You would think that the issue of diagnosis would be settled by now. So much has been written about it. It seems pretty clear to me. To treat medical conditions you need to perform a diagnosis. If chiropractors treat medical conditions, they need to do medical diagnoses. If chiropractors do not treat medical conditions, but address only one condition (which is not a medical condition), the vertebral subluxation, the only need is to determine whether the person entering the office is subluxated or not. If we do not treat diseases and we make that fact perfectly clear to the prospective practice member, then we are clear of any legal responsibility. However, even more important than that is the moral responsibility of making sure that every person coming into our office understands what our unique objective is and that it does not replace or even overlap the medical objective. That is no easy task and it may be more of a challenge than even performing a diagnosis. That is a real irony. The medically-inclined members of our profession charge that we are only technicians rather than “real” doctors because we do not diagnose but, rather, merely perform a technical procedure, that is, give an adjustment. Yet, the so-called art of diagnosis has been reduced to a procedure that can be done most of the time on the internet and is probably done tens of thousands of times a day by lay people who are using a computer program that some technician has designed. No professional expertise needed there.
If a doctor is a teacher, then the non-therapeutic, objective straight chiropractor, is more of a doctor than the broad-scope practitioner. It takes no professional training to put a modality on a patient. It takes little, if any, professional training to enter a patient’s symptoms into a computer program and watch it spit out a diagnosis. It does, however, take professional training to be able to communicate and educate people about the chiropractic objective. You see, everyone is different in their understanding and even their ability to understand the uniqueness and distinctiveness of the chiropractic objective. Educating people is an art form. We can use technology and scripts but on a certain level there must be a heart-to-heart connection between the chiropractor and the practice member to make sure they really understand what we are doing. This brings me to the issue of diagnosis that is becoming a point of contention.
Some time back it was suggested that we acknowledge the need for what was termed “referential diagnosis.” The argument, as I understand it, is not that the chiropractor must distinguish what the medical condition is but he must determine that it is not a chiropractic condition and that the person needs to see a medical physician. In light of our philosophy that makes no sense to me. If we are doing our job in explaining our objective in chiropractic and our role in the health-care delivery system the issue of diagnosis should never come up. On or by the end of the first visit, people should understand that we do not perform a diagnosis and that if they desire one they need to go to a medical doctor. How hard is it to understand a non-therapeutic objective? It seems that it is more difficult for our profession than it is for most of the public. People coming into the office seem to easily get the idea. True, they often forget a few days, weeks or months later and begin to ask about their symptoms and they need to have our objective (correcting vertebral subluxation so the innate intelligence of the body can be expressed more fully) and our non-objective (treating disease or symptoms of disease) explained again. Much of our profession, on the other hand, has never gotten it in the first place. Those of us who have should not be coerced by the insurance companies, the accrediting agency, the medical world and life viewpoint or the complaining patient into ignoring that truth and trying to find euphemistic terms to justify practicing medicine under the guise of chiropractic. V23n3