The Problem with Chiropractic Results
There’s plenty of evidence that adding energy at the right place(s) along the spine at the right time revives a person’s ability to self-heal. This has created a challenge for chiropractors.
At first glance, you’d think an intervention with such an enviable level of success and patient satisfaction would be a blessing. Instead, chiropractic results have conspired to confuse the healthcare consumer. This has bifurcated the profession and created uncertainty among the newest graduates.
Are You Practicing Medicine Without a License?
It was D. D. Palmer who observed, “The purpose of chiropractic is to connect man the spiritual with man the physical.”
Palmer didn’t mention back pain, headaches or any other malady. He envisioned chiropractic as a way to optimize life, bring integrity to the body and live life to the full. Chiropractic was a means to maximize human potential—long before there was a self-help section at Barnes & Noble.
Palmer knew that healing was a spiritual phenomenon since it ceased to occur the moment the spirit departed from the body. His son wrote that chiropractors “release the imprisoned impulse, the tiny rivulet of force that emanates from the mind and flows over the nerves to the cells, and stirs them into life.”
Again, no mention of health complaints. Instead, he described chiropractic as a means to access the nervous system and unleash the life force that coordinates our every function.
If this fledging profession was to enjoy the protection of licensure, it had to be a separate, distinct, nonduplicative healing art, different from medicine.
Don't forget his warnings about sullying the “sacred trust.” What did he mean? He was referring to the act of veering into the practice of medicine and using adjustments to treat spinal complaints.
Pleasing Patients Who Seek Symptom Relief
“Treating” is defined as an intervention with the intent of reducing or eliminating a symptom. When you treat a patient in a “treatment room,” you’re practicing medicine.
It hasn’t helped that insurance carriers expect you to treat patients. And no wonder. Their interest is to reduce symptoms, not to produce health among their policyholders.
Make no mistake. I’m not anti-medicine. Like you, I don’t want to live in a world without medical doctors, medicine and lifesaving technology. Traditional medicine is great at the heroic measures needed to extend life. But it’s hardly health care—even though that’s what most call it.
It’s barely surprising that chiropractic has become medicalized. The gravitational pull of third-party reimbursement has been enormous. In addition, patients weaned on allopathy enter a chiropractic practice wanting to have their aches or pains reduced.
As I’ll share in a moment, this isn’t about abiding by some quaint philosophical construct or irrelevant orthodoxy. Practicing chiropractic medicine creates some obligations that are difficult or impossible to fulfill. The result? Stress and uncertainty.
Avoiding the temptation to promise something over which you have little control (such as if or when the relief that patients seek will manifest) can be a clinical and communication challenge. Here’s how you might address it at your initial consultation:
“Based on what you’ve described, it sounds like you’re an excellent candidate for chiropractic care. You’re in the right place. I’m confident we can help you.
“But, we don’t treat [headaches]. Granted, we’ve helped a lot of people suffering with [headaches]. In fact, it’s almost routine. But we don’t treat [headaches]. Or anything else for that matter.
“Let me explain. Treating [headaches] would be the practice of medicine, that you have already tried. Instead, as a chiropractor, I address the underlying cause of your [headaches]. As we reduce the structural and neurological stress that most people with [headaches] have, symptoms usually lessen. Your body will no longer needs to get its your attention to make a change.”
You’ve affirmed their decision to consult your practice. You’ve offered them hope. And, even better, you’ve told the unassailable truth. You haven’t accepted the patient under false pretenses or taken on an obligation for which you have little control.
Chiropractic as a Partnership
While obvious, it bears repeating that chiropractic care reduces nervous system interference with the intent of reviving the individual’s ability to self-heal. As the neurological insult lessens, the body can better function as designed and has less reason to exhibit aches, pains or other symptoms.
Patients think their ache or pain is their problem. But pain is rarely the problem. So, if you’re not mindful, it’s easy to get seduced into thinking your obligation is to treat their pain. After all, that’s what brought them to your practice; if you don’t treat their symptoms, they’ll leave.
The problem is that you’re taking a knife to a gunfight. Instead of using a cheap and convenient opioid with close to 100% efficacy, you’re relying on improving spinal biomechanics to reduce nerve interference and revive the patients’ ability to self-heal.
Noble objectives. But, with so many variables to contend with, the outcome is completely outside your control. You have no idea what patients will or will not do between visits to support their care. Even worse, you don’t know whether the physical, chemical or emotional stress that produced the adaptation response we call vertebral subluxation is still present in their lives. If it is, your ministrations will be palliative at best.
Will your patients have the patience to give chiropractic care adequate time to work? Will they make the necessary lifestyle changes? Will they improve their exercise, nutrition, hydration and sleep so that their bodies have the resources to heal? Will their visits be frequent and consistent enough to produce spinal changes?
Chiropractic care is a partnership. Medical treatment rarely requires such collaboration.
Because Chiropractic Isn’t Enough?
If you decide to take the path of least resistance and operate a “catch and release” pain clinic, expect your patients to stop care when their symptoms subside. In fact, there’s little reason to give a formal report of findings or recommend anything more than how frequent their visits should be, with a “let’s see how it goes.” Your “treatment” will be subject to the direction of the patient and guided by how they feel. Your communication obligations will be minimal. Just keep your fingers crossed, and hope that chiropractic “works.”
Wellness care? Forget about it. Newborns, infants or children? They rarely have “bad backs.” Organic and visceral complaints? Of course not. By reducing the practice to pleasing patients by using adjustments to treat spinal complaints (cervical adjustments for headaches and lumbar adjustments for low back pain) you'll turn chiropractic into a medical subspecialty focused on the spine, hamstrung by the inability to prescribe medication.
This will create a variety of other challenges. In particular, the practice will have a voracious, never-ending appetite for new patients. Effective marketing will become a dominant preoccupation. You’ll constantly be on the lookout for the next non-chiropractic adjunct, whether massage, decompression, cold laser, nutrition, stem cells or the latest promise of new patient nirvana. While each form of therapy may be valuable in its own right, it will likely be bolted onto the practice by a profit motive or the belief that chiropractic isn’t enough.
A Way Forward
Treating spinal conditions with adjustments may fit within the scope of practice in your jurisdiction. And third parties may reimburse for them, albeit stingily. But that doesn’t make it sustainable or emotionally rewarding.
Here are some suggestions for ending the “off label” use of chiropractic and returning to the principles that have allowed it to endure even as countless medical fads have come and gone:
1. Start with your next new patient. To avoid sending your practice into shock, avoid sudden movements or dramatic changes. Ease into this. You’ll discover that patients want something different from medicine. They’ve already tried medicine. They want different. Be different.
2. Become mindful of your language. The words you use reveal how you see the world and your role in it. Choose the words “care” rather than “treat,” “adjust” rather than “manipulate,” “subluxation” rather than “spinal dysfunction.” Adopting medical languaging will not improve acceptance.
3. Explain the truth about chiropractic. Like a patient’s car key, adjustments simply unlock what is already designed into them. Same thing with adjustments. Make sure they know that they’re the doctor.
4. Assign home care procedures. Patients have become spoiled. They expect the doctor, drug or surgery to do all the heavy lifting. Inspire them to examine their nutrition, exercise, sleeping habits, emotional stress and other factors that can affect their recovery.
5. Refuse to accept credit or blame. Whether patients express delight or frustration with their progress, show up curious. Avoid responding to their frustration with defensiveness. “Why do you suppose your body isn’t responding as you and I thought it would?”
6. Aim for a cash practice. As more patients begin care because they want better health rather than pain relief, plan your escape from the bondage of third-party reimbursement. Then, with time, you’ll be comfortable with taking regular vacations, knowing that your practice will be there when you return.
7. See more miracles. As your tribe better understands the truth about chiropractic, you’re sure to see the many manifestations of reduction in nervous system interference. Patients often call them miracles, but you’ll know it’s merely their body functioning as it was designed to function.
It’s unlikely you’ll enjoy the deep satisfaction, financial stability and lasting significance that can result from practicing chiropractic if you’re not practicing chiropractic.