Sunday, January 10, 2010
Chiropractic Credibility Gap
I'm addressing an issue many choose to ignore or are simply not minful of. Why if so many people suffer from chronic pain resulting in reduced quality of life, why then at the very least don't these folks have chiropractic care on their list of treatment options? I suggest there exists a significant credibility gap; that is chiropractors are not generally trusted by many throughout the community they serve. If that's not the case then please provide a simple explanation as to why we continue to see a very small percentage of the overall general population? We must work to become a relied-upon trusted information resource throught our communities. What say you? - Sig
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Sig,
ReplyDeleteI am in total agreement with you. I believe the term is "cultural relevance". A good friend of mine Dr. M. Schnieder has been grousing about chiropractic's loss of cultural relevance for years. Or in other words the consuming health care public is slowing forgetting we exist. The cause, is jumping on the third party band wagon in the Eighties. With that we as a profession sub categorized ourselves as the back and neck pain Docs. Way to much competition for a limiting scope. As I see it chiropractors are much more and all of the profession is culpable in this trend. Me to. We all see much more than "fixing" that bad back day to day in our practices. The little kid with no earaches now. The high school runner getting back on the track and so on.
The solution, I don't know. I think maybe as individuals, gaining personally relevance with our practice members is the day to day solution. The global solution escape me for now.
I have been in practice since 1982 and the same old solutions, such as re branding, PR, sucking up to the medical community are still bantered about and things really have not changed much.
Maybe, what we as a community of providers really need to do is to decide what we really do. Pluralism is healthy to a point, but destructive in large doses.
In the past I was always in favor of more intra professional exchange on patient care. I had proposed in SJ, bimonthly colloquium dedicated to a meaningful exchange of clinical information in the early 80's. The reception of the idea was lukewarm to cold. More concern was over protecting PIP pay outs and what code to bill for traction, than what helps people get well and stay that way.
Perhaps now is the time to step back and focus on patients and providing high quality patient care in an environment of respectful collegial exchange. Wait a minute, that could be part of the solution to be more relevant as a profession. If we are truly a free market, let's do a better job and let the public decide.
Thanks for listening to a not so old, but still cranky Chiro. I appreciate your feedback critical or otherwise.
The previous post, mine, is from... Richard R. Cobb, DC in Cherry Hill, NJ I can be reached at doctor.richard.cobb@gmail.com
ReplyDeleteRRC
Appreciate the input. Just spent 5 years getting scope of practice through in NJ on behalf of ANJC. ANJC leadership is incredible. The problem was their perception of who we are, not just what we do. Trying to overcome that was our biggest challenge. Sig
ReplyDeleteThe problem I see is that the public only thinks chiropractic is for spine only problems and even worse, just for lower back pain. They are looking at chiropractic treatment as a pain relief treatment only. There is a huge gap in educating the public on what chiropractic can do for them.
ReplyDeleteI agree with all comments, however, successful medical integration can begin with non surgical spinal conditions. The medical community does not have an interest in treating these conditions and patients have few alternatives beyond medication, wait and see, physical therapy or surgery. There is tremendous need for our services as NSAIDs are becoming well recognized for their GI and Cardio risks and other traditional treatments fail to make impact. If chiropractic care can cut the dependence on medication or eliminate it altogether as well as in many cases reduce the need for surgery (ortho surgeons are happy to prevent this as well!)we can create the "need" for physicians to try chiropractic care first.
ReplyDeleteWe have tremendous evidence based research resources at our disposal to support our claims and medical physicians are happy to refer to DC's who demonstrate a scientific approach and reasonable clinical rationale to their care.
Yes, it starts at back pain but pack pain is a multi billion dollar problem and medical physicians see 83% of the patients who could presumably respond to DC care. With chiropractic care utilization shrinking (all of these stats have references for those quotes for those who want them) that represents tremendous market share that begins the appreciation of the benefits of chiro. care by the medical community.
We need MD's as our friends and its time to wave the white flag - not in surrender but in a truce and move past the previous years of conflict. We need to approach them personally because by doing so we can understand their objections to DC care and overcome them with research which provides a platform that both professions can agree upon.
While a personal approach takes many out of their comfort zones the rewards in practice stability are to great to sit idle on the sidelines while other professions already well integrated with MD's seek to claim manipulation as their own. While manipulation may not be the only tool DC's can offer patients it is one we still retain cultural authority over - for now.
Finally, much is said about supporting state and national organizations. FCER closed its doors last year due to lack of funds and operating expenses. I don't feel it's a lack of desire by our profession to support them but rather a lack of practice stability. MD's 83% of the back pain market share bring that stability allowing us the financial resources to support our state and national organizations and begin to reclaim research on our services. Last year Dr. Herring then President of FCER announced the need for funds as the PT industry was outpacing the chiropractic industry in research funds. A few months later FCER closed its doors. It is not only a credibility issue but a professional issue at the organizational and personal levels as well.
Why not capitalize on what the public perceives us to be and then grow it from there?
The public perception of chiropractic is not one of fixing the problem but doing maintenance of the problem. We have the reputation of keeping the patients coming back for more visits. Who wants to make the doctors boat payments? In this lies the fault of our education. Let me explain!
ReplyDeleteChiropractic views the world from the SOFT TISSUE "Master Control System" from the TOP DOWN. The brain, spinal cord and nerve roots telling the body what to do, when to do it and how much to do it.
What we did not learn so well was that there is another HARD TISSUE "MASTER CONTROL SYSTEM" from the GROUND UP called the "kinetic chain" which controls the rotation of the legs, hips, pelvis and spine.
Both of these "Master Control Systems" need to be in harmony for spinal and extremity stability to take place so the patient truly gets fixed.
When this happens our reputation will change with the improved results and less office visits needed to stabilize our patients.
This is taught through the Council on Extremity Adjusting through many colleges.
It really depends on the approach the doctor takes. Being a team player gets you involved with more cases however, there is still quite a bit of medical arrogance and many of the cases that we would be more effective with end up going to pt's who simple phone in it and ring up big bills for often ineffective treatment. Ask any medical assistant in a large practice and you will hear patients often return either worse after therapy or it did not really help. conversely, we are also not all the same. Some of us are better at getting results and some of us let our spinal philosphy get in the way of seeing the big picture with mechanical based problems we have to tools to master. I have few weeks where the medical disasters do not enter my office and are helped. We really need to be the best that we can be and hopefully, now that the scope and continuing manditory ed are here, we can overall improve the quality of our docs and their level of thinking as well
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