|For at least as long as any living doctor of chiropractic can remember, our profession has engaged in ongoing and sometimes heated debate about the proper role of its practitioners. Should our primary or sole focus be the spine? The nervous system? Vertebral subluxation? Back and neck pain? Should we be musculoskeletal pain specialists? Complementary care generalists? Primary care physicians?
Two new papers, one by Donald Murphy and colleagues in Chiropractic and Manual Therapies1 and the other by Jan Hartvigsen and colleagues in British Medical Journal,2 simultaneously point in the same direction—toward the role of primary spine care practitioner. The lead authors of both articles are chiropractors, Murphy from the United States and Hartvigsen from Denmark. Neither proposes the primary spine care practitioner role as the only option for DCs; both make a persuasive case that developing this role on a much more widespread basis will significantly enhance the effectiveness of the health care system’s neuromusculoskeletal (NMS) care delivery. In the process, they demonstrate why many practitioners may find work as a primary spine care practitioner attractive. To the extent that deeper integration of chiropractic is one of the profession’s primary goals, this may be one of the best vehicles for its achievement. At the very least, it’s a possibility worthy of serious examination.
World Federation of Chiropractic Identity Statement
The Murphy and Hartvigsen proposals are wholly consistent with the 2005 professional identity statement from the World Federation of Chiropractic, which grew out of an extensive consultation and consensus building process among the WFC’s membership, comprised of the national chiropractic associations of over 80 nations, including both ACA and ICA from the United States.
How do the world’s chiropractors, speaking through the WFC, define themselves? First, with a phrase summarizing the primary identity of chiropractors: “The spinal health care experts in the health care system.”
Next, with a series of qualifying statements:
- Ability to improve function in the neuromusculoskeletal system, and overall health and quality of life
- Specialized approach to examination, diagnosis and treatment, based on best available research and clinical evidence, and with particular emphasis on the relationship between the spine and the nervous system
- Tradition of effectiveness and patient satisfaction
- Without use of drugs and surgery, enabling patients to avoid these where possible
- Expertly qualified providers of spinal adjustment, manipulation and other manual treatments, exercise instruction and patient education.
- Collaboration with other health professionals
- A patient-centered and biopsychosocial approach, emphasizing the mind/body relationship in health, the self-healing powers of the individual, individual responsibility for health, and encouraging patient independence.
This WFC definition does not limit what DCs can do. Its goal is to identify and define the common ground we all share and to speed the day when patients going to a chiropractor anywhere in the world can enter that doctor’s office with a reasonable expectation of receiving certain basic diagnostic and treatment/management procedures, delivered with a high level of patient-centered professionalism. Depending on licensure laws and personal choices by individual chiropractors, some chiropractors will continue to develop expertise in additional areas and utilize these skills in patient care. But whatever worthwhile “extras” a particular practitioner might provide, he or she would be expected to deliver the core procedures that constitute the essence of chiropractic care.
Primary Spine Care Practitioners
The new commentaries by Murphy et al and Hartvigsen et al apply this spine-focused perspective in ways that meet current and emerging health care system needs. It is now obvious to virtually all informed observers that primary care physicians (PCPs) in the medical profession have neither the focused expertise nor the time to effectively serve as the first step or entry point in the management of NMS pain patients. The primary expertise of these PCPs lies elsewhere, while the highest-level diagnostic and therapeutic expertise for NMS conditions can be found among practitioners whose training strongly emphasizes it and whose NMS skills are continuously honed by interactions with virtually every patient. Chiropractors are well-positioned to fill this need.