The Spongebob Paradigm

If you have watched anything on TV in the past 10 years, you have probably run across Spongebob Squarepants at some point in your channel surfing. Spongebob is a ridiculous, irascible sponge who lives in a pineapple under the sea in the town of Bikini Bottom. He is joined by his buddy, Patrick the Starfish, Sandy the Squirrel, his boss, Mr. Crabbs, and of course the evil Plankton. The foil to Spongebob's effervescence is his neighbor Squidward – a moody, unfulfilled octopus. At best, the show is just plain ridiculous, but I have to admit that sometimes it is a great brain purge. After all, laughter is good medicine.

While walking through our family room a few days ago, I noticed my son was watching an episode of the show. Spongebob and Patrick were upset because their TV was broken and they were going to miss the new episode of their favorite television superheroes, Mermaid Man and Barnacle Boy. Spongebob and Patrick ran over to Squidward's house and begged to use his TV.

Of course, Squidward denied their request because he didn't want to watch "some men in silly costumes prancing around; [he] would rather watch more meaningful programs." Squidward then sat back and turned on a show of men in tutus performing ballet.

I hope you get the irony of the above story. Arguably, both shows were pretty ridiculous, but the importance was clearly in the opinion of the individual. So, what does this story have to do with chiropractic? Quite simply, it has everything to do with our profession.

We have many in our profession who are passionate and enthusiastic about chiropractic care, but many on the other side – medical doctors, attorneys, politicians and patients – don't share our perspective. We represent a philosophical ideology that does not fit their way of thinking. How can we present our profession in a way that protects our philosophical underpinnings, yet reaches out to those who "just don't know?" I don't think there is an easy answer to that question, but I do think the future of our profession depends on how we answer it.

First, I think we have to recognize that many of the medical definitions have been written for us. Chiropractors have our own set of words we like to use, but the reality is that the medicolegal profession has set the standards and alternate vocabulary is not relevant in the big picture.

Perhaps the best example of this is the general term drug. Typically, we thing of drugs as pharmacologics, but in the big picture, a drug can be defined as any substance you provide to a patient to change their health, mitigate a symptom or promote healing. Given the scope of that definition, can anyone really claim that chiropractic care is "drug free"? I don't think so.

I will be the first to say that I am not a fan of pharmacologics. I have seen both my grandmothers pass at the hands of irresponsible medical care. I dealt with serious gastric issues for years as fallout from allergy shots my parents were told I "had to have" in my youth. But in light of the real-world, medicolegal definition, we need to be very clear in how we define what we do as a profession. It is dangerous to say we are drug free when by some definitions, we provide "drugs."

Another topic that I have written extensively on is documentation. With the impending requirements for medical records, chiropractors must make sure we fully document all aspects of our care: presenting complaints, objective findings, relevant medical information, treatments rendered, care plan, and objective improvement with care. [Read "Welcome to the Big Show," Sept. 28, 2006 issue] For a long time, relief of symptoms was an adequate patient response, but now the goalposts have moved – we must be able to objectively show how our care provided benefit. That might be a decrease in medications, improved ROM or increased functional strength; but you must be able to state how your patient benefitted from care beyond just "feeling good."

I believe chiropractic philosophy is vital to our profession; but philosophy is only of value when applied to the real world. Last year, I wrote about a state rule for worker's comp that required you to only treat areas of documented complaint, and the argument I had with another doc over full-spine philosophy. ["A Matter of Perspective," May 20, 2010] I never told him he couldn't treat full spine, but said that he had to be able to validate that degree of care. Just the belief in full-spine care was not enough; the extra step of clinical validation needed to be there. I found it very interesting how many e-mails I received disputing this point, arguing against the need to perform "medical" documentation.

Realize that I am not advocating for medical documentation; these are the rules for health care in general. Chiropractic cannot fully participate in the health care realm if it does not step up to the plate and play by the rules that every other health care discipline must abide by. For many years, chiropractic has fought to maintain a "separate and distinct" status, but we cannot become the hub of health care from the outside. There is no philosophical compromise to working within the established medicolegal rules.

Finally, if you are not aware of the Chiropractic Summit, I encourage you to visit the organization's Web site, www.chirosummit.org. Representatives from national organizations, colleges and chiropractic associations have all come together to present a unified chiropractic message. The summit has provided a multipartisan (straight, mixer, rehabilitation practitioner; ACA, ICA, WCA, etc.) chiropractic voice for the advancement of the profession as a whole – not just one technique or ideology.

My friend and mentor, John Amaro, often refers to D.D. Palmer's famous quote: "I have never felt it beneath my dignity to alleviate human suffering..." The fun part is what comes after those three little dots: "the relief given corns and bunions by manipulation." After D.D. came B.J., of course, who arguably had one of the earliest and most advanced rehabilitation laboratories ever conceived. My point? Chiropractic has always been about more than just the spine; we need to maintain that level of passion and vision.

I love my profession and I cannot see myself doing anything other than chiropractic, but the reality is that there are a lot of "Squidwards" out there. We need to show that we can step up and fill the void – we are more than just goofy practitioners dancing around.

The world needs good health care and chiropractic needs to be at the center of that care. The responsibility falls on all of us to meet and exceed the medicolegal norms. We do not have to sacrifice the history or philosophy of our profession to function within the established health care system, but the Squidwards won't hear our message if we don't phrase it in a way they can digest.

I was able to attend National Chiropractic Legislative Conference (NCLC) this past year as an ACA delegate. I was impressed by the passion of those in our profession working to advance the integration (not assimilation) of chiropractic into the health care system. We are a viable alternative to allopathic medicine; never did I see an attempt to give up our unique "natural first" approach to health care. However, to meet this end, we need to demonstrate good care with good outcomes, validated by clear documentation. We must show that we are not just "fringe," but a relevant and vital health discipline.