Dr. David Fletcher is the creator of personal coaching and practice consultancy programs that "support and challenge chiropractors to leave behind the disappointments of past practice experiences and focus on the unlimited potential that awaits them." He also offers distant learning solutions for patient education.
When you come to the place where the branch in the road is quite apparent, you cannot go ahead. You must either go one way or the other...The whole purpose of coming this far was to decide which branch you will now take. The way you came no longer matters. It can no longer serve. No one who reaches this far can make the wrong decision, although he can delay. - The Foundation for Inner Peace, et al, A Course in Miracles
Chiropractors are faced with the challenge of working from a philosophy and hypothesis based on wellness. This nebulous concept is indeed a lofty goal, and is the quest each human endeavors to attain. By nature, humans are explorers of this new and exciting realm of wellness that constantly nudges them forward. The state of wellness in this definition is not confined to physical well-being. It can be described as an enhanced blend of physical, mental and spiritual well-being.
Hence the dilemma: A patient most often attends a chiropractic clinic with a specific need or want. "I need my neck or back fixed," or "I want to feel better" are common first complaints in our offices. A somatic boundary on health is a far cry from the transcendent goal that chiropractic adheres to. This perspective of chiropractic, as a fixer of back and neck pain, limits the patients' worldview of what wellness could entail. How often do we work within this limited scope because the outcome is more readily measurable? How much easier is it for us to provide symptom management, rather than a comprehensive strategy to search out wellness?
When a vitalistic philosophy is adhered to, the scope of chiropractic can be described as "full-spectrum." This acknowledges where the patient is in the present moment, and allows the vista of wellness to be introduced and explored. As providers of a health-related service, we have no right to limit the outcome of a chiropractic adjustment on a patient's life. If our intent is to see a limited response, then there is satisfaction and social acceptance when this occurs.
Conversely, when leading the patient with a wellness philosophy, the focus is upon a process, rather than an outcome. So, the dilemma of care-planning and goal-setting with the patient begins with an acknowledgement of the scope of chiropractic that you choose to work within.
My experiences over the past 19 years in practice have led me to certain observations when attending patients, in no particular order:
- Subluxations exist after extended periods of disturbance. They manifest as aberrant patterns in neural, muscular and skeletal tissue.
- As it is natural for innate to be adaptive to its environment, there are usually long histories of compensation in all tissues before the symptom of pain is recognized. To limit chiropractic to assessing symptomatic tissue and to limit the outcome to the relief of these symptoms is far short of the role that chiropractors can assume.
- The patient is almost always unaware of the devastating effects of the subluxation process. The causative behaviors of subluxation need to be addressed and modified.
- The process of chiropractic is best described as a "re-habituation," rather than rehabilitation. The goal is to lead the patient on a journey focused on wellness, using the chiropractic technologies and techniques as a foundation principle.
- Although the mission of each human is to explore new levels of consciousness, the subluxation robs the vitality of the patient. Decision-making can be distracted. A chiropractor must be able to lead the patient in the early phases of care with the intent of guiding them through new physical and emotional re-patterning. A direct, yet compassionate approach is often necessary early on. Endeavour to paint a picture of the magnitude and beauty of health, and then help the patient "break off bite-sized pieces."
- I have found that for some, the idea of wellness is often too large a worldview to grasp. This is why I set reasonable goals of care for which the patient can aim. I think of these as signposts along the way to their recovery, and also as an inspiring introduction to the bigger picture of full-spectrum chiropractic.
- As chiropractors, we need to instill faith and hope in patients. It is our duty to remind them that an innate intelligence is reorganizing their bodies to best adapt to their environment - at all times. There is never a moment when this life force is not acting at its utmost to allow a more enriched, living experience. As we locate and reduce the patterns of subluxation, the patient's expression of life is allowed to flow more freely. Who are we to limit the extent of that expression?
- Once the patient has accepted the adjustment as a foundation for his or her exploration of wellness, a new set of goals and signposts must be put in place. New questions, not limited to symptoms, need to be introduced. If wellness is the continued, positive adaptation to external stresses, why not focus on which stressors the patient is not coping with? Physical, mental and emotional stressors are the likely causes of recurrent subluxation patterns. I feel it is our duty to illuminate this fact and allow the patient to explore adjunctive means of reducing and coping with stress.
- Chiropractic is meant to awaken and free people from the victimization of symptom care and medical management. Our role is to share an adjustment and stand back and observe the innate expression of life. If we walk into an adjusting space without our own needs being met, we so often will need that patient to follow a course of care that is to our benefit first. I have found that to foster an innate-to-innate relationship, the doctor will have had to develop his or her own state of wellness. Consistently building a stronger personal foundation becomes the doctor's quest. Personal development invariably precedes practice development. I have utilized the services of a mentor coach to vigilantly check on the congruency of my plans and actions. Coaching can become a cornerstone in the balance between a passionate personal life and a prosperous and enlightened practice.
- And finally: Be assured that chiropractic works - always. Our vitalist philosophy states that a universal intelligence exists in all matter and is constantly giving to it all of it's properties and actions. Once this omnipotent and omnipresent force is allowed to be expressed, there is no turning back. Ask yourself, doctor: What limited scope of chiropractic are you presenting to your community?
David Fletcher, DC
Toronto, Ontario
Canada
www.chiroacademy.com
