Gatekeepers of Health?

A recent article by a well-known practice management consultant extolled the benefits of being leaders in the alternative health care community. His argument was that since we are “a frequent first ‘point of contact’” for patients we should be a “valuable resource.” His suggestion is that we should “refer to, support and integrate the services of other holistic health care providers in (y)our area into the active care plan recommendations you are making for your own patients.” (Emphasis mine) This article is written by an individual who identifies himself with the straight chiropractic community. Doing other procedures in your office was at one time considered mixing but apparently now it is perfectly acceptable to chiropractors to “assist their patients in finding the care they need, whether it be from one resource or from a combination of care options, including acupuncture, massage, homeopathy, biofeedback or traditional medicine.” He maintains that we are no longer competing with each other as health care providers, “today the goal is to unify and integrate services in order to achieve optimum health for our patients.”

I’m sorry but this is not my idea of the function of chiropractic. I see very little difference between doing the above procedures in your office, having someone else in your office do them or ascertaining the need for these procedures among your practice members and then referring the person out to someone with whom you are “networking.” It is not straight chiropractic.

Perhaps we need to go back to some philosophical basics here. It’s called checking our slipping. We maintain that chiropractic is separate and distinct from everything else. It is not “holistic health care.” We are not involved in a “new climate of cooperation or CAM (Complementary Alternative Medicine).” We are not complementary, we are not an alternative and we are not medicine. Everyone needs chiropractic care, so it is complementary to nothing (in the sense that it makes that procedure complete). Whether you need or do not need acupuncture or traditional medicine, you need chiropractic.

Further, we are not the person to decide whether you need other procedures. Our philosophy teaches that we cannot determine what is normal or needed for an individual. The issue that precipitated the furor in the profession that gave birth to the modern-day straight movement was the contention by many in the chiropractic profession that as “portal of entry” doctors (Gatekeeper is the latest buzzword for “portal of entry”) we need to know when a person needs medical care, therefore we have to be able to diagnose medical conditions. The CCE was responsible for perpetuating and forcing this idea on the colleges. (We have not come very far in 30 years!). If we maintain that we do not know and can not know when a person needs medical care, how can we claim that we know when and if they need acupuncture, biofeedback or another “alternative,” unless we have concluded that like chiropractic, everyone should be under regular “alternative medicine care.” What we have done in aligning these alternatives with chiropractic, or chiropractic with these alternatives, is to begin to look at them in the same way we look at chiropractic. Acupuncture, biofeedback, massage, and homeopathy are not in the same class as chiropractic. They are alternatives to medicine which means they are therapeutic for the treatment of some disease or condition. Chiropractic is not an alternative for the treatment of anything. People needing medical care also need chiropractic care. People with no symptoms need to have their spine checked regularly for the obvious reason that subluxations are asymptomatic. Saying we should involve other procedures in our care is equating these procedures with chiropractic, whether we personally do them or not. Equating chiropractic to the medical alternative is either bringing chiropractic down to the level of a therapy or raising acupuncture, massage, etc. above the level of a therapy. Either way it is not good for chiropractic or its future.

We all know why this practice management consultant is advertising that we network with “nutritionists, herbalist, exercise outlets, spas, or homeopaths.” It is so chiropractors can build larger practices. I am all for that. But rather than aligning ourselves with medical alternatives, let’s spend the effort educating our present practice members and the community at large as to the uniqueness of chiropractic care and do it in a way that does not compromise our philosophy.  V19n3

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