The near-universal acceptance and endorsement of the Chiropractic Paradigm developed by the Association of Chiropractic Colleges (ACC) has paved the way for the diverse components of our profession to really work together in explaining and promoting chiropractic to the general public.
To view an in-depth, graphic and narrative description of the Chiropractic Paradigm, visit the ACC's website at www.chirocolleges.org. I think you'll agree it's a historical and powerful step forward for the profession, but it's only a start. The logical next step is to articulate how we put the theory into practice to create a blueprint for doctors and students on practice scope and objectives, and patient education.
Triangle of Care
The "Triangle of Care" provides such a blueprint. Initially developed on the Palmer campuses to articulate our vision of chiropractic, it has evolved into an all-encompassing, detailed, yet highly compact explanation of chiropractic that is being embraced by large and diverse segments of our profession, and is easily understood by the general public. It clarifies the ACC Paradigm, providing a framework for practice that addresses the full continuum of care. I firmly believe this straightforward model has great potential to unify chiropractors around the real purpose of our profession, and to inspire patients to pursue care as a powerful and meaningful way to maximize their potential for wellness. Practitioners, chiropractic leaders and professional organizations that find common ground within the ACC Paradigm will also find their practice philosophy and style represented in the Triangle of Care.
Full Scope of Practice
The Triangle of Care (henceforth "triangle") illuminates the full scope of chiropractic care and practice objectives. At the center of the diagram is the subluxation - the core clinical activity of chiropractic and what makes chiropractic a unique health care service. (Of course, we assume all care revolves around patient needs as a first and obvious priority.) Patients can easily understand where they fit on the diagram, and the goals for their ongoing care. They can visualize themselves progressing from condition-based care all the way to wellness/development care, and can grasp the importance of becoming and remaining subluxation-free. Succinct language and bold graphics help to convey these topics in a way that reaches, engages and motivates patients. Because the triangle also encompasses the varied aspects of chiropractic practice, it also helps ensure that virtually all practitioners can feel comfortable with the concepts, and envision ways in which their practices reflect the contributions to the overall health care of patients. (Go to www.palmer.edu/pccf/pccf_triangle.htm for the detailed model.)
Condition-Based Care
Within the triangle, we recognize what almost all practitioners experience in the real world of caring for patients - most first come seeking relief from pain. At this point on the triangle model, the doctor of chiropractic investigates potential causes and appropriate options for the management of the condition. In addition to subluxation analysis and spinal adjustments, such care may require diagnostic/analytical considerations, as well as inter-or intra-disciplinary communication and referral. But the triangle model views condition-based care as an entry point, not a final destination. One of the greatest advantages of the model to the practicing chiropractor is the framework it provides for educating patients beyond the most basic level of pain relief and condition treatment to the concepts of prevention, wellness and optimal function.
Health Care
The primary focus of health care within the Palmer triangle is on helping people experience better function and improving the body's capacity for adaptation. Patients at this stage may regard chiropractic as a drugless, or natural approach to health and prevention. The chiropractor must communicate the need for the differential diagnosis of the subluxation and correction as part of a healthy lifestyle, and engage the patient in reassessing the "bigger picture" of health as the doctor/patient relationship progresses. Many chiropractors will also discuss other issues that can impact health at this point in a patient's care, such as nutrition, exercise and ergonomics. It can be difficult to talk with those in pain about the human potential for wellness, development and peak performance. I suggest setting the stage by educating them first about health and then slowly introducing the notions of greater wellness and performance as they begin to experience improved function. With a patient suffering from back pain, for example, you can begin the educational process at the point most relevant to the patient at that time. Namely, educate the patient about how information is conveyed from the brain through the spinal cord and across the nerve system, to determine the chemical reactions and electrical impulses that dictate muscle action, coordination, flexibility, bone strength and myriad other functions that can impact the types of symptoms he or she is experiencing. Explaining to patients how they can possibly avoid health problems by ensuring that their nervous systems are working properly is a powerful and attractive message.
Wellness/Development Care
One of the most exciting aspects of chiropractic practice is the opportunity to help people envision a higher level of health potential for themselves and their families. Most people take for granted that their bodies have certain familiar limitations. They say such things as: "I always get three colds each winter"; "I've never been able to sleep through the night"; "My son just can't pay attention for long periods of time." Without even realizing it, they have developed a very limited image of what their bodies can achieve. Certainly, most of us must accept that we are not Olympic-athlete material, but unfortunately, we tend to set our expectations artificially low for our potential for health and performance.
As you develop an ongoing, two-way conversation and relationship of mutual trust and respect with patients, you can begin to challenge some of their beliefs about health. Asking patients thought-provoking questions, such as, "How good could you feel?" or "Could your body perform at a higher level?" paves the way to interesting and nonthreatening conversations - even mutual explorations of the nature of true health and how to obtain it. Once you pique people's curiosity about the level of performance they can envision for their immune systems; athletic abilities; concentration levels; ability to sleep; emotional balance; and many other aspects of true health, you have found an avenue for introducing the greatest potential of chiropractic care for patients and their families, especially children.
Anyone who has served in chiropractic practice for a few years (or even just a few months) knows that patients under regular care experience tremendous improvements in their lives. They report better pregnancies; decreased allergies; fewer illnesses; greater coordination; enhanced stamina; and less dependence on pharmaceuticals. The list is endless, yet we are often timid about raising the idea of enhanced performance and function with patients. We wait for them to make an offhand remark about improvements in their health that they may not even have related to the regular chiropractic care they have been receiving. We must start educating patients from the first visit that as regular chiropractic care eliminates vertebral subluxation, it opens the door for better control and coordination of all body systems. The triangle model can help facilitate that conversation with patients.
A Triangle that Creates a Cycle
Although the concept behind the triangle is a potent one, I believe the visual nature of the model will make it effective in clearly and succinctly defining what we do in practice and in educating patients and the public. People are accustomed to learning by seeing. It's helpful to look at even a hand-drawn triangle with the words "subluxation," "condition-based care," "health care/prevention" and "wellness/development" written so patients can envision the impact chiropractic can have on their lives. Even if you don't mention wellness and performance at the first visit, they will notice it on the triangle and wonder what else chiropractic care may mean for them. For chiropractic students and practitioners, the triangle provides a helpful mechanism for viewing the full range of contemporary chiropractic practice presented in a unified model without contradiction or limitations. It even acknowledges that patients in health care or wellness/development care can fall back into condition-based care from time to time throughout life. It empowers each of us with a fuller understanding and appreciation of our diverse profession, and equips us with a powerful set of communication tools to effectively introduce chiropractic to others.
Educate your patients and the public that chiropractic focuses on correcting subluxations and recognizes that patients use us for the care of certain conditions to prevent disease states and symptoms through better nervous system function, and to maximize one's capacity for wellness and development at every stage of life. They will grasp the impact chiropractic can have in their lives. And they will become lifelong recipients of care - the kind of patients who draw others to your office and help establish a political and social climate that nurtures the continued advancement of the chiropractic profession.
Guy Riekeman,DC
President, Palmer College of Chiropractic
Davenport, Iowa
Dr. Guy F. Riekeman, current president of Life University in Marietta, Ga., has held leadership positions in chiropractic education essentially since his graduation from Palmer College of Chiropractic in 1972. He was appointed vice president of Sherman College in 1975 and has served as president of all three Palmer campuses and as chancellor of the Palmer Chiropractic University System. In 2006, he was elected to the board of directors of the Council on Chiropractic Education.