The profession of chiropractic finds itself in interesting times amongstthe flurry of health-care reform. Collectively, the profession’s members (and patients, for that matter) know that it holds the answers to some, and perhaps many, questions that plague our health-care system and general well-being.
The profession of chiropractic finds itself in interesting times amongst the flurry of health-care reform. Collectively, the profession’s members (and patients, for that matter) know that it holds the answers to some, and perhaps many, questions that plague our health-care system and general well-being. However, it is constantly running up against walls in its efforts to make this value known to governments, the medical establishment and the general public.
Part of the reason for this is that DCs have struggled with formulating a clear message regarding what, exactly, chiropractic is, where it is most useful, and how, precisely, it effects its benefits. Chiropractic, as a health and healing system, is multifaceted and this might, in fact, be one reason it is difficult to reduce it to one or two characteristics for public consumption. In other words, its varied proponents are not necessarily wrong in the divergent perspectives they adopt – the question is how to distil these perspectives down to effective messaging strategies. It is tempting to try to enlighten an audience with the full scope of the chiropractic message right from the get-go, but, unfortunately, this can serve to muddle the conversation, and further confuse even those with the most open of minds. And so, members of the chiropractic profession are still carrying on a dialogue regarding how to reach out and convince people that chiropractic should be retained as a viable, perhaps even primary, option, in the health and healing toolbox.
As the key to making messaging “stick” is to keep things simple, and focus on salient concerns for the audience in question, this article proposes five points that may be presented to make the case for chiropractic as a valid health-care option. These points aim to offer a clear message without watering down, or selling out, the important elements that give chiropractic a unique edge. A time may come when people are ready for more in-depth instruction. Until then, communicating the potential chiropractic has for offering tangible benefits to a wide spectrum of patients can begin as simply as presenting these points.
EFFICACY AND SAFETY
Unbeknownst to many, and in addition to the subjective testimonials of hundreds of thousands who feel they have been helped by their DCs, a plethora of studies are available to demonstrate the efficacy of chiropractic treatment in a variety of (mostly) musculoskeletal conditions and injuries.1,2,3,4,5 One can also find some preliminary studies that suggest chiropractic might have effects on other conditions as well, either incidentally or directly.6,7
At the same time, there are studies that demonstrate where chiropractic might not be useful or where it is, in fact, completely contraindicated.8,9,10 This, too, is important information.
Furthermore, there are studies in chiropractic and medical literature indicating that chiropractic is a safe form of treatment that has been utilized by hundreds of thousands of patients11 without reported side-effects or adverse outcomes.12 Again, in an effort to carefully consider both sides of every coin, there are also reports of bad outcomes or side-effects.13 These are few, however, when compared to the number of treatments that have not caused harm.14 (Even the most ardent skeptics must concede that any procedure, including the most common medical procedure, carries some risk.)
My point is simple: in an age when evidence is king, and the medical profession bases its credibility on its ongoing scientific collection of evidence for efficacy and safety, chiropractic is neither lacking in evidence of these traits, nor less passionate in its systematic pursuit of best practices, evidence-informed treatment and delivery of safe, patient-oriented care. In fact, in light of some of the challenges the profession has faced, it has become especially adept in managing these elements.15
The natural/manual healing systems (commonly known as complementary or alternative) offer two appealing elements to a public that is increasingly seeking safe and effective alternatives to conventional care16: they harness natural means to heal or to maintain health, and they do so in a holistic manner.
This holistic approach actually is opening some roads for the profession to communicate in an increasing spectrum of health-care-related dialogues. One example of these is within the area of work disability prevention and rehabilitation.
Dr. Patrick Loisel is a medical doctor and professor at the Division of Occupational and Environmental Health, Dalla Lana School of Public Health, University of Toronto. He has recently also come on staff at the Canadian Memorial Chiropractic College (CMCC). Dr. Loisel is an expert in the field of work disability prevention. A prolific writer and researcher, he is a prominent voice in this area of health care where millions of dollars continue to be spent annually, with limited results. At CMCC, it is Dr. Loisel’s mandate to set up a graduate program in work-related disability and prevention. He is pleased and intrigued to have the opportunity to do so in a chiropractic setting.
One of the reasons for this is chiropractic’s inherently holistic approach, which he feels can be beneficial in light of the varying situations presented in this field of study and treatment. Work disability issues, particularly as they pertain to return-to-work, are often multifaceted, and often have less to do with the actual injury than with other factors relating to the individual. Dr. Loisel feels chiropractors’ holistic approach to care makes them well-suited to work with those who have been injured in work-related incidents, and to assess and treat their injuries, and also to help guide these patients back to their optimal work situations.
“A chiropractic school trains chiropractors who are first-line health-care providers dedicated to disorders of the musculoskeletal system,” says Dr. Loisel, in an interview with Canadian Chiropractor. “These disorders generally give pain, and this pain may be relieved by chiropractic care.
“However, some cases may be resistant to chiropractic or other treatments and are associated with sick leave from work, sometimes leading to disabling pain. Modern science has shown that, most of the time, these cases are often not explained by a local disorder, but by a conjunction of personal, workplace and social factors that become, in fact, responsible for the work absence, resulting loss of worker’s role, quality of life and financial burden for workers, workplaces and society.
“This requires a broader biopsychosocial and multiperspective vision of the musculoskeletal symptoms when they do not heal with usual treatment,” continues Dr. Loisel. “This requires exploration of more complex dimensions of the personal, workplace and social life of the affected person and to build an appropriate management plan involving stakeholders beyond the usual binomial relation patient-care provider. Chiropractic training already transmits a holistic vision of disease and care and this new training should find fertile ground in young chiropractors following the planned advanced course.”
Work-related disability is just one area where chiropractic can harness its basic principles, with an eye to benefiting patients while garnering attention in other health care circles, and with the public, without compromising or watering down its raison d’etre.
ADDRESSes WIDESPREAD AND COSTLY MUSCULOSKELETAL ISSUES
There is no lack of studies and reports discussing how chiropractic can impact many of the costly musculoskeletal illness and injury situations that seem ubiquitous in our society today.17,18 The profession of chiropractic, particularly in Canada, must be congratulated for its achievement of collating, and continuing to refine, this information in such a meaningful way.
The question, therefore, is no longer whether chiropractic can help with these problems. The question is how may we position chiropractic as a preferred and/or primary route for addressing these issues in a health-care milieu where several other groups aspire to similar goals. Work is being done, within the profession and beyond, to help stake this claim for chiropractic; the results of this work will be important for the profession.
However, one of the biggest factors that will help the profession make inroads will be its persistence in its efforts at meaningful and repetitive communication – with the public, legislators and political bodies, as well as other health professions – regarding what it has to offer and how these offerings will help cut costs in the long run.
Much information is already available to make this point ring loud and clear – it’s a matter of strengthening efforts to harness it to the advantage of the profession.
For chiropractors, musculoskeletal protection is a fundamental principle that receives much emphasis in didactic and clinical training – prevention of injury, degeneration, etc., is considered key for optimal function and even overall good health. Therefore, prevention of musculoskeletal injuries and conditions is definitely an area where chiropractors can continue to become very active practitioners and powerful educators, advocating also for the potential cost savings to our system that effective prevention strategies can garner. This is a no-brainer and, again, requires only that DCs and/or their associations, rise up and harness opportunities to write or speak on prevention and safety.
But, as prevention is a key component in the chiropractic paradigm, DCs are becoming much more vocal in matters of prevention in areas outside of musculoskeletal considerations, as well. Although I have observed instances where DCs have been criticized for speaking on topics that appear outside of their scope of practice,19 it is not difficult to find reasons a DC should not be daunted by such heckling. A DC’s education involves the whole body, as well as various diagnostic and therapeutic procedures, pathological situations and more. It may not be a stretch, then, for a DC to include, in his or her messaging, strategies that encompass overall prevention-based health care – for example, smoking cessation, healthy eating, exercise, good sleep, etc. – in a holistic, safe manner. In other words, the concept of prevention can continue to exert more influence on how we approach our health-care issues, and chiropractic practitioners can position themselves at the forefront of this dialogue.
This last point is harder to capture. In the past, the profession has grappled with its underlying philosophical system of wellness and healing, questioning the effect that discussing it can have on how the profession is perceived. Recently, however, a much more open dialogue might be emerging within the profession, regarding some of these concepts, that may result in a spectrum of consideration that ranges from acknowledging its possible utility to considering the possibility of real and meaningful research in this area.20
Take, for instance, chiropractic’s vitalistic concepts that describe the body’s natural ability to heal itself. In this paradigm, the body requires minimum intervention to perform at its best and incites a person to ensure optimal conditions for the body to do so: rest, nutrition, exercise and so forth. When one does become ill, and requires a more aggressive strategy, this idea suggests that this same body remains occupied, despite appearances to the contrary, in its efforts toward healing. This, again calls upon the individual to uphold his or her participation in the effort. These concepts can be empowering and inclusive rather than hopeless and disenfranchising; furthermore, there are studies showing this mindset and strategy to be beneficial for healing and/or staying healthy.21
One main point this article postulates is that chiropractic’s very fundamental and salient features are its most compelling offerings – and this includes elements of chiropractic philosophy. These concepts can be introduced without confusing the audience at hand, if this is done with the intent to help, educate and give hope, rather than to overpower, and/or vindicate an idea for personal, or group, gratification.
SOME CLOSING THOUGHTS
Whether you speak to new patients or organize a health class; whether you represent your province to your politicians or speak on behalf of your profession in academic situations; or whether you are a chiropractic student trying to educate other health-care students regarding what you do, you needn’t worry that you bring less to the table than other health-care groups. When you try to communicate this, I suggest you stick to the clear and verifiable points that are relevant for the audience you are addressing and avoid:
a) introduction of complicated or esoteric information too early or out of context;
b) efforts to “fit in” to other systems or mindsets; and
c) denial of your limitations and areas where investigation is still in progress.
As a chiropractor, you already offer strategies and elements that matter in our current health milieu, not just with respect to musculoskeletal health – although this is important and significant – but in other health and health-care areas as well. You do this in ways that are relevant to society’s changing needs, and that will provide sustainable long-term benefits. This is important information that should be passed on beyond your circles. •
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