Answers to Questions about Chiropractic:
How Can a Chiropractor Build an Ethical Practice?

Samuel Homola, D.C.

Question

I recently graduated from Palmer Chiropractic College. I am working as an associate for a fairly high-volume practice and have some ethical reservations about what I see. First, each patient receives the same treatment plan: 3x per week for 4 weeks, 2x per week for 4 weeks, and 1x per week for 4 weeks, unless the patient is a child. Second, after completing the treatment plan, the patients are persuaded to begin "wellness care" which constitutes monthly adjustments. This doctor does not preach the subluxation theory, but does state that regular spinal adjustments will "keep your spine healthy" and "reduce arthritic change." Is there any truth to either of these statements? If regular chiropractic adjustments do indeed help people, then I will gladly advise patients to do so. I know that research is lacking in this area. I have come across a few poorly controlled studies, but nothing substantial. I know there are many conflicting theories on this topic, and I also know there may not be a direct answer, but I was hoping a doctor with your experience and balanced mindset could provide some insight. I just want to run an ethical practice. I want to treat patients as individuals with individual problems and not cash dispensers. Any advice would be welcomed and greatly appreciated.

Answer

Offering every patient the same treatment program, regardless of the diagnosis, is a mercenary approach that is not in the best interest of the patient. I do not know of any evidence to indicate that regular spinal adjustments will keep the spine healthy and prevent the development of spinal arthritis. Quite the contrary. Frequent spinal manipulation performed on a healthy, asymptomatic patient is unnecessary and may subject the patient to more risk than benefit, especially in the case of neck manipulation which has been linked to rare vertebrobasilar strokes caused by injury to vertebral arteries.

I do not have a problem with providing generic spinal manipulation for patients who come occasionally simply because they enjoy being "loosened up"—provided rotational neck manipulation is not routinely included and the patient is not misinformed about the need for such treatment.

The type and frequency of treatment should always depend upon the diagnosis. When correct diagnoses are made, the treatment will not the the same for every patient. Patients should not be asked to pay for months of treatment in advance. In most mechanical-type back problems, for example, treatment should be discontinued when symptoms subside and the patient is no longer benefiting from the treatment. If a patient's symptoms worsen after a week or two of treatment, or have not improved after a month of treatment, it would not make sense to continue with a pre-planned treatment program. Many such patients should be referred for medical treatment. Some patients with chronic problems may benefit from treatment on an as-needed basis for relief of symptoms. In some cases, time or no treatment at all may be the best approach.

It takes time to build an ethical practice. But properly informed, satisfied patients can sustain a practice for years to come. The feedback from such patients in their contact with friends and health professionals will build your reputation. If the office notes you share with local physicians consistently reflect appropriate treatment based on a correct diagnosis, you will eventually earn respect that will result in referrals from the health-care community.

It's important to follow your conscience in doing what is best for the health and welfare of the patients who come to you for care and guidance.

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Dr. Homola is a second-generation chiropractor who has dedicated himself to defining the proper limits on chiropractic and to educating consumers and professionals about the field. His 1963 book Bonesetting, Chiropractic, and Cultism supported the appropriate use of spinal manipulation but renounced chiropractic dogma. His 1999 book Inside Chiropractic: A Patient's Guide provides an incisive look at chiropractic's history, benefits, and shortcomings. Now retired after 43 years of practice, he lives in Panama City, Florida.

This article was posted on March 14, 2009.