Doctor means "teacher" or "counselor," so it should not surprise anyone that one who claims to be a doctor would be in the teaching or counseling business. The doctor or counselor of chiropractic offers health counseling to patients on a daily basis.
Such counseling falls under a rather large number of categories:
- biomechanics
- chiropractic principles
- rehabilitation
- nutrition
- lifestyle
- substance abuse - alcohol, smoking, drugs
- weight and eating disorders
- fitness
- stress
- sleep - including pillows, beds, style
- disease prevention
- wellness enhancement
- problem-oriented counseling
- disability
- vocational
- chronic pain
- illness-coping
- personal problems
- paralegal
- expert consultations and witness testimony
- various disorders (e.g., scoliosis, osteoporosis)
- referral to another health care professional
My list is not complete, but it gives a general view of the vast array of topics and items chiropractic "doctors" are called upon to give counsel. Counseling is a modality that is both a medium and therapy that all chiropractic utilizes, regardless of scope-of-practice philosophy, to promote patient health status and community health in general. And with any modality for which the patient requires the opinion of the treating doctor, the doctor is entitled to fair compensation for the time spent counseling the patient.
It is essential that the doctor be compensated for such counseling, because not only does it take time to counsel, but special skills need to be developed by the doctor through study and application. Counseling is not just talking to patients, or telling them what to do or not to do. Counseling takes into consideration the psychosocial aspects that affect patients in relation to their problems specifically, and health in general. Ignoring these aspects and the principles of counseling often results in low patient compliance.
Counseling is educational; supportive; short-term; structural (in contrast to just talking); solution-oriented; limited with concrete goals; and active-directive. It deals with mentally healthy people in contrast to mentally ill people seen by a psychotherapist.
A few states prohibit chiropractic physicians from counseling patients (i.e., Washington). The net result of anticounseling laws imposed on doctors of chiropractic is to prohibit them from charging for the time they spend in counseling patients, because all doctors counsel their patients regardless of the law. Without counseling, patient management would be impossible.
Counseling is intended to change people, to make them think differently, to make them feel differently and to make them behave differently. Counseling is about teaching and learning. The chiropractor is the teacher and the patient is the student. This is the active-directive role model of the therapeutic relationship. Two important aspects of this are essential: good personal skills and good technical counseling skills.
The vast majority of states allow doctors of chiropractic to do counseling. It is important for all chiropractic physicians to be vigilant and to continue to protect this right - perhaps even to expand on it - by allowing doctors to get continuing education credits for re-licensure purposes by attending seminars and workshops in counseling. Such seminars and workshops are usually not as expensive as typical chiropractic seminars and the doctor can learn to improve both relationship and counseling skills at such programs. For information regarding such programs, doctors should contact their state organizations of counseling and the counseling licensing boards.
Edward Sullivan,DC,PhD,BCIAC,FIAMA
Denver, Colorado
