When it comes to patient education, chances are pretty good that you frequently face the challenge of explaining that chiropractic is a complete approach to health, not just a therapy for neck and back pain.
Luckily, now more than ever, patients and potential patients seem to be open to learning more. An educated population, the explosion of health-care information on the Internet, a growing skepticism for traditional allopathic medicine, and increasing interest in so-called “alternative medicine” have resulted in fertile ground for the seeds of chiropractic planted 106 years ago by Dr. D.D. Palmer.
The challenge is to find a balance between “overexplaining” chiropractic principles to your patients and potential patients, while still communicating key information – including the subluxation complex – in a simple-to-understand and easy-to-remember way.
The landmark study, “Trends in Alternative Medicine Use in the United States, 1990-1997,” by David Eisenberg, MD, et al, in the November 1998 Journal of the American Medical Association, found that people are seeking alternative health-care providers, including chiropractors, in droves. Chiropractic is on the brink of stepping into public education as public universities and state legislatures are investing funds to study the feasibility of adding chiropractic to state college curricula.
More and more consumers are looking to alternative options when it comes to healthcare. A recent study published in the Journal of Family Practice examined when and why medical family practice patients included various forms of comple-mentary and alternative medicine (CAM) modalities for their health complaints. The study found that 21% of family practice patients “reported using one or more forms of CAM therapy in conjunction with the most important health problem.”
The report found many reasons why these family practice patients sought alternative care. More than two-thirds of the patients used alternative care for one of these reasons: to avoid unwanted side effects; because of the failure of traditional medicine in diagnosing or benefiting their health problem; or because they didn’t like the attitudes of the medical doctors. Clearly, many patients are dissatisfied with traditional medical treatment, and they are going elsewhere for relief from many common health problems.
All of this is heady stuff, but it raises serious questions. For instance, with public universities expressing interest in adding chiropractic to their curricula, what kind of chiropractic education will step into the public education arena? Will it be traditional chiropractic care, based on the philosophy, art and science founded 106 years ago? Or will it be more closely aligned with the medical model?
For example, a recently published study by MGT of America, Inc., for the University of Florida, provides the following definition of chiropractic care:
“Chiropractic services can be defined as: a drugless health-care profession with a relatively broad diagnostic practice scope and a treatment scope that emphasizes structure and function of the body’s musculoskeletal framework and the relationship this has to health in general….”
What is the missing word in this definition? It is the core premise of chiropractic – the subluxation and its neurological, whole-body ramifications. Chiropractors have been struggling for more than 100 years to make a skeptical public understand the relationship between subluxations, the nervous system and human function, and how the chiropractic adjustment affects the health of the body.
Now, the central premise of chiropractic – the significance of the nervous system to health and the effect of the subluxation complex on the nervous system and, therefore, the body – is in danger of being stripped out of some organizations’ “definition” of chiropractic.
What that would do is set the stage for producing a generation of chiropractors who have been taught the mechanics of performing an adjustment, but who don’t necessarily grasp the full effects of the adjustment on the body. It’s akin to teaching a football team how to execute plays, but not why a particular play will be most effective against a certain team, or that the goal is to score a touchdown.
Treatment scope in the MGT definition also refers to the medical design of disease treatment, and may tend to confine chiropractic care to a musculoskeletal domain.
What the chiropractic profession desperately needs is a succinct definition of chiropractic that is easy to explain and understand. Enter the Palmer Triangle of Care.
The Triangle of Care is an all-encompassing, all-inclusive, yet simple and concise definition of the chiropractic profession, represented by a graphic image (see image, below). Within all or some of the Triangle of Care’s three aspects or domains – condition-based care, healthcare and wellness/development care – most chiropractors and chiropractic patients can find a “home.”
At the center of the diagram is the subluxation, since the subluxation and its impact on the nervous system are the core clinical activity of chiropractic. Some have asked why the patient is not at the center of the graphic representation. The answer is simple: The goal of chiropractic care is to improve the health of patients, and that goal is implicit in the Triangle of Care.
Many health-care professionals see patients for conditions, health promotion and some form of wellness. What makes chiropractic clinical care unique is the subluxation complex.
The Triangle of Care explains the phases of chiropractic care that lead to wellness, and it’s easily communicated to the lay person. The diagram allows you to describe to patients where they fit within the three care domains, what each domain encompasses, and how they might progress from one domain to the next during their lifetime.
The fact that the subluxation is at the center of the triangle allows you to explain the impact of the vertebral subluxation complex on health within the context of your patients’ particular emphasis at any given time, be it condition-based care, healthcare, wellness/development care, or all three.
The Triangle of Care is built on relationship-based chiropractic care, in which the patient and doctor must share goals within the chiropractic continuum of care.
Therefore, the professional responsibility to provide primary care calls for the development of an ongoing relationship surrounding three aspects or domains of chiropractic care:
- Condition-Based Care: When patients present with complaints/problems, the doctor must possess certain skills that enable him or her to investigate potential causes and options for management. In addition to subluxation analysis and spinal adjustments, this care at times requires diagnostic/ analytical considerations and care regimens.
Third-party payor guidelines and reporting requirements, as well as required inter- or intra-disciplinary communication and referral may also influence this patient management. This recognizes the principles of the limitations of matter. As condition-based care is initiated, the patient is educated to understand a broader framework of care inclusive to the health and wellness/development domains of care.
- Healthcare: The focus of healthcare is to develop optimum function and adaptation within the human body; therefore, the focus is on nerve system function. These patients often do not present with symptoms or conditions, but initiate care as an overall approach to health. The doctor of chiropractic will address the need for subluxation correction as a part of a healthy lifestyle.
In addition, other issues that may affect spinal or general health such as ergonomics, physical activity and nutrition may require consideration. It’s natural for the chiropractor and patient to constantly reassess the “bigger picture” of health as the patient progresses.
- Wellness/Development Care: Wellness/development care is derived from recognition that each patient uniquely experiences development as a dynamic, lifelong process. This experience includes physical, emotional, intellectual, spiritual and relational dimensions. Chiropractic philosophy views these dimensions as a whole that provides a framework from which the doctor should assess and support development without interference, thus maximizing an individual’s potential for wellness.
The chiropractic objective is to provide a philosophical framework for lifelong relationships, anchored by the detection, reduction and correction of the vertebral subluxation and supported by the promotion of self-generated/ self-responsible health activities.
If members of the chiropractic profession are to effectively communicate the Big Idea of chiropractic to the general public, we must agree on what that idea is. Adopting the Triangle of Care is one way to unify chiropractors around a simple, visual explanation of the Big Idea. The Triangle of Care serves as a powerful tool in explaining to patients how chiropractic can positively affect their health for a lifetime.
