Chiropractic Forum

Today I thought I would do something fun and exciting by attending my first chiropractic forum.  It consisted of 3 faculty members who posed questions to the audience in regards to various subjects which are controversial within the "profession".  I left pissed off and wishing I had opened my mouth in regards to where I think the profession should be heading.

It seems as if there are a lot of students who enter chiropractic who lack personal identity and enter the profession to find themselves.  It also seems like people go into this to simply adjust people.  What I can't understand is where the patient comes into place with this mindset.  The narrow minded approach that some advocate is in my opinion ludicrous.  There should be no room for simple, narrow-minded approaches to health care.  

How do we define health?  Nobody said a word about this in the forum.  It was all about whether we should be allowed to practice "techniques" that are scientifically backed or not.  The question is raised that says, "who on Earth would practice something not knowing what the real effects are?"  For example, if I chose to cook an egg by running it under hot water I would end up with an egg that spilled down the drain.  We know that there are ways to cook an egg that give good reproducible results - poaching, frying, scrambling etc.  I truly believe the "techniques" that plague the profession of chiropractic are used as selling points to get folks in the doors to chiropractic clinics.  It is unethical, invalid and wrong to sell something that does not have a valid reason for use regardless of the patients "desire" for the treatment.

We need to define chiropractic as the wellness approach to health.  Fill the gaps that medicine has historically left wide open.  There is a biological basis for health disparities and we mustn't forget this.  But, if we approach health care as medicine has by researching ways to approach visceral  problems with manual therapy then we are doing the public a great disservice.  It is no different to hand out a pill for a disease as it is to crack someone's back for the same ailment.  If there isn't any educational efforts made then we are no different than MD's (minus the additional education they undergo that is).  We should keep in mind the public lacks the skills and behaviors to live proactively.  The majority of the public instead lives reactively and uses our and other health care provider's services to treat their symptoms.  If we want to be different we must fill the gap of being the educator for the patient.  Help them take the steps toward a healthy active life which will decrease their chances of severe chronic health problems.  We must meet their immediate needs but always take steps to get them to the wellness end of the continuum of health.  If we follow suit with a medical approach then we are really playing doctor because MD's and DO's have a better ability to manage acute and chronic disease.  That being said, we must remember that musculoskeletal issues will arise with anyone who decides to live a proactive life.  Hence, our role as their health care provider.  

Thanks for reading.

Philosophy, Ethics and Dogma

The first week of school had me all fired up in regards to the 'other side' of chiropractic that I despise.  If you are not up on this other side of chiropractic I will help you understand what it means from an objective point of view and then from a subjective point of view.  

First of all, Western States Chiropractic College follows a science-based, medical approach to health care and chiropractic, for that matter.  The school advocates a musculoskeletal/primary care approach.  This means the worst case scenario is ruled out before an adjustment is given.  From an objective point of view this makes perfect sense.  If a person presents with upper back pain and you as her practitioner know upper back pain could be associated with other things such as a heart problem, you may choose to refer her to an MD or DO who is qualified to treat her ailment if needed.  This is a perfect transition to help explain the 'other' side of chiropractic.

Too often, from personal experience, I have seen cases that were not referred to other more qualified doctors because of ego or shame the chiropractor holds deep inside.  Instead, the DC tries to manage the complicated case and ends up mismanaging the patients needs.  From my experience this type of management usually has a lot to do with the type of approach the chiropractor has with his/her patients.  The chiropractor I referred to above would be the type that has a more 'straight' approach in treating patients.  The straight approach advocates treating ALL health care problems with an adjustment to the spine because a straight spine will allow the nervous system to flow properly to organs and the like and prevent disease from ever happening.  

If you are an objective, science-minded person you too would say this approach to health care is completely fraudulent.  Many new DC's enter the field with literally no patients and have huge overhead that forces them to adhere to the straight approach to chiropractic in order to cover their bills.  If you have 5 patients and you see them twice a week for "prevention" you have 10 visits.  Add up the revenue and you will soon find out it is way easier to 'believe' in the straight approach then to actually be a physician.  Don't get me wrong, I believe in prevention, but I do not believe in manipulating the spine in hopes of good total health.  Prevention is a balance of proper nutrition, regular exercise, a positive mental attitude and a body free of biomechanical abnormalities.  However, biomechanical abnormalities can still exist in a person who is living a life of wellness.  Chiropractic is a small portion of what I consider prevention.  It is prevention of orthopedic problems and a way an ACTIVE person can stay active while minimizing injury from being active.  If a person covers their nutritional needs, follows a workout routine that gives their body a new stimulus to adapt to each month and lives life PROACTIVELY, Chiropractic will benefit their way of life.

Where straight chiropractors get into trouble is by trying to manage complicated health problems with manual therapy.  For instance, I heard of one chiropractor trying to manage a persons diabetes with spinal manipulation.  That is a big NO NO.  If fact, that is such a disrespect of the human body I would say that person should surrender their license.  We don't go through all the years of chemistry, pathology, physiology and the like to behave as if it doesn't exist.  There is so much known about the body that medicine has uncovered and to be an ethical DC you have to know where your role ends.  

My future practice will be prevention based and performance based.  That being said, if a person has a complicated medical problem that chiropractic has not been shown to improve I don't intend on managing their ailment, particularly if there are medical treatments available that have shown adequate results.  I will send them away to a qualified doctor who knows their role in health care.  That doesn't mean I haven't studied their condition or understand their problem, that means I hold the patient's best interests as my number one concern.  If there are services provided that help people take steps to be the BEST they can be, to live PROACTIVELY, Chiropractic is by far the best choice for their way of life.  Now if the person above is cured of their ailment after you promptly referred them, they will trust you and most likely your services will be utilized later.    

In my opinion, I think we have to have patience as new Doctors of Chiropractic and adhere to the preventative approach to health care rather than approach our patient care from a self-centered, money driven perspective.  If you focus on prevention, you will set yourself up for the future.

As far as the schools that support the "other" side of the chiropractic world, they get away with this by meeting technical standards set forth by the accrediting bodies.  In the classroom, passionate subluxation theorists stand there preaching the pulpit on how chiropractic is the answer to everyone's problems, no matter what they are.  This is exactly why the public views chiropractors as weirdos.  The public is smart.  Most understand what it takes to get better when they are sick and they've had experiences (many) where western medicine has brought them back from near death.  They trust medicine.  Where it gets a bit dicey is the wellness continuum.  Western medicine has traditionally and historically been used to bring the sick back to homeostasis.  

Death--------------Sick--------Homeostasis--------------------Wellness

                     (start Tx)          (stop Tx) 

Where does chiropractic fit on the wellness model?  I'd say it fits in conservative care for musculoskeletal conditions and minor health problems and it could be an access point for patients to begin living PROACTIVELY.  Understand that professional athletes, pro dancers, musicians etc., use chiropractic all the time.  They demand a lot from their bodies and the chiropractic approach is best for them.  If a DC uses their conservative care properly I truly believe there is a lot that can be done without the patient entering the western medical model and ending up in the hospital from a preventable disease.  The US is riddled with disparities associated with chronic, preventable diseases and most of the leading causes of death are ones that could be avoided by living PROACTIVELY.   If a DC fulfills this role and offers services that I explained above with the intention of taking patients/clients to the wellness end of the health care continuum, they deserve the title Physician.  I cannot say the same for the other half of the profession.  

Trying to keep up

The first week of quarter 3 is underway and boy is it trucking right along.  There is lots to do and little time to do it.  As with any educational program you must find a balance after the first couple weeks and jump in.  I finally feel like I am in graduate school.  There for a while I thought I was retaking my undergraduate coursework - leaving me a bit depressed about the whole situation.  

Our new courses are going to be challenging.  We are finally into physiology as well as neuroanatomy.  The third series of gross anatomy (visceral dissection) is also underway.  In fact, today we removed the anterior thoracic wall and took the lungs out!  A welcome back unlike any other.  Having completed the first dissection today has me pretty excited knowing only 9 more dissections are left.  To be done with this course is one of my largest goals.  It is, as I have mentioned previously, a well rounded challenge.  Mentally, physically and emotionally challenging.  It is tough to look at, tough to cut on and tough to block out the sheer disgust of the scene.  Nine more dissections, thank goodness.

I ordered new texts today.  My medical physiology text is coming next week!  This is a weird but happy thought for me.  Physiology is my greatest passion.  It is the explanation of how things operate, how things keep stable and adapt to the environment we subject ourselves to.  Unfortunately, we only get two or three courses in chiropractic school where medical school students get several more.  I will make the best of it and get ahold of all the medically based physiology reads that I can!  ;)  I took the liberty to purchase a medical neuroanatomy book along with a general neuroanatomy book.  Cross referencing is how I learn the best and with an applicable read which is medically based is just more bang for the buck.  Three hundred dollars later I have 4 books rolling my way.  

On another note, we ventured into thoracic adjusting this week.  Our class time thus far has been impulse drills on each other while our patient holds their breath.  Holding ones breath is necessary so we don't 'move' anything that shouldn't be moved or at least minimize excessive movement.  It is interesting to impulse into someone's back or rib with precision.  The skills to be able to rotate a vertebrae to one side or flex it upward or extend it takes time to learn.  And to know how 'deep' to thrust to get the job done is tricky.  Some adjustments block a segment at a lower level to induce rotation or lateral flexion on the other sides segment above.  I take mental notes each time I practice on someone so that good results continue to come.  Just recently I have been able to picture the motion of the bones beneath the soft tissues.  Biomechanics is quite interesting when you put it all together and picture the cause and effect levers and pulleys have on the entire kinetic chain.  Too often we think narrowly and forget that our bodies are delicately interlaced.  Each system balances each other out and is in a constant state of flux.   

Friday looms and it is 10 pm so I will sign off and post at the end of next week.

Thanks for reading.

Nate