When it comes to the family doctors and non-drug care vs. prescriptions, ‘I’ll take my half down the middle …The Lagom Way!’
No one could have ever imagined what happened in 2020. The societal middle ground disappeared. You were either for us or against us. “Cancel culture” created a vacuum in the middle of society. Common sense, free speech, and unbiased scientific research all but disappeared. If you apply this societal vacuum to the chiropractic pharmaceutical prescription debate, on one end is the ability of a chiropractor to prescribe medications freely like the medical family doctor, and on the other end is never taking or recommending any pharmaceutical medication, even if it is potentially lifesaving.
3 ways to look at a story
The 2020 rip in our social fabric pushed our profession to the brink of making the same fatal mistake the cancel culture did. Most of us falsely believe we have only two choices. Do we become another health care provider prescribing medication for symptoms or do we stand for what our predecessors believed and address the underlying cause of those symptoms?
In my opinion, chiropractic’s drugless, non-surgical approach to health is the hill I am willing to die on. But that still doesn’t mean I only have two choices in this debate. This turmoil reminds me what an incredibly wise man shared with me long ago. He said, “There are three ways to look at every story. Your way, my way, and what really happened somewhere in the middle.”
I believe chiropractic could own the middle ground of what is really happening in U.S. health care right now. The Gallup poll in December of last year stated that six out of 10 Americans believe we have a major crisis or problem with our current health care system. Our profession has a once-in-a-lifetime opportunity to become an entirely new type of health care provider. What if chiropractic became the new “Integrative Healthy Lifestyle Primary Care Provider” in the middle of these two extremes?
Integrative care
Many chiropractors (including myself) already provide this type of care to our patients. We live in the middle of the road. Scandinavians call it the “Lagom Way.” Loosely translated, it means “Just enough, but not too much.” This mindset was used to navigate the COVID-19 pandemic in Sweden. I believe there is a time for lifesaving medication, but my training and philosophy does not compel me to be the one prescribing it.
I’ve been a member of my local volunteer fire department for over 23 years. When I arrive on the scene of a terrible accident, the ambulance isn’t taking those victims to my office, it’s going to the emergency room for lifesaving interventions. We have the best medical model in the world for trauma and acute disease management. If I get in an accident, I will happily take my ambulance ride for acute lifesaving medical care.
However, the U.S. health care system has the highest chronic disease burden of all 11 countries that take part in the Commonwealth Fund’s International Health Policy Survey. More than 25% of U.S. adults report two or more chronic conditions. This rate is twice as high as in the Netherlands and the UK.[1]
Different approaches and opportunities
Just as the average medical family doctor has not been formally trained in nutrition, fitness, functional and lifestyle-based interventions, I have not been formally trained in pharmaceutical medicine. Medical professionals have dedicated their lives to the pursuit of allopathic knowledge. I have not. It doesn’t make either of us bad people; it just makes us different in the way we approach our patients.
Medical training is based on Germ Theory. Chiropractic training is more Terrain Theory based. Neither completely explains any specific patient encounter. Some isolated situations require acute medical intervention. However, most ongoing patient encounters do not. Our chiropractic training and philosophy is the logical choice for providing the holistic lifestyle-based approach needed to successfully address chronic patients in our current failing health care system.
Chiropractic’s opportunity is fueled by the lack of access to lifestyle-based primary care in the U.S. We know from Commonwealth Fund surveys that U.S. adults experience great affordability barriers to access lifestyle-based primary care. This leads to only acute and infectious disease visits. Increasing access to affordable health care and strengthening lifestyle-based care are two of the most important challenges for the U.S. health care system.[2]
A pharmaceutical prescription crisis
I’m fully aware some chiropractors would love the acceptance of our current medical health care model. Most older adults (especially 65 and over) continue to embrace the U.S. pharmaceutical industry. In 2017, Consumer Reports surveyed 1,947 adults and more than half of them took an average of four prescription drugs regularly.
According to Quintiles IMS in 2017, the number of prescriptions filled by all Americans increased by 85% in the last two decades while the U.S. population only grew by 21%.
Other chiropractors point to pharmaceutical failures, like the opioid crisis, to make their case against prescribing or even recommending medications. Adverse drug events cause approximately 1.3 million emergency department visits and 124,000 deaths each year, according to the CDC and FDA. No medical professional I know is comfortable with those statistics.
Addressing the root problem
My view is those two extremes need to be recognized, but then personal experience, common sense, education and gut feeling should guide your decision for the patient standing in front of you. Pharmaceuticals are not inherently bad; there is certainly a time and place for them. But my focus is to find and correct the root cause of my patient’s problem.
This brings me back to the Lagom Way, “Just enough, but not too much.” Chiropractors are in the perfect position, like the old family doctor, to talk nutrition, fitness, stress reduction, sleep and social interactions, while providing life-changing chiropractic care. We put our hands on people. We touch and connect with them. No other profession combines healthy lifestyle education and personal connection the way chiropractic does.
Taking advantage of a societal disruption
The societal disruption in 2020 could be the best thing to ever happen to chiropractic. Society already views us as different than other health care providers. Most people still have no idea what we do.
Our poor levels of insurance reimbursement have made our fees reasonable for almost everyone. We also have a much lower barrier of entry than other medical providers. These factors, along with our innate ability to connect with our patients, pave the way to create an entirely new integrative healthy lifestyle-based primary care system affordable to all.
Health care and “Big Pharma” spending on direct-to-consumer marketing grew almost 4% in 2020 to $35.7 billion. There is no way chiropractic can compete at this level. However, no amount of marketing dollars will ever top your patient telling their neighbor about the great experience they just had in your office.
They will tell others how you talked to them like an adult, not a child. You explained diet, fitness, stress management and how those things relate to their symptoms. You told them you are willing to be their partner in health. You discussed their medications but referred them to their medical doctor for any specific questions or concerns. In other words, you became their trusted authority in creating and maintaining a healthy lifestyle, not focusing on sickness.
Re-emergence of the old-time family doctor
I’m reminded of the old-time family doctor before medications became widely available. They lived next door. They were part of the community. Their practice was based on educating people about a healthy lifestyle. They asked about diet. They asked how you slept last night. They talked about exercise and your family relationships. The family doctor cared about all of you, not just your labs and medication list.
Chiropractors have the opportunity to become the reincarnation of the old-time family doctor. Last year was a huge wake-up call for all of us. The vacuum has cleared the path for chiropractic to stand in the middle of the road and stake our claim as the integrative healthy lifestyle doctor of the future. Many of us have been doing this for years already. Now, it’s time to seize the day.
Who’s with me?
BILL HEMMER, DC, has been in private practice for more than 30 years. He has expanded his practice to include customized health recovery plans and can be reached at drbillhemmer@hotmail.com.
RESOURCES
[1] Roosa Tikkanen and Melinda K. Abrams, U.S. Health Care from a Global Perspective, 2019: Higher Spending, Worse Outcomes? (Commonwealth Fund, Jan. 2020). https://doi.org/10.26099/7avy-fc29
[2] Eric C. Schneider and David Squires, “From Last to First — Could the U.S. Health Care System Become the Best in the World?,” New England Journal of Medicine 377, no. 10 (Sept. 7, 2017): 901–3; and Eric C. Schneider et al., Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care (Commonwealth Fund, July 2017).
