The two most important aspects of straight chiropractic care are the safe, effective correction of vertebral subluxations and educating the patient to the Above-Down-Inside-Out philosophy of chiropractic. A fundamental aspect of that philosophy is that the individual has or should have within them, the ability to control their own life with regard to matters of health. The chiropractic objective is to enable the patient to express that ability. Correcting subluxations allows the ability to be expressed on the innate level and patient education allows it to occur on the educated level.
The educational program of the straight chiropractor should be aimed at helping the patient to live more autonomously when it comes to decision making relative to their life and health. It involves weaning them away from depending upon an educated mind belonging to someone else (chiropractor or M.D.) and getting them to depend upon their own educated mind which is hopefully becoming more and more sensitive to the dictates of their body’s innate intelligence. That is called living form an Above-Down-Inside-Out viewpoint of life. There is a down side to this process from the chiropractor’s standpoint. It involves “cutting the apron strings” so to speak, giving the patient more and more freedom to make decisions, right or wrong, to learn from those decisions and become a more autonomous human being. It is very much like raising children. If you keep making decisions for them, forcing your advice upon them, you stunt their growth. You must allow them the opportunity to make decisions, right or wrong. Even making wrong decisions is part of the growth process. It entails recognizing a wrong decision, acknowledging it as such, accepting responsibility for the consequences of it and then learning from it. Patients as well as children need the opportunity to experience the above aspects o decision making. with regard to diet, exercise, and matters of lifestyle, the patient is ultimately the best authority and can only come to correct conclusions by applying principles to experience. We must give them the principles and then the opportunity to gain that experience. The outside-in approach to life attempts to create laws against bad decisions. Except for cases of criminality, any attempt to legislate against bad decision restricts freedom, and ultimately leaves the individual and society as a whole, worse off. We cannot allow educated minds to decide what is a bad decision and then legislate against it. Especially when most of those minds have an outside-in philosophy of life. There are numerous examples. The most glaring that affects many chiropractors is the issue of vaccination. The government has decided that choosing to not be vaccinated is a bad decision. So they have passed legislation to force this procedure upon people. Whether vaccinations are good or not is not even the issue. People should be allowed, even required to make their own decisions. I believe seat belts save lives, I’m not so sure about motorcycle helmets. But in either case I should have the right, and the responsibility for the care and safety of my own life, health, and head. No one else, especially a government should assume that responsibility.
When we as chiropractors give advice or a prescription to a patient we are assuming that responsibility. While it’s true it is not a law, we are still acting as an authority. The authority for people should always be their own free will as long as it does not interfere with another individual expressing his/her free will. When we educate we are disseminating information which an individual can accept or reject and then act upon. When we advise or prescribe we expect them to subject their free will to ours. There is of course an exception in chiropractic. That is the vertebral subluxation. There is no mechanism within the educated of the individual to know when, where and if he/she is subluxated. If therefore necessitates another authority to make that decision for the person- a chiropractor and in my case, another chiropractor.
One last area should be explored. How much control should the doctor have over the patient with regard to their care? There are chiropractors who maintain strict, almost totalitarian control over their patients, forcing them under threat of dismissal to conform to the chiropractors plan of care, including attendance at health talks, frequency of visit, lifetime care, and whatever else the chiropractor may determine is in the best interest of the patient. Conversely there are other chiropractors who give the patient tremendous freedom. They allow them to miss visits, not attend lay lectures, and have little if any other requirements, e.g. referring or bringing in other member of the family. While the former approach seems to be in the best interest of the patient, it does not really agree with the philosophy of patient responsibility that we have just presented. Every medical doctor believes it is in the best interest of the patient to give them his prescribed regimen and take control of their health. Obviously there is no easy answer to this problem. but it seems that we should be leaning toward a less regimented office and a more patient-taking-responsibility type practice. However if we do, we must be prepared to accept the patient’s decisions, even though we do not feel they are best. If the patient decides two visits per week is all they can afford in time, and money then do we have to respect that decision? If the patient decides they do not need to come to a lay lecture or do not want to come, should we accept their decision? Do we want patients to follow our recommendations (in the areas that we can legitimately recommend e.g. frequency of care, coming to lay lectures) because of our authority or because we have educated them. Ideally it is by education, however if they refuse to be educated, or reject the information given them, to what degree are we obligated to one, continue education and two continue accepting them as a patient with their less then acceptable behavior. This is obviously something that each chiropractor really must decide for himself or herself. But the overriding objective should always be to get the patient to take responsibility for their health care. How soon they are given the freedom and responsibility really depends upon the patients ability to handle that responsibility. We each individually need to establish some guidelines in our practice to determine when we feel the patient deserves that responsibility. Establishing those guidelines is no easy matter. v9n6