One of the quietest but most important intra-professional victories ever achieved was the adoption of the Chiropractic Paradigm by the school presidents in the Association of Chiropractic Colleges back in 1995. For a profession as fractious over identity and therapeutic roles and as adept at internal self-inflicted wounds as chiropractic was at the time, to get agreement on anything related to identity and practice was a significant achievement. Everyone in the group played important roles, but probably none were more significant than the efforts of John Allenburg and Gerry Clum. Working together, they forged enough consensus that the paradigm was adopted, and has served as the basis for education, clinical and legislative efforts for the last eighteen years.
It may be that many in our profession do not even know of the paradigm, but it’s under attack, and everyone should be aware of it.
As stated on the ACC website, the states the parameters for the practice of chiropractic: that it should include establishing a diagnosis; it should seek to facilitate neurological and biomechanics integrity through appropriate chiropractic case management; and that it works to promote health.
It also defines the scope of chiropractic practice–essentially what all should hold in common as essential to chiropractic’s identity, regardless of how divergent some may be beyond this foundation. It states, “Since human function is neurologically integrated, Doctors of Chiropractic evaluate and facilitate biomechanics and neuro-biological integrity through the use of appropriate conservative, diagnostic and chiropractic care procedures.” It takes the opportunity to then make the point about the centrality of these issues to population health: “Therefore, direct access to chiropractic care is integral to everyone’s health care regimen.”
The practice of chiropractic is defined with language that grounds us in important ways–yet leaves room for those who wish to use it.
Doctors of Chiropractic, as primary contact health care providers, employ the education, knowledge, diagnostic skill, and clinical judgment necessary to determine appropriate chiropractic care and management.
Doctors of Chiropractic have access to diagnostic procedures and /or referral resources as required.
Doctors of Chiropractic establish a doctor/patient relationship and utilize adjustive and other clinical procedures unique to the chiropractic discipline. Doctors of Chiropractic may also use other conservative patient care procedures, and, when appropriate, collaborate with and/or refer to other health care providers.
Doctors of Chiropractic advise and educate patients and communities in structural and spinal hygiene and healthful living practices.
What it does not do is include drugs and surgery in the practice of chiropractic. Nor does it envision doctors of chiropractic as working under the scope of other licensed providers: by emphasizing our role as primary contact health care providers and the requirement of a diagnosis as a basis for providing care.
It has language regarding subluxation–a polarizing issue for many. Yet all chiropractic school presidents agreed on this:
Chiropractic is concerned with the preservation and restoration of health, and focuses particular attention on the subluxation.
A subluxation is a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health.
A subluxation is evaluated, diagnosed, and managed through the use of chiropractic procedures based on the best available rational and empirical evidence.
Despite the profession’s challenges in defining and researching subluxation, it’s difficult to argue against this definition. Whether it serves as the central aspect of individual doctors’ practices is a personal matter. But I have viewed this as an important, pivotal definition ever since it was instituted in these definitions.
And these definitions have generally served the profession well for almost two decades. Yet there are forces at work now that want this to change. What kinds of changes? Some schools want to remove language about subluxation, neurologic integrity and other defining aspects of the profession. Many feel justified in their beliefs that doctors of chiropractic should be able to prescribe drugs as part of their practices.
This trend has me more concerned about our profession’s future than just about anything I’ve heard in years. If the chiropractic profession doesn’t split into two, I’ll be personally amazed. Do you have any opinions about this? Post them here and/or send a note to David O’Bryon, ACC Executive Director or to Dr. Brian McAulay, the ACC’s new president.