Have you ever noticed how few chiropractors there are today? Don't get me wrong, I fully realize there are about 50,000 people who hold chiropractic licenses and hundreds of graduates joining our ranks each year. There are more D.C.s than ever before, but fewer chiropractors.

Instead, we have chiropractic orthopedists, principled chiropractors, doctors of chiropractic medicine, subluxation-based chiropractors, chiropractic physicians, straight, mixed and just plain "mixed-up" chiropractors. Because of the tremendous diversity of practice approaches and philosophies, we have developed an entire lexicon to distinguish ourselves from one another.

But in reality, it doesn't matter if I understand what kind of D.C. you are or whether you know how the doctor down the road practices. What matters most -- in fact, the only thing that really matters -- is that your patients understand.

When patients go into a chiropractor's office, they have certain expectations. They might be looking for quasi-medical symptomatic relief. Or, they might be looking for a drugless way to correct the underlying cause of their problem.

Patients who understand about vertebral subluxation -- and want a good specific adjustment -- will be left unsatisfied if they enter the office of a D.C. who uses a variety of therapeutic devices but doesn't adjust.

On the other hand, those who have the mistaken notion that a D.C. is just another type of medical doctor who can diagnose everything from pityriasis rosia to neurocirculatory asthenia -- and prescribe just the right 'cure' -- will be disappointed after a visit to a conservative practitioner.

That's the strange thing about expectations: they don't always have a basis in fact. People form their expectations based on stories they've heard from ailing relatives, from newspaper and magazine articles they've read, or from wishful thinking on their own part.

Your job is to determine what patients' expectations are before any program of care begins. You need to find out what they know about chiropractic and what they hope, and expect, to receive from it.

If you're lucky, the person will either already know the truth about the human body and chiropractic's role in health care, or be open to learning. Either way, you have to make the person aware of what you offer in your office.

Within our profession, we've developed a kind of shorthand to relay this information. We have a pretty good idea right away what is meant when a colleague refers to him or herself as a "principled" chiropractor, or a "subluxation-based" chiropractor. We also know what will be offered in the offices of a chiropractic orthopedist or a doctor of chiropractic medicine.

But the public doesn't read our journals and newspapers. Most don't understand the subtle (and sometimes not-so-subtle) differences indicated by these cryptic terms. That's why it's absolutely essential that you make sure every patient understands the meaning behind the terminology -- and is comfortable with your approach to health care.

Right now, advocates of what they like to call the "progressive" branch of our profession are trying hard to re-educate the public about chiropractic. In articles and press releases, they are trying to convince people that chiropractic is a type of medical treatment which uses spinal manipulative therapy for chronic low-back pain. They refuse to publicly acknowledge the existence of vertebral subluxations and wouldn't be caught dead using the word "adjustment."

Armed with the Rand study and Mercy Guidelines as reinforcements, they are literally trying to redefine our profession.

It is their hope that, in the near future, patients will arrive at a D.C.'s office with the expectation of seeing a doctor (preferably in the obligatory white lab coat with a stethoscope strategically hanging from around the neck) who will diagnose medical problems and either treat them or refer them to a medical associate.

When those patients arrive in your office, you have only three choices. You can:

1. Try to be the doctor they expect, adhering strictly to the Mercy Guidelines and closing the door on the art and philosophy of chiropractic.

2. Accept the person as a patient and provide conservative chiropractic care. In doing so, you risk having a board complaint filed against you because you didn't meet the patient's expectations. Worse yet, you can be slapped with a malpractice suit and a dozen chiropractic physicians will be waiting with their copies of the Mercy Guidelines to testify against you in court.

3. Change the person's expectations by explaining what a chiropractor really does. Once the patient understands the goal of chiropractic and how you intend to reach that goal, you will be free to work together in harmony.

Unfortunately, there have been attempts to convince D.C.s that the third choice is no longer viable.

Several years ago, in Arizona, the executive director of the state association claimed that state law required all chiropractors to undertake physical and clinical examinations and perform medical diagnoses. Luckily, the highly respected attorney Paul Eckstein examined the laws and found that claim to be totally inaccurate.

Although a change in the scope of practice allowed D.C.s to conduct certain examinations, they were not required to do so. In fact, the law specifically defined a doctor of chiropractic as a portal of entry health care provider involved in the "...detection and correction of subluxations, functional vertebral or articular dysarthrosis or neuromuscular skeletal disorders..."

The attorney outlined a simple procedure to prevent patients from having the wrong expectations, and protect doctors from disappointed patients and spiteful colleagues.

First, Eckstein emphasized that chiropractors "should educate all of their patients through lecture and literature as to the limits of their practice -- that they are not medical physicians and that they do not undertake physical and clinical examinations or use diagnostic x-rays" (for other than the detection and analysis of vertebral subluxations).

Next, doctors were advised to use a "Terms of Acceptance" form which spells out in plain language what the chiropractor will and will not do. If you're a subluxation-based chiropractor, you need to let patients know that you will be focusing on the detection, analysis and correction of vertebral subluxations.

The patient should be required to read the form, and you or your C.A. should be available to explain it in more detail if necessary. The patient should then sign the form and receive a copy of it. The original should be filed with the patient's records.

It's important to realize that this document isn't meant as a way to absolve you of your responsibility as a doctor of chiropractic. That's something you can never merely sign away, nor would you want to. But, as a D.C., you have another duty: You must educate the public and prevent others from re-defining the profession out from under us.