As a preacher’s son, parables and examples in Scripture are never far away in my consciousness. Even though a good deal of what passes for theology makes my teeth hurt these days, there is poetry in the Bible.
Seeing some of the information being distributed by those who would expand the profession’s scope of practice to include the ability to prescribe drugs, I’m reminded of one verse in particular: ‘For how is a man benefited if he should gain the whole world and he should lose his soul?’ (Mark 8:36). Gender-slanted language aside but in the context of today’s professional struggles, it might also read, ‘How will the profession retain its soul if it becomes more like medicine?’
It’s a hard question to answer when the profession itself hasn’t had the conversation about what its own ‘soul’ is. If soul is ‘…moral or emotional nature or sense of identity’ and describes what is enduring about that nature, how would we describe chiropractic’s soul?
I can’t answer the question with material from chiropractic philosophy texts like many of my better-educated friends and peers, but I can answer it from observations after being in the profession more than thirty years. I can answer it with the example of a woman with neck pain and morbid hypertension I saw as a student intern, who had morbid hypertension and was on all kinds of medication, but who came back a year later looking decades younger–off all medication, solely due to chiropractic treatment. I can answer it with a ninety-year old woman, tough as nails, who would come in for regular adjustments and knew she needed them when her vision got fuzzy. Or the German Shepherd whose hindquarters were paralyzed after being hit by a car, but able to walk normally after chiropractic adjustments. Or the children, shamed by suffering by bedwetting but then able to feel good about themselves when it stopped after chiropractic care. Or by myself, when thoracic adjustments quiet atrial fibrillation. Or….on and on. The fact I have to point to anecdote instead of larger data sets is part of our problem.
I didn’t prescribe any medications for these people (or animals). All I did was listen, observe, measure, diagnose and adjust. We can quibble over the profession ‘evaluates’ or ‘diagnoses’ but we can’t equivocate about what’s central to the profession: the chiropractic adjustment. It’s not mobilization; it’s not tui na; it’s not osteopathic manual manipulation: it’s chiropractic. Specific; grounded in radiographic evidence of positioning; complemented if a DC so chooses with adjunctive approaches; profound in its effects.
But is a chiropractic adjustment the soul of the profession? It is certainly an enduring component, and while it can be observed, recorded and analyzed, it also has an ineffable quality that represents the art of the profession: the application of the science and understanding, however imperfectly defined, explored, or understood.
There are many practitioners who are struggling to have successful businesses in today’s chaotic health care marketplace. Their pain is real. Marginalized by the dominant medical system, misunderstood by payers and customers (and by some of their peers), pigeonholed by narrowly reductionistic research efforts, chiropractic can be forgiven if it sees itself as a solution to many problems but never getting its number called. It’s Dogfight, without the happy ending.
So it’s tempting to push at the margins of the profession’s practices, looking not just to components that ‘facilitate or complement the chiropractic adjustment’ but are able to be separately billed. While these may be important or necessary business revenue lines, they also confuse both providers and recipients about what chiropractic is. When someone leaves a DCs office after an adjustment, or leaves after receiving therapies–or even a prescription–and they don’t understand what the soul of chiropractic is, we can’t blame them for being confused. And if the DC doesn’t understand (and represent and emphasize) what the soul of the profession is, they pass that confusion along to their patients.
The reality in today’s increasingly retailized health care marketplace is that there will be customers (patients, consumers, etc.) for any services they find in a DC’s office, whether on a table, in a machine or in a pill bottle. But if they are services that are available elsewhere, those who advocate for scope expansion may in fact be inviting a whole new class of competitors. Because by broadening the service menu at DC offices they will be challenged more and more to differentiate themselves from those who offer same or similar services. For a chiropractor who offers ‘manipulation,’ how will their customers understand what sets chiropractic apart from osteopathy or from physical therapy? For a DC who can prescribe pain pills and muscle relaxants along with a chiropractic adjustment, what form of relief or physiologic change will the patient associate with improved health and well-being? How will a chiropractor be able to advocate for the time it takes for a body’s innate wisdom and healing to assert itself, when someone can feel better by taking a pill?
Those who advocate for expanded ‘rights’ for the profession employ a powerful, emotional rallying cry, and (I’m certain) trying to do what they see as the right thing for those who are struggling as ‘second class health citizens’ in today’s system. But what they may not understand is that what looks like appealing and appropriate business territory is, in fact, introducing confusion into the profession’s own marketplace. And we should not kid ourselves about competition: a whole new class of MDs, the so-called Millennials, are coming on line with views about health, healing and practices that are powerfully close to what chiropractic thinks it stands for. Those who think we can add medical services and then displace those competitors with our weaker cultural authority are kidding themselves. Marketplaces reward differentiation, market segment targeting and sensitivities to price, service, product and amenities. They punish poor imitations of the genuine article.
Anyone’s opinion aside, it’s unlikely these efforts will stop. At some point they will succeed; and from the vantage point I have after several decades of practice, lobbying, executive leadership and development both in and out of the profession, those efforts are likely to backfire and lead to greater confusion, not marketplace adoption.
In closing, it’s important to remember the context for Jesus’ admonition in the Book of Mark. His challenge was to people to understand that what looked like gains in the world actually were losses at a much deeper personal level. His followup question was, ‘Or what payment shall a man give to regain his soul again?’ Given the current trend of DCs insistent on expanding their scopes of practice, I’m afraid we’re going to find out.