It can be easy to get into a rut, get used to "the way things are" and just keep on practicing the way we have since first hanging out our shingle. Human nature often seeks the path of least resistance – to just "go with the flow." As chiropractors, that type of thinking is professional suicide. We cannot afford to be complacent, comfortable or just "status quo."

I have written several times about this topic. Most recently, I wrote about how we need to be able to justify why we treat a spinal region. I drew the analogy from an encounter with a medical doctor who could not process that medication was not necessary – and then compared that to a chiropractor who will treat full spine "just because." I noted that chiropractors have just as much of an ability to get tunnel vision as our allopathic counterparts. As expected, I had some very negative feedback.

Reading back through my article, I think it is very clear that I did not disparage practicing full spine. There is nothing wrong with practicing full spine, and full spine care definitely has tremendous value. That is my style of practice. What I did do was comment on the changes in the health care paradigm in this country. To quote the president in his recent State of the Union address, "the rules have changed." Whether we like it or not, we have professional, ethical and legal responsibilities, and in today's medical-legal climate, you must be able to objectively document why you chose a certain treatment plan.

The simple reality today is that you need to be able to show clinical findings and a clear clinical rationale for why you treat any area of the spine. It can certainly be argued that treating the neck is appropriate when addressing a lower back complaint; but are you able to explain your rationale for doing so, more than just saying: "Because I have a full-spine philosophy"? Yourphilosophy of practice is very different from your legal obligations as a practitioner to validate your care. Many insurers, including Medicare, are now asking for objective documentation. You must be able to clinically defend the care you provide.

As the president also noted in his address: "That world has changed. And for many, the change has been painful." When I graduated, the Internet was a concept. Now the Internet andelectronic medical records are the norm. I have a number of friends and colleagues who still practice the way they did 10, 15 or even 20 years ago. Some of them still keep office notes on index cards. Any new graduate will tell you that is not the recognized standard of care.