Those of you that have read my writings before know my tale of the origin of this word. I'll give you a short version of the story: King Exema had an eruption the chief physician, Agnosis, had failed to fathom. The king said, "If you cannot tell me what I have, you shall die, Agnosis."
The physician immediately said, "You have a rash, sire." Thus the condition was named a Exema and the naming of the disease diagnosis.
Do chiropractors diagnose? Most certainly, chiropractors provide a chiropractic diagnosis. So did D.D. Palmer. In "The Chiropractic," 1899, he wrote this in respect to his teaching of chiropractic.
"We need to learn to diagnose quickly and correctly. Some knowledge of anatomy is needed. You will need to know the different parts of the human body and how they are when in their natural place. Every disease has its cause, and when once you find the cause of any one disease (not at ease) you will always know just where to find that same cause in any other case."
The above quote indicates that to D.D. Palmer, diagnosis was cause determination, but the courts held, at the time, that diagnosis was the field of medicine. So to differentiate and avoid the charge of practicing medicine without a license we developed our own distinctive vernacular. D.D. Palmer realized this and from chiropractic's very inception he began developing our own "nomenclature."
"Science and art have a need of technical nomenclature. Chiropractic is no exception."
-- D.D. Palmer 1910
The term analysis was born and in my opinion should have been completely adopted and cherished as our own distinct vernacular. (Any profession of worth has its own unique lexicon.) But diagnosis stayed with us largely due to the therapeutic advocates of our dichotomy clinging to it and, of course, the public's affinity for wanting a name placed upon their condition. So the naming of symptoms and malfunctions and calling them diseases is still with us today. But chiropractic's examination, analysis, and care of the patient is not centered around naming the disease and treating the symptoms. Chiropractic's diagnosis is more reasonably termed an assessment of the patients health, our diagnosis is still geared to cause detection, not the categorization and naming of symptoms. The ultimate diagnosis of a chiropractor is subluxation, without which the patient is simply not a chiropractic case. That should be as true for chiropractors as it is for dentistry; if there is nothing wrong with your teeth and mouth you are not a case for the dentist. Thus, we are responsible to a chiropractic diagnosis, which includes an assessment of the patient's health and the monitoring of bodily functions to ascertain the response to our care and/or the need for referral. But medical diagnosis? Differential diagnosis? In the first place differential diagnosis does not mean differentiating between who is or is not a chiropractic patient. It means determining if a patient has, say viral or bacterial pneumonia. Would this diagnosis make any difference to your chiropractic care? Let me turn to the words of Dr. R.C. Schafer on this matter: (MPI's "DC", May 9, 1990).
"Because allopathic and chiropractic approaches to the same goal (health) are converse in direction and sometimes countermand in counsel, their identification and labeling systems can never be harmonious. The chiropractic approach to pharyngitis, for example, is essentially the same whether it has a bacterial or viral origin. The innervation of the pharynx, liver, spleen, etc., remains the same."
Yes, Dr. Schafer, our labeling systems "can never be harmonious" with allopathic medicine. Their diagnosis must be meticulous as they treat the disease. Misdiagnosis can result in iatrogenic death, so physician beware, if you don't name the problem, you shall die Agnosis! The chiropractic profession will not perish due to its acceptance of a reasonable and responsible range of chiropractic diagnosis, regardless of what some croaking harbingers of doom predict. It shall die when the reason we diagnose, the reason we deliver our care ceases to be chiropractic, as then we will have lost our primary focus.
"Divested of its philosophy chiropractic is divested of its uniqueness and perhaps its future."
-- E.A. Morinis
Next time, Dr. Barge speaks on immunization.
Fred Barge, D.C., Ph.C.
La Cross, Wisconsin
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
On Feb. 1, 2024, two more legislators – John R. Carter (R-Texas) and Robert “Bob” Good (R-Va.) – co-sponsored the Chiropractic Medicare Coverage Modernization Act of 2023, bringing the co-sponsor total to 155, two more than the total achieved over the entire two-year congressional cycle in which identical legislation last appeared (2021-22).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
