I recently saw an interesting advertisement for a book by a chiropractor relating to the therapeutic and diagnostic aspects of conservative health care. Across the page was an ad for a book on conservative treatment for urinary tract infections. It had never struck me before. (Probably every other chiropractor has thought of this), but there is no such thing as conservative health care, conservative medical care or conservative chiropractic care. There is only good care and bad care. Good care is accomplishing your objective (providing it is a worthwhile objective) with little or no harm to the patient. Bad care is when the treatment or procedure does less good than it should or more harm than it should. It is not necessarily good care if it does more good than harm which is a philosophy of much of allopathic medicine. It is bad care if, whatever good it does, it does more harm than it should.
If two procedures both accomplish the same objective but one does so with more harm than the other, it is not a matter of one being conservative. One is a good procedure, the other is not, therefore, one is the procedure of choice. To perform the other is irresponsible. There may be two ways to accomplish an objective, but if one is better, that is the procedure of choice. “Conservative” does not enter into it. If an aspirin treats a headache, but does more harm than an adjustment in relieving the headache, the aspirin is irresponsible care, the adjustment good care (though not necessarily straight chiropractic care). Conversely, if an aspirin effectively relieves the headache and the adjustment does not, the aspirin is the procedure of choice. That the adjustment is more “conservative” is not an issue. It comes down to what is right for each patient and what is wrong. An adjustment, no matter how much less traumatic, is wrong for a patient when open heart surgery is called for.
Good health care, then, is doing whatever procedure is best for the patient under the circumstances, be it medicine or chiropractic. If we are primary health care providers then we must make the judgment for every patient on every visit what is the best procedure (accomplishing the objective most effectively with the least amount of harm) and then perform that procedure or at the least refer them out to someone who can. Here’s the problem: to do that you must have full knowledge of the condition, the effectiveness of the adjustment versus the effectiveness of all medical/therapeutic procedures, the danger of the adjustment versus the danger of the therapy in addition to knowing all the variables and factors specific to that particular patient. To do that would necessitate having all the knowledge of a medical doctor. Anything less would be incompetence and merely a matter of luck if you decided upon the correct procedure.
Let’s look at the other side of the coin. If the M.D. is a primary health care provider, and we surely would not want to deprive him of that title, then is it not incumbent upon him to have full knowledge of the same things we learn in chiropractic school? If we deny him the ability to perform those procedures then he must, in good conscience, refer to us the conditions that can be best treated by, not conservative, but proper care for that particular patient. He must be able to determine whether chiropractic is the best care for a particular problem. Getting kind of confusing, is it not? How about the poor patient who spends half his life running back and forth between doctors.
It comes down to this, there is no conservative or extreme approach to health care. There is only good and bad. If that is the case, then medical doctors are going to have to incorporate chiropractic into their armament for the treatment of disease and chiropractors are going to have to incorporate medicine, drugs, and surgery into theirs. Anything less would be bad care. In most patients, for most conditions, it may be that the best care includes a combination of both. It is impractical for numerous reasons for two doctors to be treating the same patient for the same condition with different procedures.
What, then, is the logical conclusion to this discussion? The objective of the chiropractor is the correction of vertebral subluxations. A chiropractic adjustment is always the procedure of choice in accomplishing that objective. Anything else, the treatment of disease by whatever the most appropriate method, including manipulation, should be left up to another provider. v5n1
