And now, with so many people needing to be saved, it's a good thing the folks in Downstream have stepped things up so much. With a rescue system second to none, most people found in the water are pulled out in 20 minutes. Some even faster. Only a few don't make it before help arrives: a big improvement from the way it used to be.
Talk to the people of Downstream and they'll proudly tell you about the multimillion dollar facilities by the edge of the waters, the flotilla of rescue craft ready for any emergency, the comprehensive plans developed to coordinate it all, and the throng of highly trained swimmers always ready to risk their lives to save victims from the raging currents. Sure it costs a lot but, say the Downstreamers, what else can decent people do when human lives are at stake?
A few people raise the question now and again, but most folks are too busy to think about what's happening in Upstream. There's just so much to do helping those in the river, nobody's got time to figure out how all those bodies are getting there in the first place. That's the way things are sometimes.
Chiropractic: Downstream or Upstream?
Sound like a familiar story? This, of course, is a picture of the current (some would say fading) biomedical paradigm. It was this shift in thinking that made me, and maybe many of you, see health in a different way and lead us to a career in chiropractic.
I sometimes wonder where the chiropractic profession situates itself along the river: downstream or upstream? It seems to me that we're often following the medical profession in its outdated model of treating illness because of when we treat, and how we treat.
Pain Strikes: The When of Treatment
Many of us treat patients only when they're in pain. This is reactive medicine and downstream thinking. Our opinion? "When there's a problem, it's time to get treated." Maybe we just don't believe strongly enough in the concept of prevention to encourage our patients to seek care when not in pain. We allow an old way of thinking to influence our thinking. "Maintenance" care shouldn't be such a threatening word. It's a way of seeing. If you truly believe in preventive health care and practice it with integrity, then voices from the antiquated elements of medicine (or chiropractic) don't matter.
Nothing struck me stronger than an experience I had while travelling in China a few years ago. Did you know that in parts of that country, doctors are paid when their patients are well, not when they are ill? Imagine economic incentives to get people better, rather than relying on their illness to generate business! In such a system, what do you think the emphasis is on? We do not have to buy into this paradigm simply because it is the prevailing current in allopathic medicine. We must not be afraid to espouse upstream thinking and practice it, no matter what opposition we face.
Our Scope of Practice: The What of Treatment
In judging our relative "upstreamness," I'm also troubled by the way we limit our scope of practice in treating our patients. No matter how important we perceive the effect of the adjustment to be (specific to an adjusted joint, or more globally throughout the body), if we see health accessed only through the portal of vertebral joints, we are losing out on other crucial ways to positively affect our patients. For instance, if we see the nervous system as a system we want to affect, then it is imperative we introduce mind-body medicine into our practices. Check the literature. There is more research illustrating the effects of mind-body medicine on the nervous system than the adjustment. Don't get your shirt in a knot over this statement. It's simply the case. So why not incorporate mind-body medicine into your practice? It is easy to do and can be done without changing the way you practice.
How about nutrition? Do you think it's important to achieving optimal health? Of course it is. Just ask your patients, they'll tell you how important it is. There are innovative programs that allow you to utilize nutrition in your practice without necessarily forcing you to spend more time with your patients. You don't have to spend anymore time than usual, yet you increase your ability to help people achieve optimal health, and you get paid for it. This is done within an upstream chiropractic paradigm of health and makes your practice more interesting and more fulfilling.
The Informed Consumer
With the emergence of the Internet and the popularity of health and self-help books, patients are now well-informed consumers, recognizing the broad determinants of health. They simply don't believe that it is only through adjusting the joint over and over again that they achieve full health. Instead, many have come to believe that handling stress better, improving nutrition, and receiving regular chiropractic care is the answer to keeping the body healthy.
What do you believe? Is there a new way of "seeing" health? Do you focus solely on the vertebral joints as the way to increase your patients' health? Is that enough? Is there anything else that you can do to promote greater health for your patients or yourself? When do you currently treat patients? Only when they are in pain? In other words, is your practice at the top of the river, preventing the bodies from falling in, or are you downstream, making heroic, yet futile attempts to fish the bodies out?
Don't be afraid to stop and ask yourself these questions. Life and practice is an organic process that is constantly changing and evolving. Don't sit still because of inertia. Make it an adventure. As Joseph Campbell said, "The big question is whether you are going to be able to say a hearty yes to your adventure.
J.P. Pawliw-Fry, DC
Guelph, Ontario
metta-golden.net