J. Michael Menke, MA, DC, PhD
"History is a vast early warning system."
- Norman Cousins
Future chiropractors will treat more and more patients with complicated comorbidities of diabetes, cancer, hypertension and obesity. This is a strong reason for full integration of chiropractic into general health care delivery, as many patients will require medical co-management. Until and unless primary care chiropractors are fully prepared to assume exclusive responsibility for managing these chronic and degenerating diseases at the primary, secondary and tertiary levels of care, the future is co-management.
Medicine's spectacular discoveries over the past 200 years have tamed some very nasty bugs, but medical science is not well-suited to tackle better health through lifestyle behavior modification or wellness. And the most debilitating and expensive comorbidities are mostly diseases of bad behavior. Distinguishing and fighting the enemy with anesthesia, antiseptic. and antibiotics changed health care forever. Now, we are the enemy. Wellness could be the answer to many problems in health care, but to be taken seriously, wellness must earn its stripes and the public's trust. Chiropractors do indeed have a legitimate claim to at least some of the wellness domain, and may claim more wellness in the future if they build on their DC "black-belts" as the first step to implementing and practicing scientific wellness.
First, think of what wellness really means to society. Is it necessary? It is much easier to conceive of wellness for the elite athlete than for the poor and medically indigent. Though there may indeed be a huge, untapped market for wellness goods and services, will that make a real difference in people's lives, or will chiropractors only further their image of treating without a need? We all like patients who pay cash, and aren't really sick, but are worried about it. But wellness standards are more rigorous. Wellness must meet a need and demonstrate a measurable value.
We should take note of the new context for embarking on wellness. It will help launch us in the right direction. At the time the term emerged, the world was very different from today. We must take care not to jump on a fad that is already waning.
Take our current context of war. In war, the healing arts and professions mobilize differently. Supporting health needs takes on a new dimension. National priorities change. Governmental funding changes. Crisis care is the priority ... even in Ohio. In the 1970s, the great state of Ohio was building three new medical colleges and one osteopathic college. A major driver for medical construction was to meet the ongoing needs of returning the Vietnam War wounded. The medical school attracted resources and hired faculty over to its new facilities. It was as if the campus had a new center of gravity, and every other department leaned toward it.
In war, indulgence is less affordable and less fashionable. The romance with "me" ends. If wellness is merely pampering, or a scheme to tap disposable incomes of the worried well, it will meet a swift and silent end. "Whatever happened to wellness?" may briefly enter the conversation at a state association meeting in five years. In war, a culture doesn't appear as interested in a new physiological cosmology. Battlefield medicine is the rule. For wellness to be sustainable in the new century and culture, it must get down to real business. Wellness professionals must know something about the psychology of judgment and decisions, assessing readiness to change, and motivating, leading and measuring change. Finally, wellness professionals are patient advocates and are knowledgeable enough about medicine to keep patients from being swept away into risky care. Wellness providers must be credible; to be credible, they must be a part of health care delivery. They should have seen most types of surgeries, know medication side-effects, and understand the sensitivity, specificity and risks of medical tests. In other words, wellness is its own profession.
Chiropractors are already predisposed toward wellness. Chiropractors know health is not only a technological solution. But the concept of self-care is essential. It is just as true for chiropractic as for medicine: Health is not from a bottle or procedure. It is not "done to" a patient.
Chiropractors speak wellness, and encourage activity. When not too attached to the spine as the primary leverage to health, real wellness is possible. At its highest level, chiropractic culls and coaxes healing from a person's own natural resources, to be followed by sustained self-care. And I believe it is true that after a "wellness intervention," the best monitoring of that patient is by a chiropractor. But if chiropractors make wellness only a spinal thing, the stakes and the marketing costs will be extremely high. Increasing accountability will eventually require that chiropractors who sell wellness do what they claim. Marketing costs will rise because there will be a large and long sales cycle to get companies such as Genentech and Raytheon on board. Believing that wellness emanates from the spine sounds just exactly like a belief.
War is a call to reorganize priorities. This greathearted nation will meet the changes, and in so doing, will also change. And so, too, will chiropractic do its part. Healers prosper by giving support and solace, but also by solving difficult problems in health and health care. Scientific wellness implemented and managed by chiropractors could be an enormous contribution to our nation, and to the chiropractic profession, if chiropractors step up and do it right. Making wellness a sales gimmick will only destroy it. Helping people recover and be responsible for their own health is rewarding; keeping them well is better. Applying what works, what we know works, and what our experience teaches us is best for a patient is naturally exciting, attractive and useful. Chiropractic wellness does not convert people to a new belief. It is chiropractic beyond belief.
J. Michael Menke, DC
Tucson, Arizona
menke@u.arizona.edu
