Comments on Chiropractic - Outside Looking In

Comments from the World Federation of Chiropractic (WFC) World Meeting on Identity at Life Chiropractic College West, California 25-28 February 2004 *

Bob Barash PhD
Patient and marketing consultant, Los Angeles, US.

The two major issues for chiropractic are to establish a pre-emptive position within health care, a place solely occupied by chiropractic and hard for others to challenge, and building reputation/trust. The former must involve a combination of science and art - “chiropractor does this better than any other discipline.” For the latter it is vital, given you critics and doubters, that the profession establish one strong, centralized authority and voice in the country.

Sue Wakefield
Past senior executive, National Health Service, UK, currently Executive Director, British Chiropractic Association.

The public in the UK now sees chiropractic as a necessary part of mainstream health care - dealing with musculoskeletal problems and health in a holistic way. However the public doesn’t know your level of education and skill. Chiropractors must respect each others differing views, but the profession’s messages to the public must be kept very simple - most laypersons cannot understand the scope of chiropractic or it’s technical terms until after they are patients.

Richard Cooper MD
Former medical school dean, health policy expert, Madison, Wisconsin, US.

“You have entered the circle of accepted and reimbursed practice” and patient satisfaction is not enough for you to get by - you face the challenge of better documenting effectiveness. “There is no place for ambiguity in our present health care world” - your profession must sort out a clear role, and adopt clear positions on frequency of care and scope of practice issues such as indications for care, especially for children, and use of glandulars.

Chiropractic is “irreplaceable in our spine centre” - we have brought it in because of you knowledge of spinal mechanics and “much higher technical level of manipulation than we could find anywhere else.” But for MDs, “that’s the comfort zone.” On the other hand “it would be a public health problem to not have chiropractors there to help people get through the next week of their lives.” They offer services in this area that I recognize, but you must now do the studies to document these benefits.

I don’t see chiropractor’s future in broad primary care. Your education is not wide enough. Even if it were a good idea, there’s no market given the numbers of nurse practitioners. Nor is you future alternative care. One problem there is that you have established educational standards but in alternative care “the bar’s too low, educationally.” Therefore this area is going to have too many in the market.

“You’re the one profession I can’t place.”

Irene Turner PhD
Patient, engineer, university lecturer, Bath, UK.

‘Chiropractic’ is not well known as a word in the UK, and there is confusion about the different roles of chiropractors, osteopaths and physiotherapists. There is a lack of image and presence that needs to be addressed.

James Dillard DipAc, DC, MD
Trained as acupuncturist, then chiropractor, then MD, and now managed care executive, Baltimore, Maryland, US.

The managed care world is looking for much better evidence of effectiveness (it rates the present evidence as “neutral”), much better office documentation and more trust. Surveys show chiropractic to be one of the less trusted professions, and that has to be dealt with at this point.

There is recoil against the aggressiveness of Western medicine, and this means that the “personal, high-touch, hands-on” approach of chiropractic is very important, as important as technical excellence.

Pran Manga PhD
Patient, health economist and health policy expert, university professor, Ottawa, Canada.

There will always be variations in scope of practice within a profession, but chiropractic needs a stronger professional identity - to unify the profession, facilitate marketing, and direct the research agenda. However, the identity chosen must be “substantive and realistic.” It must be consistent with your education and the experience of patients when they seek your care.

* Reproduced with permission from The Chiropractic Report March 2004 Vol 18 No. 2.