R. Michael Cessna, DC, DABCI
With the diagnostic modalities available today, it certainly is not difficult for a doctor of chiropractic to be a "good" diagnostician, providing of course a few and rather simple tests are commonly ordered in conjunction with a detailed, in-depth history and body system review. Indeed, the advent of the computer-assisted electrocardiograph and spirometer have made cardiopulmonary interpretation and assessment quite simple. Once the diagnosis is made and the physical findings and laboratory markers for improvement are established, the chiropractic physician can then use various scientifically documented nutritional therapies, lifestyle management, exercise, and, of course, chiropractic adjustments as their natural therapeutic care strategy. Further, the baseline data obtained from the original workup can be used as a method of measuring clinical improvement. With few exceptions, all of these services are within the scope of the majority of state laws and are presently included in the curriculum of many of the CCE approved colleges. What is more, this approach is satisfied within the definition of chiropractic by the ACA.
Without question, x-rays are practically routine in all chiropractic offices, yet the ratio of useful information for internal disorders obtained on a multichannel chemistry and CBC, as compared to x-ray examination, is overwhelmingly greater for blood studies. Though most chiropractors have been taught laboratory and internal diagnosis to the degree they are able to pass their national and state boards, they do not generally use this training in their practice. Why? Certainly, most state laws allow the use of blood analysis, and still, the majority of the field practitioners fail to routinely employ this most valuable diagnostic procedure. We will never be able to convince the scientific community that we can internally diagnose if we decline to routinely order blood work. Failure to gather scientific diagnostic patient data categorically limits the practitioner of any discipline to the care and treatment of simple, non-life threatening, and often self-limiting disorders!
Obviously, the doctor who has the ability, expertise and the necessary diagnostic "tools" to identify the degree of seriousness and determine the source of the signs and symptoms that are influencing the patient's disorder is the physician that can make intelligent decisions as to the type and frequency of treatment and prognosis, "before" therapy is rendered! The days of taking a set of x-rays and dispensing a "trial" period of 25 or 30 adjustments to "see if we can help you" are over if you are going to perform in the third-party pay arena.
By elevating the "mind set" of the profession towards a focus of diagnosis and management of the "whole" person, in addition to enhancing the diagnostic skills of both the graduating doctor and the established field practitioner, the ultimate benefits to the profession and the patients we serve would be enormous. Undoubtedly, there would be greater acceptance of chiropractic service by both the public and the scientific community, as well as the health insurance industry. This diagnostic documented clinical approach would be demonstrated to insurance carriers and government agencies through repeated insurance claim submissions and thus educate these agencies by "showing," rather than "telling." Furthermore, patient education would reflect an emphasis on diagnostic modalities and the use of laboratory work, which would eventually increase the number of new patients and the return of former patients to all chiropractors. Over a period of time, the public would learn that our profession is capable of recognizing, and in most instances, treating persons with internal disorders; and more often than not, that our services and health management is efficiently administered, non-invasive, low risk, and frequently more cost effective than the allopathic approach.
The chiropractic model described above already exists today by those chiropractic practitioners that are engaged in family practice and training through the Council of Diagnosis and Internal Disorders' 300-hour diplomate program.
Based on recent studies conducted by the ACA, it appears that for professional survival within the third-party system, chiropractic must emphasize its uniqueness in two areas:
Disease Prevention: Offer an alternative to allopathic medicine through management and treatment of health disorders by natural non-toxic methods which emphasize lifestyle change, diet, nutritional advice, exercise, and care of the spine.
Low Cost: Demonstrate to third-party payers that chiropractic service offers the most cost effective contemporary health and wellness care available by virtue of preventing disease and thus avoiding costly hospitalization, surgery, and expensive diagnostic procedures. These services must not be limited to neuromusculoskeletal conditions since it is estimated that 80 percent of all the money consumed for health care is spent on chronic degenerative diseases -- diseases that are essentially preventable. Chiropractic must be the disease prevention profession.
We must engage in the management and care of patients suffering from life-threatening internal affliction. It is well-documented that the two major killers (cardiovascular disease and cancer) are primarily the result of adverse lifestyle and thus often can be averted. Nearly all state laws include in their chiropractic law the rendering of advice regarding health and lifestyle, including dietary and nutritional recommendations. To increase our "niche" in the health market as primary care professionals, chiropractic doctors must return to a therapy concept that embraces the care and management of the whole person.
Although you may disagree with some points in this article, you must agree the data is overwhelming that there is an eminent threat to the very future of the chiropractic profession and we have some real troubles.
In closing, now that you have read this paper, what are you going to do? One suggestion: You had better make certain you are a member of your county, state, and national associations. Even though you may not be political in nature, at the very minimum, you had better be a member and be active! Also, consider ordering blood work on most of your new patients to assess the possible internal problems your patient may have, in addition to documenting the need for your chiropractic services. Enroll in postgraduate studies to improve your laboratory methods and diagnostic skills. Finally, become involved in the health and wellness movement -- be wellness oriented in your practice and in your life.
One day when you find your practice is in real trouble, don't blame somebody else; the fault will lie with you and you alone. Do nothing and perish. Take action now or you and your profession will be counted out.
Michael Cessna, D.C., D.A.B.C.I.
Tuscon, Arizona
