The Art and Importance of Doctoring

Today a commentary on doctoring.  What is doctoring about?  What is the difference between doctoring and chiropractic?  Is there a difference between being a doctor and being a chiropractor?  What do most people mean by doctoring?  What is the state of doctoring and where is it headed - and are chiropractors keeping up?

What is doctoring about?  Doctoring is a field in which we address the state of health from the outside, using a wide variety of diagnostic and treatment tools.  In the beginnings of the field, the aim was the same, and the tools were the same; observation, palpation, assessment of 'objectives' like temperature and color, documentation, trial and error treatments, and alterations to the treatments based on the outcomes.  These last few elements are what we now call research, which has become it's own branch of health care. It has at times been more mystical than science-based, and continues to be in some areas of practice and in some areas of the world

What is the difference between doctoring and chiropractic? You tell me - what is the difference, in your mind?  The differences are impossible to clearly define because practically every single chiropractor in private practice uses a different set of diagnostic and treatment protocols and criteria, with the arguable exception of upper cervical or Gonstead doctors, and occasionally those things you'd really get nailed for not checking, like blood pressure.

While there is more consistency among medical doctors, there is even wide variety there in terms of diagnostic tools and preferred treatments.  The fame of mindbody medical authors like Larry Dossey, Rachel Naomi Remen and Bernie Siegel are easy examples.

So differences are extremely difficult to identify, though we can generalize.
1) DCs better understand biomechanics, NMS issues, xray diagnosis, and of course various signs of the subluxation.  In fact, if you look at the data you'll find that we have hundreds of more hours of xray and NMS classes than MDs do.

2) MDs do residencies, which we don't, which adds important experience and also adds competition to the schooling process which we don't have in our schools.  Is this a good thing?  Would we do better as a profession with this competitiveness and more high-intensity clinical training?  For sure we suffer because we don't learn about insurance panels and billing codes and the insurance system like MDs do in a residency.

3) In general, DCs are more interested in the real health care alternatives - nutrition, exercise and the mindbody continuum.  How many times have you heard "I love my chiropractor, he's like my therapist!"  This is a result of our leaning away from a cold, clinical treatment environment and towards a friendly, warm interaction.

4) The healing power of touch.  There is a truckload of research on this, and we are the only practitioners outside of massage therapists who touch people to such an extent.  This enhances number three above.

5) DCs suffer massively as a profession from insecurity, and MDs as a profession suffer from ego.  This is why we have terms floating around like "Chiropractic Medical Physician," and why they have an average $91K malpractice bill annually compared to our $5K average.  MDs also suffer as a profession from competitiveness, which is why we are called quacks and medical associations are trying to get DPTs the right to adjust.

6) We try and stimulate the body to heal itself, from outside, by adding a stimulus.  MDs try to get the body to change from the inside with a stimulus.  It is disingenuous to say that what we do is without side effects - after all, the adjustment is a microtrauma that tears scar tissue and causes a biochemical cascade - as it is disingenuous to present the concept of innate intelligence the way we do, or else the body wouldn't get subluxated in the first place.

Is there a difference between being a doctor and being a chiropractor?  This is almost entirely a matter of intention.  There are technical differences, like the cost of malpractice insurance, the ease of establishing a practice and relations with insurance companies, and though there are 'karma' differences in terms of what you inherit professionally (like the things we discussed above).  That being said, really anyone faced with working with patients in a health care setting has the opportunity to envision and act upon precisely the kind of daily experience they want to have.  MDs, DCs, DOs, reiki workers, and massage therapists all have the choice to be efficient, cold, clinical, sterile and emotionally distanced from their clients or to be efficient, warm, personal and caring with them.  While we as DCs do take on added responsibilities now that we are doctors - like diagnosing cancer on radiographs and heart murmurs - as a profession we do is much safer than what MDs do.  This is in part because by and large we choose to be warmer and more personal with our clients, and because the top reasons for malpractice lawsuits stem from clients feeling ignored, spoken down to, disregarded, or not listened to.  It is unfair and impossible to generalize and say that MDs care less about patients or their health just because we have a different opinion about the best way to help people.  I do believe that our culture is overmedicated, I do believe we are addicted to pharmaceuticals, and I do believe that people suffer a lack of information about the source of health and health alternatives, but I do not believe that all MDs are greedy people or that they don't care about the best interests of all their clients.  Nor do I believe that all DCs do.

What is the state of doctoring and where is it headed - and are chiropractors keeping up?  In the past twenty years there has been a significant shift in the medical community.  In addition to the doctors I mentioned above who have written bestsellers on health care and advocated for the integration of mind-body medicine and a heart-centered change in the ways that MDs relate to their patients, holistic medical centers and wellness establishments have sprung up all over the country.  This has resulted in no small part from the pressures of the third-party payor system, which has had a far more brutal impact on medical doctors and the choices they have to make with their patients, and also from the inhuman requirements of working in most modern hospitals, also partly because of the impact of insurance companies.  Hundreds of MDs across the country found themselves with money in the bank, but with no personal or family lives and totally burned out, having lost whatever noble or spiritual motivations led them to health care in the first place.  As a result, these doctors started looking at what their craft meant to them and how they wanted to work, and how they wanted to be with people.  As a result, these MDs started practicing more like we do, with a more personal, warm approach to patients.

In addition to this, the medical establishment started looking strategically at why all of a sudden there were more visits to alternative practitioners in this country than there were to MDs.  They found that people preferred natural, less invasive treatments, that they preferred to be free of drugs in their bodies, that they preferred a relationship with a doctor and one where they were treated with respect and given a voice in their health care, and one where the human element of their health challenges - the mental, emotional and spiritual parts of getting sick or being in pain - were acknowledged and addressed.  So, they realized, in order to survive and thrive, they'd better make some changes.  So they did.

In the last ten years, we have seen two dramatic and oppositional shifts: out of deep insecurity about ourselves as professionals and caregivers, chiropractors have become doctors, started calling ourselves 'chiropractic medical physicians,' started wearing white coats and stethoscopes, and diagnosing visceral disorders and referring people in need of chiropractic care out of their offices.  At the same time, MDs have stopped wearing white coats and have started decorating their offices in warm colors and plants and treating their patients with loving and respect.

In my opinion, we have some important decisions in front of us.  We have reacted emotionally and stupidly to the decades-long attacks of the AMA by starting to give up - actually, flee - everything that made us distinct; the very things that American consumers are begging for with their dollars (in the billions) every year.  So, are we keeping up?

There are lessons to be had from the history of doctoring, and of osteopaths and chiropractors specifically.  Both osteopathy and chiropractic were born of the conviction that medicine had something wrong. In the case of osteopathy, Still (the founder), was a medical doctor who believed that medicine at that time was corrupt and inefficient - and that it focussed on symptoms rather than causes. Sound familiar? This was the same song sung by D.D. with the exception that Still apparently hoped DOs would revolutionize medicine from within whereas D.D. preferred to stay outside.

The point is that they both felt there was something essentially wrong with the medical establishment and the approach of traditional medicine.  Remember, just 30 years earlier Semmelweis died insane after being shunned out of his career by doctors insisting that his theory about "invisible germs" was a ridiculous notion. This was an event that can be taken, even today, as a powerful learning opportunity for all health professions to acknowledge their ego and open to self-inventory. It is also interesting timing, and we are at another interesting time now, too.  Chiropractic stands on a precipice.

DC's becoming Ds. Personally, becoming a primary care physician was an irritation. I wanted to be a chiropractor, not a medical doctor or medipractor. While it's nice to be able to legally answer my clients when they come to me with more global health questions or with questions about disease or pathology, and while I do not personally believe that all illness is a result of nerve pressure, all the legal attachments and liabilities that come with being a primary care physician have nothing to do with why I became a chiropractor and arguably have nothing to do with chiropractic, period.

There are a lot of liabilities with being a PCP. First, drugs and survey are dangerous, meaning that "malpractice" cost and frequency both increase, which means practice is more expensive, which means you have to work more or see more clients to pay your bills, which means quality of care goes down and pharmaceutical sales reps become your primary source of continuing education. At least this is what it has meant for much of the medical profession, and what it will mean for DCs the closer they creep to becoming PCPs. Also with these changes comes human but unhealthy tendencies toward over scheduling, overcharging, fraud, and the like. Too many DCs who probably got into the profession out of a desire to help fell into these traps and end up ruining the reputation of the entire profession. The worst part about this is that it makes it even harder for us to help people because they have yet another reason to not come see us in the first place.

All arguments about the purpose, philosophy and direction of the profession aside, the truth is that all doctors of all disciplines could stand to have a carefully considered discussion about doctoring.

The meaning of the word doctor really means to teach, to educate, to support, to inform. That is the highest ethic that we could possibly hold ourselves to as practitioners. What people want from doctors is clear information about their disease (or their desire to avoid disease), guidance as to their options, and support for the decision that they have made. They do not want trash-talking about other doctors, other health care modalities, fear tactics, politics, lobbying, or any other kind of discussion that has more to do with what we want from them versus what they need to do to get and stay well. Sadly, this is what most people think of when they think of doctors.

Ironically this education and support has been more the foundation of the chiropractic profession, with some trash-talking mixed in there, yet we are changing. A long history of being attacked form the outside and of insecure DCs trying to change chiropractic from the inside has led to a situation where we wear white lab coats and stethoscopes in our internships while the medical profession is running away from this at high speed because they know that it is not what patients want. I used to leave my internship where my clinician checked more medical criteria on my patients than chiropractic criteria and go to see my endocrinologist who wore an unbuttoned dress shirt and Dockers to work. If we head in this direction much longer our first wake-up call is likely to be a dramatic shift in all those patient-satisfaction surveys that we like to quote so much.

We are chiropractors, and chiropractic is an amazing thing. But there is much greater and more powerful potential for us, and it has nothing to do with prescribing or doing minor surgeries or checking blood pressure on each visit. It has to do with embracing the real potential of doctoring, and asking people what they need to make their lives better, helping them identify as many resources as possible, guiding them through the sorting process, and then standing by them in support as they try to get what they need. I am nit suggesting unconditional support and cheerleading for them if they decide they need convenience and are going to eat fast food three meals a day, seven days a week - I am envisioning this within our context as educated health care providers.

But the time has come to stop with the anti-medical talk and shift to pro-chiropractic talk. The time has come to stop with unnecessary treatment recommendations born out of greed, or fear of your practice's financial insecurity, and to support your clients in a frequency of care that makes sense to them, and works with their bodies. The time has come to follow the lead of Ornish and Chopra, of Remen and Segiel, of Dossey and Weil and to advocate health on all levels and to care for the whole person, mental, emotional, physical and spiritual.

The time has come to step up and be Doctors, not mechanics.

Copyright 2011, Matthew Hertert, DC