The Emerging Health Care Paradigm

John DeFinney
February 22, 2010
Written by John DeFinney
Since its inception in 1895, the chiropractic profession has been through a lot of ups and downs, however it has undergone very few changes in the way it deals with patients. The belief that the body heals itself and that chiropractors merely help to remove any interference to the healing process, remains a cornerstone of chiropractic philosophy. Chiropractic’s method of treatment, and the tools DCs use, have not varied greatly over the years. The general public, on the other hand, has greatly changed the way it views its health. Patients are no longer complacent, nor are they seeking only traditional medical solutions to their problems.  The use of natural medicine – often, and misleadingly, dubbed complementary or alternative medicine – continues to increase. Information and advice about every disease and condition known to man is at our fingertips on the web. 

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Despite improvements in longevity, modern man is beset with chronic degenerative diseases that rob many of their vitality in their retirement years.  The first wave of baby boomers will soon be collecting Canada Pension.  Many of these individuals will be financially secure and will want to enjoy their newfound freedom to pursue recreational activities and hobbies, and fulfill travel dreams.  Unfortunately many will fall prey to their degenerative conditions, will not be able to enjoy their later years as they’d planned and, furthermore, will increase the strain on our health-care system.  In an article by Mior and Waalen, chiropractic usage by Canadian residents in 2001 was reported at approximately 12 per cent. The majority of this was for musculoskeletal problems. Physiotherapists and massage therapists see slightly less of the population than chiropractors leaving a large percentage of the population in Canada either seeing their physicians or doing nothing when they have such problems. 

However, an article in the October  2002 edition of The American Journal of Public Health found that chiropractic was the most popular CAM service provider in both Canada and the U.S. and that Canadians used chiropractors three times more than Americans did.  Since more people will be requiring care for chronic pain and other chronic disorders, and since more and more seem to be turning to chiropractic for musculoskeletal complaints, it stands to reason that perhaps chiropractic will start seeing more than 12 per cent of the population. 

But, if we hope to achieve this, then we have to change the way we view healthcare and the way we treat our patients. 

Exploring two different developments
Self Treatment
On December 22, 2009, The Globe and Mail reported, “From itches to arthritic pain relief, consumers globally are increasingly treating their own maladies”.

Some pharmaceutical companies have come to this realization and are making changes. In that same article, The Globe and Mail reported that French pharmaceutical company Sanofi-Aventis purchased American company Chattem Inc, a major consumer health-care company for $1.9 billion (US).  The CEO of Canadian operations said, “Clearly with patients taking more control of their own management of their diseases, it’s a growing market”. 

On January 5, 2010 the Globe and Mail reported that Novartis AG paid $28.1 billion for Alcon Inc, a company that specializes in vision healthcare, owned by Nestle. This was said to be  “…part of the company’s effort to branch into faster-growing areas of health care as branded prescription drugs sales slow”.  

Focus on prevention
Insurance companies are recognizing the change in the public’s approach to health care. On January 4, 2010, the Globe printed an article entitled “Rising costs lead insurers to focus on prevention.” The insurance industry is getting into the wellness business by “building detailed databases of health information on the people they insure, ranging from the drugs they take to the chiropractors they visit, to more accurately predict who might be at risk of a major health issue such as a chronic disease.  The goal is to be able to intervene before the issue becomes severe – and expensive – by prodding the person to take action that could manage or prevent the disease all together”

Positioning DCs as wellness proponents
The ideas of wellness summarized above stem from views that focus on empowering patients with knowledge and giving them the tools to achieve and maintain their own health, so that they will not have to rely on expensive treatment. 

This may sound heretical to some, and like economic suicide to others, but for chiropractic to become wellness proponents, we are going to have to establish programs and practices that are in keeping with these ideals – as well as the financial constraints that might make them necessary.  This means we will have to reduce the number of times our patients need to see us.  In a yet unpublished study, Silvano Mior, DC, found that 36 per cent of 821 surveyed chiropractic patients reported missing appointments due to financial reasons. Wellness does not involve having our patients come in to see us every week in order for them to stay well. 

Also, work by Cassidy and Coté, et al. (Spine, Vol. 30, No. 24, pages 2817-2823) reveals that back pain in individuals is not usually relegated to a single episode but rather is an ongoing process.  Should we, therefore, be claiming to be providing the cure for back pain, or rather partner with our patients to provide the safest and most effective and cost effective way to control it? 

How technology might help
Companies that manufacture products to assist with back pain – and other types of pain – might be able to play a role in the chiropractor and patient partnership against pain.  Some of these have designed medical grade products that are powerful enough to use in a professional clinic, but safe and easy enough to use adjunctively for home care. The companies are looking to work with chiropractors, whose philosophy and paradigm are suited for these types of  non-invasive treatment adjuncts, in the hopes of enhancing the results that chiropractors already see in their clinics. 

Because of their knowledge, and the credibility chiropractors have developed due to their close relationship with patients, DCs can be an excellent choice to introduce these products and explain their benefits and protocols.

On the DC’s end, this provides chiropractors with a perfect opportunity to partner with their patients to manage their problems in a more efficient and timely manner.  Rather than lose patients, as some chiropractors would fear, this partnership gives us more credibility and shows our patients that we want what’s best for them and are not trying to make them lifetime members of our clinic.  Isn’t that what we do when we give patients advice on proper posture, exercises, home care advice and when we fit them with orthotics? If DCs allow some of these technological advances to become part of their standard of care,  they may see improved results, may be able to reactivate patients, and renew the level of excitement within their practices.

Maintaining a patient-centred approach
If we want to stay competitive in the health-care field, we have to keep the needs and concerns of our patients in the forefront. We have to realize that our patients are having financial and time constraints that may be forcing them to look at alternatives to chiropractic care.  We have to develop strategies that will help us maintain positive outcomes with patients and retain their trust and confidence.

At the same time, it is important for us to stay within our scope and incorporate evidenced-based practices. 

We need to develop partnerships with other professions in order to co-operate in patient care and to encourage and support more research. 

But, above all we need to improve our communication skills with our patients, the public and governments so that we can position ourselves to bring chiropractic to those who are in need of its benefits and potential for healing.

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