November 2008

The new dynamics of practice

by Dr. Richard Barwell

In my half-century of involvement with the chiropractic profession, I have witnessed many different models of practice, but none have been so profoundly critical as the dynamics involved in practice today. When we read about the challenges faced by early chiropractors, we have to admire their courage and dedication. They faced opposition, fines, jail terms and public ridicule, but still continued to practice.

Now we are witness to history repeating itself. The current opposition to chiropractic is greater than it was in the beginning. Medicine wasn't well organized in the early 1900s and didn't have the pharmaceutical companies backing it, nor had it yet swayed the educational system to its beliefs. The chiropractic profession had not quite reached the parting of the ways, dividing its strength. Time has truly changed these points.

Today, we have a well-organized, well-capitalized opposition, in control of education and media exposure at the same time there is a severely divided chiropractic profession. We have detractors, some with fair criticisms and some just plain "whackos." Further, we now have the added challenge of government interference in practice with its ability to review our billing procedures, along with the threat of fines and jail terms back in the picture.

If you think for one minute that you are immune to any of this, then you're going to be the first to fall.

The dynamics of chiropractic practice have already made a huge shift. No longer is it acceptable to just sit back and offer care without doing a compliant consultation, history, examination and then obtaining the patient's permission to begin care.

Following that, there are two other critical issues that must be addressed. The first is that you must be prepared to establish (while I am challenged in the use of this word it is the criteria) "Medical Necessity" for care; and the second is proper record keeping.

The early days of practice where all we had to do was palpate and adjust, are gone. The days of record keeping in which the date of the visit was the only recorded data, are gone as well!

Now, a practice must exhibit a level of professionalism that is defendable in every aspect. This means that we must not only update our procedures but also our ability to determine the need for care beyond palpation and the old rhetoric of "spinal manipulation is good for you."

Don't misunderstand what I'm saying. After 32 years of practice, I have moved through many models of care and dialogues and have great respect for the benefits of chiropractic care. Yet, I'm also aware of the fact that the missing link in our profession is the lack of acceptable proof of why the chiropractic adjustment works. We have overwhelming evidence that it gets results, but the vast majority of it is anecdotal and due to our complacency when it comes to proper research, not of value in offering the critical proof we require.

Objective, reproducible studies with a focus on what the chiropractic adjustment does to alter neurological function, is where we need to direct our energies. We must move past the traditional concepts of "bone on nerve" and "nerve root compression" presented by DD Palmer, which have prevented chiropractic from developing a defendable profession.

Studies have been done on the effect of the adjustment to alter brain wave activity. Carrick's work on chiropractic and changes in hemisphere function are well known. The foundations are in place for acceptable proof.

While the primary focus of chiropractic has always been the nervous system, locking ourselves into a dogmatic dialogue has kept us from moving chiropractic along with the new scientific information on the nervous system and corresponding brain research that support this primary focus.

We now have instrumentation that can prove what we have long believed -- and, best of all, it's affordable! It costs much less than an x-ray unit, which only presents a history of poor neurological function. The instrumentation provides acceptable data on neurological function, which provides proof of "Medical Necessity for care."

It seems to me that the timing couldn't be better. We are at a crossroads in our profession. We have different factions in chiropractic, some wanting to head into the medical realm, and I can understand why. The embarrassment of our lack of proof weighs on us all.

To those who react by thinking that we don't need to know anything more than the fact that we get results, I pose two simple questions. First, what if we could get even better results though greater knowledge? Second, isn't it our responsibility to improve our care? My view is that we owe it to our patients, and to chiropractic to better our profession.

These new practice dynamics are real and it's time for all of us to come together with the intent of improving chiropractic. The best news is that today we have the ability to bring our profession into the 21st Century and to demonstrate to the world of skeptics and challengers that we are, beyond any doubt -- and with acceptable proof -- "Functional Neurologists."

(Dr. Richard Barwell is the founder and president of the chiropractic Equity Offices, Inc. program, and has more than 30 years of experience in chiropractic practice. After graduating with honors from Canadian Memorial Chiropractic College in 1964, he started a family wellness practice in British Columbia. He has since established numerous successful practices, won several awards and guest lectured at various chiropractic institutions. Before establishing CEO, Inc. Dr. Barwell was the director of seminars and programs at Quest and executive director of the chiropractic Leadership Alliance.)