Progress through patient focus and integration

Kenneth Young, DC, PhD is a Course Leader for Chiropractic at the University of Central Lancashire. The opinions expressed here are the author’s alone and do not necessarily represent those of the University of Central Lancashire.

A panoply of perspectives

Different chiropractors see progress in different ways. One of the most joyful – and confounding – aspects of chiropractic is the diversity of perspectives that have always existed within it. The late chiropractor Stanley Martin is quoted as referring to chiropractic as embodying a version of Newton’s third law of motion: “For every chiropractor, there is an equal and opposite chiropractor.” 

That quip is clever and funny, and it captures a common impression of chiropractic. But from a professional perspective, it loses a bit of its charm. The truth in it has resulted in public confusion about what chiropractors do, distrust among practitioners, the persistence of fringe practices, and a long period of being shut out of university education. 

Australia & pursuing a chiropractic profession

I love Australia. I’ve been fascinated with it since I first heard Radio Australia on shortwave from my childhood home in north-eastern USA. I love the landscape, the kangaroos, the bandicoots, the eucalyptus trees, the weather, the wildness. Most of all, I love the optimistic, forward-looking people. Australians are innovative, resilient, willing to muck in, and welcoming to strangers. 

I made no secret of my affection for my adoptive country when I was there, and the most common question I have had since returning to the UK has been: Why would you leave? There are personal reasons: family connections and a desire to show our kids Europe. But what really compelled me to come back here was the opportunity to help develop the chiropractic profession.

When tolerance poses a problem

Tolerance and diversity are beautiful things. I actively try to increase the diversity of people in chiropractic care. I’ve written a paper on it. But the diversity of practice within chiropractic can be more problematic. 

This comes down to a fundamental idea in professionalism: the fiduciary agreement. When someone becomes a member of any profession, from accounting to medicine to law, they agree to put the interests of the public ahead of their own. In exchange, they are granted self-regulation, that is, they are trusted to train subsequent generations of practitioners, determine who becomes a member of their profession, and so on. They are also granted a certain status in society, often publicly proclaimed with a title such as ‘Dr’ or letters such as LLB after their names. 

But professionals are human. We have frailties, vanities, and other shortcomings that sometimes allow us to lose sight of our shared priority to serve the public. I wrote about a particularly noteworthy instance of this. It is something I think about quite a bit.

If we stubbornly adhere to a historic concept of how disease and health work, or fail to evolve when a particular treatment or technique system becomes outdated, we will not serve the people whom society has entrusted to our care.

If we tolerate practice systems that have no scientific underpinning, we will serve individual practitioners, not the public. 

If we support education providers whose official documentation differs from what is actually taught in practice, we break the fiduciary contract.

Integration, not separation

DD Palmer invented chiropractic as an alternative to medicine. His son BJ promoted and legally defended chiropractic as separate and distinct from medicine. That strategy served chiropractic well; arguably, it allowed chiropractic to avoid being destroyed by claims of practising medicine without a licence. Some chiropractors still see ‘separate and distinct’ as the way forward. But by its very nature, that way defines a path to further marginalisation. 

I see progress not as going back to that historical strategy, but as moving forward toward evidence-based practice and integration with the other health professions. 

Integration would mean we could eliminate public confusion about what chiropractors do. We would be manual musculoskeletal therapists with excellent diagnostic capabilities who excel at spinal care and joint manipulation. Referrals both to and from chiropractors and other health professionals would increase. Research opportunities would increase. We would reduce fringe practices without losing our identity. We would be respected members of multidisciplinary teams, working in hospitals, care homes, and other settings, as well as private clinics. Most importantly, integration would mean that people get the care that they need as individuals in the timeliest fashion. 

Acceptance starts with education

I guess I have a bit of Australia in me because I am looking forward and I am optimistic. I came to the UK to muck in and work towards progress in chiropractic. I am now a Course Leader for Chiropractic at the University of Central Lancashire, which has a variety of other health care programmes including a medical school. I would like to see a systemic, sustainable integration of chiropractic with the wider health sector. 

Acceptance will not come easily, but it begins with education. I believe university-based chiropractic courses like ours can develop chiropractors who are better understood, accepted and integrated by their colleagues in other health professions, ultimately leading to better patient outcomes. 

I believe that we chiropractors can win over the medical doctors, physios and others. We can make chiropractic thrive if we show that we understand science, evidence and the fiduciary agreement. 

Progress will be achieved through mutual understanding among the health professions, and a focus on one key question for all decisions: How does this help patients?