Critical thinking for chiropractic: bridging the gap
Health insurance claims are denied for many reasons. If a practitioner suspects third-party bias, ACA's insurance relations department steps in.
However, language and science can also create stumbling blocks. Insurers would like to see a linguistically level playing field--where the terminology used on claims is the same across the board and where all practitioners use credible scientific research as a basis for treatment. While some DCs read and search the scientific literature and use terms the medical establishment understands, others may feel insurers are pushing them to become allopaths in all but name. That is not going down well. Nor is it true.
Our interviewees for this segment are Reed Phillips, DC, PhD, former president of Southern California University of Health Sciences; Michele Maiers, DC, MPH, associate professor, Wolfe Harris Center for Clinical Studies, Northwestern University of Health Sciences; and Christopher Roecker, DC, clinical research fellow, Palmer Center for Chiropractic Research, Palmer College of Chiropractic.
Chiropractic thought and innovative ideas come from a variety of sources--both scientific and philosophical--coupled with practical experience. This article is less about philosophy than it is about related attitudes and behaviors that affect the chiropractic bottom line in today's rapidly changing health care environment.
Chiropractic thought in 1895 was formed around deductive principles, while medicine's approach was transitioning to inductive principles. In the clinic, however, says Reed Phillips, DC, PhD, clear distinctions between the two are often not made. Some DCs who learned inductive thinking use deductive processes in practice--and vice versa. "Both deductive and inductive approaches require critical thinking," he says. "In the clinical sense, we observe, examine, take measurements, and then based on some known theory, come to a conclusion about what is wrong with the patient. This is the 'inductive' reasoning process. This is what is commonly taught in the schools and is consistent with CCE Standards and the methods of modern-day science.
"On the other hand, we also see the 'deductive' reasoning process. For example, the practitioner starts the examination process with the belief that Innate Intelligence has experienced some sort of interference, a 'subluxation,' that ultimately affects the well-being of the patient. The doctor's mission is to identify the 'interference' and remove it by adjusting the spine. If successful, the patient will be relieved of this interference and the process of 'dis-ease' will be stopped.
"While there is overlap between these two approaches to patient management, the underlying philosophical principles differ," he says. Although some DCs do practice exclusively at either end of the spectrum, most are pragmatic. They use whatever works to benefit the patient.
All three doctors interviewed said chiropractic practices will require doctors to understand and use both deductive and inductive approaches. Christopher Roecker, DC, commented that DCs who do not master inductive methods will face serious obstacles because "Pressures from a rapidly evolving health care environment are pushing doctors toward a more inductive practice process. Neither anecdotal nor unsystematic methods in the clinical setting prepare the DC for survival today."
Dr. Phillips speculates...