Why Continue Chiropractic Care After Symptoms are Gone?
Survival of Your Practice May Depend on It!
Victor Strang, D.C.
Dr. Strang graduated as class valedictorian from Palmer College of Chiroipractic in 1977 and joined the Palmer faculty in 1978. He has served as the director of clinics and dean of philosophy and now is a professor of philosophy. This article was published in the Winter 2003 edition of the school's magazine, Streams from the Fountainhead. The article advisess that the key to success and survival of a chiropractic practice is persuading patients to have frequent checkups to detect and correct their "subluxations" even if they have no symptoms. The article was accompanied by a photo of him with a patient who had been treated by him and his father, Virgil Strang, D.C., for 32 years and was a " firm believer in long-term regular chiropractic care." This concept of "preventive maintainence" is not shared by the scientific community.
I released one of my patients from care recently. A gathering was held, attended by many family members and friends. There were many tears shed by those present, including myself. However, this wasn't a happy farewell to a retiree headed for warmer climates. There were no balloons, cookies or punch at this gathering. Joe, our patient, family member and Friend, had passed away at the age of 80, diagnosed with lung cancer metastasized to the liver.
Joe had received the best medical care available, and he had maintained the same positive attitude he always displayed. I also adjusted Joe during his last year, not in an attempt to alter the course of his disease, but for the same reasons that he had been coming to see us for most of the preceding 35 years. He got his spine checked regularly for subluxations to help ensure that his nervous system was free of interference. Joe and his family stated that he was relatively pain-free and able to function normally until the very end. Ultimately, how-ever, everyone's efforts weren't enough. So, Joe had to be released from care.
Joe's story illustrates several important things that chiropractors know but sometimes have to be reminded of. First is the realization that all of our patients will someday die, in spite of our desire for them to live forever. We would like to give them a sort of immunity from aging and death through years of diligent chiropractic care, but we can't do it. We will meet the same fate ourselves. Not only do patients sometimes meet with tragedy at a young age, but, escaping that, they inevitably grow old, and their physical life journeys come to an end. All living things share this fate.
Joe's experience also reminds us that any human being who has a subluxation benefits from chiropractic care, regardless of his or her "condition." The goal of the chiropractor for any patient is to correct subluxations as completely as possible. This is as important for an 80-year-old with cancer as it is for an asymptomatic teenager. Joe knew he was in a battle for his very life. He also knew he would be better off in his efforts if he received chiropractic care when necessary. When he died, it was not a failure of chiropractic technique or principle-he just couldn't adapt to the damage in his system any longer.
Thirdly, as many D.C.s will attest, our practice members often become more than patients or clients; they become part of an extended family. After 25 years in a practice that has been growing for more than 50 years, I am confronting this last realization with disturbing frequency these days. I find myself scanning the obituary page of the local paper every day because I never know when another of our "family" has been released. It is hard to lose family members, but another quite pragmatic concern arises. If a practice is to survive, new practice members must come along to replace those who leave.
As I also care for Joe's children and grandchildren, his "place" in our practice has already been taken. ln a new practice, though, it requires the chiropractor to develop a rationale for delivering chiropractic care for reasons beyond pain and ill health. If patients are prompted to get their spines checked only ·when they're experiencing symptoms, and they discontinue care or are released when they feel better, then a steady stream of new patients who are suffering must come into the practice to keep it alive. That means continuous marketing, practice-building and promotion are necessary, just to maintain the status quo. This can be expensive and frustrating, contributing to burnout in competent practitioners who should be able to render care for many more years than they do. It also can foster the notion of saturation-that there are "too many chiropractors in my area." Protection of one's share of the market and suspicion of the effects of new graduates on a practice can become preoccupations.
Framing health, subluxation and the chiropractic adjustment in the context of Palmer's Triangle of Care will allow a chiropractic practice to grow continuously in the most "saturated" areas. If practice members see the value of chiropractic care from birth to death, they are never really released until their final breath is taken. If they understand that an optimally-functioning nervous system is the goal of the adjustment, they will have themselves and their families checked regularly, even after their symptoms have subsided. Although they may find it hard to get past the notion of needing symptoms in order to be checked, some reframing of what constitutes a sign of subluxation can get them in for checking more regularly.
My mother often "diagnosed" a subluxated state in her brood of nine children by behavior—when one of us wasn't "himself," she suspected an adjustment was needed. More often than not, she was right. There didn't have to be a limp, antalgic lean, headache or expressions of pain. Sometimes, she or my father merely decided it was "time to get checked." If our practice members are encouraged to recognize very subtle signs of subluxation in themselves, like a change in sleep quality or general irritability, they will not only come in to get checked more frequently, they will often avoid the recurrence of that all-too-familiar back pain.
I am often struck by the parallels in this approach with the example of preventive dentistry. Virtually everyone in the U.S. has been exposed to the paradigm of dental hygiene, which includes periodic cleaning and inspection of one's teeth. It seems irrational to question the wisdom of preventing tooth decay and ultimate loss by making those semiannual visits to our dental professionals. Why is it any different or any less important to get one's spine checked and corrected if necessary on a regular basis, even if we have no spinal pain or obvious syrnptoms7 Why do we not have enough patients who come in because it's just "time to get checked?"
Even in our 50-year-old practice, a portion of our practice members come in for care only when they have symptoms. Others get checked at regular intervals for varying periods of time, but then have lapses in care. My late father was always very gentle in his approach to both of these groups. Signing up for an extended program of care was always the choice of the individual. Likewise, those who skipped a month, a year, or five years between visits were greeted like old friends when they returned-no questions asked. The result7 We have been caring for quite a number of these people for several decades of their lives. Even patients with those gaps in care or those who come in mostly when hurting have received far more care than most of the general population. We also have cared for their families. One of my greatest thrills in practice was recently adjusting four generations of a particular family on the same visit.
Another very gratifying result of long-term care, whether on a symptomatic or preventive basis, is being able to help people age "normally." I love interacting with my octogenarian friends who take no medications and are mentally sharp, even though they carry with them some physical limitations that come from a lot of "mileage." They don't ask that I make or keep them pain-free, or that I restore their spines to like-new condition. All they ask is that I do what I was trained to do—check their spines for subluxations, and advise them on health issues and matters of concern needing an experienced, understanding and conservative viewpoint. What they really want is to be able to enjoy those things they like to do, be it gardening, bird-watching, or merely playing with their grandchildren. It is always amazing to me when they say things like, "The only reason I am alive today is chiropractic." I am sometimes at a loss to respond to these comments, because I don't always understand it myself. Most of the time, we just share our appreciation for the benefits we both receive from our relationship, and we discuss ways to get their children and grandchildren in for care.
To me, the implications of all this are clear. . When all members of the practice understand the premise that subluxations can occur and recur without associated symptoms, they will get their spines checked at least as regularly as they get their teeth checked—and usually more often than that. In a mostly symptom-oriented practice, patients are released from care, or release themselves from care, when their symptoms are gone. A constant influx of new patients is needed to replace them if the practice is to grow and ultimately survive.
When patients like Joe are fully "released" from chiropractic care only upon their demise, new patients must wait until there's room to accommodate them. This type of practice problem is one that I hope all chiropractors will begin to share with me very soon. To the extent that this happens, the future of chiropractic will be assured.
This article was posted on August 26, 2018.