What kind of chiropractor are you?

I find it curious that this is a question that is asked so frequently, and almost always by individuals inside of the profession.  Naturally, there are some patients who have had multiple doctors for some reason or the other, and they may be asking about the doctor’s technique, but these are the minority.  Although there are multiple ways to answer this question, including on the basis of technique, philosophy, or other criteria, we most commonly identify ourselves by our Alma Mater.  I do this, of course, proudly identifying myself as a recent Northwestern graduate.  I have only recently realized that this might be a problem.

Let me stress first, however, that I have absolutely no problem with school pride.  I loved attending Northwestern and although I will admit that no school is perfect, I am happy to say that after visiting more than a dozen different campuses around the world, I am still glad I chose Northwestern and I would choose it all over again.  I am sure there are other students who feel the same way about their own programs.  This is natural, and to be expected.

Where I see it being a potential problem, however, is when where you completed your coursework actually means you are a different “kind of chiropractor”.  What is a “chiropractor”?  Does the word actually mean anything?  If patients cannot open a phone book and know that whoever they go see will at least offer them the same basic standards of care, no matter which school they attended, how can we legitimately call ourselves a profession?

Among the first things on our list to do as a group of committed individuals is to standardize our education at a international level.  Before you throw up your defenses with regard to the sanctity of the sovereignty of each individual school, hear me out.  I think we need to boil everything down into what actually makes us what we are, and ensure that all chiropractic students are taught this foundation and that they all reach the defined level of competency.  Then, of course, there are a lot of “extras”, and each school can mix and match these electives as they see fit to expand on the curriculum and add their own particular “flavor”.

For example, I think we can all agree that if you will get a slightly different medical education if you go to Harvard compared to attending Iowa State.  At one school you might have more focus on clinical research or the inclusion of information about Acupunture, while at the other they might have extra classes in public health.  My point is that both schools will require their students to take anatomy, physiology, pathology, pharmacology, etc. and both schools demand a certain level of competency which is subsequently independently verified.  This results in two different, but credible and strong academic programs.  It means that when a mother brings in her child to one of these two MDs, she can be sure that she will have a similar experience, even if the treatment eventually selected by the specific doctor might be different.  Basically what I am trying to say, is when you make an appointment to go see your local MD, even if you have never met them, you kind of know what they do and you can, with notable exception, reasonably predict what you’re going to go through when you get there.

Can we make this same claim?  Do we have a well-defined and accepted cultural identity?  If you walk up and down the street and ask people what a chiropractor does, how many different answers do you think you will get?  Can we begin to see that having nearly 40 global schools each doing their own thing, training dozens of different “kinds of chiropractors”, might actually be a problem?

The reason why this point is especially pressing for me is because of the work I am doing and the experiences I am having here in Geneva.  As the only chiropractor to have ever been in my position, I am constantly having to define who I am and what I do to people who have little to no understanding of the practice of chiropractic.  I do not mean in the slightest to underplay the amazing work that the World Federation of Chiropractic (WFC) has done, both within the Secretariat and among national policy-makers at events such as the Executive Board meetings and World Health Assemblies.  To make the point plain, without the work that WFC has done and continues to do, without the foundation they have built, and without their status as the only chiropractic-related NGO in official relations with WHO, I would not be here.  However, nearly every day I have someone ask me about chiropractic.  It is only very rarely that they have absolutely no idea, rather it is more common that they have heard something, but do not really understand.  Depending upon their level of existing knowledge, and any preconceived notions they may have developed along the way, I have to explain in a different way.

As an example, I might have to explain to the Minister of the Permanent Mission of XXXXX that although he has believed that as a “chiropractor” I am some sort of massage therapist, I actually completed a doctoral level program of education in the United States which covered all the basic science areas such as anatomy, histology, and biochemistry, and the clinical science areas of radiology, clinical pathology, neurodiagnosis, EENT, etc.  as well as having spent considerable time focusing on the techniques of manual medicine and the diagnosis and treatment of neuromusculoskeletal conditions.  Next, however, when speaking to the German representative of XXXXX I need to explain that the “chiropractor” she visited with whom she had a very bad experience may or may not actually have been trained as such, as there is no regulation on the practice or protection of the title “chiropractor” in her home country.  I need to explain to a WHO Coordinator why chiropractic interventions should be considered when writing “best practice” protocols for some non-communicable diseases, when she is from a North African country but knows “chiropractic” in terms of what she saw when working in New Zealand.  I must be aware that the University of Southern Denmark and the University of Zurich are fully integrated into the health care programs in their countries, with Switzerland admitting chiropractic and medical school students together as a joint class for the initial stages, but that the United States schools are generally entirely privately funded and independent.  My point is that to know how to explain chiropractic to an international audience, you must explain each school independently, as every one is a special case!

So what is the actual solution?

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