Given the complexities involved in identifying and reporting suspected cases of child abuse and neglect, it's crucial that the Mandated Reporter Guide emphasizes the importance of objective findings as solid evidence.
Objective findings, such as radiological findings in chiropractic clinics, can provide concrete evidence of abuse that may otherwise be missed. Radiological examinations often reveal patterns of injuries that are inconsistent with the explanations provided. For example, multiple fractures at different stages of healing, unusual fractures for the child's developmental stage, or injuries that are rare from accidental trauma.
Therefore, the guide should recommend that:
Chiropractors should consider ordering radiological examinations when physical examination and patient history raise suspicion of abuse, even in the absence of visible injuries.
Findings from these examinations should be thoroughly documented, including the location, nature, and age of injuries.
Any discrepancy between these findings and the provided history of the injury should be noted as it may indicate a potential case of abuse.
While subjective findings such as inconsistencies in injury history or behavioral signs can be crucial, they should not be the sole basis for reporting suspicion of abuse. Children and elderly patients may have difficulty accurately recalling events, leading to inconsistencies that are not necessarily indicative of abuse.
This doesn't mean we should disregard subjective findings. On the contrary, the guide should instruct chiropractors to:
Be attentive to verbal and non-verbal cues that may indicate distress or fear.
Document any observed behavioral changes or emotional responses that seem disproportionate to the situation.
Note any inconsistencies in the history and presentation of injuries.
Limitations of Physical Examination
Given the nature of chiropractic practice, chiropractors may not examine private parts such as breasts and female chest, potentially missing signs of abuse. The guide should acknowledge this limitation and recommend that:
Chiropractors should be trained to identify signs of abuse visible in the areas they typically examine.
If suspicion arises from observed or reported symptoms that fall outside the chiropractor's scope of practice, the chiropractor should refer the patient to a suitable medical professional for a more comprehensive examination.
In conclusion, the Mandated Reporter Guide should emphasize the importance of both objective and subjective findings in identifying potential abuse cases. It should also acknowledge the limitations of physical examinations in chiropractic settings and provide guidance on referring patients for further evaluation when necessary.
As the Chairman of the Chiropractic Doctors Association of Hong Kong (CDAHK), I am penning this letter to express our support for the public consultation on the Vibrant, Healthy, and Tobacco-free Hong Kong initiative. We acknowledge the compelling need to address the prevalent issue of tobacco usage in our society.
We concur with your concerns about the health implications of smoking, particularly in light of our aging population and the rising incidence of chronic diseases. The uptrend in female smokers and the vulnerability of secondary school students to smoking pose serious threats that demand immediate attention.
Research has shown that chiropractors cater to a significant proportion of tobacco users (Muramoto ML et al., 2014). Our health and healing philosophies, as well as our practice patterns, are ideally suited to provide brief interventions (Muramoto ML et al., 2014). Studies have illuminated the feasibility of implementing systematic changes in chiropractic settings to identify tobacco users, advise them to quit, and refer them to cessation services (Buettner-Schmidt K et al., 2018). Chiropractors have proven their ability to offer effective smoking cessation counsel (Buettner-Schmidt K et al., 2018).
Given the link between tobacco usage and the health issues often treated by chiropractors, we are uniquely positioned to provide patients with personalized health feedback, which could potentially motivate them to quit smoking. Despite the potential value of chiropractors in conducting tobacco interventions, we are often underutilized and inadequately trained in these techniques (Rose KA, 2017). Thus, including alternative practitioners in tobacco cessation efforts can be beneficial (Eaves ER, 2017).
We are in complete agreement with the government's endorsement of the WHO's recommendations to achieve a smoking prevalence target of 7.8% by 2025 and aim for further reduction in the long term. The strategies outlined in the consultation document are in alignment with these objectives.
However, to fully harness the potential of the chiropractic community in tobacco control, we suggest putting more emphasis on the strategy to 'Enhance Education, Support Cessation.' Chiropractors can contribute by educating patients on the health risks of smoking during consultations and providing referrals to cessation support services as needed. We recommend the introduction of training programs for chiropractors on conducting effective tobacco interventions.
I am writing to you on behalf of the Chiropractic Doctors Association of Hong Kong to bring your attention to a pressing issue affecting our profession. We recently conducted a study to investigate the utilization, challenges, and attitudes of chiropractors in Hong Kong towards laboratory testing and radiological imaging. The findings reveal that a significant proportion of chiropractors are frequently facing rejection of their referrals for diagnostic tests and imaging, which adversely impacts the quality of care they can provide to their patients.
Our cross-sectional survey was conducted and involved 151 registered chiropractors, representing a response rate of 46.5%. The results indicate that chiropractors in Hong Kong actively utilize laboratory testing and radiological imaging for diagnosis, monitoring of existing conditions, and disease progression. However, high rejection rates for specific imaging requests lead to patient frustration, increased costs, and delayed diagnosis. Despite these challenges, our respondents demonstrated a strong belief in evidence-based practice and a willingness to incorporate relevant literature into their daily practice.
Chiropractors in Hong Kong are facing high rate of rejection in referrals. In light of these findings, we urge the Chiropractors Council of Hong Kong to take the necessary steps to address this issue and facilitate better communication and collaboration with other regulatory professionals, including the boards and associations of radiographers, radiologists, and laboratory technicians. It is essential to ensure that chiropractors' referrals are fully accepted to enable them to provide optimal care to their patients.
We strongly believe that enhancing access to diagnostic tests and working towards reducing rejection rates will play a pivotal role in supporting chiropractors' role as primary healthcare providers in Hong Kong. By fostering collaborative efforts among chiropractors, healthcare professionals, healthcare facilities, policymakers, and insurance companies, we can effectively address the challenges identified in our study and improve patient care outcomes.
We look forward to working closely with the Chiropractors Council of Hong Kong to address this issue and continuously advance the chiropractic patient's benefit in our region.
Thank you for your attention to this matter.
Dr. Eric Chun-Pu Chu, BSc, DC, PhD, FRCC (ortho),
Chairman, Chiropractic Doctors Association of Hong Kong
As the largest professional chiropractic association, I am writing to propose the integration of chiropractic care into Hong Kong's primary healthcare system. Our healthcare system is currently shifting towards a preventive and primary care approach to address the complex demands of our aging population. Chiropractic professionals are uniquely positioned to contribute to this prevention-focused strategy.
Incorporating chiropractors into public health programs can significantly improve population health in Hong Kong and strengthen primary care. By identifying musculoskeletal problems early, chiropractic care can effectively reduce risks, prevent complications, and promote healthy lifestyles. We propose the inclusion of chiropractors in district health centres and other initiatives, offering safer and more cost-effective options for treating functional issues and chronic pain. This integration of chiropractic care will not only benefit our citizens but also alleviate the burden on our healthcare system.
Internationally, chiropractors play a vital role in prevention-focused healthcare systems, such as in North America and Europe. In these systems, chiropractic care has proven to reduce disability and healthcare costs while generating high patient satisfaction. By learning from these successful models, Hong Kong can integrate chiropractors into its healthcare system and provide affordable, sustainable musculoskeletal and wellness-focused care.
In our quest to create a sustainable healthcare system that meets Hong Kong's long-term healthcare requirements, it is crucial to involve chiropractors in policymaking efforts. The Chiropractic Doctors Association of Hong Kong is committed to working alongside the Hong Kong Healthcare Commission and other stakeholders to ensure the successful integration of chiropractic care into our healthcare system. We kindly request the Hong Kong Healthcare Commission's support and collaboration in promoting the inclusion of chiropractic care in our primary healthcare system. Together, we can make a positive impact on the health and well-being of our community. Thank you for your consideration. We look forward to further discussing this proposal and exploring how we can work together to enhance Hong Kong's healthcare system. Our detail proposal are peer-reviewed at published at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10064816/
WORLD SPINE DAY COMPETITION WINNERS ANNOUNCED. Chiropractic Doctors Association of Hong Kong has been awarded Second PRIZE of the WFC World Spine Day Competition.