Patient-reported outcome measures quantify patients’ subjective symptoms and are often more in line with accomplishing patient-centered goals. Patient-reported outcomes can give valuable information to evaluate the success of a treatment plan and aid in determining a prognosis based on past response. They are also used by insurance companies for re-imbursement purposes, such as determining medical necessity. Chiarotto et al. developed a core outcome set for use in clinical practice with accompanying suggested measures for patients with low back pain.

In the past year, many chiropractors have discussed indications for radiographic examination with renewed interest. In particular, they have questioned the X-ray recommendations of the Choosing Wisely initiative, a project of the American Board of Internal Medicine that seeks to promote more effective use of healthcare resources. The recommendations are hardly revolutionary, and well in line with current radiology education. In my own final radiology classes, professors emphasized that what we learned was only the foundation of what we would need in practice, and a mere fraction of what our peers would learn should they choose to become chiropractic radiologists. The recommendations in Choosing Wisely are shorthand for what we already know. 

It’s been one year since the American Chiropractic Association released its Choosing Wisely list, which features recommendations designed to help patients start conversations with their chiropractors about appropriate care. In an era of evidence-based care and shared decision making, patients need this type of information to have meaningful discussions with their doctors that lead to better care and, ultimately, better outcomes.

Ethics and evidence-based practice are "inextricably" linked, according to Charles A Simpson, DC, DABCO, a presenter at the 2018 National Chiropractic Leadership Conference (NCLC). Over his 40-plus year career in chiropractic and through his work as a health care workforce regulator, Dr. Simpson has witnessed ethical highs and lows among health care providers of all types. His experience has left him with keen insights into how to run a practice ethically as well as successfully.