Horror Stories: Don’t Be That Guy

Chiropractic is a phenomenal healing science.  It’s also an art.  (Repeat after me: it’s a science first; art and philosophy tie for distant second.  But I digress.)

I know there are a bunch of disillusioned naysayers who failed in practice (most likely because they also fail in personality and possibly other attributes as well).  They’ve even set up their own little boys’ club-like internet discussion forums devoted solely to sitting around blaming chiropractic itself for the doctors’ inability to succeed.  Rest assured that as critical as I am of certain practitioners and philosophies, I’m not one of those people.

However, sometimes this Eeyore camp raises some damn good points.

And sometimes, these points are thorns in the chirovangelist’s ribs.

Going through school, the DC-vs-MD sentiment was alive and well, bordering on downright hostility toward anything having to do with conventional medicine, even going so far as to imply that conventional medicine was hardly necessary and served little purpose.  We were told that our profession had not advanced much because we were being “held down” by the medical profession and its unfair bias.  If we’re not successful, it’s their fault.  They pass legislation, they attack us, and they hold us down, keeping us from achieving success and prosperity.

Don’t believe it for a second.

The reason we see a so-called 6-12% of the population has much less to do with medical bias than with some of the stunts we pull from within.
Consumer Reports ran an article on Complementary and Alternative Medicine circa the mid-2000s, stating that 25% of the population had visited a DC at least once.  If we were collectively that miraculous and wonderful, we would’ve not only retained most of that 25%, but we would’ve also gotten the other 75% through referrals, for at least one visit.  What this means, simplistically, is that instead of gaining and retaining patients, we are effectively losing 19% of the population.  We’re keeping only about a quarter of those who try us out, and we’re not growing.

The truth is, chiropractic itself IS that miraculous and wonderful, but we end up sabotaging ourselves.  To put it bluntly, we resort to stupidity.

Horror Story #1: Who in their right minds would adjust someone while intoxicated?  Well, that’s what happened to a lady I talked to at the large state fair of a large state while manning a health-related booth.  Given my profession, I was shocked she gave me the time of day, especially as she began to tell her story.  At a casino in the southwest, a DC she sat next to at a poker table offered to adjust her.  At first she said no, but of course with drinks in their systems, he kept on and she finally gave in.  In summary, he ended up severely injuring her and apparently he knew it, because overnight, he packed up, left down, and disappeared.  For every “chiropractors cause stroke” lie plastered across a city bus in Connecticut that we must rally against and after which we must follow up with damage control, there’s someone in the Deep South walking around with a story like that, willing (rightfully) to tell anyone.

Horror Story #2: Or what about one of our patients, whose picture of her in a gown was taken not only without her consent, but against her stated wishes?  She’d had good luck with DCs before, so naturally, after being involved in a car wreck over the weekend, a DC’s office was her first stop Monday morning.  During the x-ray shot, she was gowned, as is standard procedure.  However, during the shot, the doc walked in and prepared to take a picture of some bruising, using his iPhone.  She objected, knowing that smart phones are connected to the internet and are frequently used to access social networking sites and online photo albums.  She knew that in a split second, this photo could be sent anywhere, to anyone, out of her hands.  At first, the DC respected her wishes but then moved in quickly to snap the picture without warning, against her wishes, a few minutes later.  Understandably feeling violated and betrayed, this person ended up in our office the following day, vowing never to go back to the previous doc.  Luckily, her positive chiropractic experience from before that incident prompted her to write off this experience as an unfortunate fluke and she decided to give chiropractic another chance.

Horror Story #3 and beyond: Sometimes it’s not such a blatant, extreme violation.  Most of us wouldn’t ever dream of carrying out the stories above.  But what about those of us who deliver the same treatment to every patient?  Or continue delivering the same treatment, despite a lack of results?  How many of us write it off, brush it off, explain it away, justify it, or come up with some vague unscientific excuse?  Do we justify adverse reactions as “normal” each time without actually investigating the cause or explaining it to our patients?  Do we accept adverse reactions without ever changing our treatment plan or technique?

Apparently we have a few issues.  Our collective diagnostic skills blow.   We fail to construct quality differential diagnosis lists, and we fail to effectively rule a condition in or out.  This is because we also fail to substantiate or back up what we think we might see.  And sometimes, we don’t even do enough to detect findings in the first place; in many instances, our physical exams are grossly incomplete and haphazard–if we do them at all.  Word to the wise: Subluxation Stations and their competitive counterparts do not “count” as a physical exam.  They are not diagnostic and they are too easily influenced by the practitioner, and thus their results mean exactly zilch.

We also don’t rank high in the ethics or honesty department.  Obviously, the Credeur fiasco was mostly unjustified.  He was an easy target – practicing something largely unknown by the mainstream, expressing some revolutionary ideas, and charging a lot of money for it–which he is completely entitled to do (but it still made him an easy target).

That aside, Houston, we have a problem when only 36% of the population thinks we’re honest and ethical.  And how does that happen?  It starts with the 3- and 4-day report of findings processes, the poorly-taken x-rays, the practice management company scripts, the evangelistic preaching, the religious overtones, the year-o’-care plans, the large sums upfront (for future services, as opposed to services rendered up front), the dubious exam methods, the high-pressure sales tactics, the unfounded claims, the vehement anti-medicine stance, you get the picture.

I would venture to say that we do at least as much damage to ourselves than we endure from any outside entity.  It seems as though everywhere I turn, we’re shooting ourselves in the foot.  Whether it’s a refusal to get with the times, a reluctance to conduct research, a neglect to investigate a patient’s persistent problem, the tendency to forget academic material and resort to technician-based activities and mindset, or the inclination to use simplistic, outdated, and incorrect concepts during patient education.

If you’re taking offense to this, chances are it applies to you.  If it applies to you, you are indeed part of the problem.  I encourage you to resist getting mad at me; I didn’t create the problem, and instead, I’m offering a very viable solution.  I know that reforming the profession means spending considerable time and effort (and sometimes money) in making new plans, as well as carrying them out.  But, look at it this way – if you haven’t been 100% squeaky clean (in your diagnosis, care, treatment plans, documentation, research), you’ve been skimping and skating, putting in too little time and effort, for probably quite some time now.  It’s time to rise to the challenge and play catch-up.  You owe it to yourself, your profession, and undoubtedly most importantly: your patients.

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