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Dynamic Chiropractic April 10, 1992, Volume 10, Issue 08 |
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Chiropractic Standards of Practice and Quality of CareEdited by -- Herbert J. Vear, D.C.Hardcover -- 300 pagesPlease see pages xx, #T-141 for information on how to order Everyone wants to define chiropractic: insurance companies; state legislatures; state and national associations; lawyers; the federal government; and other chiropractors -- each with the idea of putting a philosophical and economic wall around us. When I was on the Vermont state board there was a move by the insurance companies to define what we do. This makes sense until you realize that once you tell someone what you do, you're also telling them what you don't do. This leaves little, if any room to expand or grow with the future. Then ask yourself how medicine is "defined." Imagine for a moment, what it might be like if some ten years from now some new form of technology was developed that would enhance the chiropractic adjustment. "Sorry," we could be told, "but that's not within the definition of your profession." Of course this would be just dandy for the supers who would have every DC adjust and wear clothes like B.J. Palmer. They're in their little time warp. But for the vast majority a wealth of modern technology could be lost to us. Needless to say, the Vermont board, at that time, demurred from defining ourselves out of a future. What is most annoying is when we cuddle up to some MDs and others outside of our profession and invite them to sit on committees that are formed to set standards of practice for our profession. To some, this adds some kind of pseudolegitimacy to a chiropractic function. Here we are -- a profession built upon medical failure, asking medical personnel to set the standards of practice that we must follow. It's sickening to think of all the servile DCs seeking the approbation of the drug dealers and butchers of the healing arts -- so we can be "official." As you might imagine, when a volume about chiropractic standards of care is submitted for review, it raises a few hackles on the back of my neck. This feeling was quickly dissipated when I found that the chapters of Chiropractic Standards of Practice and Quality of Care were written by chiropractors or personnel associated with chiropractic academia. This was a good start. It didn't take long to realize that what I was reading was a cogent text on the need to pull together the threads that make up the fabric of our profession. The fact that I resist defining chiropractic doesn't negate the fact that everyone else does, and that if we don't formulate some kind of cohesive design for our practice someone else, not necessarily our friends, most surely will. With this in mind, Herbert Vear has assembled a thought-provoking group of papers arranged in 13 chapters that both challenges and guides the reader into constructive assumptions. Vear sets the stage in Chapter I by examining the incongruities of the practice acts in the different states, provinces, and countries. This hit a sore spot, for it always reminds me of the West Coast of the continental United States where one can do a little of this and that in California, just about everything you were taught and more in Oregon, and be arrested in Washington for even thinking about more than holding a B.J. green book in one hand and adjusting with the other. Obviously, something is very wrong here. Vear's postulates are amplified by the authors of the second chapter who advocate that intensive research and clinical evaluation be correlated with the structuring of our standards and scope of practice. The chapters that follow concentrate on the scope of chiropractic practice and the importance of quality assurance within the profession. Then, in chapter six, we find the text devoted to the possible dangers of upper cervical corrections and the procedures needed to reduce pathological residuals. While somewhat disconcerting in its placement and subject matter, I found the author articulate and the chapter filled with useful information. The rest of the volume follows along a predictable construct: clinical procedure; interprofessional and patient relationships; the indications and contraindications for spinal manipulation; the legal ramifications of the scope under which we might practice; and finally the responsibilities indigenous to a physician/third-party payer relationships. The two appendices on the attributes of chiropractic practice guidelines and the glossary on general and managed health care round out a volume that I highly recommend. If we must be "defined," let it begin now.
RHT
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Dynamic Chiropractic April 10, 1992, Volume 10, Issue 08 |
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