The future of chiropractic is immensely rich with clinical promise!
In the last hundred years, the chiropractic profession has grown from a single practitioner to tens of thousands of chiropractors throughout the world. Despite unrelenting pressure, and against immense odds, chiropractic has not only survived, but flourished.
What will be our role in 21st century health care? Will it occur as a result of careful deliberation, or the caprice of political processes?
Let us consider our options.
Sociologist Wardwell suggests that chiropractic become a “limited medical specialty” such as dentistry, optometry or podiatry, which does not challenge the theoretical basis of allopathic medicine.(1)
Nelson has proposed that chiropractic be limited to a neuromusculoskeletal specialty.(2)
Both authors suggest that our direction be determined by the public’s perception of the role of the profession. Is this an appropriate way to define a profession?
In a recent poll conducted by Nolo Press, 58% of those surveyed described their lawyer’s ability as “poor.” 52% were “extremely dissatisfied” with the outcome of their case.(3)
Can you imagine the future of the legal profession if members of the bar decided to promote themselves as inept bunglers, because, after all, this is how the public seems them?
In chiropractic, the folly of such thinking is eloquently refuted by medical anthropologist Morinis:
“Only the chiropractic philosophy significantly distinguishes the chiropractic practitioner. And yet the philosophy is kept hidden away. … The public knows next to nothing of chiropractic philosophy of healing and its mechanisms: If hospitals offer spinal manipulation, a chiropractor offers nothing else. This distortion of the chiropractic tradition can only be overcome by a reevaluation of the place of theory in chiropractic. … Dispossessed of its philosophy, chiropractic is dispossessed of its uniqueness, and perhaps its future.”(4)
Osteopathic researcher I.M. Korr, in observing that profession, stated: “It is beyond debate that you have established yourself as a profession. But it is time — long past time — to ask again, ‘for what?’… Your profession endlessly debates how to carry out its function without a clear view of what that function is. Without such a guide, the only possible ‘policy’ is expediency: That which will win approval for this or that activity, from this or that one of many publics, at this or that time. … The profession neutralizes its great strength and dissipates its resources in diverse and conflicting efforts because, without a clear view of its central functions and objectives, it can have no dependable scale of values for assignment of priorities and for apportionment of its resources.”(5)
Will we be treaters of musculoskeletal pain syndromes? Or will our legacy be to champion the reform movement so desperately needed in health care? Will we be just one of many purveyors of manipulation? Or will chiropractic philosophy permeate our culture as awareness of its potential contribution increases in society?
Are we to be practitioners of a very limited branch of allopathy? Or are we to be doctors skilled in the correction of nerve interference due to vertebral subluxation? Are we to acknowledge the supremacy of the nervous system in the maintenance of optimal function? Or will we acquiesce to the perceived demands of the managed care world?
In our quest for recognition, we seem to have forgotten that our objective was to enable us to deliver — as widely and fully possible — the unique benefits of chiropractic care. Some in our profession consider the recognition to be an end in itself. In doing so, they have apparently lost sight of the fact that chiropractic’s objective is the analysis and correction of vertebral subluxations.
It is certainly not attempting to jump onto the bandwagon of any therapeutic fad that comes along, be it physical therapy, colonic irrigation, or manipulation for the symptomatic relief of mechanical back pain.
Nor can we permit ourselves to become chameleons endeavoring to sell whatever the public wants to buy. Some have suggested that we “think like a chameleon” in response to managed care.(6)
It is well to note that a chameleon is a cold blooded creature driven by fear and avoidance, which uses strategies of deception to achieve short-term advantage. The limited and aberrated perception a large segment of the public has concerning chiropractic should serve as a call to arms to return to our fundamental principles.
Thankfully, in a position paper signed by all 16 presidents of the chiropractic colleges in North America, agreement has been reached on issues including (yet not limited to) the purpose, principle, and practice of chiropractic, as well as the subluxation.
According to the position paper, the PURPOSE of chiropractic is to optimize health. While the ACC position paper does not define health, a definition offered by the World Health Organization is appropriate. Health is defined as optimum physical, mental, and social well being, and not merely the absence of disease or infirmity.
My observations in the field are that the most successful practices today are those which offer high tech, low cost, lifetime subluxation-based wellness care.
These are practices where issues of value and appropriateness are addressed by the affected parties — the doctor and the patient. They are not practices where a third party bean counter, or a “doctor of the evening” stands between doctor and patient, applying secret utilization criteria or Machiavellian practice guidelines based upon the opinions of individuals who have never seen the patient in question.
Just as insurance was a brief aberration in the continuum of healthcare delivery, I predict managed care will suffer the same fate.
I know of no method of healthcare delivery, save government socialization, which “enjoys” more dissatisfaction. In a Harris survey, when asked which industries are doing a good job serving the consumer, managed care firms were rated second to last, just ahead of tobacco companies.(7)
Those who chant the “mantra” of resignation — “like it or not, it’s here to stay” — are selling tickets to the Titanic. The sick care system is crumbling. The healthcare revolution is underway. We are perfectly positioned to lead that revolution, yet the “window of opportunity” is closing rapidly.
Strengthened by increased recognition, we must now direct our efforts toward an increased awareness of why we sought that recognition. The pendulum must swing toward a renewed commitment to that which is uniquely chiropractic.
As Dr. C.S. Cleveland III stated, “in today’s chiropractic profession, there are pall bearers and there are torch bearers.”(8)
Let us hold high the torch and lead the revolution. Humanity deserves no less.
References
1. Wardwell W: “The triumph of chiropractic — and the what?” Journal of Sociology and Social Welfare 1980 7(3):425.
2. Nelson C: “Chiropractic scope of practice.” JMPT 1993 16(7):488.
3. “Swimming with the sharks.” Home Office Computing. July, 1997. Page 22.
4. Morinis EA: “Theory and practice of chiropractic: an anthropological perspective.” JCCA 1980 24(3):118.
5. Korr IM: “The function of the osteopathic profession: a matter for decision.” Keynote address to 63rd annual convention of the American Osteopathic Association. July 13, 1959. Chicago, IL.
6. Advertisement for National Chiropractic Mutual Insurance Company. Journal of the ACA. April, 1997.Page 11.
7. Cheney K: “How to be a managed care winner.” Money. July, 1997. Page 122.
8. Cleveland CS III: Address before the California Chiropractic Association. June 21, 1997.
