The Anti-Cloning of the Physician
It is well recognized that the practice of health care is more art than science whether it is based on chiropractic, allopathic, or osteopathic concepts. Science offers the practice only a certain degree of justification. Because all variables cannot be known in any situation, the current facts of science often fail us in our reasoning. And what is more variable than our patients with their differing genetic make-up, nutrition, occupational stress, anomalies, history of trauma, personality fabric, and numerous other inconsistencies from the norm or average? Because patients are a storehouse of unique variables, reasoning based on personal experiences, their results, and the skills acquired (empiricism) must be added to the formulation of any rational treatment plan.
This presents the basic problem facing any writer in our field. Communication is the ability to convey an idea from one mind to another. But this is not an easy process because facts and concepts often become intertwined during the communication process.
Facts are specifics. They can be imagined and duplicated. Thus, facts can be communicated from one person to another of reasonable intelligence. Units of measurement, for example, are facts. They mean the same thing to everybody if the context is known: an inch is an inch; a quart is a quart. Circumstances vary, but a clinical fact or law is not variable. The core of science and technology is a data bank of knowledge that has the same significance (projects the same images) to an American, European, or Asian. The science of chiropractic or traditional medicine is founded on basic sciences and clinical principles.
Standardization in examining and diagnostic processes is therefore logical if it is an attempt to establish minimal levels of professional conduct. It should, however, always leave room for expansion and empiric embellishment to meet the needs at hand because the "standard" patient does not exist. Each is unique, and this uniqueness varies at specific particular moments.
A professional art is a means to achieve a goal. A professional philosophy is an attempt to explain why the goal should be reached. The art and philosophy of chiropractic (or traditional medicine) are based on concepts and images, and all are but intellectual abstracts. The development of mental visualization is initiated by an idea; coupled ideas form a concept; and combined concepts sculpture an image in the mind, often awaiting embellishment. The dynamic, largely neuronal, process, we call consciousness.
Many words used in communication are generalities: e.g., table, house, triangle, cow, automobile. The significance of such words cannot be imagined; that is, they are almost "meaningless." To imagine a "table," for instance, we must either fantasize or know many facts about the table in question: e.g., size, shape, color, design, purpose, etc. The word "table" in itself communicates little. It's a generalization, and generalizations cannot be visualized. A blanket can be used as a table at a picnic. There are wood, metal, and plastic kitchen tables of various sizes, colors, shapes, and designs; and there are tables in books to classify or organize data by various characteristics. Geologists often refer to a flat elevated region as a table.
Terms such as adjustment, manipulation, nutrition, physiologic therapeutics, resistance to disease, exercise, and innate are concepts. Thus, any attempt to standardize (clone) an art or philosophy strives for an impossible goal. The result is an attempt at dogmatism, fanaticism, and the subjugation of reason and creativity. Analysis of the rationale of radical fringes in any group readily underscores this point.
The attempt to clone physicians is on the rise. It has resulted in recent years from dictates by the insurance industries (health care and malpractice) to "treat by the book approved by us" or else. In addition, such cloning has for decades been reinforced in chiropractic as a principle by a minority who demand that their personal interpretation of the philosophy of B. J. Palmer of the 1920s be followed to the letter in the year 2000 despite what the founder of chiropractic, D. D. Palmer, postulated or what current science has established as the rationale of chiropractic.
The common goal is homeostasis. D. D. Palmer founded chiropractic on the basis of maintaining neurologic homeostasis ---a state he called "tone," as so announced to the world on the title page of his only book. Thus, any method that aids the achievement of this goal is in harmony with the basic premise of chiropractic. Standardization in the case management process therefore is illogical if it is an attempt to establish bounds for sagacious thinking and action. And because patients are a storehouse of variables, deduction and induction based on experiences, their results, and the skills acquired (empiricism) should be added to the formulation of any rational treatment plan.
History shows that many eclectic procedures of today become the orthodoxy of tomorrow. It was only learned in the 1970s why aspirin relieved headache, yet it had been used for this purpose for over a century. Anecdotal evidence has always been popular in health care because so often it is the only deposition available.
The primary purpose of my writings is to provide the chiropractic physician and advanced student a reference to successful therapeutic protocols. This is helpful when (1) a condition is infrequently treated or (2) a condition frequently treated fails to respond as anticipated. Obviously, there is no need to refer to any manual if the doctor is confident that he can treat a particular disorder efficiently, and the patient responds in a satisfactory manner. Even with successful cases, however, the reader may find that future clinical planning and approaches can be enhanced by the suggestions described.
When patients enter a DC's office, they seek relief. Certainly, they want to know the cause of their problem (the diagnosis), but their priority is to find relief as rapidly as possible. That is the objective of my books and papers: to offer rational protocols for the relief of pain and disability likely before the diagnosis is firmed. More often than not, patients' complaints may be resolved or greatly eased before the final diagnosis is determined.
The proprieties suggested are based on positive results with thousands of patients, but they are not written in stone. They should always be questioned early by the practitioner with, "Why is this concern or procedure recommended here?" Knowing the "why" is what differentiates the methodology of the physician from that of the therapist. It also allows for modification to accommodate the needs of a particular patient or pathologic state ---thus the antithesis of cloning.
Although my literature describes many therapeutic approaches, the core therapy is invariably the spinal or extraspinal articular adjustment when appropriate. It is alarming how many graduates since 1960 have not been taught how to properly "deliver" a chiropractic adjustment. They have been thoroughly taught the mechanics but not the finesse. The latter is the "art," and it is parallel in importance to the "scientific" mechanical objective. As far as I can perceive the future, a robot or clone can never master the art of chiropractic.
From, with slight modification, Schafer RC: Dynamic Chiropractic, Viewpoint: State of Our Art, The Anti-Cloning of the Physician. Early 1990s.
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