Pondering prescriptions

Keeping drugs away from our scope of practice
Ed Lubberdink
November 23, 2017
Written by Ed Lubberdink
Pondering prescriptions
Photo: Getty Images
I was horrified to see that 47 per cent of our profession is in favour of the move to expand the chiropractic scope of practice to include limited prescription rights. This is according to results from the recent Canadian Chiropractor Practice Trends Survey.

As a practicing chiropractor for 36 years, I have never found a situation where my prescribing would have been of value to the patient. If the patient insists on taking drugs then there is enough drugs over the counter, such as Advil, Tylenol and Robax, that they have access to. I am not saying that I recommend these to my patients; I am saying they have access if required.

So, why the desire to prescribe? I would say the reason has more to do with the “optics” to the public and other competing professions that manage “pain-based” care.

I recall going to Parker seminars early in my career and listening to senior chiropractors talk about chiropractors who actually went to jail to preserve their philosophy. That is how strong their conviction was in the principle of what they were doing. While I do not recommend we all camp out at BJ Palmers campsite, and that chiropractic has evolved since then, we must not lose the philosophy that started our profession. The philosophy is the foundation of our profession.

I recall also at a Parker seminar that an osteopath named Fred Lorenz spoke and his message was very clear, “hold on to your drugless philosophy as that is the very thing we gave up and was the demise of our profession” He had stated the number of osteopathic schools in the United States had dropped by over 80 per cent five years after the inclusion of drugs and minor surgery into their profession. He also stated that they were now a profession in “limbo” as they had “sold out.”

One also must think of the malpractice premium increase our profession will have if we include drugs into our profession. Is that what we want? There might be an increase in the length of the school term to incorporate this into the curriculum. Is that what we want? Do you think the medical profession will be happy once chiropractors start prescribing? They will fight that tooth and nail – and I don’t blame them as we don’t want them adjusting spines, either. So why would they want us prescribing medications?

Every profession has a philosophy. It is best to stick with it rather than trying to become a jack-of-all-trades. That is why we have an acupuncturist in our office, a nautropath, RMTs and soon, a physiotherapist. The four chiropractors in our office practice chiropractic, i.e. adjusting of the spine. We are all busy and happy. I realize in smaller towns you might not be able to hire one of these other professions to work in your office, but chances are that you can refer to them in your town. We were always busy enough just doing chiropractic before we brought these other services into our office, after realizing there was a value to bringing them under one roof.

This leads me to my next point: Why has our profession become so diluted in its product that our identity has been watered down to what many now call “physiopractic?” Chiropractors are out there doing acupuncture, ultrasound, laser, tens, low volt stimulation, shock wave, ART, Graston, etc. – and now we want to add prescription drugs? Even our school is providing more hours for soft tissue and modalities than chiropractic technique.

My belief is that we have become a symptom-based rather than a wellness-based profession. All our marketing and focus is on pain so the public thinks that is all we are about. If all chiropractors were busy in their respective practices, the idea of prescribing drugs would be of little interest – which leads to the question: why are many chiropractors not as busy as they want to be? I believe that if you focus only on symptoms, then you are forever looking for patients to fill the void.

One of my early practice mentors was Dr. James Carter, who taught us wellness-based case histories. Even though the patient usually comes in with pain, while doing a history we ask questions and explain that “sometimes misalignment of the spine can cause…” (and we mention a host of internal symptoms). We plant the seed that there can be a relationship between subluxation and internal health. When we do our progress exams in 12 visits we revisit the findings that were positive. Example would be, “When you initially presented to our office with lower back pain you also mentioned that you had headaches, low energy, trouble sleeping, and constipation. Did those issues get better, same or worse?” It’s amazing how often they will remark better, then you relate how subluxations can affect internal health.

Your faith confidence and belief as a chiropractor will increase if you yourself see these changes that you previously heard about but were skeptical. The more faith, confidence and belief you have the more people are attracted to you.

After initial exams, a health talk to a group of your new patients – explaining why chiropractic takes time, their responsibilities in recovery, and what spinal adjustments actually do – is also worthwhile. If you do full spine initial histories, exams, adjusting, and communication on each visit, you’ll see how the practice grows. People now see you beyond just a “crack for back pain.” Guess what: they stay, pay and refer. They are happy and you are as well.

Do we really want drugs in our profession? I ask you to think long and hard about that decision as people increasingly want more drug-free, healthy choices. Hold on to your philosophy, it is what started this great profession. Opioids are on the rise, we have a so-called crisis. An opioid is a drug, stay drugless my friends.


Dr. Ed Lubberdink has been a chiropractor in the same location for 35 years. He has three chiropractic associates, four massage therapists and a naturopath on his team. Lubberdink has attended over 100 post-graduate seminars to stay current and inspired. The clinic focus is certainly on wellness.


Comments  

 
0 #5 Peter Emary 2017-12-07 13:48
And for more inspiration - particularly as it relates to serving vulnerable, low-income populations using evidence-based, patient-centred chiropractic care - here’s an excellent commentary by World Spine Care (WSC) Clinical Director, Dr. Geoff Outerbridge:

http://www.journalchirohumanities.com/article/S1556-3499(17)30010-4/pdf
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0 #4 Peter Emary 2017-12-07 13:20
And for those who don’t think that treating pain is congruent with patient “wellness”, read the following commentary by Dr. Greg Kawchuk:

http://www.journalchirohumanities.com/article/S1556-3499(17)30015-3/pdf
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0 #3 Peter Emary 2017-12-02 07:25
And as for the identity of the chiropractic profession, numerous articles have been written on the benefits of embracing evidence-based practice with a focus on spine care:

https://chiromt.biomedcentral.com/articles/10.1186/1746-1340-13-9

https://chiromt.biomedcentral.com/articles/10.1186/1746-1340-16-10

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3845476/

https://chiromt.biomedcentral.com/articles/10.1186/s12998-016-0108-9

http://www.journalchirohumanities.com/article/S1556-3499(16)30016-X/fulltext

My personal favourite is “The New Chiropractic” by Dr. Bruce Walker.
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0 #2 Peter Emary 2017-11-27 19:01
I'm curious to know more about the chiropractic profession in Switzerland. Swiss chiropractors have had limited prescribing rights for almost 20 years now. How are things going for them?

If you read the literature and talk to Swiss chiropractors it appears that they're doing very well. They are fully integrated into the healthcare system and are also accepted by the medical profession - despite having limited prescribing rights. The reason is that their scope of practice is focused on diagnosing and managing MSK disorders. They do not operate as general physicians. They have cultural authority in society as primary spine care providers. They are also evidence-based, and have the highest educational standards in the chiropractic profession.

Before we close the door on prescribing rights in chiropractic, perhaps we could learn a little more on this topic from our colleagues in Switzerland? It appears as though this scope expansion has been working for them.
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0 #1 Dr Darrell Morin 2017-11-27 15:17
I am with you 100% on all counts. I will however admit to being one of the DC's voting yes to prescribing. I voted yes because I wanted the right, education and scope to tell patients not to take drugs. I also can't imagine a situation where I would prescribe something. However, many perceive my anti drug stance is simply from the fact that I am not qualified to prescribe them. If I am perceived as qualified but not likely to prescribe I think its a win-win. I would trust a salesman touting the benefits a Ford over a GM if he also sold GM's. My reason for saying yes is very different from most of our colleagues so I am on the fence. I agree with you ; it's a slippery slope we are setting up here. I can only hope that our schools are teaching our chiropractors to be chiropractors. You may be right though. Perhaps it is not possible to have your foot in both camps and still maintain our identity. I know I can but how that translates to our profession remains to be seen.
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