January 16, 2019

MAC Board of Directors Passes “Resolution Supporting the Chiropractor’s Right to Clinical Decision-Making Regarding Radiology

At the October 5, 2017, meeting of the Michigan Association of Chiropractors’ Board of Directors, the Board passed a Resolution Supporting the Chiropractor’s Right to Clinical Decision-Making Regarding Radiology. This resolution is a rejection of the recent publication from the American Board of Internal Medicine (ABIM) Foundation as part of their Choose Wisely® campaign. The Resolution notes that the MAC “works to protect the right of individual chiropractors to choose the clinical procedures within the chiropractic standard of care and practice, that he or she believes best address the patient’s complaint and/or diagnosis.”

Specifically, with this Resolution, the MAC Board of Directors fundamentally rejects the statement in the Choosing Wisely® document that states: “Do not obtain spinal imaging for patients with acute low-back pain during the six (6) weeks after onset in the absence of red flags.”

The Resolution also rejects the practice of certain entities, such as insurance companies and insurance claims reviewers, using the Choose Wisely® document to deny the use of radiographic studies to patients and deny reimbursement for such studies to chiropractors.

While recognizing the need for scientific evidence to support 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, the MAC Resolution states “that clinical practice guidelines do not, cannot, and should not represent a ‘set-in-stone’ prescription of care, as they do not take into account such critical factors as the judgment of the chiropractor and the individual circumstances and values of the patient.”

The Resolution further notes that in 2008 the MAC Board of Directors, while stipulating that no guideline can replace the clinical decisions made by a chiropractor in the course of treating an individual patient, passed a Resolution promoting and supporting the evidence-based science for appropriate radiologic evaluations of patients seeking chiropractic care developed by the Practicing Chiropractor’s Committee on Radiology Protocols (PCCRP).

As the MAC Board 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 – the Board re-affirmed the 2008 Resolution to promote and support the PPCRP’s Guidelines and recommended that all Michigan doctors of chiropractic who utilize radiologic evaluations in their practice familiarize themselves with the PCCRP X-ray Guidelines, which can be accessed online at www.pccrp.org.

To access the full Resolution Supporting the Chiropractor’s Right to Clinical Decision-Making Regarding Radiology online, click HERE.