It seems that much of the frustration and disenchantment within the straight chiropractic movement lies in the image it has portrayed. Largely, it has been negative. To a great extent it can be understood. It is quite difficult to keep a positive image when you are fighting desperately for survival. Perhaps now that survival appears to be assured, it is time to present a new, more positive image of straight chiropractic. It seems one of the major problems is that we have presented ourselves as limited scope practitioners. The so-called broadscope practitioner (mixer), the one who appears to do more, is looked at in an unfavorable light by the straight chiropractor, and yet held in esteem by the general public. Most people believe that more is better. Our philosophy teaches us that this is not necessarily so, however, the public does not readily understand this concept. They say "Is that all you do? The chiropractor on the other side of town does much more. He uses this machine and that device in addition to the adjustment." (All the while, assuming that more is better.) Our recourse is usually to condemn these procedures, thus, continuing the conflict. Perhaps we need to make a 180 degree turn. Instead of talking about our limited scope of practice and the so called mixer's broadscope approach it is time we turn it around. Are we not, after all, the ones with a broad vision? We view chiropractic as something necessary for every man, woman, and child no matter what their age or state of health. With this understanding (broad vision) we narrow our activity to adjusting subluxations exclusively. Unfortunately, what we generally convey to the public is information about what we do rather than what we think. Consequently, we are viewed as limited practitioners rather than visionaries. The mixer who adds procedure after procedure affects less people but has a more widespread appeal. The majority are taking care of only musculoskeletal problems, primarily low back. Contrary to popular belief, they do not have broad vision. For the most part they view chiropractic as a limited treatment for a limited number of musculoskeletal conditions and must rely upon their ability to determine what musculoskeletal conditions they can effectively treat. So the next time a patient asks you what the difference between a mixer and a straight is, rather than talking about machines, techniques, procedures and practice, talk about vision. Try explaining, objectively, that the mixer has a more limited idea of chiropractic...that he feels it is primarily effective for musculoskeletal problems, therefore he incorporates various procedures that he believes may help their problems. You, on the other hand, see that chiropractic is for the entire human race, because you understand that everyone needs a good nerve supply for maximum health. Consequently, you do not choose to limit your time and expend your energy in treating musculoskeletal conditions. Try it. You may like the more positive feeling it gives you. It will surely make you less condemning or judgmental of your mixer colleague and, most importantly, you will be taking an opportunity to explain to a person what the true benefit and scope of chiropractic is. That alone will make the effort worthwhile.
A PHILOSOPHICAL CASE HISTORY AN ANSWER Two issues ago (Vol. I No. 4) we presented the case history of an individual with a heart transplant and addressed the question: If the innate intelligence of the body were trying to reject the transplanted heart, would chiropractic adjustments increase the innate potential and hasten the rejection process? We received some interesting comments. P/Some of the comments were made from either an empirical or an inductive viewpoint. Answering from an empirical position we would say that the adjustment would enhance rejection and therefore the patient should not be adjusted. Answering from an inductive position will, as with most inductive thinking, lead you to the acknowledge that you do not know. This would, of course, make the average chiropractor reluctant to adjust. Chiropractic, however, is largely deductive in its application. In deduction we start with a major premise or a chiropractic axiom. In this case that axiom is principle number 25. "The forces of innate intelligence will never do anything to harm the tissues in which they reside." What we are saying is that every time we give an adjustment we know that we are doing the very best we can for that person. The innate intelligence of the body is expressing itself more fully and the person is better off. We do this based upon a deductive principle, one that is just as much truth, just as accurate as our Major Premise. Having that knowledge, that conviction, that confidence is the most important concept that any practitioner could possibly have as he goes about the task of removing interference to the expression of innate intelligence.
DO CHIROPRACTORS REFER?
Whether referrals are part of the practice of straight chiropractic is another controversial issue. The generally understood position of the "straight movement" is that we do not refer. This, of course, raises the ire of many critics of straight chiropractic, especially those within the profession at large. It also gives them an opportunity to point the finger of scorn at us and say to government and society "See, there is one more example of their irresponsibility." The issue, more than likely, causes some concern even among straight chiropractors. While not admitting it, some do make referrals. Others admit it and fear that they are being condemned by their fellow straights. Unfortunately, in chiropractic many questions have no easy answers and this is one of them. But there are answers. The first issue to resolve involves determining what constitutes a referral. To do that, we must define our terms. Often a debater's technique is to play the semantics game. The straight chiropractic opponent may say there is no difference between such terms as diagnosis and analysis, manipulation and adjustment, and disease and subluxation. The term "referral" is another word that fits into this category. The straight chiropractic antagonist would very much like the response to "Do you refer?" to be "yes" or "no." The chiropractor who attempts to answer either in the affirmative or negative is in as much trouble as the man required to answer the question "Do you still beat your wife?" with a yes or no answer. If the realm of chiropractic principles could be reduced to yes or no answers, we would not need four academic years to teach it. So the response must be, "What do you mean by a referral?" Webster defines the word as "(2) To send or direct (to some person or place) as for treatment, aid, decision, etc." To you, to refer may mean to tell an out-of-state relative or patient the name of a chiropractor in her town. To the opposition this also constitutes referral. However, to him referral may also mean making the determination that a disease or condition needs more than just chiropractic "treatment" and then directing the patient to the appropriate health care provider. He usually, but not always, expects follow-up reports and/or consultations with the other provider. The mixer believes the recognition and determination that a patient needs another specific health care practitioner (orthopedist, internist, dermatologist, podiatrist, opthamologist, etc.) is within his area of expertise. The straight would not agree. He believes that the patient, the family physician, (M.D.) or another qualified professional should make that judgment. The straight chiropractor does not assume that responsibility, and so informs the patient of that fact from the start. He continually reinforces his objective and responsibility while the patient is under his care. A wise man once said that there is no right answer to a wrong question. "Do you refer?" is a question that must be clarified. If a patient asks me for the name of a good auto mechanic and I give them the name of my service station, does that constitute a referral? If a patient asks where the nearest 7-11 is located and I give them the name of one or two that are equally close, is that a referral? By a broad interpretation of the word it could be so construed. The following are two very different hypothetical scenarios; both could be considered referrals. A patient may say "I have something wrong with my foot, I think I need a podiatrist. Do you know one?" A straight chiropractor may answer, "Yes, Dr. Smith up the street, I am told, is a fine podiatrist. He is a nice enough fellow and he comes in this office to have his spine checked regularly. However, there is also a different concept. A mixer would say in response to the same question, "Let me examine your foot." He would then make a diagnosis or determine whether the foot problem is best treated by a podiatrist, dermatologist, or perhaps himself, if, in fact, the foot needed any care. Thus, we have two different responses to the same question, determined by the chiropractor's objective. Apparently we need a different term to describe what each of the two chiropractors did. For the sake of the rest of the article, let us call the first scenario above a "referral" and the second (involving differential diagnosis) a "Referral." You can be sure that when a straight chiropractic opponent poses this question, he means "Refer."
As we answer this question, we need to consider it from a practical standpoint. Most of us will never be in a position of debate so we need practical answers. A straight chiropractor who has adequately educated the patient should never be placed in a position to have to Refer to another health care provider. If the patient understands the chiropractic objective and the chiropractor is practicing that objective, the situation should never arise. The patient may indeed need specific care by another trained professional but he would not ask his chiropractor to Refer him to a particular health care provider. He would realize that that is not in the area of his chiropractor's expertise. The straight chiropractor should be correcting subluxations exclusively, something that no other health care provider can provide. If a patient asks whether he or she should see a physician, orthopedist, neurologist, internist, etc., then the chiropractor has probably failed somewhere in educating that patient as to his role in the patients' health care. If the patient has decided to see one of the above and asks for a name from you, it would not be a Referral anymore than giving them the name of an auto mechanic, by Webster's definition. You did not "send or direct" them for "treatment." He decided on his own to go. It is, however, my opinion that, in the case of health care providers, it is unwise to give out any names. The best and safest response is to advise them to see their family physician for a recommendation. This prevents any confusion regarding the chiropractic objective. If more patients ask you for the names of other professionals within the health field than they do for auto mechanics, there is a good possibility that you are not making your objective as clear as you should. This may be stretching it, but I think you get the point. The question of a chiropractor noticing an obvious deviation from the average in examining a patient's spine can be raised. It is, of course, the responsibility of the D.C. to make known to the patient his "unusual finding." If the patient wants to know what to do about it, then his options should be explained to him. But then, every patient coming in with a symptom, should have his four options explained to him prior to beginning care. If you do not know what these options are or how to explain those options, write the Foundation and we will send you information on how we think they should be explained.
