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Dynamic Chiropractic – July 29, 2002, Vol. 20, Issue 16
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Dynamic Chiropractic

Exam Procedures Must Go Beyond Chiropractic Techniques

By K. Jeffrey Miller, DC, MBA

Editor's note: Dr. Miller is the author of Practical Assessment of the Chiropractic Patient.

Chiropractic colleges teach a variety of techniques, each of which usually has two components: a system of analysis; and a system for delivering the adjustment.

Most of us begin gravitating toward one or more techniques while in chiropractic college. Our preferences are influenced by field practitioners; personal results; teachers; other students; literature; comfort; and many other factors. Some become purists focusing on a single technique, while others (myself included) decide to use a combination of two or more techniques. Chiropractors are usually very proud of their technique choices, and will often identify themselves by their technique. For example: "I'm a Gonstead practitioner."

Being proud of our techniques is important. They are our heritage and our future. Our methods of identifying and correcting the subluxation complex are what distinguish us from other health care practitioners, and will continue to distinguish us as health care evolves. It is safe to say that our success over the past 100-plus years has been because of these unique techniques. Thus, our most important tools are our techniques.

Despite our emphasis on the subluxation complex over the course of our existence, chiropractic and chiropractic colleges have adapted several evaluation procedures from our allopathic counterparts. Histories; physical examination procedures; orthopedic and neurological tests; and lab and imaging studies are utilized daily in modern chiropractic. Most practitioners mix and match chiropractic technique analysis and medical examination procedures. However, some choose to utilize technique-based analytical procedures exclusively.

Exclusive use of technique analysis is often based on philosophical reasoning. This direction may also be taken after coming to the realization that many of the medically based procedures are often unfruitful for the average chiropractic patient. It is not unusual to examine the patient with considerable health complaints and not encounter a single positive orthopedic or neurological test. Yet, several technique-related findings would be evident. Over time, the doctor may begin to think technique analysis is all that is necessary. Despite the reasons listed, exclusive use of technique-based analytical procedures is risky. It must be remembered that often the absence of certain positive findings helps confirm that a patient has a chiropractic case.

I firmly believe that 99 percent of the patients who enter a chiropractic office are subluxated. I also believe that while almost everyone is subluxated, not everyone needs an adjustment. Patients with primary and secondary cancers; carotid artery blockage; aortic aneurysms; vertebral artery compromises; cauda equina syndrome; meningitis; upper motor neuron lesions; and other ominous conditions may be subluxated, but they are better off in the care of our allopathic colleagues. Identifying these patients and making proper referrals is often dependent upon the procedures we have adapted from the medical world, not technique analysis.

While our emphasis is primarily on the subluxation complex, doctors of chiropractic are not excused from the responsibility of ruling out other disease processes or contraindications to adjusting. We also are not excused from abandoning skills learned in school, or from failing to stay abreast of professional advancements. While I admire the purist's philosophical stance and understand wanting to skip over the medical-based procedures to get to the chiropractic analysis, I doubt that an admiring, understanding chiropractor will ever be allowed to sit on a malpractice jury when another doctor's methods of evaluation and diagnosis (or lack thereof) are challenged.

K. Jeffrey Miller,DC,DABCO
Shelbyville, Kentucky

Click here for more information about K. Jeffrey Miller, DC, MBA.

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