absolutely know and absolutely care and leverage it to our advantage. We should know about upregulated CNS and educate patients about it. Because it matters. The question might be, “Why would people keep going back?”
Well a lot don’t but, in general the ones that do have typically had the crap scared out of them based on x-rays that usually shouldn’t have even been taken in the first place. “Looky here, loss of curvature, that is so concerning. I’m really worried about this and what it means for your future if we don’t get that fixed. That’ll be 58 visits this year at a cost of $4800. That’ll be upfront and here’s the contract to hold you to it.” Predatory, unbelievably unethical, astoundingly unprofessional, and embarrassing. Fro every patient referred to a clinic like this, I’d guess they lose one that thinks they and every other chiropractor on the planet is insane.
Thank you vitalists. I really appreciate it. So much. thank you. Clinics like this only see their successes. So they think they’re amazing. I’ll be honest, I see A LOT of patients coming to see me from practices like this because patients can’t stand being shuttled through like cattle, not being listened to, feeling that the care is substandard, being scared by the doctor into treatment, being scared into contracts, and things of that sor They feel taken advantage of and they don’t like it. And I don’t blame them. I just appreciate them for giving me a chance to show them that the majority of chiropractors don’t engage in foolish crap.
That we can play an integral part in resolving their pain. I have heard the most embarrassing stories about chiropractors from patients that escaped clinics like this. A chiropractor can still focus on subluxations but do it in an evidence based, patient-cantered way. Wanna help more people? Hire more docs to handle that patient load and be able to have the time it takes to spend with the patients to do a proper job. Serve more people. Just hire more people to do it. I just want better from this guy and people like him. I want a standard in our profession. I want more from our profession. I want to have a conversation with someone in the medical field or someone that knows very little about chiropractic and not feel the need to apologize for guys like this.
He’s clearly a talented guy and a leader on some level. I just wish the talent was more focused on evidence-based, patient-centered endeavors. Basically, I don’t have a problem with people practicing under the subluxation model when they’re not advising against vaccines. We didn’t learn enough about them to be a damn authority on it. Stay out of the conversation either direction. It is not ours to have. Can you imagine telling a mother not to get a baby vaccinated and then the baby gets measles? Steer clear of that conversation. Anyway, I don’t mind people practicing that model. At the end of the day, we are all moving bones. The adjustment is the cornerstone of my practice but it’s only a piece of my practice. IT’s not the end-all-be-all. IT’s a puzzle piece but the piece is the biggest piece of my puzzle and it’s right in the center of the puzzle. Nothing more nothing less.
It’s not spiritual. It’s just a really big, very effective tool I have. My issue is the thought that a thorough and comprehensive exam is not necessary. That connecting with patients is not important. That talking with them, answering their silly questions, and educating them is not important. It all is very important and all of it, like it or not, takes time. It just does and time is a constant we must all contend with and work within the contraints of. So….that’s me, folks. Raw. And mostly censored because trust me, I cuss like a sailor when I’m not on this podcast. I could make this discussion so much more colorful and it’s deserving of the cuss words. I know many of you know this guy and you think he’s the bees knees and you’ll probably tune out here and think I’m just an awful person because
I’m talking this way about him but here’s the deal, we cannot let quackery and foolishness not only permeat what should be an evidence-based, patient-centered healthcare discipline…..but it is pervasive. Not only is it permeating, but it’s pervasive. You don’t have to look far to find a sycophant. I have 34 nutual friends with this knucklehead afterall. What more do I need to say? So, more akin to the medical field, we should recognize BS, we should call it out, and we should educate against it. And that’s what I’m doing. Every week. It’s not the subluxation-based thing that gets me. I’m used to that. It’s the culture around it that is insane.
Don’t vaccinate, as long as you stay adjusted, don’t worry about COVID, or any other disease, I say a knucklehead guru in school telling me adjstements pushed cancer out of guy’s body. Come on, man. When New Mexico had a shortage of practitioners and allowed chirorpactors to go to two extra years of education to get an advanced practitioner certificate to help prescribe and help handle the patient load, you know who showed up to testify against their own colleagues? Vitalist, subluxation-based, crazy-eyed imbecile chiropractors holding on to green books, the words of BJ, and a philosophy created in the late 1800’s.
Yeah, great look folks. You know who is against the ACA’s push for Medicare parity? Yeah, not just the usual suspects like the AMA. Nope, hell, the AMA’s best teamates against chiropractic are the vitalists. Yeah, I’ve seen the sychophants of Matthew McCoy railing against us being treated equally under Medicare. Explain that for me….someone….please explain that. Again, it’s not the subluxation. I don’t personally use or care for that word or philosophy but that’s not it. IT’s the insane leaders of that cult and the culture surrounding it that makes me want to punt baby bunnies into the damn stratosphere. So, if you’re a subluxation person, my beef is not with you as long as you’re not scaring and taking advantage of your patients. As long as you’re not telling them to see you 80 times this year to keep them healthy and all that. I have no beef with you.
Especially if you’re a Christian. Telling a patient that they were made imperfectly by a God you put every bit of your faith in makes no sense. at all. Y’all I’m a Christian. God makes no mistakes. He didn’t put us on Earth imperfect and in need of a chiropractor every week of our lives or be a miserable wreck of a person just waiting around on death’s doorstep. What a foolish concept for the faith-based models out there. The Body By God group. It’s silly. Sure be faitful, no problem there. But don’t tell people that they need you.
Otherwise, God can’t express himself fully without you. Yes, that is one of their talking points in case you were wondering. Insanity. Current guides tell us to use spinal manipulative therapy for movement dysfunction, use exercise and rehabilitation, use low level laser, use heat, yoga, acupuncture, and soft tissue manual therapy, use balance and proprioceptive training as well. These are all ways of leveraging modalities to great effect in resolving pain. They also teach us to NOT create dependency in the patient upon us.
They shouldn’t depend on us. We should be teaching them ways to self manage ongoing pain at home and see them for periodic flare-ups. That’s evidence-based and that’s patient-centered. 180 degrees opposite of what this practice I’m speaking about is doing. There are so many amazing chiropractors in the world that have raised their games to such a level that they can command respect and money for their opinions and treatment. Then…..there just aren’t. They’re educationally lazy but they can sure talk a great game. I’d like to see eveyrone raising the level. Raising the standard and taking this profession into an era of growth, progress, and respect.
It’s called “The disappearance of the primary care physical examination – losing touch” by Dr. Paul Hyman(Hyman P 2020), and MD and it was published in JAMA on August 24, 2020. Damn the sizzle!!
It’s an article so high points we will hit upon He starts out by asking, “What is a physica examination worth?” He says he’s noticed that physical exams seem to be falling by the wayside in recent years and that fact has been highlighted for him since looking at the daily schedule and determining which will be see face to face in the days of COVID. He says that an exam is clearly needed at times for a diagnosis but that he’s realizing other ways he commonly uses exams as well. He says it is a means through which he pauses and physically connects with patients. It’s a way to demonstrate his knowledge and authority to the patient.
He says it’s also a chance to persuade patients and reevaluate their narrative. On the part about demostrating your knowledge, what are you demonstrating when you do a minimal, piss ant exam? Whether you know it or not, you may be demonstrating your lack of knowledge, right? Especially when that patient has had enough of your crap and goes to someone that knows what they’re doing. When the patients say, “This is awesome! The other chiropractor didn’t do any of this,” well, we have a pretty good idea of where you’ve been before getting to us. He goes on to say, “When patients and I disagree on a plan, the physical examination not only provides data, it also acts as an arbiter.”
He makes an excellent point here when he says, “In an admission of my own insecurity, the physical examination remains one of the few domains where I maintain a sense of professional skill and authority. I have never been much of a proceduralist. The mainstay of what I offer to patients is the ability to listen to them, to use critical thinking skills, and to offer my knowledge and experience. But those skills are sometimes challenged in a world where patients research their own health and develop their own medical narratives.
The physical examination remains a place where I offer something of distinct value that is appreciated.” You cannot make a difference in patients’ lives when you don’t know what the hell is wrong with them because you didn’t have the knowledge it takes to be accurate or because you only took 10 minutes to examine them. CHIROUP ADVERTISEMENT
This second item is called “Chiropractic, one big unhappy family: better together or apart?” by Leboeuf-Yde et. al. (Leboeuf-Yde C 2020) from February 2019 and published in Chirorpactic and Manual Therapies.
Again, it’s an article so hittin the high spots. They say that the profession has a long history of internal conflict. Today, the division is between the ‘evidence-friendly’ faction that focuses on musculoskeletal problems based on a contemporary and evidence-based paradigm, and the ‘traditional’ group that subscribes to concepts such as ‘subluxation’ and the spine as the centre of good health. This difference is becoming increasingly obvious and problematic from both within and outside of the profession in light of the general acceptance of evidence-based practice as the basis for health care. They argue here that the situation within the chiropractic profession corresponds very much to that of an unhappy couple that stays together for reasons that are unconnected with love or even mutual respect. We also contend that the profession could be conceptualised as existing on a spectrum with the ‘evidence-friendly’ and the ‘traditional’ groups inhabiting the end points, with the majority of chiropractors in the middle. I personally call the ones in the middle agnostics.
They take a little subluxation/innate talk to heart but think evidence-based is the way to go but are not motivated about learning any of the evidence and research. Or just don’t know where to go to find it. They say this middle group does not appear to be greatly concerned with either faction and seems comfortable taking an approach of ‘you never know who and what will respond to spinal manipulation’. We believe that this ‘silent majority’ makes it possible for groups of chiropractors to practice outside the logical framework of today’s scientific concepts. In their conclusion they say, “There is a need to pause and consider if the many reasons for disharmony within the chiropractic profession are, in fact, irreconcilable. It is time to openly debate the issue of a professional split by engaging in formal and courageous discussions.
This item should be prioritised on the agendas of national associations, conferences, teaching institutions, and licensing/registration as well as accreditation bodies. However, for this to happen, the middle group of chiropractors will have to become engaged and consider the benefits and risks of respectively staying together or breaking up.” No matter where you stand on it, it’s though-provoking and I’m sure to find email inbox filling. Lol.
I’m sure I get plenty of hate mail on this episode but I’ll get a lot of support as well. I cannot simply sit by and see BS and sweep it up under the rug. We have to meet it and stand boldly in front of it, and turn it away. For the betterment of ourselves, our profession, and our patients.
Alright, that’s it.
Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week. Store Remember the evidence-informed brochures and posters at chiropracticforward.com.
The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventativly after initial recovery, we can usually keep it that way while raising the overall level of health!
Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic!
Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms. We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.
Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
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About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
- Hyman P (2020). “The Disappearance of the Primary Care Physical Examination—Losing Touch.” JAMA Internal Med 180(11): 1417-1418.
- Leboeuf-Yde C, I. S., Young K, Kauchuk G, Hartvigsen J, (2020). “Chiropractic, one big unhappy family: better together or apart?” Chiropr Man Therap 27(4).