Chiropractors as Wellness Practitioners: An Idea Whose Time Has Come

In a recent article authored by chiropractors in the Annals of Internal Medicine (perhaps another first for the profession), chiropractic was called a "profession at the crossroads" of mainstream and alternative care.¹ There are several views among DCs on which path to follow at the crossroads. Some would have us be musculoskeletal or back specialists, dealing exclusively with pain management; others would have us be subluxation specialists, limiting our concern to the articulations of the spine - an extreme of reductionism, though perhaps a viable one for many; and yet others (I'm in this group) would like to see us as primary care providers, differing from medical physicians in our focus on health, rather than disease, and on assisting the body through noninvasive means to restore balance and achieve optimal function.

However, it will not be our preferences alone that drive the future direction of our profession. The most important (if not the only) force that will drive us in one direction or the other will be the "power of the people," what the general population believes we do.²

Currently, the "back-doctor" view prevails among the general public; 94 to 99 percent of chiropractic patients present for care with musculoskeletal pain.^3-5 Other professions' view of chiropractic is the same as that of the general public, but they also tend to view chiropractic not as a profession but as a procedure, synonymous with spinal manipulation.⁶ This view is illustrated by the National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health, which categorizes chiropractic among the "body-based healing systems," along with massage, rather than among the "alternative systems," in which naturopathy is placed.⁷ Thus, for those of us who see chiropractors as primary care providers of health care, NCCAM's view is distressingly similar to what some (not me) have called "spine jockeys"- chiropractors who want to restrict our practice exclusively to removing subluxations.

If we do want to establish ourselves as primary care providers of health care, we clearly have some work to do in communicating that concept to the public and the health care community.

The American Chiropractic Association has already begun work toward this end with its "wellness campaign committee," and its recently announced "long-range plan designed to transform the health care system." A significant portion of this plan addresses the need to educate the public on "the importance of conservative health care options offered by doctors of chiropractic as wellness experts..." and "motivate the public to follow good health habits for optimum function and wellness." The outcome of this portion of the plan is to establish chiropractors as "health and wellness experts."⁸

Contributing to the implementation of the long-range plan, the wellness campaign committee was formed in 2001 to develop, among other activities, a consensus document describing the relationship between wellness and chiropractic.

Perhaps the most significant aspects of the consensus document developed by this committee are:

1. an emphasis on patient-centered care, in which the patients are actively involved in regaining their balance between the internal and external environment - the goal of wellness care; and
2. the adoption of the national goals for health set by Healthy People 2010.^9,10

Chiropractic has been unaware, of or has declined to participate, in such national efforts in the past. This focus on involvement with mainstream activities congruent with our philosophy and practice is essential if we are to extend the influence of chiropractic. Exemplifying this attitude, a report on the ACA's wellness campaign was given at an interdisciplinary session sponsored by the Chiropractic Health Care Section of the American Public Health Association (APHA) at APHA's November 2002 meeting in Philadelphia.

It appears that the profession must emphasize two essential issues if we are to be seen as primary care providers focusing on wellness:

1. We must show the public that we provide patient-centered care in which we assist patients in self-care to facilitate optimal function - the definition of wellness.² In addition to being seen as only deliverers of spinal manipulation ("spine jockeys"), chiropractors are too often seen as providing only passive care.¹¹
2. We must continue to join with other professions, agencies and members of the public to contribute to the health of the entire nation and world. Too often, chiropractors are seen as self-serving and only interested in legislation that directly concerns them. Joining the World Health Organization, the Healthy People 2010 initiatives (at the national and local level) and the APHA demonstrate that chiropractic can integrate with the rest of the health care community, with tremendous benefit to both sides.

To join the Chiropractic Health Care Section of the APHA, contact Lisa Killinger,DC at 563-884-5150 or go to www.apha.org.

References

1. Meeker WC, Haldeman S. Chiropractic: A profession at the crossroads of mainstream and alternative medicine. Annals Int Med 2002;136(3):216-227.
2. Hawk C. The wellness hypothesis. In: The Chiropractic Theories. Leach R, ed. Baltimore: Williams & Wilkins, 2002 (in press).
3. Hurwitz EL, Coulter ID, Adams AH, Genovese BJ, Shekelle PG. Use of chiropractic services from 1985 through 1991 in the United States and Canada. Am J Public Health 1998;88(5):771-776.
4. Coulter ID, Hurwitz EL, Adams AH, Genovese BJ, Hays R, Shekelle PG. Patients using chiropractic in North America. Spine 2002;27(3):291-298.
5. Hawk C, Long CR, Boulanger K, Morschhauser E, Fuhr A. Chiropractic care for patients aged 55 years and older: report from a practice-based research program. J Am Geriatr Soc 2000;48(5):534-545.
6. Berman BM, Singh BK, Lao L, Singh BS, Ferentz KS, Hartjnoll SM. Physicians' attitudes toward complementary or alternative medicine: a regional survey. J Am Board Fam Pract. 1995;8(5):361-366.
7. Pavek RR, Trachtenberg AI. Current status of alternative health practices in the United States. Contemp Intern Med 1995;7(8):61-71.
8. American Chiropractic Association. Hot topics. www.amerchiro.org.
9. ACA Resolution 2000 [9] - 4: Chiropractic Wellness Campaign, June 2000.
10. U.S. Dept. of Health and Human Services. Healthy People 2010: Understanding and Improving Health. 2nd edition. Washington, D.C.: U.S. Government Printing Office, November 2000.
11. Hawk C, Killinger L, Dusio M. Perceived barriers to chiropractic utilization: a qualitative study using focus groups. J Am Chiropractic Assoc June 1995:39-44.

Cheryl Hawk,DC,PhD
Professor, Palmer Research Department,
Membership Chairwoman, Chiropractic Health Care Section of APHA
Davenport,Iowa