Chiropractic law in France

The Chiropractic in France: Challanging !!!

In 11^th of January 2011, the first minister (work ministry, health ministry and enployment ministry) published a low describing the acts and conditions of the chiropractic practice in France.

In this low, the ministry started saying: The health in France is getting worse for the last 15 years especially in the areas of cardiovascular diseases, cancers, sedentary life style and bad nutrition, especially in Paris the capital of France very large town that count about 12 million people.

I want to share with you my analyze of the situation caused by this low.

For the chiropractic profession, the challenges are numerous in France:

There is no insurance and no social security reimbursement for any chiropractic care.

The development of chiropractic by making it famous, on the right way, an unknown profession represents a tremendous work. For example, when we look for a chiropractor with “google research”, we find an osteopath in 90-95% of research. The reason why is because there are about more than 70 osteopath schools in France and 1 college of chiropractic. This college teaches mainly 90% of medicine class for about 10% chiropractic. The other reason is because osteopaths can “adjust” patients.

The first step (the new law), just voted by the government last year (January 2011), and it is great news for the chiropractic profession to be officially recognized. This law defines the profession and who and how to practice chiropractic all over the country.

I will share with you an extract of what are the key points of this low and what the law emphasis on:

CHAPTER I (strict translation):

Practitioners as justifying a chiropractor diploma are allowed to practice acts of manipulation and manual mobilization, mechanically assisted or instrumental, direct and indirect, with or without force vector, whose sole purpose is to prevent or remedy disorders of the musculoskeletal system of the human body and their consequences, particularly at the spine. This excludes organic pathologies requiring therapeutic intervention, medical, surgical, or medicinal. They perform in accordance with good practice guidelines established by the French High Authority of Health.

These acts of manipulation and mobilization are neuro-musculoskeletal, exclusively external. Advices or non-invasive techniques, conservative and non-medication for pain relief may supplement them.

Practitioners who have completed a chiropractor formation as this is required, if they have not themselves the MD qualities, refer the patient to a MD when symptoms require diagnosis or medical treatment, when found a persistence or worsening of these symptoms or disorders presented exceed their jurisdiction.

The practitioner as showing a chiropractor cannot perform the following acts:

– Handling obstetric and gynecology;

– Pelvic Touches.

1) After a diagnosis by a MD attesting to the absence of medical contraindications against the chiropractic practitioner act, as showing, a chiropractor should perform the manipulations of the skull, face and spine in infants less six months.

2) The acts of manipulation of the cervical spine are performed by the practitioner as showing a chiropractor, subject to the restrictions contained in the annex.

The provisions of Sections 1) to 2) above shall not apply to MDs or other health professionals when they are empowered to carry out these acts as part of their professional health and in compliance provisions relating to their practice.

CHAPTER II (strict translation)

Practitioners as justifying a chiropractor are required; if they have not themselves the quality of a MD, they must refer the patient to a MD if the symptoms require a diagnosis or medical treatment, or if he/she state an persistent or worsening of the symptoms or if the patient’s troubles are not beyond their field of practice.

FOLLOWING CHAPTERS 3 to 28 (some translated extracts)

Persons authorized to use the professional title of chiropractor should holds a diploma in chiropractic

– The professional title of chiropractor is reserved:

Holders of a diploma certifying specific training in chiropractic issued by a training institution (schools, colleges…) approved by the precedent law of March 4, 2002.

– The holders of a license can practice chiropractic and use a chiropractic title must be issued by the competent administrative who have the authority to give that licence.

– For the MD, midwives, physiotherapists and nurses to practice holding a university degree or Inter-University certifying training followed in this area in a “unit training” and research in medicine awarded by a University of medicine and recognized by the National Council of the Medical Association.

When registering, they must specify the nature of the study program or diploma authorizing them to use the title chiropractor and, if they are health professionals, the state diplomas, titles, certificates or authorizations referred to in this law they also hold.

The CEO of the regional agency for health in the Ile-de-France may authorize individual to use the title of chiropractor nationals of a Member State of the Union European or other State party to the Agreement on the European Economic Area, who have successfully completed a post-secondary course.

If they are not likely to cover, in whole or in part, these differences, the committee proposes a compensation consisting of the candidate’s choice either an “aptitude test”, or an “adaptation period”.

– The aptitude test is to verify through written and oral examinations that the person demonstrated “appropriate” knowledge of the subjects in the curriculum of the academic title for the exercise of professional chiropractic activity in France, which did not initially been taught or has not be acquired during his past professional experience.

– Practitioners authorized to use the title of chiropractor must indicate on their plate and documents professional, graduate, and if they are health professionals in office, the State of the diplomas, the titles, certificates or authorizations professional they also practice.

– Practitioners who have completed a title of chiropractor must refrain from undue pose a risk to the person receiving care, including informed consent must be sought in all cases. They inform the patient of the possible risks of cervical manipulation or mobilization they intend to achieve. They must remain available to patients within 48 hours after cervical manipulation or mobilization performed.

A N N E X E D to the law

– The chiropractor must not undertake an operation or a cervical mobilization in the presence of the following clinical signs:

Clinical signs, by class of risk, which should alert the chiropractor to the possibility of a serious underlying pathology and the need for further investigation:

– Trauma: pain and functional impairment in a major trauma, especially if there is a context of fragile bones.

– Neoplastic non-mechanical pain recrudescence at night, alteration of general condition, especially in patients with a history or neoplastic.

– Rheumatology: non-mechanical pain, chronic and recurring, especially in the context of systemic inflammatory rheumatic diseases.

– Infectious: not mechanical pain recrudescence at night, especially if there is a context of recent infection and / or fever.

– Vascular signs of vertebrobasilar insufficiency.

– Neurological signs of central nervous system impairment or radiculopathy.

– The chiropractor must not manipulate or mobilize a cervical in case of the following contraindications:

– Fracture, compression fracture, ligaments tear with joint instability.

– Malignant cancer (primary or secondary, meningeal tumors), benign tumors making weak the structural bones.

– Spondylitis, osteomyelitis.

– Rhumatismal pathology systemic with great instability.

– Vertebrobasilar insuffisance.

– Severe osteopenia, myelopathy.

– Radicular compression.

– Meningitis.

CONCLUSION:

This law is a good start because of the Chiropractic can be legally practiced now in France. We can also read in this law that the chiropractic is still a lot misunderstood. To me, the most “funny” example is the “radicular compression”, which is contraindicated to the adjustment. Also we can read that a MD, midwives, physiotherapists and nurses with a complementary formation can practice with a legal the chiropractor title. In France, obviously, the necessary chiropractor’s competences are not enough, misunderstood and these “doctorish professions” will make the patient education and spread the chiropractic message/philosophy all over the country.

France needs good teachers and because there just 1 college, some other “competitive” chiropractic colleges teaching a good chiropractic.