It goes without saying that among the most important factors in achieving excellence in any field is mindset. Mindsets are deeply held beliefs, attitudes, and assumptions we have about who we are and how the world works. To improve our abilities and be better at the practice of chiropractic, we can adopt he following 4 perspectives.


Clinical Jazz vs. Clinical Symphony:

Many practice frameworks, evidence-based and otherwise, produce flow charts and guidelines that purport to define best practices and care plans. The metaphoric model they promote is one of a clinical symphony, with all the factors of patient care participating as a well-coordinated orchestra. The doctor then acts as the conductor leading the players in a well-structured musical piece.

In actual practice multiple factors coalesce and interact in an improvisational fashion, being more like a jazz ensemble. Clinical jazz combines the best research findings, the patients’ clinical presentation a doctor’s clinical expertise and technical artistic mastery, and the patients’ desires into a coherent performance.  Doctors make their decisions in a flexible and dynamic manner, participating and guiding the process to produce the beautiful music of positive results.



General vs. Specific Knowledge and Skill Sets:

Success in adjusting is like success in golf – a specific skill performed in a fairly consistent or “tame” environment. Expertise requires the application of Ericsson’s metaphorical “10,000-hour rule” of deliberate repetitive practice: e.g. Tiger Woods. Too much emphasis on such a narrow band of abilities may lead a DC to becoming a technician or a “master of one” skill.

Success in practice is like success in tennis or quarterbacking. Performed in a highly changeable or “wicked” environment, it requires a degree of proficiency in a broad range of skills. It also demands a fluidity in their application to find a “best match”; e.g. Roger Federer, Russell Wilson, Cam Newton. Of course, too much emphasis on this generalist approach may lead a DC to become a dilettante, never achieving the needed mastery and forever being a “Jack of all trades”.

One of the premises of the management theory of constraints states that every business, such as a chiropractic practice, can only grow to the limit of its least developed or weakest functioning area. There are many areas in practice, such as: clinical skills, communication skills, marketing, finance and accounting, human resources and personnel, operating systems, etc. Success in practice requires fluency in each of these areas. One of the reasons that some of the most talented clinicians and most proficient adjusters struggle to succeed in practice is that they don’t develop the global array of skill sets and strategies needed to run a practice. Conversely, a doctor who is mediocre in clinical skills but excels in the other areas can have a practice that can thrive.


Fixed vs. Growth Mindset

In a fixed mindset, people believe their basic qualities, like intelligence or talent, are simply fixed traits. They spend their time documenting their intelligence or rehashing their abilities instead of developing them. They also believe that talent alone creates success – either you have it or you don’t.

In a growth mindset, people believe that their most basic abilities can be developed through dedication and hard work—brains and talent are just the starting point. This view creates a love of learning and a resilience that is essential for great accomplishment.

Chiropractors with a fixed mindset too often assume that the theories and skills they learned in school or through a chosen technique system are timeless. They have low motivation to change or develop their skills. Continuing education is done to fulfill licensing requirements, not to learn better ways and methodologies of practice.

Those with a growth mindset come from the perspective that graduation from Chiropractic college was just the beginning of their journey to excellence. They regularly develop their proficiencies, learn new skills and methods, and disrupt their modus operandi when new information challenges their assumptions. They recognize that the art and science of chiropractic and health care is never complete and continuously evolves.


Clinical Practices – Best, Good, Emergent

A best practice is a practice that has been proven to work better than other methods through research or over time. The practical goal of evidence-based practice is to uncover or produce methods, protocols and guidelines that are superior to its alternatives. Currently, there are few best practices in chiropractic practice.

Good practice is the recognition that caring for real patients in the real world is more complicated, has more confounders, and is overall messier than many research designs can account for. It acknowledges that there are multiple options for achieving results with patients. Another name for good practice might be effective practice – it reliably generates desired outcomes, but may not have been rigorously studied. Both personal experience and professional consensus contribute to the development of good practices.

Often patients present themselves with complex problems and situations as such that no recognized good or best practice to applies to them. Their problems are either unique and unconventional (ie. unprecedented), or recurrent and ongoing (ie. are continuously re-solved). These are cases where no guideline or clinical heuristic can be constructively applied. In these cases, the art of practice comes in. Through collaboration with other clinicians and “n of 1” trials, an emergent practice develops. Effective emergent practices that can be repeatedly applied to a similar cohort of patients adds to the growing catalogue of good practices we can utilize.


Everyone one of us can be better at the practice of chiropractic if we adopt these mindsets. In the end a curious mind, a compassionate heart, and a commitment to the continuing pursuit of the advancement of chiropractic practice benefits us all.


About the Author

Dr. David Graber is the chairperson of the ANJC Council on Technique and Clinical Excellence. He maintains a private practice in Parsippany, NJ. He can be reached at: DrDavidGraber@gmail.com.

Originally published in The New Jersey Chiropractor, Summer 2019

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