by clicking the arrows at the side of the page, or by using the toolbar.
by clicking anywhere on the page.
by dragging the page around when zoomed in.
by clicking anywhere on the page when zoomed in.
web sites or send emails by clicking on hyperlinks.
Email this page to a friend
Search this issue
Index - jump to page or section
Archive - view past issues
Chiropractic Journal of Australia : CJA March 2012
9 Chiropractic Journal of Australia Volume 42 Number 1 March 2012 at a time when we had dreamed of a greater role within an expanding ‘wellness industry’ with the heavy backing of government health policy. In reality however, the mainstream opportunities for chiropractic appear to be more complex and challenging. The criteria to achieve a strong mainstream role within health reform requires an increased willingness to play a collaborative and often integrated role with other professions and to be able to offer cultural authority within a specifc clinical feld.2,3 The Benchmark In a recent and critically timed article for our profession, Villanueva-Russell4 explores the wider parameters for successfully achieving professional autonomy and cultural authority. She provides two important factors that were frst identifed by Halpern5 that play a signifcant role for a profession to successfully break through into a previously controlled area: 1) cognitive legitimacy (couching our expertise in the common language); and, 2) the profession needing to demonstrate that their interests are compatible with the wider healthcare group. Villanueva-Russell further adds growing consumer demand as the third factor in this breaking through process. The following is an expansion of these three identifed factors: 1. Finding a common language A clear understanding of the common language, common goal or common product delivered by chiropractic can be a challenge for a profession that is barrelling down a freeway but still cannot agree on which freeway exit it should take and what cargo to have on board. One group has taken the freeway exit limiting chiropractic to spine related pain; others turn on their indicator and exit towards our capacity on a wide range of spine-related neuromusculoskeletal health disorders. Another segment have their high-beam singularly on vitalistic-care centred around the poorly defned parameters of vertebral subluxation complex; and yet others still have all but u-turned on any single focus on spine-subluxation and adjustment – the central precepts of chiropractic -- in preference for a broad focus on a range of health-care domains encompassing nutrition, ftness and stress (my apologies to all the other sub-groups too numerous to mention in the traffc congestion that are also included inside brand-chiropractic). Compounding this identity chaos is a broad range of disconnected methods of patient assessment, over 100 often disconnected protocols of chiropractic care6 and wildly different views on the benchmark for how we might measure the benefts and outcomes of our care. Villanueva-Russell4 observes the resulting “emotional and rancorous name- calling” (p.4) this diverse and often divisive chiropractic world has created, as these different groups often separate themselves from one another within this internal identity and power struggle. In private practice, this chaos regularly presents itself when I am required to offer advice when referring a patient to a chiropractor in a different town. How confusing it must be for the government, the health funds, a more integrated health team and the public at large, when chiropractors themselves are unable to imagine what their own patients may face under the ever-widening umbrella that encompasses a single health profession? It may be diffcult to achieve cognitive legitimacy under a common language within mainstream health while we lack any clear common focus or purpose. 2. Compatibility within the Healthcare Team Some suggest that our separateness is the result of a deliberate and entirely unprovoked policy of medical containment as central to our silo-like history. This rally-cry can provoke a go-it-alone and separatist view of our place within the healthcare machine. While there is no doubt there have been clear historical examples where this has been true, it is diffcult to fnd the same level of continued containment when one examines the modern-day relationship between medicine and the other allied professions. These professions may be less isolated when theyoffer greater collaboration and less confrontation overtime. Chiropractic has the legacy of a long history from the time of DD Palmer and BJ Palmer for sharing an antagonistic and adversarial relationship with orthodox medicine and other allied-professions within the mainstream healthcare arena. Historically, we have often shown limited interest in defning ourselves around the notion of having a specifc compatibility or assumed position within the wider healthcare group. This separateness contributes to adversity more than collaboration or integration. We have created alternative and confrontational views on mainstream healthcare concepts with regard to notions of diagnosis, treatment, reductionist care and inclusive patient management long before establishing any clear and credible cultural authority of our own. Other professions have become more collaborative and integrative with the so-called ‘medical- monster’ while establishing a far greater cultural authority within a specifc feld of expertise. They have achieved this while remaining inside the mainstream. In Australia, perhaps chiropractic and medicine both share some of the responsibility for the more poisonous aspects of our historical relationship. In Australia, could we have been more effective in seizing opportunities at political turning points to improve the course of this relationship? If we now see the need for greater collaboration and even integration inside mainstream health to reduce our current isolation do we understand what it will take to get there? In comparison, we can see greater strategic compatibility for chiropractic in other world regions. The success of this approach can be seen in a Canadian survey,7 where an impressive 44 per cent of physicians indicated that they refer patients for chiropractic treatment. It is Canadian health policy that all health science students have formal inter- professional education in their curricula so they will better understand the roles of all health professionals and work in greater collaboration within a contemporary healthcare system in the interests of the patient.8 Compatibility is also on display in the US where there are chiropractic services at 81 military and veterans’ medical centres/hospitals throughout the US, and chiropractic students from 11 US colleges doing clinical rotations at these facilities.8 Indeed chiropractors are being provided with increasing opportunities to participate in multidisciplinary clinics and hospitals around the world including Australian GP super clinics. This mixture of collaboration and integration provides the chance to improve effciencies and cost effectiveness and move away from our historical silo. Villanueva-Russell4 warns us of Hollenberg and Muzzin’s9 observations that when Complementary and Alternative STEERING THE CHIROPRACTIC MODEL MOORE
CJA June 2012