PROFESSIONAL SURVIVAL VALUES

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In chiropractic philosophy, there is a technical concept called Survival Values. (For an in-depth explanation see Stephenson’s Chiropractic Textbook or Strauss’ Chiropractic Philosophy.) Basically, the concept deals with positive experiences that lead to the survival of an organism as opposed to the negative experiences. The cumulative effect determines the organism’s lifespan. Every positive adaptative experience adds to our “bank account”; every negative adaptative experience is a withdrawal. When the organism becomes overdrawn, death occurs.

Applying the principle to our profession, we can see that there are positive experiences that add to our survival, and there are negative ones that lead to our demise. Positive experiences, of course, include the myriad of satisfied patients who extol the benefits of chiropractic care and refer their friends. Another positive experience is good patient education and good public relations. The victory in the AMA antitrust suit is another. These add to the survival of the profession. There are historical events that have not yet been determined to be positive or negative. Insurance inclusion has helped the profession but may prove to be more damaging to our survival than beneficial.

Other than a few on the radical fringe, every member of the profession would agree that adding drugs and surgery would be destructive to the survival of the chiropractic profession. These are clearly medical procedures or should we say procedures ordinarily performed by the medical profession. It then is only left to determine what other procedures that are ordinarily performed by the medical profession would be destructive to the survival of the chiropractic profession if performed by its members. Unfortunately, while there is almost universal agreement against the use of drugs and surgery, almost every other procedure creates adamant arguments both pro and con. On one side is a group that says chiropractors should be able to do any procedure that a medical doctor does except administer drugs and perform surgery. On the other extreme is a group saying that chiropractors should perform no medical procedures. As always, most chiropractors are somewhere in-between. Some feel machines are out but diagnosis is important. Others feel diagnosis is not part of chiropractic, but they are not adverse to using a modality now and then. Some would not think of using a modality but will prescribe nutrition and exercise. With such diverse ideas of what is acceptable chiropractic, it is virtually impossible to come up with a definitive agreement. But one thing all would agree upon, that is, certain procedures are detrimental to the continuation of chiropractic as a separate and distinct profession. Some feel diagnosis is the most destructive (the “super straights”) while others feel diagnosis is not destructive at all but necessary at this point in history.

It seems clear to me that procedures which resemble medical procedures, that make us look more like medicine, are destructive survival values. Those procedures that make us look like something different are positive survival values. Therefore, anything that we do that resembles medicine is a negative survival value. Here’s the problem: there are certain things that we are forced to do or that are valuable to the practice of chiropractic that may fall under the category of destructive survival values (D.S.V.). For instance, a case history of disease and medical care does not help a competent chiropractor locate, analyze, and correct vertebral subluxations. Taking a case history is a medical procedure. It is detrimental to the identity of chiropractic as separate and distinct. However, it is necessary if for no other reason than to avoid introducing a force that would injure and to determine contraindications to certain techniques. It is also necessary to protect the D.C. from possible suit. We all do a case history to some degree, but it is a D.S.V. X-ray is a similar example. Even if not for diagnostic purposes, it is used to rule out medical conditions that would contraindicate thrusting in certain areas of the spine. It is a standard medical procedure. Some of us even send our patients to be x-rayed to physicians. But it is necessary. Now in both these examples, it could be argued by the “super straight” that it is only being done for contraindication. But whatever the motive, it is being done to some degree, and that degree is a D.S.V.

Every time a chiropractor listens or relates to a patient’s symptom, that is one small D.S.V. Just like the D.S.V. of the body, if you have enough of them, despite constructive survival values, the body succumbs.

Some chiropractors, particularly young ones with little technique experience, feel that orthopedic and neurological tests are valuable to them in locating vertebral subluxations. Perhaps they are, but they are a D.S.V. I am not judging these chiropractors, nor saying they are wrong, just stating a principle.

Recently, there has been a good deal of interest in chiropractors getting into hospitals. A chiropractor who would describe himself as a straight has gone so far as to say that D.C.’s should be on the staff of hospitals, after all people with diseases need adjustments as much or more than anyone else. But the chiropractor misses the greater point. Chiropractors should be able to go into hospitals to adjust patients, but chiropractic should not be any more associated with the hospital than the florist who delivers flowers or the clergyman who gives comfort to one of his parishioners who is a patient. Any clergyman has the right to visit in any hospital and minister to the patient’s spiritual needs, but he is not a staff member of the hospital, and no one confuses his ministrations for the practice of medicine. The chiropractor should be viewed in the same way. If the hospital puts a D.C. on staff, it is usually because it recognizes chiropractic as effective in treating certain diseases. We are coming in on their terms, and that is a D.S.V. If the hospital would have a chiropractor on staff to check every patient every day for vertebral subluxation, perhaps the constructive effects would outweigh the D.V.S. (being associated with an institution of sickness and disease).

Changes in society are forcing changes in our profession. Many people are coming to chiropractors first rather than as a last resort or after they have been diagnosed and treated by M.D.’s. As a result, many say we must do more medical type procedures than we did in the past. Perhaps they are right. Even if only done to protect ourselves, it is a consideration that cannot be ignored. But even if we do these procedures out of necessity for malpractice protection, to rule out contraindications to certain techniques or because the state law requires them, we must acknowledge that they are a D.S.V. for our profession, and if enough of them are incorporated into chiropractic procedure, they will lead to our demise. We may be able to neutralize many of these D.V.S. by the utilization of constructive ones, particularly the education of the patient as to the distinct and different nature of chiropractic and its unique objective. The more medical-type procedures, the more you must educate. Unfortunately, the old adage of “what you do speaks so loudly I cannot hear what you say” comes into effect. We must be careful that in the name of science, protecting ourselves, for the good of the patient, we do not incorporate so many procedures attributed to the medical field that the public loses sight of our specialized service and the identity of chiropractic is destroyed. This can easily happen by the accumulated actions of thousands of chiropractors coming in contact with thousands of patients every day. We must evaluate our practices and our procedures, each one individually, and decide whether we are contributing more destructive survival values to our profession than constructive ones.v5n2

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