**ACBC's Statement on Chiropractic - Standard of Care/Patient Safety
¤ Rationale
The fact that there are two schools of thought existing within the chiropractic profession is well documented. These two schools of thought are most commonly referred to as "straight" and "mixer." As would occur in any profession that supports two schools of thought, much misunderstanding occurs, not only within the profession, but also among various publics of the profession, by the continuing flow of claims and counter-claims by the two schools of thought. One of the most maligned areas is that of Standard of Care as is taught in the educational programs of "straight" colleges of chiropractic and as it is administered in "straight" professional practice. Because of the foregoing, there is a need for a normal statement of position on Standard of Care for straight chiropractic.
¤ Purpose
This statement of position has been established to clarify the Standard of Care for the practice of straight chiropractic as 1) taught in the educational programs of colleges of "straight" chiropractic and 2) practiced by straight chiropractors
¤ Endorsement
This statement of position on straight chiropractic Standard of Cafe is endorsed by the Federation of Straight Chiropractic Organizations (FSCO) and the Association of Straight Chiropractic Colleges (ASCC).
¤ Explanation of Commonly Used and Misused Terms
Straight Chiropractic:
A non-therapeutic, primary portal of entry health care profession whose objective is to contribute to health through the adjustment of vertebral subluxations. It is based in an evolving philosophy and science and is practiced as an art.
Commentary: Objectives and procedures, inconsistent with the above definition, have been embraced by a faction of the profession. This faction has historically been known as "mixing" chiropractic while that which adheres to the traditional objective of chiropractic has been designated as "straight" chiropractic. Although the "mixing" faction has deviated strikingly from the chiropractic objective, it has not disclosed, designated or identified this fact to the public. For this reason, the adjective "straight" (as defined by Webster: "...undeviated, unmixed...") has been employed to distinguish those who adhere to the above definition from those who do not ("mixers").
Vertebral Subluxation:
A condition in which a vertebra has lost its proper juxtaposition with an adjacent vertebra (to an extent less than a luxation) in such a way as to alter nerve function.
Structure and Function:
Biological function is a manifestation of living structure. Any disturbance in structure causes a corresponding disturbance in function. Vertebral subluxation is a disturbance in the structural relationship of the vertebrae and the nerves they protect. This disturbance in structure reduces the body's ability to maintain its own health.
Morbidity:
Straight Chiropractic does not offer to treat any disease or morbidity process. It's objective is to contribute health through the correction of vertebral subluxation.
Straight Chiropractic Analysis:
Those procedures which disclose the presence, location and character of a vertebral subluxation along with the determination of the safety and propriety of straight chiropractic care and the election of an appropriate straight chiropractic adjustment. Included in straight chiropractic analysis is the recognition of unusual findings which present themselves in the cause of analysis. Although there have been attempts to use terms like, "diagnosis" or "chiropractic diagnosis" to describe chiropractic analysis, these are indistinct and misleading uses of medical terminology which may create false patient expectations. Diagnosis is universally understood to be a medical procedure concerning disease or morbid processes. Because straight chiropractic is non-therapeutic, the term "diagnosis" is not germane to the practice of straight chiropractic.
Commentary: The educational programs in straight chiropractic colleges include course work in medical diagnosis to comply with certain jurisdictional regulations which require the straight chiropractic educational program to include medical diagnosis. Furthermore, though the vast majority of state/provincial laws prohibit the chiropractor in the treatment of disease (which is the logical culmination of medical diagnosis), most licensing boards require examinations in medical diagnosis.
Chiropractic Adjustment:
An adjustment is the application of specific scientific procedures for the sole purpose of releasing vertebral subluxations.
First Aid:
Those procedures designated by the handbook of the Red Cross as basic first aid. The chiropractor accepts the responsibility for determining the need for and administration of basic first aid.
Treatment:
Those things done to or for a patient for the alleviation of symptoms and/or disease. Since the straight chiropractic objective does not include the treatment of symptoms and/or disease, the term is not appropriate in straight chiropractic.
Manipulation:
Manipulation is defined as the forceful, passive movement of a joint beyond its active limits of motion. Manipulation does not imply specificity or the correction of the vertebral subluxation, and therefore, is not synonymous with the chiropractic adjustment.
Primary Portal of Entry Provider:
Those health care providers whom the law and professional ethics allow a patient to consult, without referral from another provider.
Limited and Unlimited Providers:
There are two types of primary, portal of entry providers: limited and unlimited. These terms refer to the scope of practice relative to area of anatomy addressed, conditions addressed, and procedures used. Allopathic and osteopathic physicians are examples of unlimited providers, while dentists and optometrists are examples of limited providers. Virtually all state/provincial laws are based upon the concept of the chiropractor as a limited, primary, portal of entry health care provider. Straight chiropractic is a limited health care profession while mixing chiropractic considers itself an unlimited health care profession.
Patient Safety Standards
Chiropractic is always practiced in the context of the patient's welfare being supreme. While few rules may be applicable to all clinical situations, the welfare of the patient being supreme is inviolable. In accordance with this principle, the following criteria have been established:
1. Clinical responsibilities are to:
a. Fully inform the patient concerning the straight chiropractic objective: the release of vertebral subluxation.
b. Elicit a case history which will be used to gather information which will assist in the administration of appropriate straight chiropractic care.
c. Determine the propriety of straight chiropractic procedures.
d. Determine the presence or absence of vertebral subluxation.
e. Determine and inform the patient of any unusual findings which are uncovered during a straight chiropractic spinal analysis.
f. Specifically adjust any vertebral subluxation using techniques appropriate to the patient.
g. Refrain from further care when the subluxation is not being released and make the appropriate referral to another chiropractor.
2. Safety Criteria
a. Provide the patient with relevant information as to the objective of straight chiropractic.
b. Complete a case history with information which will assist in the administration of safe and effective straight chiropractic care.
c. Perform a complete straight chiropractic analysis which determines the presence and character of a vertebral subluxation.
d. Recognize unusual findings which present themselves during a straight chiropractic analysis. These must be noted and reported to the patient. The patient should also be informed that the diagnosis, significance, or possible treatments for these findings are outside the scope of straight chiropractic practice.
e. Select an adjusting technique that provides for the safe and effective release of the vertebral subluxation.
3. Referral
The actions related to professional referral are multidimensional. The chiropractor holds himself/herself out as being competent to make referrals and engender a patient expectation concerning referrals only within the area of the chiropractor's expertise. The chiropractor has the responsibility to render first aid and secure medical services for a patient having a medical emergency as listed in the handbook of the Red Cross.
Straight Chiropractic referrals are of two types:
a. Intra-professional referral. Such a referral pertains to the occasion when the chiropractic needs of a particular patient cannot be addressed by the chiropractor in attendance. In such circumstances, the chiropractor should consult with or refer to another chiropractor whose training, methods or capabilities are more appropriate to the needs of the patient.
b. Inter-professional referral. When a straight chiropractor recognizes an unusual finding the course of straight chiropractic analysis which is outside the scope of straight chiropractic practice, the chiropractor must:
1. Inform the patient immediately of the existence of the finding.
2. Enter such existence in to the patient's record.
3. Inform the patient that it is outside the scope of practice to diagnose, determine prognosis, treat, or offer advice concerning non-chiropractic findings, since to do so would require expertise which the chiropractor lacks by virtue of education and licensing. This does not preclude the continuance of chiropractic are should it be safe and prudent to do so.
Commentary: Straight Chiropractors are under no obligation to perform the duties of any profession for which they are not trained or licensed (beyond first aid). Implicit in any requirement that a straight chiropractor refer a patient to a medical doctor is the imposition on the straight chiropractor to make a medical determination that the patient needs medical care, such a determination could not be made without employing medical knowledge. Because a chiropractor is not licensed or trained to practice medicine, he or she is incapable of making such a referral. Further, any attempt by the straight chiropractor to imply such expertise engenders false expectations and is, therefore, fraudulent and misleading.
**Statement on Chiropractic - Standard of Care/Patient Safety is copied from the Federation of Straight Chiropractors (FSCO)