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Crossing the Line

crossing line imageYou’ve probably heard that “England and America are two countries separated by the same language.” Apparently, add chiropractic to the mix and you have an even greater separation.

I mention this because on Monday, March 8, 2010 the General Chiropractic Council (GCC), the governmental body ostensibly created to “protect patients” (apparently from chiropractors) and “set standards” (apparently for chiropractors), released their new leaflet (brochure), “What can I expect when I see a chiropractor?”

Besides being a collector of chiropractic brochures going on 25 years, I’m keenly interested in what the GCC might have to say. Especially in light of the recent brouhaha regarding what is permissible for a chiropractor to publish on his or her practice website in the UK.

I quickly found two serious, yet common errors on the second page. And they weren’t merely typographical errors.

When chiropractors, or governing bodies in this case, make such errors, they find themselves swerving over the double yellow lines from the practice of chiropractic, into the oncoming traffic of the practice of medicine. Which, I assume, chiropractors in the UK as elsewhere are specifically precluded from doing.

Keep in mind that chiropractors where granted the privilege to practice chiropractic, at least in the US, without the fear of being incarcerated for “practicing medicine without a license” by being licensed as a separate, distinct and nonduplicative healing art, different from medicine.

This is often forgotten by those too young to know or speak with chiropractors who were jailed. And while I’m not sure about the historical circumstances that prompted licensure in the UK, it would seem safe to imagine that it too would have been as a result of recognizing the distinction between chiropractic and medicine.

Common Mistake #1: Offering Chiropractic Treatment

The subhead on page two of the new GCC patient brochure reads: What is chiropractic treatment?

Now, if this indiscretion were the only one, I’d probably look past it as I do countless times when speaking with some chiropractors who routinely use the word “treatment.” Many refer to their intervention as a “treatment” and the place in their practice where they do it as the “treatment” room.

“And?” I can almost hear some chiropractors uttering.

Treatment is the practice of medicine. Consult Dorland’s Medical Dictionary and you’ll find the first definition is “the management and care of a patient.” This isn’t how most chiropractors use the term. But the second definition is: “The combating of a disease or disorder.”

Many chiropractors “treat” subluxations as if they were medical doctors “treating” cancer or failing gall bladder. Clearly medicine. And, as in medicine, the intervention is intended to fix or cure, in this case, the offending spinal condition.

“And?” I hear the perplexed readers who are still with me asking.

Chiropractic doesn’t fix anything. If there’s going to be any fixing, the recipient’s body will do it. Little or no credit is attributed to the intervention itself. This may be at odds with technique peddlers, but the hero in chiropractic is the recipient, not the miracle adjustment or, in the case of medicine, the miracle drug. Instead, the intent of the chiropractic intervention is to enhance the circumstances in which a patient’s inborn ability to self-heal can be more fully invoked.

If a governing body makes this error, it’s easy to see how the governed might be confused, if not worried.

Common Mistake #2: Limited to Bones and Muscles

The first sentence in the GCC leaflet following the use of the word treatment reads, “Chiropractors are concerned with the framework of bones and muscles that support the body (the ‘musculoskeletal system’).”

Really? That sounds more like an exercise physiologist. Or a physical therapist.

Remove the neurological implications of chiropractic and you have either an overpaid spinal therapist or an overeducated massage therapist!

I can understand how an observer watching a chiropractor at work might reach the conclusion that chiropractic is about bones and muscles. But that would be like saying that “electricians concern themselves with wire insulation.” Are they mindful of insulation? Certainly. But they’re considerably more interested in the circuit. Same with chiropractors.

Restrict chiropractic to bones and muscles and it becomes clear why a governing body might get nervous (pun intended) about chiropractors in the UK seeing newborns, infants or those with visceral or whole-body organic complaints. Why would a chiropractor invite parents with a colicky baby to consult their practice? Or a bed wetter? It just wouldn’t make sense.

If, as a regulatory body, you look through a bone and muscle lens and see chiropractors who simply want to revive the integrity of nervous systems, regardless of the presence of an obvious or named disease, it’s easy to see how misunderstandings, even disciplinary actions could follow.

By the way, are you curious to know who voted to establish this regulatory body with deep government pockets and the authority to reprimand chiropractors in the UK? Drum roll please… chiropractors! Yes, but order all the leaflets you want. They’re free.

Comments (10)

Bill, you can more in a paragraph than most can in a page.

Thanks for making the point and for the clarity - for those who need it.

Hard to know whether it's just sloppy thinking that leads to the sloppy language, whether these folks really do not get it, or whether they do get it and still choose an agenda that destroys the Chiropractic distinction. Is it any wonder that our chiropractic ancestors chose to become "outlaws?"

At any rate it's a shame that those who really need to read what you write probably won't.

Hi Bill, is it any wonder why our patients are confused?????????

KenC:

Hi Bill,
Great comments, I couldn't agree more. I left the British Chiropractic Association this year because of the ridiculous move to prescription rights. The fact that 78% of BCA members voted for it scares the hell out of me! How the hell do we turn this Super Tanker around and get back on course for what DD, BJ, Clarence Gonstead and all of the other chiropractic greats left for us. I would hate to be part of the generation that screwed up all of their hard work and left this profession to become some quasi medical subspecialty.

girlpower:

Chiropractic in the UK is at a crossroads. It can either decide to be true to foundational principles and tenets of science, art AND philosophy or it can disappear off into the ether in the next few years. What RL stated is true - the profession will end up like osteopaths in the US in the near future if it does not start standing up to the so-called leaders in the profession.
Chiropractic has never been a therapy, never been about treatment of a condition - yet the primacy of the nervous system is seen as being an outdated phenomenon by some at the BCA. All these blogs, all these complaints about Chiropractors and their advertising comes down to Chiropractors not giving a clear message about the philosophy of Chiropractic - the profession is advertising treatments of conditions which is exactly what medicine does. The profession is the first to complain when others do 'manipulation' or use Chiropractic techniques but it quite happily likes treading into other health and sickness care regimens under the name of Chiropractic. What is practised is incongruent with Chiropractic philosophy - that is why the profession has attracted all that is happening. The BCA calls itself a Chiropractic association but in reality it would appear that it would quite happily have Chiropractors as manipulative physios. The Chiropractic philosophy defines the profession but they and the schools in the UK would have it off the education program. The attacks on the profession will only increase if it follows the fateful road of chasing prescription rights and medication. Don't be fooled into thinking that this will solve all practice challenges; if you can only give that cortisone injection or subscribe that anti-inflammatory. Don't also be fooled into thinking that supporting this motion will be necessary to allow you to use nutrition/orthotics etc. There is NO reason for this to be lumped into one package unless your leaders allow it to be so. They like to tell you this though in their drive towards medicalisation and 'acceptance'.

This leaflet by the GCC is appalling. I am an Australian trained chiropractor (working in the UK) and it seems that the Aussies are more inclined to fight their corner. The UK chiro's tend to stick their head in the sand when there is a slightest whiff that things won't go their way.

Chiropractic is not just about the bones and the musculoskeletal system. What makes these things work? The nervous system which in turn is controlled by the brain.

Chiropractic should take an integrated approach looking at the whole person according to their needs. Not just "treat" the symptoms whether that be back pain or a fixation. A Subluxation is the effect of a dysfunction within the body. I always thought chiropractic was about finding the cause, not just placating the symptoms. By finding the primary cause of the problem (which is often expressed as a subluxation)and corrected with an adjustment (not a manipulation as in the GCC leaflet)the body's own healing is enabled thus helping the patient to recover. When this is acheived the time to recover is often halved and stays that way for longer.

Chiropractic is not about "moving a bone" or massaging sore muscles, that is someone else's domain. However it seems that this is where a lot of UK chiropractors are at.

Victor Sanudo:

As an AECC graduate, I can tell you that if there is a country in the world where chiropractic has a bright future, it´s the UK. Nevertheless, it seems that some chiropractors over there are more interested in "fitting in" or "being accepted", or becoming "real doctors". That is happening all around the world, chiropractors are more interested in learning things outside chiropractic, than really understanding who they are, what they do and what they stand for. Some would love to become chartered physiotherapists, or biomechanical engineers, everything but chiropractors. I guess they watch "Two and a half men" way too much!

It’s rather disconcerting. Pseudo-leaders within our own profession have decided to define who we are as a profession. Decisions continued to be made for all of us with no regard for an established, agreed upon set of definitions. Each school, state association and even management firm make a statement as to what they think is in our best interest. It seems to revolve around how we get reimbursed. It revolves around a third party pay model that died a few years ago but we can’t seem to realize that as a group. It revolves around care only when a symptom is present. It revolves around the latest greatest gadget or system to manipulate someone into more care. It revolves around outcome, evidence-based bunches of crap that can only lead to more anti-depressants and sedatives.
Nowhere in this mix do I hear this is what we stand for. We adjust the spine to remove interference to allow the body to express itself to the best of its ability.
That doesn’t take a gadget. Doesn’t take insurance. Doesn’t require a symptom. But it does take LEADERSHIP. Where are our leaders? Selling things.
Take a damn stand. Take it for yourself. Bill has been screaming it at us for years.
We have turned this profession into an amalgamated mess of massage therapists, pseudo-nutritionists and acupuncturists. Not that they are wrong. They are just not chiropractic.
When you feel tempted to redefine chiropractic for your own gain, STOP.
Shut your mouth. When you feel tempted to sell out to a managed care group for your perceived financial gain, STOP. Put your pen down. When you feel like sending your money to a group that does not represent chiropractic, STOP. Put your money down.
When do we get pissed? When do we as a group say enough is enough? When are we going to stand up and tell our evidenced-based colleagues and institutions that they are WRONG and then be able to coherently tell them why?
When are you going to attend The Conversation with Bill? When are you going to figure out what we do? When will we figure out who we ARE?
Thanks Bill. Thanks for having a backbone. The next step is to get in the face of our so-called leaders and encourage them to lead.

They also removed an explanation for subluxation from their FAQs. I have been blogging about this since I resigned from the GCC register in January 2009. Unfortunately the UK profession does not have the stomach for the fight. They talk the talk but that’s about it. I have been a lone voice fighting the medicalisation of chiropractic in the UK for many years now.

Five years from now chiropractors in the UK will be very similar to the Osteopaths in the US.

As the British Chiropractic Association (BCA) is seeking prescribing rights for its members it can not be right that the BCA is the only chiropractic association in the UK that the WFC will recognise and speak with. US chiropractors should be lobbying their associations to pressure the BCA to withdraw their request.
Richard

nick:

Hi Bill, great post!

Unfortunately it gets worse. The British Chiropractic Association (that represents about 40% of UK chiros) has recently balleted its members on the possibility of obtaining prescription rights!!! Their main argument - to keep up with other healthcare providers. The result of the ballet was that a wapping 78% of those that replied were in favour of prescription rights.

Personally I find this completely outragous. How can a single chiropractic organisation change one of the defining priniciples of chiropractic?

Bill, I am with you all the way on point 2.

On point 1 you quote Dorland's definition of treatment as "combating disease or disorder."

I view subluxation as a disorder in and of itself, just like hypertension or cancer. Yes, it has secondary symptoms and implications. True it is up to the body to self regulate and heal, and we can't control this, but the disorder is the subluxation. We "combat" subluxation with the adjustment. I agree, we shouldn't pretend to treat back pain or whatever drives a patient in the door, but we do not "treat" subluxation?

WDE: It is my opinion that if you "treat" subluxation you are practicing medicine. Subluxation is merely a symptom of the body's attempt at accommodating physical, emotional or chemical stress. It is a short-term survival strategy; a defense mechanism. If, through your ministrations, the subluxation is reduced or resolves, you have facilitated the body's abililty to adapt more resourcefully to its environment.

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From March 9, 2010 7:15 PM

This page contains a single entry from the blog posted on March 9, 2010 7:15 PM.

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