Should chiropractors try to prevent subluxations in their patients? Without a doubt this is one of the most controversial questions among the straights. Many sincere young chiropractors have a concern that by not looking for the cause of subluxations, we are adjusting “effects” and allowing patients to go out and re-subluxate themselves. We all realize that chiropractors cannot go around picking up every banana peel on the sidewalk to prevent people from slipping, but are there things we can do? Are there things we should do?
Each chiropractor has to make the decision for himself and obviously the extremes of the issue exist. There are chiropractors who would not even recommend a firm mattress and others who use every modality, device, and procedure, justifying it by virtue of their intent to “prevent subluxations.” There are emotional factors involved. There are things which we as doctors of chiropractic perceive as common sense and yet we see that patients don’t understand these things. Should we tell them? Trying to settle as complex an issue as this in a short article is virtually impossible. But, there are some philosophical thoughts that can be examined.
There are numerous problems, some practical, some philosophical, that are involved with trying to prevent subluxations.
1. Trying to prevent subluxations involves making judgments for patients. That is:
A. Philosophically unsound making a determination concerning a patient’s lifestyle in order to help prevent subluxations is saying “my educated intelligence knows better how to handle your universal forces than does the innate intelligence of your body.” The philosophy of chiropractic maintains that the patient’s body knows better what its needs and limitations are.
B. Practically impossible to make a halfway intelligent decision would necessitate omniscience and omnipresence. The doctor would have to follow the patient 24 hours a day.
2. Trying to prevent subluxations fosters the medical concept that man can and should make decisions for his fellow man. Making decisions is one of the most important aspects of life. There are two schools of thought on the subject of making decisions:
A. People are products of their decisions. This is the inside-out approach. It maintains that an individual’s decisions create the environment in which he lives. This school of thought fits into the chiropractic philosophy.
B. People are products of their environment, that environment causes decisions. This is the outside-in approach and is espoused by most of the medical community.
The first group says that decisions regarding diet, rest, exercise and getting adjustments cause diseases. Those who adhere to the second school of thought say that germs cause disease. The inside-out group says that decisions resulting in a body not working properly and decisions to abuse the body result in creating an internal environment that makes the body susceptible to pollen in the air. The outside-in group disagrees, saying that the environment in the form of ragweed pollen causes hay fever and ultimately causes the decision that you should move to Arizona. Many decisions are made in ignorance but a decision made in ignorance is still a decision and if we must place responsibility for that decision it is always with the person making it. If I decide to drive 40 mph in a 25 mph speed zone it is my decision. Even if I’m ignorant of the speed limit I am still culpable. If you don’t believe that, try telling the police officer you should not get a ticket because you didn’t know what the speed limit was.
Here’s the point. If we accept that people are products of their own decisions and we deny people the opportunity to make decisions, we reduce the product or reduce the quality of that person’s life. Why don’t parents continue to make decisions for their children as long as they live? The answer is obvious. Our adult offspring would remain intellectual children. There was a movie made some years ago called “The Stepford Wives.” The men in a small New England town drugged their wives with a substance that would make them sweet, obedient, dutiful housewives. The side-effect, which was not really a side-effect but the actual desired effect, was that they were zombies with no ability to think. Do you see the analogy? By telling people how to live their lives in order to prevent subluxations, we are creating health zombies, people with no ability to think for themselves. It may be great for the ego of the doctor, but it is bad for the health of the patient.
3. Trying to prevent subluxations takes away the patient’s responsibility. Is that bad? After all, many people don’t want responsibility. But if we take away responsibility we also take away freedom. The greater the responsibility the greater the freedom; less responsibility, less freedom. Some people are apparently willing to give up their responsibility and freedom for security. In discussing this issue in a philosophy class, I once mentioned that if you want no responsibility, then you should somehow get yourself committed to a prison. There you will have plenty of security, three meals and a roof over your head, guaranteed, but no freedom. A student argued that you have no security in prison, at least no security in your person. You can be raped or killed in prison. He was right. When you take away responsibility, you take away freedom and you leave a false security. In a capitalistic society you have responsibility for success or failure and the freedom to pursue either, thus giving the potential for security. In a communistic society you have no responsibility, no freedom, and only false security. You are only as secure as the system and the whims of those running the system. Many a Russian has felt secure one day and has been on his way to Siberia the next. Being free to lock yourself in your home or buy a gun to protect yourself is true security. Being in prison is false personal security. Many a senior citizen can tell you about a false system of financial security called Social Security. The truly secure ones are those who are free and responsible enough to invest their money wisely.
The patient’s security is only as good as the doctor who has taken away his freedom and responsibility. If the doctor’s whims, knowledge, or thinking changes, the patient is out in the cold. Doctors do retire and die. If you really want to take responsibility for your patients’ health, do it properly adopt them!
4. Giving advice in order to prevent subluxations has to be one of the most frustrating things one can do. It really is rather arrogant to believe that people are going to listen to you when they have ignored their medical doctor, the American Cancer Society, the American Heart Association, and all the other authorities, especially when these other authorities are making recommendations to prevent having a painful disease that people have seen others succumb to. There you are, trying to give advice to prevent the unseen and unfelt, seemingly innocuous vertebral subluxation. As a philosopher, I never thought I’d say it, but… let’s be practical!
Herocles of Ephesus, a 5th century B.C. philosopher once said “the easiest thing in the world to do is give advice, the hardest thing is to know yourself.” Trying to prevent subluxations involves getting people to be a better expression of their innate intelligence, which is knowing yourself understanding your body, its needs, its potential and its limitations.
There is one final important point to make on this subject. Not giving advice to people to prevent subluxations is not an excuse for a lack of patient education. We should be educating our patients about health, chiropractic, and understanding their bodies needs and limitations. What then is the difference between patient education and giving advice?
Patient education can be done on a group basis and, for practical purposes, must be done on a group basis. Advice must be given on an individual basis. Here is an interesting irony. Chiropractic deals with a personal application of health (patients living in accordance with the dictates of their innate intelligence) and therefore must be explained impersonally (in a group.) Advice, on the other hand, deals with an impersonal application of health (conforming people to a standard of lifestyle, e.g. sit this way, do this exercise, eat this food.) It may be slightly different for each patient (although it usually isn’t), however, it is still someone else’s standard, not the patient’s innate standard. Advice must be given personally.
How can you tell whether you are giving advice or doing patient education? If the information you are imparting could be given to a group of people, it is probably patient education. If the information is specifically meant for that person, it is probably advice. There are exceptions to this rule, but it is generally applicable. v3n6
