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CAM and Chiropractic Prognosis
By Joseph Brimhall, D.C., president of Western States Chiropractic College
Contemplating the future of chiropractic and its role in the health care delivery system involves assessing trends, developing reliable forecasts and thinking about possible scenarios. No one can precisely foretell the outcome of upcoming events; predicting the future remains an uncertain practice. However, it seems that members of the profession should actively study current developments in order to effectively prepare for the challenges and opportunities that lie ahead.
Since its beginnings over a century ago, chiropractic has grown and progressed in its role as a separate and distinct health care profession. The terms “separate and distinct” are frequently employed to distinguish chiropractic from allopathic health care. Allopathic medicine has become the dominant force in contemporary American health care, relying on a disease-based model that utilizes prescription drugs and surgery as primary interventions. Allopathic methods are directed toward curing the patient by the use of remedies or procedures that produce effects different from those caused by the patient’s disease or condition.
In recent decades, health care consumers have exercised a strong influence on health care delivery systems by demonstrating preferences for safer, more effective and less expensive options. Many patients have turned from the prevailing dominant allopathic medical model, instead choosing care from non-allopathic providers. This shift has had measurable impact and has been studied for a number of years now. Attempts have been made to understand this trend, and various individuals and organizations have taken action in response to changes in consumer behavior that seeks optimal health care. Non-allopathic therapies, professions and practitioners have been labeled as “Complementary and Alternative Medicine,” or “CAM.” Although the “CAM” label probably does not adequately or completely describe the entities it references, the nickname has become somewhat entrenched in the current health care jargon.
As CAM alternatives increase in popularity with the consuming public, allopathic medicine has taken steps to respond to, incorporate, and in some cases, regulate CAM practices. Some have speculated that the CAM professions, ?including chiropractic, will be influenced by the actions of organized allopathic medicine. What is the future for the CAM disciplines in general and for chiropractic in particular?
It seems that at least three discrete scenarios emerge as potential futures for the CAM professions and practitioners. Certainly, other outcomes are possible as well. The value in assessing and considering potential scenarios lies in the enhanced capacity to prepare for and influence the desired outcome, by identifying actions and attitudes that must be adopted in order to maximize potentials for the future that we seek. It is interesting to note that the following examples are not mutually exclusive and may very well represent three different ways that CAM may be concomitantly utilized in health care delivery. Also, these models may already be in operation, at least to some degree, in current health care models.
1
Allopathic health care takes over CAM. In this scenario, CAM provides treatments for disease-based care in addition to or in place of drugs or surgery. The risk for chiropractic and other professions in this approach is that CAM disciplines are reduced to therapies suitable for treatment of specific diseases, conditions or body regions, while the unique philosophies and paradigms of the involved disciplines are diminished. CAM therapies may then become recognized “specialties” within the dominant allopathic system. For example, chiropractors become identified as the spinal health care experts in the health care system, while chiropractic educational and practice standards become heavily influenced by conventional medicine. Primary access to patients may be retained for spinal conditions, but treatment for other conditions and regions of the body may require referral, and perhaps supervision, of a licensed allopathic provider. The regulation of chiropractic scope of practice may then become more limited by state and federal laws, managed care policies and administrative rules aimed at restricting the development of the profession. Chiropractic as a “separate and distinct” discipline is viewed in the context of its specialized contributions to health care, instead of a profession that is specifically differentiated from allopathic medicine.
2
CAM takes over allopathic health care. In this model, chiropractic and other CAM disciplines become the preferred and primary health options emphasizing conservative, effective and safe choices for patient care. Doctors of chiropractic and other CAM providers may serve as gate-keepers to health care systems (including managed care networks), making referrals to allopathic doctors and other providers as appropriate to minimize costs and increase effectiveness of health care delivery. CAM professions work together to find ways to protect and enhance the health of individual patients and the public. The focus on this model is an emphasis on functional optimization, or maximizing the body’s inherent healing systems, through natural and minimally invasive methods. Prominent focus is placed on health promotion and lifestyle modifications. Treatment modalities are aimed at supporting the structural, metabolic and functional patterns unique to each patient. Allopathic medicine becomes secondary to CAM care, relegated to only those instances where drugs and surgery have been proven effective.
3
CAM and allopathic health professions work together for the benefit of the patient. Some individuals may refer to this scenario as “integrated” care. In this example, modalities and therapies are openly shared among CAM and allopathic health care professions in order to allow each discipline the opportunity to gain appreciation for the others. Practitioners exchange information, refer to members of other professions, and hold the patients’ interests above all. Effective business models are created that provide necessary incentives for improvement while allowing CAM and allopathic providers alike to earn appropriate incomes. Health care is integrated at hospitals and clinics, allowing the patient access to a full spectrum of services. CAM professions retain their individuality and uniqueness, incorporating new information as the discipline develops within its paradigm of choice.
Which ending will it be? Like a movie that has alternative endings chosen by the viewer, it is certain that future outcomes will be a product of choices made by the consumer, the public as a whole, and the members of the respective professions. Although the scenarios presented above seem simple and straightforward, the political and economic factors influencing these potential futures are powerful and exceedingly complex. The CAM professions, including chiropractic, must engage difficult questions and be willing to embrace uncertainty if we wish to shape the future.
The chiropractic profession should view this time as an opportunity to step forward and assume responsibility for potential future roles. We have the potential to play a unique role in creating the future for ourselves and our patients. However, I believe that there are a few action steps that we must address immediately:
Stop the chiropractic infighting. We must find space for dialogue, perhaps by creating opportunities for a facilitated “think tank” processes that provides for conflict resolution and the development of value alignment. While national chiropractic unity may be as implausible as achieving room temperature nuclear fusion, we need to find ways to identify our commonalities and minimize our differences. Patients and legislators find no value in this bickering, and they make decisions accordingly that directly impact the profession. The most reliable method to ensure our demise is to maintain internal conflict and hostility.
Articulate a professional identity that is consistent, reliable and realistic. The public should understand that doctors of chiropractic are specifically trained and qualified to treat patients as whole beings. Characteristics that distinguish chiropractic care from allopathic medicine should be acknowledged and communicated.
Find ways to work effectively with other health care professions. Legislative battles designed to restrict the scope of other professions are temporary solutions that create barriers to professional cooperation. We must discover methods that encourage collaboration among the professions, in order to find optimal solutions for ourselves and our patients.
The future is inextricably tied to the decisions we make and the actions we engage in today. It is in our hands. What will it be?
©2006 Today's Chiropractic