An interesting philosophical question was presented to me by a group of students. Why are the students always the ones to raise the insightful questions? Do we stop thinking once we get out of chiropractic college? There was a difference of opinion among the students as to the scope of the chiropractor’s responsibility in informing the patient regarding the effects of the adjustment on someone taking medication. The issue surrounded how the chiropractor should address a patient who is taking certain medications, specifically insulin and anti-hypertensives. One group said that addressing it was a medical issue and outside the realm of straight chiropractic, therefore, the chiropractor should not even bring up the subject! The other group maintained that if the blood pressure or insulin level was normalized under chiropractic care, then the drug could have a detrimental effect on the body and actually cause problems. Of course, the other side responded that the drug was already having a detrimental effect even if it was relieving some symptoms and that was a choice the patient had made. What is a chiropractor to do?
I think there are a number of issues to be explored relative to this question. First, we must realize that the ramifications are actually far greater than just the two medications raised in the question. If we accept the premise behind the Chemistry of Life, then every drug affects body chemistry. At the same time, every adjustment has the potential to normalize body chemistry. For a chiropractor to know the effects of all drugs including psychotropic drugs, tranquilizers, antidepressants, heart medications, and on and on, and how they individually impact on the body in any combination might be impossible. Not only do we not have the necessary pharmacological education but every drug is different in every person, the effects of which are virtually impossible to predict with any certainty. We could not possibly explain every drug action, but perhaps we do need to say something.
I believe this issue falls into the same area as apprising patients of a contraindication to a chiropractic adjustment in a certain area either because of a medical problem (diagnosed by their medical doctor) or an unusual finding (found by you incidental to your spinal examination). Further, as chiropractors, we should always explain to patients the four options that they have regarding care and the ramifications of those options (see Case Management for Straight Chiropractors, pp103-104). This particular case is a ramification of receiving both medical care and chiropractic care, option number four. It seems to me that we are obligated to explain this to patients. Perhaps we do not have to get into specifics and, of course, we are not going to make any claims that chiropractic is going to definitely normalize their body chemistry but the potential is there. From a patient-education perspective, this is a perfect place to explain how chiropractic affects body chemistry. This is a personal application of the Chemistry of Life talk. I think it has the potential to be a great tool for patient education. Of course, the patient must understand that your responsibility as a chiropractor ends with informing them that chiropractic care has the potential to normalize their body chemistry and that their medication may have an increasingly greater negative effect on their body. It is then necessary for the patient and their medical doctor to monitor those effects and make the necessary adjustments.
This question brings up two other issues. The first relates to what I call “doctor syndrome,” or the traditional chiropractor who wants to replace the medical doctor as the family doctor and do medical tests. In this particular scenario he would have to engage in even more medical procedures to monitor possible changes that might occur because of the adjustments. He would have to do regular blood tests and understand all of the ramifications of drug actions and interactions upon body chemistry. Of course, if disease is not your concern, then you merely have to inform the patient that he or she and their doctor are going to have to monitor their disease and its need for treatment or a change in treatment and get on with the business of locating, analyzing and correcting vertebral subluxation.
The other issue relates to a discussion that was included in the last Pivot Review (Vol. 14, Number 3), regarding whether chiropractic is a health profession or not. Whether we are or not, the fact remains that chiropractic care does impact upon issues of health and we need to be prepared to explain that to every person that comes into the office. However, the sword cuts both ways. Not only do we relate to health issues but our care can impact almost every area of an individual’s life and it is incumbent upon us to explain that to every patient that comes in the office as well. Granted, we do not have to warn the patient that their golf game may improve or that they may be more effective and efficient in their job or that they will sleep better or have more energy, because those are not potentially negative results. But if this whole issue is about educating the patient as we said at the beginning, then it behooves us to explain that chiropractic may affect body chemistry in any number of ways and that those affects may greatly impact the individual’s life.v14n4