How Much Is Enough? Chiropractic Philosophy in the "New" Health Care
By Douglas R. Briggs, DC, Dipl. Ac. (IAMA), DAAPM
One of the primary arguments used against chiropractic care is the "overuse" of treatment: "Once you see a chiropractor, you have to go forever." I have been in practice long enough to have encountered this argument more than once, and understand the issue must be met with a balanced perspective, particularly these days.
The world has changed. Don't get me wrong, I still think that chiropractic is the best health care option out there, but the way society as a whole views health care is different. We must recognize this reality and approach it accordingly.
Health Care Then and Now
Back in the early days of the profession, when D.D. Palmer was in practice with A.T. Still and they were performing magnetic healing, folks went to a doctor when they had a problem. I clearly remember being treated by the same pediatrician who took care of my mom – he was a stately old gentleman who looked a lot like Col. Sanders.
He did everything – blood pressure, exam, shots; he even made his own medications there in the office. He was the one my family considered responsible for my health care – and the family followed his advice. After all, this was the same guy who'd taken care of my mom 25 years earlier.
That kind of health care is dead and gone. If you see the family doc or pediatrician now, you go through the front desk, then the nurse, then somebody else, then maybe the doc stops in to say hello; then the nurse comes back in to finish up and direct you to the front counter for payment. Not quite the old-school, personal touch of the "good old days."
As much as I miss that level of personalized care by the doctor, their interaction with every aspect of the office encounter is not really possible – even for most chiropractors – in today's world. I cannot see my patients, do my exams and notes, render my care – and at the same time handle the front-desk schedule, negotiate insurance calls, and supervise three other patients doing active rehab. I just can't. That era of health care has passed.
Notice I am not suggesting that chiropractic has changed or that our philosophy needs to change – we just have to recognize that the medical, legal and social elements of health care in the modern world are vastly different from even 25 short years ago.
Going Mainstream: Teaching the Value of Our Care
There is great value to chiropractic care as health care, regardless of the health care environment. It is up to us to make that presentation in such a way that patients "get it." When a patient comes in with a specific complaint, I will tell them I recognize that we are going to deal with their specific issue, but looking forward there is more I can do to help them feel better and prevent those problems from recurring.
People expect a quick fix now. The focus of health care is still on symptom relief, not necessarily wellness. As chiropractors, we need to recognize this when dealing with patients, not to mention insurance companies and attorneys. Again, I am not saying anything about compromising philosophy or principles – I am saying we need to recognize the change.
Moreover, many folks are used to taking their "normal" medications for their "normal" headaches, back pain, etc. Why should chiropractic care be any different? Even better, why should chiropractic care not be the normal replacement for those other options? What is the problem? What is the pattern interrupt?
Simply put, we are – we as a profession are the problem. To a large extent, many in our profession have so alienated themselves from the mainstream that we have become an irrelevant distraction.
Remember Dale Carnegie? Approach people in such a way that you bring them around to your way of thinking, but don't berate them and scold them about how they are wrong – no one likes to be told that, and more often than not they will walk away.
I am still not suggesting you compromise chiropractic principles or philosophy. I am suggesting we present the message in such a way that it will be heard, digested and accepted.
How Much Is Enough? Injury vs. Ongoing
When it comes to our profession, what we do, we want everyone to embrace the logic of a lifetime of chiropractic health care. It is our responsibility to recognize where people are in their personal philosophy, and then engage them and explain the wisdom of a chiropractic lifestyle. Yes, this does imply ongoing care, but hopefully they recognize it is reasonable.
How often do you see your dentist? Once every six months? That's ongoing! How often do you take your car in for a lube-oil-filter change? Every 3,000 miles or so? That's ongoing!
There is nothing wrong with ongoing care if it has a clear value. Keeping your teeth clean prevents cavities and saves a lot of pain and expense on dental work. A tune-up every so often is a lot cheaper than waiting until the transmission falls out and you need a new engine. There is value to care; we just need to show it.
One of the most vocal groups I have encountered about chiropractic care is defense attorneys – they expect us to overtreat. In reality, they should be our biggest allies. When someone is injured, we should be able to clearly define that, provide a good course of care to get them back to pre-injury status, then release them from that care. (Yes, some people have chronic issues – that is generally the exception, not the norm.)
Release them from care in relation to the injury case, not from care overall.
There is a point at which you have reached maximal improvement with the care provided in relation to an injury. At some point, it is expected that the cast comes off, the crutches get put away and the patient goes back to normal life. That does not mean care stops; the patient should recognize the value of taking care of their health with chiropractic.
It is not reasonable that a defined injury claim suddenly is on the hook for a lifetime of palliative support. There should come a time when the patient has reached "pre-injury" status and can get back to "normal" chiropractic health care.
If we can't get them better from an injury and back to pre-injury, then what good is the care we provide? The patients can't understand that until we do, and it is up to us to clearly explain it to them.
Promote Your Unique Value
If the patient doesn't see the value in care and doesn't want to pursue care on their own, then we have lost the fight to present ourselves as the best option for health care. As I shared before, chiropractic has value, but only as much as we give it. You need to be engaged in your practice every day to promote the services you provide. Provide the highest quality services you are able. If we do not promote the value of our profession, someone else will step up to take our place.
Be the goldfish in the bowl – set apart, unique, valuable.1 Don't settle for anything less.
Click here for more information about Douglas R. Briggs, DC, Dipl. Ac. (IAMA), DAAPM.