The World Chiropractic Alliance (WCA) has issued a position paper on the duty of chiropractors to diagnose, inform patients of unusual findings, and make referrals to other health care practitioners.

The dilemma of what kind of diagnoses a doctor of chiropractic is expected and permitted by law to make is one of the most controversial in the profession. On one end of the spectrum are those who feel a D.C. is capable of, and responsible for, full-body medical diagnoses. On the other are those who feel a D.C. is limited, by training and law, to the detection and correction of vertebral subluxation.

The lack of a standard definition of chiropractic diagnosis has resulted in confusion among the public and numerous malpractice lawsuits.

"We need a clear and consistent understanding of our responsibility when it comes to diagnosis," states Terry A. Rondberg, D.C., WCA president. "As it stands now, doctors are being sued when they do diagnose medical conditions, and sued when they don't."

In addition, doctors are often unsure how to proceed if they observe an unusual, non-chiropractic finding during their examination. Although they feel an ethical and moral obligation to inform the patient, a mis-diagnosis can leave the doctor vulnerable to a charge of malpractice or even of practicing medicine without a license.

Finally, doctors face the problem of whether they should refer patients to other health care providers in the event of an unusual finding and if so, to whom.

"It's unfortunate, but there have been cases where the referring doctor has been sued if the second doctor commits malpractice," Dr. Rondberg notes. "The health care landscape is dotted with malpractice land mines. The World Chiropractic Alliance's position paper is intended to provide guidance in these matters, and support in court and before boards."

The position paper relied on the Council on Chiropractic Practice Guidelines, the Association of Chiropractic Colleges Position Paper No. 1, literature from the World Health Organization, state scope-of-practice statutes, and numerous legal decisions. The WCA Board of Directors consulted with Matthew McCoy, D.C., editor of the Journal of Vertebral Subluxation Research to arrive at the final language, which was approved by the Board in August.

The position paper addresses each of the three major issues:

1. Diagnosis — While noting that chiropractors may be permitted by law in certain states to provide a broader range of diagnostic services, doctors are free to limit their practice to the "detection, characterization and care of vertebral subluxations, and determining the safety and appropriateness of chiropractic care." The WCA has long advocated the use of a "Terms of Acceptance" form, which explains to patients precisely what the examination will — and will not — involve. The validity and legality of such forms have been upheld in court.

2. Informing patients of unusual findings — The position paper reiterates the CCP Guideline's conclusion that when D.C.s encounter findings outside their professional or legal scope, they must report those findings to their patients, and record their existence. However, the Guideline does not require that the D.C. make a medical diagnosis.

3. Referral — Since there are many factors that must be considered when choosing a health care provider, the paper notes that, "it is not possible to dictate a particular class of provider that a patient must see for evaluation of unusual findings." Rondberg states, "We must permit our patients to make that decision based on their own needs and inclinations."