ANOREXIA PHILOSOPHICA For those within our profession that have a predilection towards diagnosis we have a new disease. Unfortunately those who practice "diagnostic chiropractic" are the ones least capable of recognizing this condition. However, it appears the problem is not confined to any one group but is endemic throughout the entire profession. The signs and symptoms are classical, the chief of which is a lifeless practice. The majority of the patients come for symptomatic relief of bad backs and stiff necks; very few families; even less children as patients. No educational program for the patient, a lethargic attitude by the office staff, and an obvious lack of enthusiasm on the part of the doctor are other symptoms. Unfortunately, as with most diseases, the condition begins very insidiously and the chiropractor usually doesn't realize he has it, primarily because there almost always is a feeling of well being and success while the condition is developing. By the time the chiropractor realizes he is suffering with anorexia philosophica, he thinks he is too far gone to seek help and begins to think that this syndrome is a normal state and that there is really nothing wrong with him. It appears the condition has one predominant cause: the lack of desire to metabolize philosophy. This usually begins in chiropractic college. The student is presented the chiropractic philosophy in either a palatable or unfortunately unpalatable manner. But, that is really not an excuse for lack of metabolization. Granted, the more esthetically pleasing the food, the easier to get it down. But, from a nutritional standpoint it means very little. (Didn't it always seem as we were growing up that the yuckiest looking food was supposedly the best for us?) To get it down was unpleasant and took a certain amount of discipline self discipline or that imposed by our parents. In any case, it was necessary. The chiropractic student refuses or rejects the philosophy because it appears unusual, goes against his preconceived ideas. Or he rejects it because it is too "dry." Unlike certain foods we were made to eat, you cannot "wash down the philosophy" without diluting its nutritional value. If we somehow force feed the philosophy down the student's throat, it merely remains there to be regurgitated at mid-term and final time. As everyone knows, regurgitated food has no nutritional value and produces no growth. The same is true for regurgitated philosophy. Unless it is digested and metabolized it does not become part of our being. The innate intelligence of the body is responsible for the metabolization of food. The Big Idea is responsible for the metabolization of chiropractic philosophy. It appears then that you have to get the Big Idea before you can begin to metabolize the philosophy, make the information useful to your everyday practice and a part of your very being. That appears to be a catch-22. You cannot understand the philosophy without having the Big Idea and it would seem that you cannot get the Big Idea without first understanding the philosophy. If that's the case we are all in big trouble for if you get the Big Idea all else follows. By all else we assume understanding, application, and spizzerinctum. It would logically follow then that if we don't get the Big Idea, nothing else follows, Hegelian logic. The Big Idea then is that which takes the food (philosophy) sitting in the stomach (brain) and transforms it into utilizable substance (information). Fortunately with regard to food, it is purely an innate function and we do not have to think about digestion and assimilation. However, with regard to the philosophy of chiropractic, it appears to necessitate an action of the will, which is a function of the educated brain. We must come to accept the Big Idea, whatever it might be, through some means, deductive reasoning, faith, or empiricism, before we can begin to make the chiropractic philosophy a utilizable force in our lives and practices. If you have the ability to ingest and metabolize the philosophy and yet do not exercise that ability it is absolutely worthless to you. It is possible to starve to death in a room with tons of good nutritional food. You must make the effort to eat it, raise the fork to your lips and start to chew and then swallow. That's a fairly elementary process, wouldn't you say? It takes very little effort and after you begin that process, the innate intelligence of the body takes over, swallowing, digesting, metabolizing, etc. No more effort on your part, only the rewards. How could anyone allow themselves to starve to death in a room full of food? We would conclude that he or she were malfunctioning mentally (if we were prone toward diagnosis). Yet thousands of chiropractors are starving philosophically while green books sit on the shelf collecting dust, articles go unread, tapes not listened to, seminars unattended. Granted there isn't a plethora of philosophical information available to the field chiropractor. But there is surely sufficient to keep you from starving to death chiropractically or even manifesting the above symptoms of anorexia philosophica.
NEUROLOGICAL-ORTHOPEDIC TESTS
It is interesting how so many aspects of chiropractic deal with cycles. It appears we have made a full circle in chiropractic with regard to certain analytical procedures in the chiropractic office. In the beginning of our profession, the primary method of determining the presence of vertebral subluxation was the presence of symptoms. If the patient complained of stomach problems the chiropractor would thrust in the mid-thoracic region; chest cold, the upper-thoracic. If the patient had a stiff neck or headaches he would "rip the ole cervicals". We used medical subjective findings to determine when and where to adjust. The "Meric System" of adjusting was developed around this concept. As the art of chiropractic was developed, the Meric System was discarded by most chiropractors because it is not at all specific. The complexity and the individuality of the human nervous system makes it virtually impossible to relate any symptoms to a specific vertebra in the spinal column. Further, chiropractic thought has advanced enough in recent years to recognize that absence of symptoms does not necessarily mean a subluxation is not present. These two factors have led to the development of some very sophisticated chiropractic analytical instruments. It is not necessary to explain the principles behind them because every chiropractor, unless he has been practicing with his head buried in the sand for the past 15 years, is aware of them. There have also been some pretty interesting advancements in the art of muscle and motion palpation. If that is the case, it seems rather strange that so many chiropractors are turning to orthopedic and neurological tests to ascertain the presence and location of vertebral subluxation and, for all intents and purposes, returning to the crude analytical procedures of the early practitioners. These categories of tests are designed to elicit information that results in a symptomatic picture pursuant to a medical diagnosis. There is very little difference between eliciting subjective symptoms and adjusting accordingly and doing orthopedic and neurological tests eliciting objective findings and adjusting accordingly. There is nothing wrong with using part of the medical armament to help locate and categorize vertebral subluxations. That is what we are doing with Konrad Roentgen's invention, the x-ray. X-ray is used by M.D.'s to aid in the diagnosis of certain diseases. X-ray is used by chiropractors or should be use to aid in the establishment of subluxation listing. But the neurological-orthopedic tests are different. The chiropractor's findings are the same as the medical doctor's. That appears to be a giant step backward in development of chiropractic analytical technique. We might as well bring back the Meric Chart. If you are going to use a Trendelenberg to determine a 5th lumbar subluxation, well, let's adjust "the stomach place" if the person has abdominal discomfort. Has the art of chiropractic advanced so little? Using neurological and orthopedic tests seems to me to be even less scientific than D.D. Palmer examining Harvey Lillard's "bump." Neurological-orthopedic tests demonstrate symptoms of disease. Symptoms of disease are the absolute poorest criteria for determining the absence or presence of a vertebral subluxation. Yet more and more chiropractors are using them. Even the so-called straight chiropractors are into doing neurological-orthopedic tests. The "mixers" do it legitimately. You may not agree with them doing it but you have to respect them. They are pretending to be medical doctors so it logically follows that they would do medical procedures to ascertain medical findings to make a medical diagnosis. The "straight" on the other hand looks down his nose at the pretenders and then uses a medical procedure himself. For what reason? There can only be three: 1. To impress the patient. That is not ethical. If you feel the need to impress a patient with your thoroughness and expertise, do it in the form of a chiropractic examination. 2. To charge the insurance company. That's not honest. To charge an insurance company for a needless and worthless procedure is just as bad as charging the patient for it. It is plain and simple stealing. 3. To determine the presence of vertebral subluxation. That is poor technical skills at best, incompetence at worst. If any chiropractor out there is really using neurological and orthopedic tests to determine vertebral subluxations in the light of present day instrumentation and technical procedures and using it sincerely, he should be aware that he is setting chiropractic technique procedures back 70 years. Vertebral subluxation is the physical representation of the absence of something (ease). Symptoms are the physical representation of the presence of something (disease). Therefore, a procedure that elicits symptoms of disease is not chiropractically sound or technically acceptable.
CARING IN CHIROPRACTIC
In the busy day to day activity of practice, adjusting spines, analyzing x-rays, and a dozen other activities, do we really take the time to care about people? Are we concerned about our patients as human beings in need of a vital service or do we just see them as another spine or worse yet, another fee to be collected from an insurance company? If they are more than small bricks in the practice building program we are utilizing, do they know it? Do we really communicate to our patients somehow that we love them, are concerned about them, and are doing all that we possibly can to restore and maintain their health? One of the problems with the non-symptom oriented practice that "corrects vertebral subluxations because they in and of themselves are harmful to the organism" is that the patient often assumes that the chiropractor's lack of attention to their physical ailments is a disinterest in them. Even the gas station attendant greets the patient on the way to the chiropractic office with "how are you today?" It may be only a perfunctory greeting, but the chiropractor on the other hand avoids any greeting or conversation that could be misconstrued as eliciting information relative to the patient's disease. As if that were not enough, we now have a tremendous preoccupation with money among the profession. Years ago the "family doctor" took care of you and was paid according to the patient's means. Historically, being a doctor was rewarded in great satisfaction, not in great wealth. Many a doctor was paid in produce or a scrawny chicken. Now you had better have all your insurance information in hand ready to be punched into the doctor's computer before you even catch a glimpse of the doctor let alone be examined. Getting to see the doctor in this hi tech system is about as personal as having your car serviced at a dealer other than where you bought the car. Lastly, and far from the least, is the problem of the large volume practice. While the number of volume practices appear to be decreasing, the fact remains that most chiropractors see quite a few patients in a short period of time. Perhaps it is not so much that chiropractors are seeing that many people but that they squeeze them into three six hour days a week. Did you ever wonder what the guy who works forty hours a week at the steel mill and barely scrapes by, thinks of you whose office hours represent half that time, no weekends, no night emergencies, no shift work. We must compensate for the resentment and envy that can easily develop. Instead we are often in and out of the room in a couple of minutes especially when the waiting room is backed up. The impersonal, apparent lack of concern for people is fast becoming a problem in a profession that has been known for its concern for people and for the loyalty that it has developed in patients. If you listen to some of the stories old timers tell, you hear how 30, 40, 50 years ago there was a real love relationship between the chiropractor and his patients. He was willing to go to jail for adjusting them and they almost worshipped him for that commitment. That relationship appears to have gone by the wayside. Part of it may be due to the coldness of the 1980's lifestyle. There are legitimate problems in trying to address ourselves to the difficulty that the modern chiropractic office presents. The chiropractor cannot get involved with the patients ailments without compromising the objectives of chiropractic. Computers are fast becoming a necessity in the modern chiropractor's office and seeing many patients does necessitate spending very little time with each patient. The solution to the problem is two-fold. As with most problems in chiropractic, the primary solution is in patient education. If the patient understands why you are not interested in symptoms, not because you don't care but because they are simply not good indicators of health, which you are vitally concerned about, this makes a great difference. We must educate patients to understand that we are dedicated to doing the one very best thing we can possibly do for their health correct vertebral subluxations. We must also make them understand that we see them for such a short time because that is all it takes to turn on the force within their bodies and because love of humanity demands we see as many people as possible. But education in this particular problem is not enough! We must truly love people. Maybe each chiropractor should periodically reassess himself or herself and determine whether he or she really has a love for humanity. If not, well... better get into another line of work. If you do, then communicate that to the patients. That doesn't mean every chiropractor must be Leo Buscaglla. Frankly; his gushy "hug everybody" love concept turns me off! But, we must somehow communicate to our patients that they are the reason for our existence. The busier the office, the more efficient and more modern the office, the greater need. Try thinking of an idea each week for the next month that will demonstrate to the patients that you love them and care for them. Try it and see how it works. You may be pleasantly surprised at the changes in your attitude and that of your patients.
