By Michel Tetrault, DC
– Begin with the end in mind. (Steven Covey)
Chiropractic education (chiropractic schools) is at a turning point in its history. As a follow-up to the conference on Philosophy in Chiropractic Education in November 2000, the WFC and the ACC have been planning an equally important conference on clinical education: WFC/ACC Conference on Clinical Education – São Paulo, Brazil, October 26-29, 2002. Core Curriculum contents will be discussed and debated seeking agreement on what should be the core clinical skills in chiropractic education for today’s students world-wide, that will set the foundation for International Standards on Chiropractic Education and the private practicing DCs need to make their voices to be heard. The following 2 Part article is designed to inform and inspire you to actively engage and participate in this process.
In the advent of globalizing the chiropractic education process, it is paramount we first understand that our profession is able to qualify Doctors of Chiropractic (DC) under an accredited chiropractic program which permits students to satisfy internship requirements in an on-campus clinical setting concomitant with completion of their formal education. This is particularly important for the new schools that are added to an established university such as the new school in Mexico. Countries that are actively pursuing the establishment of a chiropractic program that meets International standards are: Argentina, Costa Rica, Egypt, Hong Kong, India, Italy, Japan, Malaysia, Netherlands, Peru, Philippines, Portugal, Spain, Sweden, Taiwan, and Thailand.
However, if a course of study in chiropractic does not produce a chiropractor who grasps the principle of increased vivification as a result of the adjustment, he will be more inclined to follow preceding chiropractors who have assumed the mantle of a “fixer” or cricks, backaches and strains. Such a practitioner will eagerly embrace the notion of full-body treatment and non-legend drugs. The end result of this scenario is a “rudderless” doctor of chiropractic, inclined to embrace whatever may recommend itself to him.
This would also severely compromise any effort to establish legislative authority for chiropractic in these developing countries. What appeals to the law makers is the addition of a new and viable profession, unique and distinct, clear in its service mission and not one that merely tries to duplicate services already provided by other existing licensed health care professionals.
From the patient’s perspective, they want a doctor to perform according to their highest skills in whatever discipline of health care they seek services. A chiropractor who takes 100 hours in acupuncture does not an acupuncturist make; no more than 100 hours in manipulation by a Physical Therapist or Medical Doctor qualify him to perform chiropractic. Lawmakers and patients alike want and are entitled to access the expert who is most qualified to deliver that particular service. For the correction of spinal subluxations and to experience better overall health from that adjustment, the patients prefer the DC because of the unique education and level of skill that education process produces. That is the outcome of beginning with the end in mind: a chiropractor who can adjust the spine and deliver that unique service to mankind. Everything else is supplemental or supportive to that end and new schools must place this premise first and foremost. After a century of refining great techniques our new schools have many options available.
Chiropractors have provided a service needed by all mankind – a need that has never been so comprehensively met before in history. Immediate attention by all levels of the profession is needed to carefully scrutinize what a chiropractic curriculum should be as we approach this time in our history when we will soon see a proliferation of International DC programs. The basic sciences, presented from a viewpoint of interrelationship and master control, combined with a thorough presentation of the clinical sciences, will only serve to yield a chiropractor who is first a chiropractor – a chiropractor who understands the philosophical underpinnings of his profession, who knows how his beliefs differ from the medical profession; one who is proud of the difference.
The field and the colleges must come to grips with what and where we are. We, as a profession, have been authorized to legally function upon the basis of our philosophical approach to health and sickness. Our legislative niche has been delegated to us, not as a replacement for or a variety of medicine, but rather as a new science based on a new idea of service and a new method in the care and management as a specific area of the body that may and usually does affect the entire body. Yet, it is the recognition and understanding of his philosophic, professional and legal parameters that allows the chiropractor to maintain his role as a primary health care provider.
Chiropractic exists today as a separate and distinct profession, as does dentistry, optometry, and podiatry, each having a legal basis upon which to function as an exception to the various medical practice acts throughout the country and throughout the world.
The New Zealand Report of 1979 expresses our uniqueness very well: “The chiropractors differential diagnosis is not aimed at identifying the patients disorder so that a specific treatment for the disorder may be prescribed, but instead is aimed at determining whether spinal manual therapy should be undertaken at all, and whether the patient should be encouraged to take medical advice.” The report summarizes the reason for our care by stating: “by treating that malfunction, the chiropractor expects the patient’s general condition to improve, and the specific condition of which the patient complained may be relieved…”
The text states that the “reason for treatment is” “to correct spinal malfunctions so that the body’s own recuperative forces can work unimpeded…” The Commission concludes that: “the chiropractor occupies a unique position as a spinal specialist.
To emphasize the significance of a philosophical base, consider if you will, two students of economics, with each being equally intelligent, dedicated and motivated. Each studies the principles of economics and the laws of supply and demand. Upon graduation day they emerge, one as a capitalist, the other as a socialist – the lectures were the same and the textbooks were the same. The difference arose from the philosophic base upon each placed the building blocks of his science.
Similarly, two students may study the basic sciences. Again, both of equal intelligence, dedication and motivation. One chooses to align himself with the philosophy of the medical practitioner, which is aimed at diagnosing all variety of human disease and then treating them with whatever remedies man or science can discover. An allopath’s philosophy centers around the specific diagnosis and the treatment of illness, regardless of the method. The medical practitioner may utilize the natural forces of air, light, and water and herbs, as in homeopathy or naturopathy, or he may utilize materia medica because, in his view of allopathic medicine, all agents are designed for the treatment of disease.
The other chooses the chiropractic philosophic system of health care, a legalized exception to the medical practice act.
The hard reality in beginning with the question of philosophy is a devastating one. We either continue in the marketplace as a separate, distinct and non-duplicating philosophy, art and science, or we approach the path of duplicating existing services as limited, “drugless physicians” constantly seeking to expand our background to gain esteem, dignity, and acceptance – ultimately losing legality as did the naturopaths.
As ludicrous as this may sound, the fact remains that many chiropractors do not hesitate to diagnose and attempt to treat conditions other than those which are biomechanical and neuromuscular in nature, which are within the chiropractic scope of practice as defined by the CCE and the various state legislatures.
Schools of dentistry, optometry, podiatry and chiropractic provide an education, which in some areas is quantitatively and qualitatively similar to that provided osteopaths and allopaths. Even though all health care professionals may share limited commonalities within their individual educational curricula, their profession is by design and intent separate and distinct, affording a generalist or specialized education.
Dentists, podiatrists and optometrists do not perform broad body diagnosis, seek to treat the whole body or add competencies to their practice not provided for by the emphasis in their specialized education and accepted area of professional expertise. If you were to visit a dentist who began to diagnose and treat conditions outside of the dental scope of practice, you would probably take issue with their attempt to treat anything outside the mouth… and change dentist, quickly.
Chiropractic education institutions have never been in a position where they enjoyed the luxury of surplus instructional time. Operating within the time constraints we now experience demands dedication and professionalism to qualify a chiropractor eminently in his specialized field. To think we could qualify graduates to diagnose and treat the whole body, given the amount of classroom instruction and the length and nature of the clinical experience they now receive is beyond belief. What we do – and we do well – is give the chiropractic student a solid understanding and experience with the osseous structure, particularly the spine, and how that relationship with the nervous system affects the restoration and preservation of health. This is a far cry from diagnosing with eminent qualifications all diseases throughout the entire body and treating them with various treatment procedures.
Claiming our own
Next, let us compare the extent of clinical internship between chiropractic and allopathic education formats and how the actual framework of this experience determines what areas of the body the practitioner becomes qualified to treat and the foundation for the laws devised for professional license.
Standards of the Council on Chiropractic Education (CCE) establish the area of eminent qualification and eminent domain of the chiropractor: “skeletal biomechanical and subluxation evaluation” and general screening of the patient for referral and consultation.
The following extracts address CCE positions/ policies:
“With respect to diagnosis, it is the position of the CCE that appropriate evaluative procedures must be undertaken by the chiropractic physician prior to initiation of patient care. There must be proper and necessary examination procedures including recording of patient and family history, presenting complaint, subjective symptoms, objective findings and skeletal biomechanical and subluxation evaluation.”
Chiropractic care and patient management:
“The following categories constitute acceptable avenues for patient care when in accordance with chiropractic physician’s clinical judgment. He/she is expected to render care in accordance with the patient’s need, and in the public interest.”
Spinal adjusting / Manipulation
- Soft Tissue
Adjunctive Physical Procedures, Nutritional and Psychological Counseling
- First Aid and Emergency Procedures
- Supportive Procedures
- Patient Education
- Consultation and/or Referral
Spinal adjusting is described as including both manual joint and soft tissue components. Adjunctive procedures are used preparatory to or subsequent to the chiropractic adjustment that mainly include lifestyle changes advised by the chiropractor to the patient.
“The educational process should be a reinforcement of the validity of the basic principles of chiropractic and an encouragement to the student to apply those principles in his or her clinical programs with emphasis given to the detection and correction of the vertebral subluxation. Adjunctive procedures are to be considered ancillary and used if required preparatory to or subsequent to the chiropractic manipulative procedure.” Make particular note that the physical procedures are not allopathic or treatment of diseases or conditions, they are ancillary, complimentary or preparatory to the chiropractic adjustment.
Patients expect and are entitled to a certain level of clinical expertise from their health care providers. They can do this because the educational programs have been consistent in the specialized clinical internships that apply to the respective disciplines. In dentistry and optometry as well as chiropractic, the clinical experience is incorporated concomitant with their academic studies in preparation to graduation and limited to their area of specialization. The allopath’s educational preparation, on the other hand, fully supports broad body diagnosis and treatment. It is structured to eminently qualify him in the above areas by virtue of curriculum content and the “serves” he performs during two years of postgraduate internship.
A “serve” is a specifically designed training sequence to acquaint the student with the particular body area or function that its design specifies. The various serves collectively cover all areas of the body and all treatment procedures known to science below the specialist level. The intern spends a certain amount of time in each serve with practical hands-on experience studying the conditions and treatment procedures associated with the serve. The electives and non-electives include: bio-statistics, cardiology, EENT, emergency medicine, family practice, intensive care, internal medicine, nephrology, neurosurgery, nutritional medicine, OB-GYN, opthalmology, orthopedics, psychiatry, radiology and surgery. The end result of academic preparation and clinic internship by the allopath is a generalist with low-level whole body qualifications.
Some of the above “serves” may be addressed in the chiropractic college curriculum but are done so within an academic rather than clinical setting, designed to acquaint the student rather than qualifying him for a given competency. There can be no question that the depth of the educational experience of the allopath accords him, not the chiropractor, eminent qualification in the area of full-body diagnosis and treatment. In the like manner, the MD does not have eminent qualifications to practice chiropractic.
Chiropractic alone understands how to achieve vivification and enhanced homeostasis without recourse to chemicals or artificial intervention. We are afforded the unique opportunity to observe in a clinical setting the results of the adjustment as it manifests itself in increased vivification, an opportunity no other health care profession enjoys. It is this aspect of training, which is wholly missing in the clinical experience of the allopath, thus fostering and perpetuating doubt and mistrust in chiropractic and what it can accomplish when applied properly. In like manner, the lack of emphasis on this aspect by certain chiropractic colleges only encourages the chiropractor to use more treatments; a predictable response when one does not know the effect the adjustment has on vivification and homeostasis.
The chiropractor’s clinical serve experience has provided him with extensive opportunities to observe the effect of the vivification process on healing and the restoration and preservation of health. In a clinical setting, we can observe the short and long-term effects of the adjustment as it releases vivification and homeostasis. We may observe these effects as they apply to manifestations of dysfunctions through increased vivification as the result of the chiropractic adjustment. No other health profession has grasped this principle; it is virtually unknown outside of chiropractic.
The chiropractic profession is gradually beginning to expand its ability to educate chiropractors in an increasing number of countries. There is a need for an organized effort to package an exportable educational product that complies with the legitimate and established professional standards. This subject will be covered in greater depth in the following parts of this article series.
What can you do to help? A good place to start is to be active in your Alumni Association, but even if you are not, contact your Alma Mata and find out who they are sending to the WFC/ACC conference. Express interest for input – ask the school to state their position on subjects that you feel are important to include in this International dialogue. Engage in deeper discussions if you are not satisfied with their reply and even consider attending the conference this October in Brazil yourself. (For details of the conference go to www.wfc.org)