Five Arguments For the Rejection of Chiropractic
by William D. Esteb
With the recent flurry of media attention chiropractic is receiving you'd think there would be a line out in front of most chiropractor's offices. But in fact, many offices report their new patient statistics are down. How come?
Those who claim that the television reports and magazine articles have not been positive enough don't understand how the media works. Actually, to the average viewer or reader, the message has been relatively even handed. Sure, chiropractors hate being relegated to the narrow field of neuromuscularskeletal specialists, but that is the entry point for today's health care consumer. In another generation, if we play our cards right, that may change. Think of
neuromuscularskeletal as the camel in the old Arabic parable that states, "once the camel's nose is under the tent flap, you can't keep the camel out."
Approaching the general public with the message of the innate healing capacity of each individual and the often wayward character of the educated mind, is not going to win chiropractic a lot of friends. Take the inroads where you can find them! Find a tent flap and push!
Yet even with the welcomed publicity (did they spell our name right?), chiropractic has a long row to hoe to gain the acceptance and utilization most chiropractic doctors dream of. While I'm hopeful, real breakthroughs are unlikely for many years ahead. I hope history proves me wrong, however here are five reasons I'd cite for my lack of optimism:
1. Chiropractic is too low tech. Chiropractic doesn't have the buttons, dials, and digital readouts our culture has become so enamored with. The religion of scientism that dominates our world today (if you can't touch it, taste it, see it, measure it, etc. it doesn't exist) works against the concept that we are each responsible for our own healing. What do you mean doctors and drugs don't heal the body? The prevailing mechanistic world view makes embracing the holistic chiropractic approach seem primitive and cultish.
Interestingly, at the higher levels of physics where the laws of quantum mechanics are being explored, there is a new respect for the mind/body connection; even the power of thought. Researchers are finding relationships between how they "think" a high energy particle beam experiment will turn out is affecting the results of their experiment. Watch out what for what you wish--you may just get it! Until these and other similar observations become mainstream, chiropractic cannot expect to be embraced by the logical, rational, mechanistic keepers of public opinion.
Action steps: Until the world is ready to mend the dichotomy between brain and body, consider collecting a brief synopsis of various research projects. Get a copy of the New Zealand report and highlight important passages for your patients. Subscribe to David Chapman Smith's reports on legal and scientific issues. Have key paragraphs enlarged and posted on a bulletin board reserved for scientific topics. Invest in more technology. Digitized X-rays, EMG, and other forms of technology are often perceived by patients as evidence of "accuracy" and make recommendations more believable. The key is to help your current patients understand the "scientific" nature of chiropractic so they can more successfully combat the attitudes of their friends and family outside your office. Attitude adjustment by communication warfare!
2. Chiropractic lacks instant gratification. Madison Avenue recognizes that when we get a headache, we want "fast, fast relief." The latest products and services advertise the characteristics of "instant", "quick dissolving formula", "microwavable", and "non-stop service". Time is of the essence. If it isn't fast it must be old. Apparently fast is perceived as stronger, newer, and better.
When chiropractors warn their patients that their problem may actually get worse before it gets better, it flies in the face of this prevailing sensitivity to time. When chiropractors explain that it takes time to heal the body, in fact, certain chronic conditions in adults may require a lifetime of maintenance care to prevent a relapse, it runs counter to a patient's desire for instant gratification.
Action steps: Avoid long waits in your office by more efficient procedures, or at least in the minimum, keep the line moving, even if it's just to another part of your office. Stress patient education. Use a series of progressive examinations to help patients see small increments of progress during the healing process. Ask them what they can do or have been doing that they hadn't been able to before beginning chiropractic care. Ask patients how long they think it takes to heal a broken bone or heal damaged muscle tissue. Remind patients that the long-term aspect of chiropractic care is not the fault of chiropractic, it is the result of the "time clock" of their own body. Place a calendar in your report of findings room for a year or two in the future. "You're probably wondering why I have next year's calendar hanging in my office. It's because many of the patients I'm seeing this year won't start enjoying the real benefits of regular chiropractic until then. The reason for that is because..."
3. Chiropractic is difficult to explain. This may be more problematical than the other reasons because it is dependent upon each practitioner to accomplish. Even offices that smugly report that they use patient education videos, new patient orientation lectures, and a bulging pamphlet rack lack effective patient education. Of course, the litmus test is to ask your patients, "How do you describe what goes on in our office to others?" The answers you hear, even from your best patients, may depress you if you're brave enough to ask. If your best patients can't adequately describe chiropractic, get busy! Since drug companies won't and national chiropractic associations aren't providing leadership in this area, it's the responsibility of every doctor.
And it's not just because most patients find it difficult to put the terms "adjustment" and "subluxation" into street language an 8th grader can understand (you try it!). If you were to ask someone on the street what's more important: the heart or the nervous system, nine times out of ten they'll say heart! Check out a typical hospital. Do you think neurologists or brain surgeons rule the roost? No. It's the cardiac boys! The heart specialists are always getting the latest high-tech equipment. Open heart surgery is a real money-maker for most hospitals.
The problem isn't just priorities. It's communications. When patients go to the dentist they can easily describe to others what happened. When patients show up at the hospital for outpatient surgery, they can return home and show others their stitches and explain what happened and why.
Not so with chiropractic. Poor posture, except the most obvious, is rarely noticed by the general public. Poor spinal biomechanics are hidden from view, unlike poor dental health. When orthodontic appliances are purchased, we get to display our financial ability to others--orthodontic braces for adults are the new status symbol. Not so with chiropractic. Your patients are walking the streets and no one can tell they've been to your office.
Action steps: Obviously patient education is the key. Rather than a wordy, total oral report of findings, start using more pictures. Bring artifacts into your office so patients can see the barnacles on a rock and rusty antique hinge (subluxation degeneration). Put a dimmer switch in the room where you give your report of findings. Make more of your patient education effort experiential. Patients aren't reading your wordy brochures. They're not remembering the eloquent words spoken during your report. Use pictures.
4. Chiropractic has a poor public image. Although many chiropractors have lost touch with some of the prevailing attitudes about chiropractic, the profession and it's practitioners still have a tarnished public image. Being perceived as an "alternative" non-mainstream healing "art", with its bearded, charismatic, and uneducated-white-leather-plaid-polyester "doctors" is a severe handicap. Rarely does today's chiropractic student choose chiropractic because they couldn't get into medical school, yet the stigma of being less than a "real" doctor remains. The image of chiropractic is a serious fault at a time when the "quality" of a product or service is often more important than the price. Many of us willingly pay extra for brand name products.
This creates a damaging form of peer pressure in which many of your patients, even those who get great results from your care, are unwilling to divulge to others that they consulted your office. These are the same people who at home, pour less expensive scotch into their expensive brand name bottle and announce to the world on their license plate that "my other car is a BMW". Image and style has become substance. Being associated with an "alternative healing art" is a reflection of poor judgment or the lack of financial resources. The "chiropractic underground" continues to thrive.
Those who argue that this attitude is changing are right. Disappointment with the medical model and an avoidance of drugs and surgery are helping attract patients to chiropractic. Yet for many, they aren't necessarily "voting" for chiropractic, they are simply voting against medicine.
Action steps: Explain to your patients the decision-making process you went through when deciding to become a chiropractic doctor. Then, set a good example in everything you say and do. Current patients and potential patients in your community are watching your actions, studying your habits, analyzing the decisions you make, and judging your appearance. Avoid short-term promotional strategies that sabotage your professional stature. Since changing these perceptions of chiropractic should start in your office, ask each patient "what do you think the general public's biggest misconception about chiropractic is?" Since they won't be able to consult the latest Gallup poll, their answer is most likely going to be what their own biggest misconception is. "And how do you explain to others that that misconception is inaccurate?" you ask as a follow up question. Make sure your own patients can properly defend the misconceptions they encounter. Make your patients more resourceful should the opportunity to mention, explain, or defend chiropractic presents itself in their sphere of influence.
5. Chiropractic is expensive. While it's true countless research studies indicate that chiropractic care is more effective and less expensive than other forms of care for similar conditions, this information is lost on the general public. Influenced heavily by the insurance industry, most chiropractic doctors have fashioned a fee policy in the upper limits of what this sickness care industry will pay. Suddenly we have adjustments costing as much as $25, $35, $45, or higher, depending upon where you practice. If only one or two adjustment were needed, this probably would fly. But when prospective patients learn that months or years of repeated visits are needed (once you start going you have to go for the rest of your life), the perceived cost of care becomes a major limiting factor.
Today, as the insurance industry crumbles, this is an even more important concern. If after every $45 adjustment the patient saw radical physiological changes in their body; a "tingling" that lasted for days or at least hours afterwards--no problem. But after the first few visits, the effect is more subtle. Sure, there are those who will continue their care for the rest of their lives because "it feels good", but this is a small part of your practice.
Setting a fee structure that is responsive to the budget constraints of today's economic realities is a major challenge for most doctors. This is especially difficult for doctors and staff who get their care without impact to their monthly budget to understand.
Action steps: Become more resourceful in the presentation of your financial policies by having more organized options to offer. Perhaps develop a case management fee (as long as you don't imply cure) and a wellness fee arrangement (unlimited wellness care for a fixed monthly fee). Brainstorm what you'd change if tomorrow all insurance coverage for chiropractic was rescinded in your state. Start making changes now!
You can't afford the luxury to take a single new patient for granted. Patients bold enough to try chiropractic are often doing so based on the encouragement of a trusted friend or the patient education efforts of someone you haven't even met. They're desperate. They're afraid. And they're bucking the establishment. Many are coming to your office with misgivings and questioning their own judgment. If you have relatives who still don't accept, understand, or respect what you do, then you understand how many of these new patients are suffering.
Buy the book
My Report of Findings
Originally published in 1993
240 Pages
US $24.95
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