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The legacy continues.

In addition to our annual educational license renewal requirements (which all professions have), boundary training was added to our state's agenda.


Boundary Training!! ... I often thought that rather than have the focus only on anti-sexual doctor-patient education, there is more to the boundaries of practice than sexuality. Our boundaries are not only set in moral and legal stone, but our boundaries as doctors are defined by our personal fortitude, based on our knowledge, and desire.

Sexual prowess has no place in professional service. It is unethical behavior and should not be tolerated. This narrow scope of boundary training is important in clarifying what "it" means, and what is meant by sexual innuendo. I've heard this presentation several years and it doesn't seem to vary. I think I've got it: keep your hands to yourself in any kind of sexually suggestive manner, and when you are treating any member of the opposite sex (yin/yang) always have a staff member present to remove any doubt of inappropriateness or malintent.

Some of the boundaries/limitations set forth toward our ability to provide for our patients, with no further ado in regards to sex and other inappropriate professional behavior include cancer, infectious disease, inflammatory disease, and emergency situations. These are listed in the order of which they came to mind. There are probably more, but it is my hope that these and their subsets will serve to point out and guide toward enlightened personal goals. As Grandad, Dr. A. J. Kessinger so aptly said, "You can do whatever you're big enough to do."

Cancer treatment is legally a medical bailiwick; however, the diagnosis of the likelihood for, and the treatment of, the sequelae of cancer is well within the scope of chiropractic. Such endeavors should be of paramount stature within the chiropractic physician's mind's eye, whether with direct personal involvement or indirect application, via a surrogate chiropractic internist utilizing DABCI principles and protocols The services offered by the orthodox medical oncology department is, at best, lacking. To take up the slack in an intelligent attempt to provide individually optimal health care, even to those with "terminal disease," it would behoove us to strive toward their allowance of necessary nutrients essential to ramp up their recuperative capabilities to the max. It is not humane to allow patients and their family members to suffer the mal-effects of palliative treatments with the misunderstanding that there is nothing else that can be done. When was the last time anyone recalls an orthodox oncology department recommending, much less acknowledging an alternative form of treatment even when theirs is of admitted no hope? This is a void in the world of oncology; an absence of ability or willingness to look outside the accepted scope of tradition to solve a life threatening conundrum with increased quality of life; that chiropractic is not only suited for, in its holistic DABCI form, but was created to provide.

Treatment of infectious disease is another topic for analysis. An infectious disease is a disease caused by bacterial, viral, fungal, or protozoan infection. Though some infectious diseases are not contagious, others may be transmitted from animal to person (bird flu and cat scratch disease) or from person to person (MRSA, STDs, etc.). Among the almost infinite varieties of microorganisms, relatively few cause disease in otherwise healthy individuals. As a portal of entry into the professional health care delivery system, a physician must be able to define the severity, or the potential severity, of their patient's condition, and provide a reasonable and informed decision of treatment options from which the patients or their representative may choose.

Although the main emphasis in our clinic is to provide a good offense i.e., prevention is the best medicine there are many times in which a patient presents with an infectious condition that can be successfully treated with natural methods. A positive streptococcus pharyngeal screen in a child doesn't dictate antibiotic usage, but it does require a doctor's supervision to evaluate the successful eradication of a potential cardiologic pathogen. Pneumonia doesn't require emergency medical care unless the natural means of treatment fail to provide ample oxygenation and recuperation. By monitoring and maintaining an individual healthy im-mune system and utilizing a conservative chiropractic approach, optimal health most often can be restored and maintained without the use of pharmaceutical intervention. However, it is wonderful that we live in the day and age of advanced emergency medicine. If natural means fail to achieve set goals of recovery in a specific period of time, as noted by diligent testing and retesting, then advanced emergency medical care will have ample time to render its desired effect. If, on the other hand, the patient with the infectious disease is one who always succumbs initially to unscrupulous antibiotic therapy, there will most likely become a time when his friendly bacteria will rebel against the antibacterial onslaught, and metamorph into a pathogenic resistant bacteria potentially resulting in impetigo or MRSA-like infection.

Inflammatory disease and emergency situations, such as appendicitis, heel spurs, and car accidents bring the boundary lines of practice to mind in similar yet diverse manners. In the case of appendicitis, a condition thought to be an emergency medical bailiwick, hospitalization is not always necessary initially: however, I've always found solace in the fact there's an emergency room right around the corner. I've successfully treated several of these, but the one I didn't inform of the diagnosis went to the hospital where the surgeon said, "You got here in the nick of time, because it was ready to explode." Heel spurs seem to always be amendable to natural means, but this is not to say that I haven't had patients that sought surgical intervention before my treatment protocol was fully implemented. Sometimes the only thing you can do with people is just love them, because you are not in control of anyone but yourself. But you should always act with informed consent, and the only way to keep your patient informed is to be informed. In the last menioned situation, I treat a lot of car accident victims. I haven't seen any of them in my office while they were still visibly bleeding; however, I like to perform a complete blood test to ascertain if there are any internal blood loss. If I'm in a car wreck I want to go to the hospital, if I am bleeding. Medicine's greatest benefit is keeping its patients alive; however, its greatest weakness is its refusal to look outside of itself to prevent people from needing its service. That almost makes sense too.

These are but a few boundaries in which we need to consider expanding. Bubba's line, "It depent on what you mean by "it" still doesn't hold water. There are some boundaries that are never to be crossed, much less to even get near, while there are others that we need to expand for the benefit of those we serve.

You don't to do things the way they have always been done just because they've always been done that way. in the 1800's tomatoes were considered poisonous in America while Europeans routinely consumed them.

Don't let the tomato effect hold you down.

by A.Jay Kessinger IV, DC, ND, DABCI
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Author:Kessinger, A.Jay
Publication:Original Internist
Geographic Code:1USA
Date:Jun 1, 2008
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