I'm a member of the Association of Chiropractic History. It isn't a big group - just about enough people to fill up a wagon for a hayride - but bless all of these members for helping to keep "the story" alive. I like to study chiropractic history, since it is one of the most classic American stories out there, with passion, self-sacrifice, David-and-Goliath imagery, tribal intrigue, and the mythology of "one cause, one disease." There is not much I haven't heard of in our profession, so when I come across history repeating itself, I pay attention.
It seems there are some "gentlemen" who own an insurance company. They offer really cheap malpractice insurance, but the catch is that a chiropractor must agree to have all patients sign something called the "terms of acceptance." The agreement says, "We do not offer to diagnose or treat any disease." The agreement goes on to say that the chiropractor will diagnose only "subluxations or neuro-musculoskeletal conditions" (all right, that sounds a little better). But then it states, "Our only practice objective is to eliminate major interference to the expression of the body's innate wisdom." The patient is required to read and accept these terms before starting any treatment, even if they aren't particularly concerned about the status of their body's innate wisdom.
My initial reaction when I encountered the "terms" was: Is this a good idea? Most DCs know the story of B.J. Palmer defining chiropractic in this way, so that courts in the individual states would not arrest chiropractors for practicing medicine without a license. Many state chiropractic laws still are haunted by language such as that used in the "terms." However, times have changed. Chiropractors usually are considered bright enough to make a diagnosis. I, for example, have even been trained to take a patient's blood pressure!
In my state, I am required to record a diagnosis, and sometimes I find things that deserve discussion. So, I don't know how I would handle a practice ruled by the "terms." What could I say if a patient asked, "Dr. Hanks, do you think I'm overweight?" Maybe I would be allowed to say, "Well, Mrs. Kopopkins, you look fat to me, but our terms of acceptance say I can't suggest you may be suffering from obesity." And what about that blood pressure reading? "Dr. Hanks, was my blood pressure high?" "Well, Mrs. K, the numbers were high, but our agreement says I can't tell you what that means." Saying that a DC does not diagnose anything except subluxations is like a psychiatrist saying, "I treat tics and annoying quirks, but I do not treat neuroses," or a podiatrist saying, "I don't treat fungal infections of the toes; I just trim toenails."
If this picture of chiropractic practice is the goal for the profession, why require all the education? Why rack up a $75,000 student loan? Surely, one could be trained in subluxation detection and correction much more quickly and cheaply. We could go back to 1905, when the Palmer School course was only nine months. In fact, according to Joe Keating in his book, B.J. of Davenport, the Palmers were strongly against increasing the length of study, since they felt that would call for "instruction and practice in subjects considered beyond the scope of chiropractic." So much for that boring biochemistry.
Perhaps the company that thought up the "terms" could offer a new malpractice insurance product to chiropractors who choose only to adjust the first two vertebrae in the neck. It seems logical. If just saving money and reducing one's scope of practice are the goals, then a return to the "hole-in-one" days of the "upper cervical specific" makes sense. A policy covering a practice like that shouldn't cost more than $100 a year.
I understand the philosophy behind, "We don't do diagnosis." But wait a minute! Wasn't the whole point of lifting our profession up from our humble beginnings the achievement of a highly educated and competent profession? Didn't hundreds of our leaders give up big chunks of their personal and family lives to work for the betterment of the profession, primarily for the chiropractors of the future? Didn't they want to build confidence in the minds of future patients that chiropractic is valid and responsible? Then, I would have to say that this "terms" trend is promoting the "dumbing down" of the profession.
What would the educational pioneers in our profession think? I think they would be rotisserizing in their graves if they read the "terms." "Wake up, Drs. Janse, Nugent and Napolitano! You've got to look at this! Wake up, Dr. Homewood and Dr. Dave Palmer, you're not going to believe it!"
In the early '80s, there was a rock band called Devo, whose name was based on the theory of de-evolution. The theory states that mankind and nature are actually "de-evolving," or going backward in complexity - getting simpler, rather than more complex. The idea is based on the concept of entropy, which can be defined in Webster's as "the steady degradation or disorganization of a system."
Reductionist movements pop up in all sectors of society from time to time - but do we really want to return to the status of barefoot bonesetters? Is the past really a good model for the future? I think not. To quote a line from Devo's most popular song, "Crack that whip, give the past the slip."
John Hanks, DC
Denver, Colorado
jwhanksdc@earthlink.net
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
On Feb. 1, 2024, two more legislators – John R. Carter (R-Texas) and Robert “Bob” Good (R-Va.) – co-sponsored the Chiropractic Medicare Coverage Modernization Act of 2023, bringing the co-sponsor total to 155, two more than the total achieved over the entire two-year congressional cycle in which identical legislation last appeared (2021-22).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
