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Let the Marketplace Decide

It was with great interest that I read "Trouble in the Wellness Waters?" in the May 1, 2015 issue of Dynamic Chiropractic. I heartily applaud Dr. Hayes for his insightful and informative article. Certainly wellness / lifestyle is coming to the forefront of the shifting health care paradigm among all disciplines. This shift is driven in large part by medical economics among all the professions, as all providers are looking for supplemental income streams due to the cost-cutting policies of insurers, declining insurance reimbursement, onerous and ever-increasing documentation requirements, and the demand by numerous patient populations tired of the "pill for every ill" approach of orthodox medicine.

I do not think Dr. Hayes is necessarily being paranoid in his concern that the new medical specialty of lifestyle medicine may threaten the chiropractic profession's ability to provide wellness care. It may turn out to be a real concern in the near future. However, I would like to offer a different perspective on this issue as someone who has practiced wellness / lifestyle care with patients since obtaining licensure more than 30 years ago.

Dr. Hayes is correct in his assertion, "We're likely to wake up someday and find we are on the outside looking in." My perspective on this differs in that I do not believe there necessarily is a vast medical conspiracy to push us out of the wellness picture as was found in the Wilk case from years past. Certainly there still is an undercurrent of lack of respect for the chiropractic profession in certain medical circles, as evidenced by the American College of Lifestyle Medicine having DCs and other non-MD, DO providers in a separate membership category. Frustrating? Unfair? Yes. But rather than continue to blame the medical profession for our lack of a level playing field, I submit for consideration that we must look inward and assess our own commitment as a profession to lifestyle / wellness in the truest sense of the definition.

I am reminded of a quote from one of the leaders in the chiropractic profession in the area of lifestyle / wellness, the late Dr. Jack Kessinger. Dr. Kessinger, along with Dr. Michael Cessna (both of whom I consider close friends and mentors), were among two of the early diplomate chiropractic internists. Dr. Kessinger would say, "The chiropractic adjustment is the foundation of what we do, but it is not the ceiling." The Council on Diagnosis and Internal Disorders of the American Chiropractic Association has long promoted the concept of expanding the depth, breadth and scope of our beloved profession to include diagnosis and treatment protocols beyond the musculoskeletal. This includes laboratory diagnosis, functional medicine testing, wellness / lifestyle counseling, nutrition, diet and various other patient-centered therapies.

I am also reminded of a quote by the late Dr. Joseph Janse, past president of my alma mater, National University of Health Sciences (formerly the National College of Chiropractic): "Legislate as broadly as possible, so you can practice as narrowly as you would like to."

There are abundant opportunities now within the chiropractic profession to assure our rightful place in the area of lifestyle / wellness "medicine." These opportunities include pursuing a diplomate or taking relevant courses with the American Board of Chiropractic Internists, the American Clinical Board of Nutrition or the Chiropractic Board of Clinical Nutrition. Additionally, there are numerous educational seminars and courses outside the chiropractic profession in nutrition, functional medicine and wellness care. In my opinion, as physicians it is each of our personal responsibility to advance the profession in the area of wellness if we have the interest and desire to do so. Admittedly, not all DCs have an interest in internal diagnosis, nutrition or wellness as the emerging definition dictates, and that is perfectly fine as well ( see Dr. Janse's quote above).

If we do lose out in the area of wellness / lifestyle, in great part it will be of our own doing. Although we may have been among the first professions to promote these concepts, along with naturopaths, the truth of the matter is that we unfortunately do not solely "own" the wellness / lifestyle concepts. The real danger is getting shut out if we do not make our presence and interest widely known and stake our claim both within and for the chiropractic profession, as well as within the broader category of orthodox medicine. If we do not claim it, they surely will.

We know medical care in the United States is the best in the world when it comes to emergency medicine, acute serious infections and trauma. We also know orthodox medicine has been and continues to be a dismal failure with regard to chronic, degenerative conditions such as arthritis, cardiac disease, diabetes, obesity, etc.. They know it, too, but are actively seeking to change.

One of my sons is entering his third year as a medical student at the University of South Florida Health Morsani College of Medicine SELECT program (Scholarly Excellence. Leadership Experiences. Collaborative Training.) The focus of this program is to recruit medical students with "the empathy,creativity and passion to change patient care, the health of communities and the medical profession". In summary,to graduate physicians that are holistic minded and patient centered by educating "students with a strong foundation in emotional intelligence and become more engaged, compassionate physicians who will connect deeply with their patients and their patient's families; feel more comfortable with and be more effective as team leaders and team members; and have the relationship building skills and systems perspectives to more effectively lead change in health care organizations."

Sounds like they are taking this new lifestyle medical specialty concept seriously, doesn't it? This concept is rapidly expanding in medical education. My son, on the first day of his third-year clinical clerkship, was handed a textbook on clinical nutrition and wellness care and told, "This is going to be an important part of your medical education."

In closing, let me say this: In my opinion, we cannot advance the chiropractic profession by attempting to keep other professions out of the wellness / lifestyle area or complain they are in the game now. The horse is already out of the gate. This is true in many aspects of health care and crossover taking place in practice scope.

I recently spoke with a new graduate of a doctorate program in physical therapy. She proudly told me that in PT school, they emphasized over and over that one of the goals of the PT profession now is "to have PTs replace chiropractors as the sole providers of spinal manipulation in the public perception." How ironic: We were disparaged before, but are being imitated now.

We need to and should readily advance our own education, interest and desire to compete in the wellness / lifestyle arena and let the marketplace decide who they perceive the preferred wellness doctors are. We have a more than100 years' head start in this area. Let's continue to claim our birthright and continue to move forward.

John Podlaski, DC, NMD, DABCI, DACBN, DCBCN, CNS
Ocala, Fla.