Not a Threat to the Public
Dear Editor:
In response to the recent article, "Diagnosis Is Your Legal and Ethical Responsibility," by Dr. James Lehman [Dec. 1, 2015 issue; see related column in this issue], I would like to offer a few thoughts on this matter.
Dr. Lehman takes issue with resolutions that the Colorado Chiropractic Association adopted on Sept. 11, 2015. The resolutions stated that it is an acceptable practice to deliver chiropractic care solely for the location, analysis and correction of spinal subluxation. He states that the resolutions passed by the CCA are both "illegal and unethical." He also has concern that these resolutions absolve the chiropractor from performing a detailed examination in order to arrive at a proper diagnosis.
I contacted a member of the CCA who was involved with these resolutions; he advised me that in no way were the resolutions designed to lessen the current standard of care that exists in Colorado. Rather, the resolutions were implemented to give support to those practitioners who choose to focus their practice on the structural and functional integrity of the spine and nerve system.
It would seem that according to Dr. Lehman, in order to provide any type of care, an examination and diagnosis must be made. It is certainly acceptable that vertebral subluxation does constitute a valid, recognized diagnosis that would warrant care, regardless of if symptoms were present at the time.
Dr. Lehman states in the article that it is his "opinion" that the new CCA standards eliminate the need for a proper diagnosis prior to chiropractic treatment. If the chiropractor uses objective measures to identify abnormalities in the structure and function of the spine, and then uses these findings to determine the patient does indeed have vertebral subluxation(s) present, this would constitute a working diagnosis.
In addition, a proper case history and examination would identify any concerns that would necessitate care from another provider or be considered a contraindication to chiropractic care at that time. Furthermore, each patient should be signing an informed consent to care which details the focus of the practice and allows a full understanding of the doctor-patient relationship.
Dr. Lehman states in his article that the standards do not protect the public and calls the behavior "irresponsible." I find this to be alarming. Certainly a chiropractor has the right to focus his/her practice on the structural and functional integrity of the spine and nerve system, as long as that falls within the scope of practice in their state.
Part of every patient encounter is "triage." A responsible chiropractor knows that during each patient encounter, new or established, there should be a watchful eye for anything that doesn't fit the norm. In the event that a finding is discovered that does not fall within the scope or focus of the practice, that finding should be discussed with the patient, documented, and proper steps should be taken to direct the patient to receive any additional care that might be needed.
A practice that chooses to focus on the detection and correction of vertebral subluxation is not a threat to the public at all. In fact, it is a beneficial service that needs to be made readily available to those who seek our care. Practitioners who choose to practice in this manner still have the responsibility to ensure safe and effective care for their patients, but should not ever feel they are "illegal or unethical" for practicing this way.
Chris Waddell, DC
President, Oklahoma Board of Chiropractic Examiners
