In The Pivot Review, Volume 2, Number 2, there was an essay on Neurological Orthopedic Tests being performed by chiropractors. The article basically addressed the fallacy of straights using the tests to determine the absence or presence of vertebral subluxation. There is now, however, a new approach by some D.C.s. They are using them to determine the safety of chiropractic care. The chiropractor will claim he/she is not making a diagnosis, but merely determining through these tests whether it is safe to introduce an adjusting thrust. The argument is used that a straight will use a case history and x-ray to determine safety of adjusting in a certain area of the spine, why not N.O.T.s? There are numerous arguments against straight chiropractors using N.O.T.s to determine the safety of an adjustment. Obviously, mixers should use them for they are determining whether to treat a patient for a specific disease or condition and must know what that condition is. Perhaps something should be stated right now, lest any chiropractor misunderstand the straight chiropractic position. It is the position of the Federation of Straight Chiropractic Organizations in their Chiropractic Standard of Care/Patient Safety that: “clinical responsibilities are . . . C. to determine the propriety of chiropractic procedures” (Chiropractic Philosophy, 208). This determination is a necessary part of the practice of straight chiropractic care. With that said, let us look at the arguments against using N.O.T.s from a philosophical, practical and legal standpoint. First, philosophically it is unsound. Chiropractic is not medicine. It has a different objective, different terminology, and different procedures. Medicine is locating and treating the presence of something (disease), chiropractic is restoring something that is absent (ease). If chiropractic is to maintain the uniqueness its philosophy dictates it must endeavor to look less and less like medicine, not more and more.
But most of those advocating the use of N.O.T.s are not concerned with philosophy so let us look at the practical reasons. The first and foremost reason is that N.O.T.s do not tell you whether to adjust an area or not. Every chiropractor who has been in practice for some time or seen a number of patients has had numerous cases to prove this. A patient will come into the office saying they have been medically diagnosed as having a herniated disc, and told that surgery is needed. The chiropractor, based upon his evaluation and whatever criteria he uses, determines that it is safe to introduce a force into that area of the spine. He does so and ten years later the patient is still under care, still apparently healthy and still without the spinal surgery. Maybe the D.C. was lucky, maybe he was foolish, or both, but the point is that a patient who has positive responses to N.O.T.s is not necessarily ruled out as being able to receive a chiropractic adjustment, even in the involved areas. Thousands of chiropractors are knowingly adjusting in areas where people have disc problems, osteoporosis, vascular deficiencies and are not causing any problems. Thousands of chiropractors, mixers and straights alike, are unknowingly doing the same thing and are not causing any problems. In fact, when it comes right down to it, chiropractors causing a problem by their adjusting is so rare and unusual that it does not even seem worth the discussion. It seems that some of the straights have bought the mixer lie that our non-diagnostic care is going to injure people. Yet, history and malpractice statistics would argue that it is not even a problem. Those few cases that do occur can easily be prevented by a little common sense, improved adjusting techniques, and procedures that are not inconsistent with our philosophy. N.O.T.s are not a logical approach for chiropractors, simply because they are not accurate for chiropractic care. They were designed to determine the presence or absence of a medical entity, not presence or absence of a vertebral subluxation. They were intended to give medical information, not to tell the chiropractor whether it is safe to adjust in a particular area. You cannot use anything for a purpose other than what it was intended for and expect it to do an adequate job. Razor blades are for shaving, not for sharpening pencils, automobiles are for driving on roads, not plowing fields, and N.O.T.s are not intended for determining the safety of chiropractic care. They are simply inadequate for the task. Let’s find something that is adequate, and is consistent with our philosophy rather than falling back on procedures which are questionably adequate for the purpose in which they were intended (medical) and in no way adequate for our purposes.
The last area to evaluate is the legal one. Obviously all these areas are interrelated. That which is philosophically sound is also logical and presents the legally safest approach. N.O.T.s are a screening process used by physicians to diagnose and determine the appropriate treatment. If a chiropractor does these tests and his/her records indicate it, he/she is professing to have a level of expertise which he/she will be judged by. N.O.T.s are merely one of the first steps to determining a diagnosis. If you perform these steps and do not follow through with the subsequent procedures such as CAT Scan or MRI you could be judged to have deviated from the accepted standard of care. What I’m saying is that you cannot pick and choose which aspects of medical procedure you want to do. If you start down the medical road you better be prepared to go all the way. A well-known malpractice case took place in New York some years back where the D.C. did certain diagnostic tests and then claimed he did not diagnose and he hence was not responsible for a condition that the M.D. expert witness said any third year medical student would have determined. The jury ruled against the chiropractor, the judgment was in excess of three million dollars!
It is clear we in chiropractic must have standards of care and procedures to determine patient safety. But adopting medical procedures is not the answer. v8n2