The term “primary health care provider” appears to be a focus of controversy between the different segments of the profession. the mixing element says that the straights are a danger because as primary health care providers, they should diagnose disease and then either treat patients if chiropractic care is appropriate or refer them to someone who can treat them. As primary health care providers who are taking care of people with serious disorders, they say that we have a responsibility to diagnose and the straight chiropractor who does not is giving less then adequate care.
The straight, on the other hand, maintains that being a primary health care provider does not mandate or obligate us to perform full body, medical diagnosis. He can cite the letter from David A. Kindig, M.D. to Reginald Gold, D.C. dated January 30, 1975. In that letter Dr. Kindig states being a primary health care provider does not require medical diagnosis.
The question is, does being a primary health care provider require chiropractors to diagnose or does it leave that option up to them? As a portal of entry is it not incumbent upon the chiropractor to do some type of diagnosis? The argument is made that optometrists and dentists are primary health care providers, and they are not expected to do full body diagnosis. They are only expected to be responsible for their respective areas of expertise. But they still are responsible for a degree of diagnosis. They diagnose conditions that are related to their area of concern, eye and dental problems.
It could, and has been argued that the vertebral subluxation is a condition that requires a diagnosis. Whether this is just a semantical discussion is open to argument. Commonly understood, diagnosis is discerning one disease from another or determining the presence of a disease entity from many numerous possibilities. This is clearly not the chiropractic situation. The straight chiropractor is determining whether a vertebral subluxation is present or not. It is clear that the objectives of mixing chiropractic would require some type of diagnostic activity while that of straight chiropractic would preclude it. This is why the mixers say it is ridiculous to think that chiropractors do not diagnose and why straights say its ridiculous to think that chiropractors need to diagnose.
It seems that a third perspective may be helpful in understanding the issue. Perhaps chiropractors are or should be designated primary health care providers not because of what we do that is similar to other primary health care providers but because of what we do that is unique and that is not duplicated by any other primary health care provider. The mixer says that other primary health care providers diagnose, hence we should. But perhaps we are a primary health care provider because we have a function or provide a service that no one else can duplicate. Not only is it a service that no other primary health care provider can perform (the correcting of vertebral subluxation) but it is a service for which no other primary health care provider including a medical doctor can even determine the necessity. No medical doctor can determine whether a patient has a vertebral subluxation or not, so they are not qualified to act as a primary health care provider in determining the need for chiropractic care. They cannot say, “you have a vertebral subluxation, I am going to refer you to a chiropractor.” If they could, there would be no need for us to be primary health care providers. We could function along the same lines as the physical therapist. The physician would make the determination for the need for chiropractic care and the chiropractor would perform the needed adjustments.
Here is the irony of the situation. The uniqueness of straight chiropractic, locating analyzing and correcting vertebral subluxations is what makes us primary health care providers. No one else can perform that health care service. The primary interest of the mixer chiropractor, taking care of musculoskeletal conditions, is the very thing that excludes him from being a primary health care provider. It is a duplication of service. The medical physician is entirely capable of determining whether a patient has a musculoskeletal condition. In fact if we want to be honest, we would have to admit that he is better qualified than the chiropractic physician to determine whether there is a musculoskeletal condition or a serious medical condition necessitating medical intervention. Once the determination is make that it is a musculoskeletal problem, then the patient can be referred to the chiropractic physician and he can determine the most appropriate treatment (adjustment, physical therapy, etc.). Doesn’t that seem like the most logical, safe, cost effective way of giving care to the American public?
It is not our ability to do what the medical physician does that makes us primary health care providers. It is our ability to do what they cannot do that gives us that title. The straight chiropractor, who focuses solely on the subluxation solidifies that position and title. The mixers who diagnose like an M.D. and choose to treat medical conditions undermine the chiropractic profession’s unique role and hence its position as primary health care providers. v9n3