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Hi, I am Dr. Mark Studin and thank you to ChiroSecure for giving me this forum to share with you my perspective after 44 years in the industry and not seeing it all, thankfully. ’cause there’s a lot more to look forward to, but be able to share with you from my perspective. Of what I’ve seen and where the trajectory of the profession should be going.
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Today we’re gonna talk about clinical competency and clinical excellence and what’s necessary to take the chiropractic profession to the next decade, the next century, the next generation. So now we’re gonna go to the slides and we’re gonna start cha challenging you actually about.
A critical checkup for your chiropractic clinical competency. And really this is a test for not just you, but the entire profession. Now, I’m gonna do something I don’t often do is I’m gonna read and I’m gonna read because the words are important because clinical excellence is not a granted, it’s earned.
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Let’s be clear. You do not graduate from chiropractic school as a clinically excellent doctor. You graduate, having met the minimum academic requirements necessary to pass licensing examinations, and that’s not a criticism. It’s the same with every profession, but it’s the reality of the system.
Licensure is a threshold, a minimum threshold, not a validation of that clinical excellence. Your clinical excellence begins. After your graduation. Now, in most healthcare professions, this gap is addressed through structural residencies, intensive supervised environments where foundational knowledge is refined into clinical judgment.
Chiropractic does not have that system, and it’s a critical deficiency. We’re not there yet, and we’ve got some time to go to get there, but as a result, the responsibility shifts entirely to you, the practitioner, and continuing education. Now continuing education is not optional, thank goodness, but that is your residency and what you choose to study.
How deeply you commit and how you apply that knowledge will determine the safety of your patients, the accuracy of your diagnosis, the defense ability of your clinical decisions, and the trajectory of your career. I say that and I underscore it. Most importantly, it will determine whether you are practicing at a level of true clinical competence or simply functioning within the minimum standard.
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Knowledge alone isn’t enough. Credentials matter. You have to position yourself, and that’s what I’m really good at, is helping position people and the ability to demonstrate, defend, and communicate your clinical decisions is what separates the average practitioners from those operating at the highest level.
Just as a spoiler alert, to let you know, I’ve been tinkering with this at very significant levels for the past 14 years, since 2012, and I can tell you right now that I can account for 2.3 million additional chiropractic patients simply based on the doctor’s clinical excellence and being positioned appropriately.
And those that hi, that operate at the higher level, go at the higher level typically. Have a more successful practice. Why do they have a more successful practice? Because patients know when you’re full of crap, basically. They know. Or if you miss something that the ortho neuro picked neurosurgeon picked up that you should have picked up, and guess what?
You referral sources the one you collaborate with, the orthos, neuros, neurosurgeons. They know who’s good or not. I have one doctor in Georgia. The number one referral is an orthopedic extremity surgeon, a shoulder surgeon. He says, ’cause I know they have spine issues also almost every one, and I’m sending them to you, the chiropractor because you are the best spinal diagnostician di diagnostician.
I know you the chiropractor. You can read MRI as good as anybody. You’re great at examining cervical spine. You’re great at looking for ligamentous damage and he sends probably 15, 20 a month. To this chiropractor to be evaluated, to be collaborative, collaboratively treated with him. That’s what clinical excellence looks like.
So I have a doctor in west Monroe, Louisiana. A neurosurgeon won’t see the patient unless the chiropractor clears him for ligamentous issues or laxity issues. To help define what the lesion is with an accurate MRI, using the appropriate slice sequences. All of these things are critical, but then when we look at Spine Journal in 2017, which evaluated the correctness or the accuracy.
Of general radiologists reporting on the morphology of spinal disc issues, meaning are they accurate? And they come up with a 43.6% error rate, almost a 50% error rate, diagnosing and accurately diagnosing the images that you send your patients to, but yet you’re delivering a high velocity, low amplitude thrust into almost a 50%.
Mistaken diagnosis. You need to know what that is, and you need to call them out on it. You need to share that with the medical primaries, the medical specialists, they’ll know and they’ll know you’re excellent, but more importantly, you’re protecting the safety of your patient. Now, let’s do a little itty bitty quiz.
Okay, so let’s do a clinical reality check. Now, the following assessment is designed to challenge your understanding of spinal pathology and the types of cases you see every day. It’s not academic trivia. This is the knowledge that directly impacts your patient outcomes and risk. These are patients you are seeing in your office every single day have these issues.
The first question, myelopathy can be caused by, first you have to know myelopathy is, so the answers could be cord compression, cord abutment, increased cerebral spinal fluid pressure, A and B, only compression or abutment, or all of the above. The answer is E, all of the above. Number two on a T two weighted image assist typically appears as high signal, low signal, intermediate signal, or variable based on level.
The answer is a high level. Number three, myomalacia and cord abutment can appear the same. There are two separate issues. One is swelling and one is contracted. But can they appear the same on an MRI? And the answer is true. It can. Is cord compression possible in the lumbar spine? Now, that’s a tricky question because you have to determine where does the spinal cord end and then can that happen in the lumbar spine?
The answer is yes, it can happen in the lumbar spine, but there’s very specific circumstances. Five. The following could cause cord abutment, a herniated disc, a bulging disc, a varis. What’s a varis, an appendamoma, or is it only a herniated a bulging disc, or is it a herniated bulging disc and a varis? But the answer is all of the above.
Now, the following could cause cord compression. Again, the first is cord abutment, and the second is cord compression. The same choices, herniated, bulging disc a viruses. Appendamoma, a variation of A and B, A, B, and C, and the answer really is all of the above on both of them. It’s all of the above can cause a chord abutment, but you have to know what those things are.
A vertebra becomes pathological with translation. Okay. Of what? A translation at what level? Okay. So the answer is translation. It should say not what? Wait, but I, it should say width. Okay. I apologize. I can’t change it right now. It should say width. Width, is it one millimeter of translation? 0.5 millimeters, 1.2 millimeters, 0.78 millimeters or 0.58 millimeters.
And the answer is 0.78 millimeters. So these are seven standard basic questions. Every spine specialist should know, and you folks are a spine specialist. Almost every ortho neuro neurosurgeon, pain management knows these answers because it’s beat into them in their advanced training, not in their basic training to become a medical doctor in their residencies through their continuing medical education.
So the answer is, or the issue is if you got so, so by the way. Where do you really stand? Now? If you disagree with any of the answers, that’s fine, and I welcome a phone call to discuss your dis your opinion. But in clinical practice, opinions are irrelevant without literature-based support and defensible reasoning.
If you’re gonna call me, you best be prepared, okay? You best be prepared. You n and these are stuff you’re gonna have to know this stuff. So let’s look at your score if you got one wrong. Out of all of these, if you got just one wrong out of all of these, Hey, you know what? You need a little clinical brush up.
You’re on track, but you’re not finished. Okay? Clinical excellence requires consistent refinement. The targeted brush up is appropriate, but if you got two to three incorrect answers, you have gaps in your clinical foundation. It must be addressed and they must be addressed At this level, patient safety is compromised.
Diagnostic accuracy becomes inconsistent. Clinical decisions become difficult to defend. Immediate action is required if you only got two to three wrong. So I urge you. Take primary spine care number 15 and number 18. Okay Each are valid for 12 chiropractic CE and medical CME credits. You get COC credentialed through chiropractic and medical academia.
That’s all good for CE in almost every state in the country. But the point is you need real advanced academics to help you to understand this stuff. If you got more than three incorrect, this is no longer a matter of improvement. It’s a matter of risk. It’s a matter of risk. You’re a level of clinical understanding, may place patients in harm’s way and expose you to significant professional liability.
This demands immediate structured intervention. The recommended pathway is primary spine care, 15, 16, 17, and 18. Each of them are good for 12 CE credits for chiropractic and medical. You’ll get an incredible foundation there. By the way, the courses I’m giving you are just the beginning of where your EEC academics should go.
This is about meaningful educ education. What do I need to know? I can close my eyes and adjust, oh, I’m gonna grow hair in a cube wall. Okay, I’m gonna get ’em. No, there’s a lot more to that. Remember. Your responsibility is diagnosis, prognosis, and treatment plan. First, you have to know what’s wrong with them.
You come up with a conclusive diagnosis, then you need a prognosis. Can I help them? And how long will it take? And then lastly, what is the appropriate treatment plan? What am I gonna do? It’s not, okay, lay down, let’s start treating. No. And here’s a hard mark rule. Something I created 26 years ago when I started consulting nationally, and something that was beaten to me 44 years ago when I started in this industry.
If you don’t know, don’t touch. Do not touch. Oh, there’s pain radiating down the arm. What’s causing that pain radiating down the arm? Is it a varix? Is it a Pendo? Is it a herniated disc? You have no clue, and you might not even know what those words mean, but you have to. You could hurt somebody irreparably, and that’s on you.
Hippocrates said, doctors do no harm. That’s your first credo. But in order to do no harm diagnosis, prognosis, treatment plan. And if you don’t know, don’t touch. Folks, the next step is you need to take control of your clinical future. If you’re serious about elevating your clinical standard, not just appearing competent, but demonstrating and defending excellence, we should have a conversation.
Here’s my cell phone number. Call me, gimme a chat. I’m happy to talk with you. I’m not here to sell you anything. I’m here to help you be better doctors. I’m here to help chiropractic if every chiropractor understood those questions alone, intimately. Our profession would be just so much better. I will help you identify exactly where you are, where you need to be, and the most efficient path to get there.
My mission, the chiropractic profession does not currently have a residency model that is a systemic limitation, but not an excuse. My mission is to close the gap through meaningful, high level continuing education that produces measurable improvements in clinical competency. Patient safety, case outcomes, and professional credibility.
Clinical excellence is not a given. It is built deliberately, rigorously, and continuously and is your responsibility. So folks, my name is Dr. Mark Studin. Thank you so much, Kyra Secure for being able to share that, to allow me to share this with you and where the chiropractic profession goes From here is purely dependent upon you.
We’ll catch you next time. Thank you.
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