Does Practice Purpose Match Research?
Friday, February 11, 2011 at 4:44PM 
Len Siskin, DC
Promote Chiropractic,
Co-Chair ICA Best Practices
INTRODUCTION
Just this morning my wife and I were surfing the Internet before the sun came up and read a statement made by a ‘principled’ chiropractor. He said that chiropractors who don't adjust on the first visit and ask the patient to wait until visit number two to review findings are lying to the patient and setting the patient up to build anxiety so the chiropractor can ask them for a year’s commitment and a large advance check. While I guess this might be true some of the time, I know in our office the reason we ask the patient to wait to be adjusted until the second visit in most cases is because our experience has been that the patient's who we've adjusted on the first visit in the past are more likely to become confused.
Patients don’t know whether the treatment was supposed to completely fix them despite our best efforts at communicating chiropractic and our expectations. Research demonstrates that patients have about a 56% chance of worsening from the first adjustment; albeit temporarily.1 Using research to justify treatment has been considered by some chiropractors to be a form of manipulation of information for the health of the chiropractor’s wallet.
By the same token selecting which research should be taken seriously by groups writing particular chiropractic guidelines or by the insurance industry may be accused of the same motive. Incidentally, treatments in our office are typically paid for on each visit and not in advance.
Whenever I speak with chiropractors about what the research says I always tell them it's important to understand each research paper on an individual basis and that it's important to understand the methods section about how the research was conducted to guide the reader about the quality of the research they're looking at. Just because a study shows something doesn't mean it's true but when 10 studies show the same thing it’s much more likely to be true. By the same token if one extremely well done high quality study has very meticulous procedures it may be the equivalent of many more simple studies in drawing conclusions which should be believable.
In our office we actually use a combination of what the research supports and a set of values as a map by which to judge whether our recommendations to patients are ethical, sound, scientific, and in the best interest of the patient. We then gage what the patient wants according to their own health values which may be different than ours.
We believe patient care comes first which involves building collaborative relationships with our patients through compassion and empathy and the celebration of any health success related to their care in our office. We believe it's far too common for people to be treated in a cold manner in clinical settings. As chiropractors, we have a golden opportunity to connect with our patients and to learn what benefit they would like in their health. In doing this, patient's come to understand the Dr. does not actually fix the patient and it is actually the patient's body that does the healing. We use research to show examples of this and to communicate the human body is a self-healing organism using a little scientific backing. In this way we are able to hold the patient accountable for their choices and for the actions they participate in which ultimately result in their health outcome. Part of our job is to understand what they want at any given time and what they need in line with their own stated personal goals.
Our office is fun. In our experience this is completely different than most clinical settings which can be cold and impersonal. Since healing takes time and often working with the patient requires repetition in order to see changes and results, the patient's meet their goals better when they actually want to come to the office. Without fun, any activity becomes difficult. Having fun in an appropriate manner makes the patient experience in our office more rewarding for us as well as for the patient and makes it unique and special within our current healthcare environment.
In our office we use research, our training, and clinical experience to inform and educate to facilitate patient learning about their own health and help them understand their power in maintaining and sustaining health and improving life. We don't jam concepts down the throats of our patients and we don't have a generic topic each day that everybody has to listen to. On every interaction with each different individual we learn about their concerns then educate and inform based on what is interesting to them at that exact moment.
Our office is professional and staffs in our office are encouraged not to complain or react negatively in an emotional way nor judge people's lifestyles or their own personal values or play favorites among patients.
We embrace traits of responsibility, accuracy and efficiency in working with our patients as well as with staff and other professionals and the general community.
When deciding how to behave inside and outside the office, all of us consider the above points as well as what we know about what chiropractic research and education shows. We use these values and the information as a roadmap to clear the path and highlight the direction that we should move in both with business and in patient care. We do this in alignment with both our clinical as well as our healthcare business values. The beautiful thing about all of this is it simply requires honesty. Sometimes it's difficult to differentiate the impulse to do something which sounds good at the time, from confidently moving forward with an agenda that is concretely in line with our office values and our mission to help our community.
The best practices guidelines of the international chiropractors Association along with the PCCRP x-ray guidelines2 now serve as part of our roadmap for how to behave with patient's and how to move forward in educating patients about their health and their care with integrity in a fun, educational and professional manner. This helps us utilize responsibility, accuracy, and efficiency to the best of our ability to pull it off every day.
Any time a patient asks what kind of research exists on a particular named medical condition, all I have to do is open up the best practices guidelines book on my desk and point it out to them. I can do the same when asked by another professional whether there's any information behind statements I might make about chiropractic or how the human body works.
I strongly encourage anyone who has not yet received a copy of these guidelines to go to the ICA's website at www.CHIROPRACTIC.org and pick up a copy. The money you spend in purchasing these guidelines will be used to distribute them to schools, chiropractic associations, and those who influence lawmaking and policy development so that they may understand the importance and the greatness of chiropractic.
Finally, if you are interested in what has held more current influence in some of the content here I have listed some of my resources3-6
REFERENCES
1. www.ICABestPractices.org; www.Chiropractic.org
3. The Anatomy of Peace: Resolving the Heart of Conflict, The Arbinger Institute; may 1, 2008: ISBN-10: 1576755843
4. Switch: How to Change Things When Change Is Hard by Chip Heath and Dan Heath; 2/16/2010; ISBN-10: 0385528752
5. Delivering Happiness: A Path to Profits, Passion, and Purpose by Tony Hsieh; 6/7/2010; ISBN-10: 0446563048