Are Old Ideas Holding Chiropractors Back From Contemporary Acceptance?
Dear Editor:
It's become a common theme in my office these days to not only provide manual therapeutic relief to my patients, but also to be a "dispeller of chiropractic myths" that are present in our profession.
Although a number of patients receive care from both chiropractic and medical professions during the course of their lives, we often don't see eye to eye. It wasn't until 1983 that the American Medical Association stopped holding the belief that is was unethical for medical physicians to associate with chiropractors! Recently, a survey was performed to assess orthopaedic surgeons' attitudes toward chiropractic; the results were not surprising. Between 2006 and 2008, 1,000 orthopaedic surgeons (500 from Canada, 500 from the U.S.) were polled, revealing that 96.7% indicated they had some knowledge of chiropractic; 82.7% were somewhat comfortable discussing chiropractic with their patients; 67.9% felt that chiropractic education should be included in their medical training; and 27.2% were interested in learning more about chiropractic.
However, of the orthopaedic surgeons included in the study, only 51.4% reported that they would refer patients for chiropractic care; only 15.9% felt that chiropractic care should be available in hospitals; and only 29.4% endorsed a positive impression of chiropractic, while 44.5% endorsed a negative impression of chiropractic; and 26.1% endorsed an unsure impression.
Some reasons for such a negative impression of chiropractic were related to the assumption that chiropractors provide unnecessary treatment, acquire excessive amounts of X-rays, engage in overly aggressive marketing, breed dependency on short-term symptomatic relief, and do not treat in accordance with evidence-based practices!
One of the biggest hurdles we as chiropractors face is our diversity within the profession regarding treatment protocols, philosophies, and even in the chiropractic "language" that we use. Until our profession's regulatory bodies can begin to institute standardize measures regarding how we assess, treat, and communicate with our patients and health care colleagues, we will not receive the respect from our contemporary medical counterparts that we deserve.
Dean McDougall, DC, ART
Calgary, Alberta, Canada
A Definition of Subluxation
Dear Editor:
I'd like the opportunity to respond to Dr. Kent's statement, "I believe that the controversy and confusion surrounding the chiropractic concept of vertebral subluxation is due, in part, to the lack of an operational definition compatible with most techniques." ["A Four-Dimensional Model of Vertebral Subluxation," Jan. 1, 2011 issue] In my opinion, the recently published (and accepted in the NGC) Practicing Chiropractors' Committee on Radiology Protocols defines six applicable categories of subluxation regardless of technique. Quoted from the NGC:
"Definition of Subluxation and Average Normal Spinal Alignment: Vertebral subluxation should be maintained as the primary health disorder that comprises the chiropractic profession's identity. The 6 structural categories of subluxation presented herein are recommended descriptions for the biomechanical component of vertebral subluxation. Radiography is indicated for the qualitative and/or quantitative assessment of the biomechanical components of these 6 vertebral subluxation categories. When using radiography, a baseline value of the mechanical displacement should be determined prior to the initiation of chiropractic treatment intervention. In this manner, response to care can be determined."
I hope y'all have the opportunity to review this text in its entirety. It is heavily referenced with literature published in the National Library of Medicine and, in my opinion, clearly defines the categories of the vertebral subluxation complex.
David Doperak, DC
Phoenix, Ariz.
We Need to Show Students They Can Participate
Dear Editor:
It was with some sadness that I read Dr. Guy Riekeman's article [Dec. 16, 2010 issue] regarding stagnation in the number of enrolled chiropractic students; it seems that this is another manifestation of the fractured nature of our profession at this time. I think it is very difficult to attract a student interested in health care to a profession with a self-imposed narrow scope, a loose affiliation of providers who can't agree on what they wish to do or sometimes even what to call themselves, and who stand in a circle and shoot at any opportunity.
Dr. Riekeman mentions the value of preventive/wellness care after the acute musculoskeletal flare-ups that often bring in a patient in the first place - but in most states we can discuss diet and nutrition as well as exercise, but we can't council patients on their prescription drugs or offer them these therapies if appropriate, help them with possible natural alternatives, offer them IV nutritional support or injectable therapies if appropriate, or even be paid adequately for exercise training and other advice.
The CCE is attempting to expand the training of new docs in these areas to more fully integrate them in primary care, but the new guidelines have been met with a flurry of dissent from a variety of folks who really don't want to move the profession into the 21st century; even though no one is suggesting that they change anything at all in their personal practices if they are happy with their productivity and outcomes.
If we wish to make the profession attractive to prospective students, we have to show them that they can participate in the paradigm of health care as it exists today with a broader scope and a full toolbox to help their patients.
Cathlynn Groh, DC
Englewood, Colo.