In the prevailing therapeutic model of care, the principal goal of care is to alleviate or remove a particular diagnosed condition. Let's say the patient has low back pain caused by vertebral subluxation, associated with work-related postural strain. The goal of therapeutic care is to identify or diagnose the condition, create a care plan, and rid the patient of the condition. When the condition is gone, care ends, until the patient re-injures themselves or experiences symptomatic exacerbation.
The bottom line: symptoms, conditions, and diseases drive a therapeutically-based model of health care. Indeed we could call care based on the therapeutic model disease or illness care instead of health care. A central feature of the therapeutic care model is that when conditions are corrected or removed, the rationale for care is also removed. If the patient is not diagnosed as having a condition, no care is provided. In fact, providing care is often considered unethical or in some way fraudulent in the absence of a condition or disease.
A disease or illness-based therapeutic model of care is an outgrowth of reactive crisis-oriented management. When the crisis comes we react to fix it. When the crisis or illness passes, management or care is discontinued. In many ways this model is very limited and short-sighted. It is not focused on improving health. Chiropractic care has never fit the therapeutic model of disease care well, because chiropractic care is based on the paradigm that the body has the capacity to heal itself.
According to the foreword from the Council on Chiropractic Education's 1995 report: "The application of science in chiropractic concerns itself with the relationship between structure, primarily the spine, and function primarily coordinated by the nervous system of the human body as that relationship may affect the restoration and preservation of health. Further, this application of science in chiropractic focuses on the inherent ability of the body to heal without the use of drugs or surgery." The CCE's foreword also states that "wellness promotion" is the responsibility of chiropractic clinicians.
The cornerstone of chiropractic science is the body's inherent ability to heal itself when the structural components of the spinal column and the functional homeostatic components of the neuroimmune systems are balanced and at ease. The self-healing focus of chiropractic has a strong parallel in patient-centered, wellness philosophy. The central theme of wellness philosophy is empowering patients to take charge of their own health. In both chiropractic and wellness we are talking about a revolutionary concept of health from the inside-out. According to this view health lies inside each of us, and it is largely our own responsibility to maintain wellness. Chiropractic care helps empower people to live more stress-free, balanced, healthy lives. There is a natural marriage between chiropractic and wellness.
In a wellness-based model of care, the goal of care is much more than symptomatic improvement or the removal of conditions. The goal is patient wellness, optimal health, fitness and full functional capacity. In a wellness-based model of care chiropractors partner with patients providing active subluxation/structurally-based care and education to promote wellness and help prevent patient symptoms and diseases before they occur. In this model of care chiropractors empower patients to achieve and maintain maximal health. In my opinion a wellness-based paradigm of chiropractic care provides the focus and orientation necessary to optimize the health of the American people. Wellness care is health driven instead of disease or condition driven. Wellness care does not stop when symptoms or diseases terminate.
In Ecclesiastes it is said:
"To every thing there is a season, and a time to every purpose under the heaven."
Shakespeare penned:
"There is a tide in the affairs of men,
Which, taken at the flood, leads on to fortune;
Omitted, all the voyage of their life
Is bound in shallows and in miseries."
I believe the tide is rising for chiropractic. A wave of wellness is shaking the core of the health care industry in this country. A paradigm shift is occurring. People are beginning to take charge of their own health, realizing that health comes from the inside out. To quote Dr. Sid Williams, "The world is hungry for the chiropractic message."
The public is skeptical of drugs and the deleterious side effects leading to billions of dollars worth of unnecessary suffering and untimely deaths. According to medical postulations published in the JAMA, as many as 180,000 people may die yearly partly because of iatrogenic injuries, the equivalent of three jumbo jet crashes every two days. People are looking for alternatives that are natural, safe, and effective. This can be our finest hour. Or we can miss the wave and slip quietly into mediocrity, content to care for low back pain, headaches, cricks and strains.
A choice lies before us. We can copy the medical therapeutic model and create guidelines which largely mimic that model, or we can continue to innovate and lead wellness-oriented health care with guidelines which focus on health rather than diseases. Our founding fathers had a much larger vision than symptom driven therapeutic care. I believe most of us still do. Our beliefs must also be validated by outcomes assessment-based research which assesses patient quality of life and well-being, rather than symptomatic improvement only!
From the beginning chiropractors have focused on the body's inherent ability to heal itself -- to be well, if structurally and functionally balanced. We have focused on correcting vertebral subluxations and structural distortion of the spinal column allowing the body to heal itself naturally. D. D. Palmer's new idea was that vertebral subluxations distressed the spinal column and the nervous system. He said that nerve interference lead to generalized state of distress in the body that he called dis-ease -- a lack of wholeness, homeostatic balance, and wellness. D.D. Palmer's visionary concept of dis-ease predated by several decades Hans Selye's conceptualization of stress as a general cause of diseases.
In modern vernacular, we say that vertebral subluxations and spinal column distress cause nervous system distress, homeostatic imbalance and multisystemic dysfunction. We correct spinal structural distortion to restore ease, wholeness and wellness in our patients. Our goal is not only the removal of symptoms, but rather the full restoration of health and wellness. The disease care-based therapeutic model has not fit chiropractic well, nor has it always served chiropractors well. At times it has been used punitively to terminate payment for care. Our care should not be terminated based solely on our patients' symptomatic relief. In my opinion, chiropractic care should not be terminated, period.
Do we terminate brushing our teeth, waiting for them to decay and then frantically begin to brush them again to cure decay? Do we get fit, only to stop exercising until we are out of shape and then begin in vain to exercise again? Do we stop eating wholesome natural foods, until we get ill and then resume eating well once again? Do we stop thinking in a positive proactive creative manner, until we become depressed and then begin to think positively out of desperation? Or do we participate in positive, health producing activities regularly, habitually, because they are intrinsically good for us?
A wellness-oriented lifestyle should be actively engaged in regularly, actively over the entire span of a life-time. I deeply believe in and am committed to life long chiropractic care. After all, chiropractic care helps maintain optimal spinal health and functional capability. It promotes spinal ease, balance, and mobility. Wellness-based chiropractic care helps to prevent spinal degenerative disease and disc degeneration. Regular chiropractic care reduces stress, produces a sense of well-being, and enhances the quality of life of our patients, as Dr. Malik Slosberg clearly articulates.
Our patients need to be regularly monitored, adjusted and counseled about wellness. Don't we all go to the dentist for regular check-ups and teeth cleaning? I intend to see my dentist regularly over the course of a lifetime. Who questions the logic of that? Let's not only brush our teeth, but let's polish our self-esteem a little and realize the tremendous worth of what we do!
These are such exciting times for chiropractic. Researchers are exploring the ways in which the body achieves wellness, health and homeostatic balance. A more holistically-oriented science is discovering the vast degree of interconnectedness between the nervous system, endocrine system, and immune system, the three systems primarily responsible for homeostasis. Candice Pert and numerous other researchers are showing us that the nervous system and immune system are inextricably linked by a network of common molecular substrates, including neurotransmitters, neuropeptides, neurotrophins, neuroendocrine hormones, lymphokines, and cytokines. According to Booth and Ashridge, our nervous and immune systems are constantly interacting homeostatically to define our health. When subluxations and spinal structural distortions distress the nervous system, they automatically also disrupt the immune system, endocrine system and ultimately the entire human organism, body and mind. Structural distortion of the vertebral column is capable of disrupting the internal homeostatic systems of the human organism, affecting function at the primary cellular level.
Do we have a sense of the times? Science is providing the infrastructure for our health from our philosophy. The health mind-set of our people and practitioners is fascinated by the concept of inner wellness. Deepak Chopra is turning the heads of the medical world, talking about the body's "inner wisdom" and ability to heal itself. Dr. Chopra has stated publicly that he personally is extremely fascinated by the chiropractic concept of "innate intelligence." Do we have the vision and positive self-esteem to realize that the core concepts of chiropractic are scientifically solid and valid, and that inner-wellness oriented health care is at the apex or focal point of change? In more simple terms, "We're what's happenin'!"
Do we have a positive enough self-image as a profession to dare to be distinctive, to dare to lead based on our distinctive chiropractic paradigm? Can we create outcomes assessment-based research to further validate what we know empirically: that chiropractic care keeps people well? Based on evidence in the scientific literature, through the consensus process, can we create guidelines that are wellness-based, instead of illness-based? Can we focus our care on subluxation and spinal structural distortion as they distress the neuroimmune systems, and not get lost trying to treat the myriads of conditions that beset the human body? Can we dare to place the patient at the center of health care instead of a disease or symptom? Can we partner with our patients and teach them about health from the inside out? Can we model positive lifestyle choices "teaching our patients to fish" instead of just "giving them a fish?" Through chiropractic care and a wellness-oriented life style, can we help them achieve their full human potential, facing life and its challenges with vitality, strength, versatility, and endurance? Can we all learn to dream a bigger dream and make it come true by living it?
At Life College, Dr. Sid Williams has had the vision to create a chiropractic curriculum that focuses on the body's inner wisdom and innate self-healing capacity and also challenges students to engage in a wellness-oriented lifestyle. In addition to basic, clinical and chiropractic science courses, experientially-based wellness courses are interspersed throughout the curriculum. Students are not only taught about health from the inside out, and self-responsibility for health; they are living it. In addition to receiving excellent chiropractic care for health and wellness, students are participating in aerobics training, using campus running trails and the college's aerobic equipment. They are learning the chiropractic message and making healthy life style choices. These future chiropractors are increasing their strength through resistance training on state-of-the-art equipment, and learning about the benefits of whole natural foods and a naturally-based life-style. They also know that they are the agents of their own health.
Our chiropractic students are the future of chiropractic, as are our patients. Let's strive to delineate chiropractic health care guidelines that emphasize chiropractic care for health and optimal well-being. Let's go for it and catch the wave of wellness. The tide is rising for chiropractic, if we have the vision and courage to seize the moment. As Shakespeare said, "There is a tide in the affairs of men." I think I see our ship coming in.
Ron Kirk, MA, DC
Marietta, Georgia
DC
Dr. Ron Kirk is a professor at Life University and the seed and Delphi panel facilitator for Just Start Walking. He serves in a similar capacity for the Straighten Up spinal health initiative. Contact Dr. Kirk with questions regarding the Just Start Walking program at
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