Standard Operating Procedure / Standard of Care
Overview
3rd Paradigm Chiropractic may also be called:
- Non-Therapeutic Chiropractic
- Non-Medical Chiropractic
- Objective Straight Chiropractic
The following information will provide a Standard of Care that only applies to 3rd Paradigm Chiropractors and that it is unethical to judge 3rd Paradigm Chiropractors with a 2nd Paradigm standard of care.
Board Standards for all Chiropractors
The first part of the standard of care that must be followed are the rules and regulations of the Board. Unfortunately these rules are not clearly written and require the chiropractor to very carefully exam every section of the rules and regulations.
SDCA Additional Standards for 3rd Paradigm Chiropractic
The following provides a standard of care in addition to the Board regulations. It is important to remember that all Chiropractors need to follow the Board regulations first and then use the SDCA Standard of Care to make a final set of standards to follow.
Non-Therapeutic chiropractic Objective
Non-Therapeutic Chiropractic has the sole objective of helping the body heal Vertebral Subluxation. The bodies level of harmony is increased as the presence of Vertebral Subluxation is decreased and the bodies Innate Intelligence is allowed to be more fully expressed.
Pain Findings, Medical Conditions and Symptom Questions
A Non-Therapeutic Chiropractor understands that questions about pain, conditions and symptoms are not in the scope of 3rd Paradigm Chiropractic, and may be misleading, causing the person seeking help to believe that the pain they are experiencing or the medical condition they have is caused by the Vertebral Subluxation. This misunderstanding regarding symptoms may cause a person under 3rd Paradigm Chiropractic to not seek out or delay seeking out Medical Treatment because they believe that their symptom and condition is going to be cured through 3rd Paradigm Chiropractic. The 3rd Paradigm Chiropractor understands that asking about pain and Medical Conditions in a Health History is misleading the public regarding what 3rd Paradigm Chiropractic can do, and would be conduct which has endangered or is likely to endanger the health, welfare, or safety of the public. Asking about symptoms and Medical Conditions is the job of properly trained Medical Doctors and 2nd Paradigm Chiropractors.
Details of Items not included in Non-Therapeutic Chiropractic
Physical examination
Performing a Physical Examination is Medical procedure and is not in the scope of 3rd Paradigm Chiropractic. See Vertebral Subluxation Analysis/Evaluation for information on finding a Vertebral Subluxation.
diagnostic Procedures
Diagnosis is a Medical Procedure and is not in the Scope of 3rd Paradigm Chiropractic. SDCA sets a standard of not performing diagnostic procedures. SDCA recognizes that the purpose of Diagnostic Procedures is to provide a Differential Diagnosis. A 3rd Paradigm Chiropractor is only looking for Vertebral Subluxation and that a Vertebral Subluxation can be present with or without a medical disease or condition in the patient.
orthopedic tests
Orthopedic Tests are Medical procedures and are not in the Scope of 3rd Paradigm Chiropractic. See Vertebral Subluxation Analysis/Evaluation for information on finding a Vertebral Subluxation.
treatment
Treatment is a Medical Procedure and is not in the Scope of 3rd Paradigm Chiropractic. SDCA recognizes that Medical Treatment has a beginning of treatment and an end of treatment based on Medical Diagnostic Procedures. A Vertebral Subluxation is some place along a continuum, either improving in function or decreasing in function. There is no end to how much improvement in function of the Vertebral Subluxation, a 3rd Paradigm Chiropractor can help the body achieve.
Details of items included in Non-Therapeutic Chiropractic SOP
Health History
I Health History is only concerned with asking questions that will help determine the presence of contraindications to adjusting or if a different adjustment technique is required or if an area of the spine should not be adjusted.
Unusual Findings
A Non-Therapeutic Chiropractor is only looking for Vertebral Subluxation. If Unusual Findings are found the Non-Therapeutic Chiropractor should immediately tell the patient and document the finding. The presence of Unusual Findings does not necessarily negate an Adjustment.
Vertebral Subluxation Analysis/Evaluation
3rd Paradigm Chiropractors can use any system of analysis that allows the finding of Vertebral Subluxations. Some common techniques are listed below but are not the only techniques available. The following are some of the more recognized techniques used to find VS.
- Static Palpation
- Motion Palpation
- Dual Probe heat sensing Interments
- Visualization
- X-Ray or other imaging procedure
Static palpation
This may be the most use technique for finding VS. since it gives the most feedback with the least amount of disruption to the spinal joint. The most common information that is gathered from Static Palpation is:
- Point Tender Spinous Process
- Posterior and inferior Spinous Process
- Trophic Change
Motion palpation
This is used less often compared to Static Palpation since it can aggravate the spinal joint and decrease the effectiveness of the adjustment.
Dual Probe heat sensing intruments
There are several different brands and they are used primarily in one of two ways. The first technique is to help identify the level of the VS. and the second is to identify that there is a VS but not specifically at the level of the reading.
Visualazation
This technique may be used to start evaluating a patient as they walk in the room. Visualization may also help identify unusual findings.
X-ray
No technique is more controversial than x-ray. The reasons in favor include increased knowledge of the spine and to gather a multi axial listing. The reasons against include increased radiation, and not providing consistent care for children and pregnancy. If x-ray is needed for everyone, how do you adjust children and pregnancy with out the use of x-ray.
SDCA sets the standard to only use x-ray if you need it to find the VS or complete the spinal analysis.
Non-Therapeutic Chiropractic Adjustment
There are many recognized Chiropractic Adjusting Techniques. SDCA recognizes the use of any Chiropractic Adjusting Technique so long as it is recognized in the Chiropractic community. Regardless of the Adjusting Technique used all Non-Therapeutic Chiropractors must have the objective of helping the body heal itself from a Vertebral Subluxation.
Billing and Payment Standards
- 3rd Paradigm Chiropractic is not recognized or reimbursed through Medical Insurance since it is not a Medical Procedure.
- SDCA recognizes all payment systems as long as they are fair and ethical.
- SDCA recognizes that many chiropractors do not provide billing for non-therapeutic care.
- SDCA recognizes that many chiropractors do not keep billing records since patients are only required to pay what they can afford. An example of this would be the Box on the Wall system or a Self-Pay Patient Accountability system.
Contraindications to receiving a Non-Therapeutic Adjustment
SDCA sets a standard of no contraindications to receiving a Non-Therapeutic Chiropractic adjustment as long as the adjustment technique is compatible with the evaluation findings. In many cases a contraindication will only effect a portion of the spine allowing an adjustment to be performed away from the contraindication.
According to Dr. Reggie Gold and Dr. Joseph Strauss the leading authority on Non-Therapeutic Chiropractic. Everyone regardless of the presence or absence of condition or disease should be checked for Vertebral Subluxation at least once a week and that everyone is better off without Vertebral Subluxation than with it. Dr. Strauss discusses this topic in his book, “Case Management for the Straight Chiropractor”, and recommends adjusting the spine only in the areas away from the contraindication.
The BOCE Laws list no contraindication for a Chiropractic Adjustment.
Initial documentation
Non-Therapeutic Chiropractic initial documentation should include only what is relevant to the location and correction of Vertebral Subluxation. There are 5 items that should be included in the documentation:
- Health History as it relates to contraindications or info needed to locate the VS
- Unusual findings
- Contraindications
- Vertebral Subluxations and the findings used to identify them
- Informed Consent
The system of documentation is at the discretion of the Chiropractor as long as all the information is covered. This can be as simple as listing the items on the Informed Consent or a more complex system requiring a detailed sheet for each item documented.
ongoing Documentation
The purpose of medical documentation is to track change in the symptoms so that the treatment can be evaluated for correction. Evaluating symptoms is not part of the Non-Therapeutic Objective and so the medical per visit documentation would not apply.
The documentation that should be recorded on each visit is:
- Any changes in the patients Health History
- Unusual findings
- Contraindications
- Analysis findings used to locate VS
- Vertebral Subluxations
- Post Check of VS
- Adjusting Technique
Informed consent
A Non-Therapeutic Chiropractic informed consent is different from a medical informed consent because, an Adjustment enables the innate forces of the body to be expressed more fully.
The informed consent should be used to educate the patient about the Non-Therapeutic Objective.
Additional Information
Federation of Straight Chiropractors and Organizations Statement on Chiropractic Standard of Care/Patient Safety
Non-Therapeutic Chiropractic Education Program
International Federation of Chiropractic Organizations
Educators
Although there are many accomplished Non-Therapeutic Chiropractors the two most notable are Dr. Reggie Gold and Dr. Joseph Strauss.
Dr. Reggie Gold, Recognized Teacher and developer of 3rd Paradigm Chiropractic: Dr. Reggie Gold developed 3rd Paradigm Chiropractic and the topic has been well documented. Many Chiropractors across the United States practice the principles of 3rd Paradigm Chiropractic. Dr. Reggie Gold practiced in Spring Valley, New York and began teaching at the Columbia Institute of Chiropractic and later at Sherman College of Straight Chiropractic. He also who went on to receive an advanced Ph.C from Palmer College in Davenport in 1961. His lectures spanned chiropractic colleges around the world and had a positive effect on generations of doctors.
Reggie Gold’s explanation of 3rd Paradigm Chiropractic
Third Paradigm Chiropractic – Dr. Reggie Gold
There are three possible paradigms of chiropractic thinking. Each chiropractor must choose one of these three to live by or else live in a fuzzy world of half truth, a world in which refusing to face facts not only results in an inability to talk about chiropractic with clarity, but also the inability to practice chiropractic with a clear purpose.
Paradigm #1 holds that chiropractic cures all disease. This paradigm is in line with the advertisement which B.J. Palmer and D.D. Palmer ran in the Davenport Times in 1902 which proclaimed, “You have no right to be sick when chiropractic cures all disease.” Practitioners of this paradigm, though they are in truth few and far between would live by such slogans as, “The power that made the body heals the body.” They neglect to mention, however, that while it is true that the only power that heals the body is the power which made it, sometimes even that power can’t heal. Some people are beyond healing. The pretense that all sick people get well when properly adjusted merely holds us up to ridicule by intelligent people. Other similar slogans claim that “Chiropractic gets sick people well” without adding the necessary word, “sometimes” which would make it true. This latter slogan, incidentally, even if true, would offer chiropractic care to sick people only and deny it to those who are not yet sick by clinical or laboratory symptoms.
A second paradigm of chiropractic thinking and practice holds that only some sick people get better when their vertebral subluxations are corrected. Because of the nature of their disease, or the advanced stages of it, others require medical intervention or adjunctive therapy. This paradigm of treating some and referring others sounds logical and caring, and is most likely to earn us the respect of the community of health care providers. This paradigm represents the thinking of the vast majority of chiropractors. Though there is disagreement how patients should be treated, when to refer, and which treatments to administer in the chiropractic office, the second paradigm is heartily subscribed to by the two largest national organizations. Since both organizations agree on this major issue, it makes one wonder why we have two separate major organizations. If they both agree to treat some diseases and refer others, what are they disagreeing about?
There is, of course, one slight problem that arises when deciding which patients and diseases to treat and which to refer: all treatment or referral decisions are dependent upon diagnosis. Diagnosis is the one great area of weakness in this practice paradigm. Diagnosis is, after all, the greatest challenge the area of greatest risk of mistakes being made. Yet chiropractors, who receive much less diagnostic training than MD’s think they are competent to diagnose for purposes of referral. How is this possible when they:
- Denied by law the use of all diagnostic methods that invade the body chemically or surgically
- generally learn diagnosis out of textbooks without ever seeing cases of the diseases they purport to identify
- frequently learn diagnosis from other chiropractors who also learned from textbooks and have never seen cases of the disease
- often couldn’t pass national board exams in diagnosis without a crash course before the exam.
Some say that to practice without diagnosis would be dangerous. I suggest that nothing is more dangerous than incompetent diagnosis. Every year tens of thousands of sick people visit chiropractors of the second paradigm. People seeing chiropractors complain of a variety of problems, which could be the manifestation of vertebral subluxation, or could just as easily be symptomatic of something else, possibly a lifethreatening disease. Instead of practicing chiropractic, the paradigm two chiropractor does a medical diagnostic exam, followed by a medical report of findings in which the DC claims to have identified the cause of the problem. And with such blithe and dangerous comments as, “We do not treat the symptom, we correct the cause,” the DC proceeds to offer treatment, which delays medical care for what may be a life-threatening medical emergency.
Was the backache really caused by vertebral subluxation, or is it perhaps a manifestation of prostate cancer, kidney stones, or referred angina from an impending heart attack? Is that headache caused by subluxation or is there an aneurysm at the Circle of Willis, or a brain tumor causing the symptom? How good is the chiropractor’s diagnosis?
Another point to consider is that while thousands of people go to chiropractors every day, millions more stay subluxated because they have no symptoms. For over a 100 years we have exposed people to the limited understanding of chiropractic that results from paradigm two. The treatment of some diseases by adjustment and the referral of others based upon our diagnostic knowledge is not chiropractic at all, it is the practice of manipulative medicine, and it is even more dangerous than paradigm one.
Paradigm one is obviously stupid, so stupid that nobody really believes it. Nobody believes that all disease is caused by vertebral subluxation, so nobody gets hurt by it except the chiropractor who tries to make a living at it. Paradigm two, however, sounds logical. It is saleable and, subsequently, dangerous. If paradigm one is stupid, and paradigm two is dangerous, let us consider a third paradigm.
This paradigm make sense to me. It is a paradigm that thousands of chiropractors practice on their families, yet neglect to offer the public. Paradigm three is nether based upon the claim to cure all disease, nor an attempt to prejudge which diseases might be cured if vertebral subluxations are corrected. In fact, it has no disease treatment at all. It is totally non-therapeutic in its intent and practice.
Chiropractic holds that a vertebral subluxation, by its very existence, inhibits the body’s ability to fully express its inherent potential. Every vertebral subluxation, by definition, includes some alteration of nerve function from perfection to something else. Vertebral subluxation is, at the very least, a change in the body’s structure, and every scientist knows that a change in structure must inevitably result in a change in function. Therefore, all vertebral subluxations must result in altered function. In short, people with vertebral subluxations would be better off without them.
It does not matter if a subluxated person has a disease or if any disease would be best treated by manipulative medicine or some other treatment. The presence or absence of disease is irrelevant. Every human being, sick or well, newborn or aged, regardless of nutrition, exercise, occupation, sex, race, religion, and all other factors of life, is better off without vertebral subluxation. Why then do some chiropractors and organizations want to limit chiropractic correction of subluxations to certain categories? Is the person with AIDS or terminal cancer better off left subluxated? Should an infant with a vertebral subluxation but no determinable disease symptoms be left subluxated until symptoms occur? Symptoms are the last stages of malfunction, not the first.
By the time symptoms have occurred, years of opportunity for repair may have been lost. Why not correct vertebral subluxations when they occur, rather than wait for years of damage to produce symptoms?
To restrict chiropractic to sick people is as stupid as restricting vitamin C to people who have a cold. Furthermore, to treat disease by manipulation is necessarily to delay alternative treatment and thus, possibly endanger life.
The third paradigm of chiropractic practice is the only one that makes sense. It makes so much sense that thousands of chiropractors use it for themselves and their own families, yet because medical insurance does not pay for it, they do not teach its value to the public at large. We live in a country that spends billions of dollars a year on the treatment of sickness and disease, but precious little on health. Our chiropractic profession is supposed to lead the world into a new and more intelligent way of thinking, not follow the mistakes of the past.
Paradigm three is not about health and sickness. It is about the recognition that vertebral subluxation causes more than just lost health potential and loss of every human potential. The nervous system is the coordinating system whereby the countless billions of body cells interact in harmony to express mind, body, spirit, emotion, artistic talent, speed, stamina, coordination, and family relations. Vertebral subluxation is a cause of disharmony to this beautiful thing we call life.
Paradigms one and two are about backaches; paradigm three is about life. We can choose to conform to the errors of the past, or we can step proudly to the forefront and lead the way into the future.
Other Resources
How to transfer to a 3rd Paradigm Chiropractic Practice
#59 How To Transition From 2nd To 3rd Paradigm Chiropractic
SDCA 