Chiropractors and Public Health: Measuring Success One Patient at a Time

I was watching one of those crazy legal shows the other night, and when the witness put their hand on the Bible and stated they were "going to tell the truth, so help me God," I had a thought. What if people really knew the truth about the potential impact spinal adjustments have on neurological function and how chiropractic care can help so many people with so many different health concerns?

How many of us have been in conversations with people at a social gathering and thought to ourselves, If they only came in for care, or I wish I could adjust their child in that wheelchair, or I wonder what their upper cervical X-rays look like? or Do you really think taking Oxycontin every day is the answer? I think chiropractors by nature suffer a lot of compassion fatigue (I know I do). I think because of our caring nature we always want to help.

One of the reasons I joined the Chiropractic Health Care section of the American Public Health Association (APHA) was that this organization looks globally. It takes the big view. It seeks to take chiropractic health care to the next level and promotes our conservative care to people of all walks of life. When I walked around this past year's convention in Philadelphia and visited all of the vendors, I took my time to see what aspects of chiropractic care could be applicable and tried to educate and make contacts, but many people looked at me with glazed stares. You can adjust a child? Chiropractors care for pregnant women? What does chiropractic have to do with arthritis? We in the profession know the impact we can have on our population's health, but I believe few DCs would argue that our care is helping all the people who really need it. The majority of the public is still unaware and misinformed, and hardly anyone is educating them.

Whether at a maternal and child health forum, a neuromusculoskeletal organization meeting, or a public health curriculum at a local university, I always try to educate them on what chiropractic does and what it focuses on, as opposed to just limiting our scope of disorders to the lumbagos. If it is true that only 5 percent to 9 percent of the population actually uses our care, then we need to drastically enhance our educational, public-relations and public-health efforts in our own communities. The reports and all the research are pointing in the same positive direction; we need to use it to our advantage to promote and make more people aware of our valuable service. We all know it goes way beyond caring for someone with a bad back.

In my office, vernacular is extremely important. When someone asks me, "Hey Doc, can you crack my neck?" I politely diffuse them by asking, "If your sick child could benefit from our care, would you take them to a doctor who would 'crack' your child?" Of course not! So pay attention to what you are saying to your patients, even when you are just kidding around; it could impact whether the parent brings that child in for care.

Another word I use heavily in conversation is underutilization. When you look at the number of people who rely on pain medication and other things just to get through the day, no one should think twice about how we can positively contribute to the world. Chiropractic health care on a local, national, and global level is so underutilized, to the point that we desperately need to have greater access and improved public perception. If you look at the definition of medical underutilization, it is defined as the failure to provide a health care service that would have produced a favorable outcome and increased potential. Have you ever seen someone suffering needlessly from chiropractic underutilization?

We all know we work hard in our practices. We don't have large advertising and marketing campaigns advocating for our profession like Big Pharma and the hospitals do. Why is it that the majority of practices are not filled with people? Is it because of a relative dearth of DCs? No, it's most likely due to perception. People are either afraid, lack understanding, or no one ever told them so they are not looking to you as the solution or as part of their health care team.

As a Massachusetts state-association board director in charge of public information and education, one of my goals is to build better relationships with third-party payers, get involved in grassroots efforts, and enhance and promote our profession with integrity by telling people the truth about what it is that we do. What does this have to do with public health? Lots. When I get on the phone with a nurse case manager and she asks me why I am caring for a 5-year-old who concomitantly suffers with asthma, I can say that by adjusting this child, I am allowing their body to function better and that as a result, use of a steroid nebulizer was almost eliminated by the first re-exam. That is a public health win, no doubt about it.

So, how do you determine public health successes in chiropractic? We do it every day. We don't have enough time to measure all the successes and translate them into research, although we really need to strive for evidence-based practices. Every person whose health improves, can go about their job a little easier, or doesn't have to rely on pain medication every day - those are truly public health victories. Despite the importance of the CDC tracking the prevalence rates of H1N1, it's when little Jimmy is having trouble breathing, and you adjust his thoracic subluxation to allow his body to function better and then he can breathe easier - that's when public health really matters most. And that is the truth, so help me God.