I took last week off from putting my thoughts out here in cyberspace.
I had this post ready to go but it did not feel quite right. While my writing style can often be rather blunt and biting, something pulled me back. Actually, it was the wise counsel of a great friend and colleague as well as an intuitive urging to let it sit awhile.
I’m glad I did.
I toned it down. I tuned it in. I tamed it in hopes not to draw swords but to draw attention to the things we say and do.
Slipping and Checking
I am fairly certain it was BJ Palmer who coined this term. A loving reminder that we all slip at times and that it is the responsibility of our colleagues to check us when we do. He warned us of how the outside in worldview would slowly whittle away at our mission and methods and so he gave us this gem to right our paths.
All too often though, the checker uses the force of a professional hockey player instead of the gentle, authentic reminder of a brother or sister. Alternatively, the slipee often responds hostilely or with a thesis rationalizing their actions. Perhaps we can all lower our guard and the next time our congruence is questioned, allow a moment of deep introspection to see if there is any merit in the claim.
We hear this term, “congruency,” thrown around a lot in chiropractic. “He’s not congruent.” “That is not congruent with our philosophy.” And on, and on.
And even though it has been played, this old record will continue spinning as long as we practice in a profession that has multiple philosophies, values, scopes and agendas that often oppose and even negate each other at times.
Being congruent in one’s words and deeds is very important in every walk of life.
It breeds respect, integrity and gives others an idea of who you are and what you value and stand for. In chiropractic that importance is magnified many times over as a war of words stretches the profession, while our deeds often bring us closer than we would ever allow ourselves to realize.
Being congruent in chiropractic really has to do with what type of chiropractic you are practicing. While it can easily be argued that chiropractic has a clearly defined objective, mission and philosophy and that one’s congruence would then be based upon their actions in relation to those items, clearly the profession has multiple modes of practice at play.
If you practice in a broad scope, incongruence may take the form of recommending 12 visits for an acute low back but checking your family regularly for wellness and prevention without mentioning those benefits to your patients.
If you practice in the middle, incongruence often finds its way into practices when procedures are added not for patient benefit but for added reimbursement.
It is the focused scope, however, that holds the most challenges to practicing congruently. I find myself slipping at times when I become too condition or research focused. Now don’t get me wrong, research and science are a central component of the focused scope, however, their language can cloud and confuse the beautiful philosophy and objective of the focused scope chiropractor when practicing his art.
The solution: Balance
The last few months have found me heavily focused on science. Yesterday I picked up Dr. Joseph Strauss’ Case Management for Straight Chiropractors. Many gems are contained within and various opportunities to check my slipping.
Come as You Are
So whether you are a focused, middle or broad scope chiropractor, my suggestion is to come as you are.
While it may be tempting to add procedures for economic benefit or to hide that those services are offered in your office to maintain a certain impression amongst your colleagues, neither scenario serves the profession.
Just because it can be billed doesn’t mean it should be, and just because you can mix anchovies with pizza doesn’t make it a good idea either. When you mix certain substances or philosophies, you end up with something entirely different from which you started.
Some people may like anchovies on their pizza, but if you claim to be serving only pepperoni then serve that.
And now back to the beginning and the reason for this post.
My chiropractic bubbles have been bursting all around me lately.
Colleagues that I thought practiced within the focused scope are now offering the latest weight loss, laser therapy or vibrational plates in their offices. “Principled” seminars put sponsor reps on stage telling us how “BJ Would Be Recommending Supplements.”
Really? Really? umm… nothing he ever wrote slightly points to that conclusion.
Apparently chiropractic’s New Normal is spreading faster than I thought. Like an infectious cold sore it seems to jump from chiropractor to chiropractor as fast as one can rationalize their actions.
Anchovies or Pepperoni?
As I’ve stated previously, I am not knocking the middle or broad scope, however, I would like to know what type of chiropractic I can expect when I refer someone to a fellow DC or what type of education or mixed messages students referred to our colleges may be receiving.
Call me crazy, but I also expect if someone refers to themselves as “straight, pure, principled,” etc, and stands on stages declaring the same, that they would serve that in their offices.
Perhaps I’m asking too much.
I wouldn’t care so much that people decided to do such things, but don’t call it something it is not. I’ve already explained the danger in doing so and why it harms the identity of the entire profession.
You see, little things do make a big difference.
Let me give you an example.
In just a few short days the Wave promises seminar attendees that they will “Feel the Energy of Principled, Vitalistic Chiropractic,” yet when all 1200-1400 of them show up later this week, they will be greeted by the decidedly unvitalitisic presence of NCMIC.
That little detail is the reason I and at least a few other colleagues are staying home this year.
While some may not view it as a big deal, it is much bigger than most think.
The president of NCMIC has publicly stated that his company would insure DCs who wish to prescribe drugs. Life West has publicly denounced such a movement towards scope expansion yet is still allowing them to be a Silver sponsor of their event. I am very grateful for Dr. Kelly’s willingness to take that stand as most of our college presidents have been unwilling to publicly do so, however, NCMIC’s presence at the Wave is a glaring contradiction.
I sincerely hope next year they will reconsider their involvement with organizations not congruent with the mission and vision of the college. If that mission is now more in line with the middle or broad scope, then I think supporters have the right to know that as well.
Life West is certainly not alone in this example. All you have to do is visit the vendor hall of just about every “principled” seminar and you will witness the same.
Another example of chiropractic incongruence comes from the former Fountainhead.
While Palmer has clearly embraced a middle scope perspective, one has to wonder if those running that institution had one eye closed when putting together the speakers lineup for the 2013 Palmer College of Chiropractic Homecoming.
While some gems can be found in the mostly irrelevant information, one has to wonder in disbelief at the decision to place Donald Murphy, D.C on the stage. Who’s Donald Murphy? Besides being the immediate past president of the West Hartford Group, a decidedly anti-subluxationist pseudo-academic think tank, he also has had this to say about his colleagues:
“Chiropractors who try to sell the public on lifetime adjustments to improve health – in the absence of any evidence that this is beneficial for anything (other than the chiropractor) – are rampant in our profession. This behavior needs to be exposed and condemned in the same way that the DC article exposes and condemns “the medicalization of everyday life.” The scientific evidence may support some of the things that the Times essay condemns and may not support others. But it certainly does not support the “chiropracticization of everyday life” and the “chiropracticization of childhood.” It is time for our profession to stop tolerating such irresponsible and self-serving behaviors in our colleagues.” Letter to the Editor, Dynamic Chiropractic May 7, 2007
And this piece of anti-science from his paper, How can chiropractic become a respected mainstream profession? The example of podiatry:
“Chiropractic has frequently been described as being two professions masquerading as one, and those two professions have attempted to live under one roof. One profession, the “subluxation-based” profession, occupies the same metaphysical and pseudoscientific space as foot reflexology.
…We must finally come to the painful realization that the chiropractic concept of spinal subluxation as the cause of “dis-ease” within the human body is an untested hypothesis. It is an albatross around our collective necks that impedes progress. There can be no unity between the majority of non-surgical spine specialist chiropractic physicians and the minority of chiropractors who espouse metaphysical, pseudoreligious views of spinal subluxations as “silent killers”. The latter minority group needs to be marginalized from the mainstream majority group, and no longer should unrealistic efforts be made toward unification of these disparate factions within the profession.”
While I can certainly agree with Dr. Murphy regarding the need to remove pseudoreligious associations from our description of subluxation, to deny the neurophysiological impact of subluxation on human health and function is a most uneducated position.
Some references for the fine doctor are provided below.
The phone number of Palmer College for alumni wishing to voice their opinions is (800) 722-2586.
Congruency in chiropractic can be a difficult thing.
The moral of the story: Be congruent and come as you are.
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Basic reading for anyone interested in learning about subluxation:
- Owens E., Koch, D, & Moore, L (1999) Hypothesis Formulation for Scientific Investigation of Vertebral Subluxation. Journal of Vertebral Subluxation Research. 1999; 3(3).
- Owens EF, Pennacchio VA. Operational Definitions of Vertebral Subluxation: A Case Study. Topics in Clinical Chiropractic 2001; 8(1). In press
- Kent C. Models of vertebral subluxation: a review. Journal of Vertebral Subluxation Research, 1996;1(1):11.
- Chestnut, J. The Fourteen Foundational Premises for the Scientific and Philosophical Validation of the Chiropractic Wellness Paradigm
- Bolton, P. S. (2000). Reflex effects of vertebral subluxations: the peripheral nervous system. An update. Journal of manipulative and physiological therapeutics, 23(2), 101-103.
- Seaman, D. R. (1997). JOINT COMPLEX DYSFUNCTION, A NOVEL TERM TO REPLACE SUBLUXATION/SUBLUXATIONCOMPLEX: ETIOLOGICAL AND TREATMENT CONSIDERATIONS. Journal of manipulative and physiological therapeutics, 20(9), 634-644.
- McLain, R. F. (1994). Mechanoreceptor endings in human cervical facet joints.Spine, 19(5), 495-501.
- Taylor, H. H., Holt, K., & Murphy, B. (2010). Exploring the neuromodulatory effects of the vertebral subluxation and chiropractic care. Chiropr J Aust, 40, 37-44.
- Haavik-Taylor, H., & Murphy, B. (2007). Cervical spine manipulation alters sensorimotor integration: a somatosensory evoked potential study. Clinical neurophysiology, 118(2), 391-402.
- Daligadu, J. (2012). Cortical and cerebellar motor processing changes subsequent to motor training and cervical spine manipulation.
- Marshall, L. D. (2013). The effect of cervical spine manipulation on elbow joint position sense in patients with acute cervical facet syndrome.
- Haavik, H., & Murphy, B. (2012). The role of spinal manipulation in addressing disordered sensorimotor integration and altered motor control. Journal of Electromyography and Kinesiology, 22(5), 768-776.
- Haavik, H., & Murphy, B. (2011). Subclinical neck pain and the effects of cervical manipulation on elbow joint position sense. Journal of manipulative and physiological therapeutics, 34(2), 88-97.
- Haavik-Taylor, H., & Murphy, B. (2007). Transient modulation of intracortical inhibition following spinal manipulation. Chiropractic Journal of Australia, 37(3), 106.
- Taylor, H. H., & Murphy, B. (2010). The effects of spinal manipulation on central integration of dual somatosensory input observed after motor training: a crossover study. Journal of manipulative and physiological therapeutics, 33(4), 261-272.
- Taylor, H. H., & Murphy, B. (2010). Altered central integration of dual somatosensory input after cervical spine manipulation. Journal of manipulative and physiological therapeutics, 33(3), 178-188.
- Taylor, H. H., & Murphy, B. (2008). Altered sensorimotor integration with cervical spine manipulation. Journal of manipulative and physiological therapeutics, 31(2), 115-126.