I will begin by congratulating the ACA, NCMIC, California Chiropractic Association, and the Consortium for Chiropractic Research for having the vision to see the need for outcome assessments. Involving the chiropractic profession in the essential process of studying one of the main aspects of our therapeutic intervention, which is the spinal adjustment, shows a recognition of today's needs based on today's issues. The demands placed upon all health providers today by government, third-party payers, managed care purchasers, the ultimate end-users, and the consumers of health care services, makes this project essential. They want to know how effective the treatment proposed by their doctor is, in their particular condition.
Today's consumer is knowledgeable and much more sophisticated than the consumer of yesteryear. The public will no longer stand back silently and watch health care costs soar. The public is not satisfied with limited reimbursement and mediocre therapeutic benefits. They are demanding that there be a change. Therefore, the chiropractic profession must be prepared to play "catch up."
The profession must develop "standards of care" or "practice guidelines" in order to meet the ever-increasing demands of scientific scrutiny and peer review. It must be done by impartial research, in which the objective is not to prove chiropractic "works," or medicine doesn't "work," but rather what procedure works best and which provider renders that service in the most efficient, cost-effective, and therapeutically effective manner. The AMA has no more power in this process than the chiropractic profession. The knife will cut equally as hard against the medical community to curtail costly hi-tech procedures with limited value. The outcome assessments will provide the evidence and that will be the basis of a redirection toward those procedures that can show valid, demonstrable outcomes.
If I had to select one area to which I would direct our energies, it would be to enhance the personal image of the DC and the collective image of the profession. My objective would be to build a better knowledge of chiropractic benefits with the consumer and a better working relationship with the medical community.
This is not to say that there still is not medical opposition to chiropractic. But this new decade needs to be fought not with confrontational debates about what the AMA did 30 years ago, but rather on the basis of current research which validates the therapeutic effectiveness of the chiropractic spinal manipulation for a variety of conditions. And we need to go even one step farther: to dare to say that chiropractic spinal manipulation is better than all the conventional treatment provided previously.
We need to enter this image-building decade with a new war to fight, a war which we can win by claiming superiority with demonstrable proof, rather than anecdotal evidence. The war of image today needs to be fought not in the courtroom or in the TV studio dredging up old war stories, and showing old battle scars that have no relevance in the '90s, but with the new weapons of imagery -- modern public relations approaches that enhance the stature of the chiropractic profession.
Our task is to cause consumers and decision makers to perceive chiropractic physicians as well as educated health care professionals, well-versed in the literature, knowledgeable about the best approach to the conditions best suited to chiropractic care, and conscientious members of the health care team and the community. We must give consumers confidence that the chiropractor is a responsible doctor, capable of providing effective assistance for their health care needs. Not a miracle man, not someone claiming to cure anything and everything, not a huckster -- but rather a qualified, reliable practitioner with the best interests of the patient at heart.
Additionally, the image of the profession collectively must be "cleaned up" by a massive effort of the individual DC. If I had my wish, the first thing to go would be the Yellow Pages of every telephone book in the USA. Somewhere between chimney sweeps and Christian Scientists, the chiropractic section of the Yellow Pages looks like a cross between a flea market and a discount department store. Free this and free that, with a coupon worth $100 toward your next spinal overhaul. If we were to take a few steps back and look at the Yellow Page's advertisements and newspaper promotions, we would have to admit that they rival the worst of the tactics employed by used car and aluminum siding entrepreneurs. Is it any wonder we are considered to be either glorified "givers of free service" or "specialists in chronic and difficult cases."
I would ask DCs to view some of their ads, maybe their own, and be honest: Would a sane, serious-thinking person select a health care professional that conveyed that kind of carnival, discount, bargain-basement image? No wonder chiropractors often draw last resort patients, many of whom are not loyal, and some of whom unfortunately are easy set-ups for con artists and big-buck schemes.
The next 10 years will be a challenge to upgrade the image of the individual DC, which was destroyed by decades of second class citizen propaganda. More than a challenge, it is going to be a necessity. To correct the image problem, however, we must employ methods that are highly professional. The message must portray a discipline that is thoughtful, concerned, caring, honest, ethical, effective, and professional.
The vision in my mind of chiropractic as a profession is certainly not one which would relegate the profession to the role of acute back strain technician. Certainly that role would eliminate any dispute with other health care disciplines. They would gladly reimburse for the "single service" concept and willingly permit the doctor of chiropractic to be a subservient, limited provider with limited scope and limited ability. No, the vision I have for this great profession lies in validating through future research the impact that spinal manipulation has on the total human health potential. I see chiropractic in the future exploring such areas as the body's immune response to spinal manipulation, enzyme changes due to spinal nerve irritation, the role of the cervical spine in headaches and vertigo, cardiovascular effects of spinal nerve irritation, and the ultimate effect upon health that a new "wellness" model of chiropractic will provide. I see us making a strong place for ourselves by proving our value, our benefits, and our worth. That's something that no one, not even the AMA with its power and money, can overcome.
The easy road for chiropractic will be to succumb to the path offering the least resistance and immediate acceptance. We can do this and continue to fight skirmishes as second class citizens or we can develop the type of profession and the type of image we should have -- strong, secure, confident, and well-recognized.
It is the next decade which will decide the ultimate fate for this profession. We have enough brains to meet the challenges of research, government, and the consuming public. The question is, do we have the commitment of the entire profession to have the collective vision of where we want to go. In today's communications-heavy society, one unethical, controversial, or heavy-handed DC on major TV, radio, or newspaper can destroy many years of image building by a group with a desire to remain professional.
Chiropractic has made a quantum leap in the past few years from a public perception of faith healer and cultist, to a scientifically based clinician. We should be proud. We have gone from "how to get into the system," to "what have you to offer as a player?" We have gone from the media seeking advice about chiropractic from the AMA, to the media seeking our input as to why medical procedures are not effective within our specialized domain. We have gone from no researchers 30 years ago, to a rapidly developing cadre of chiropractically-based researchers. We have gone from no inclusion to full inclusion, but also unfortunately to the possibility of once again being excluded from participating in the process unless we measure up to new criteria.
In closing, my vision would be to see every member of this profession pay a fair share by belonging to the ACA which would afford the national organization the dollars needed to continue forging new frontiers and going where chiropractic has never gone before. ACA membership is no longer a "nice thing" if you can afford it. It is a "survival thing" which you must afford in order for your profession to progress. It is as important to your practice as your adjusting table, maybe even more.
If my project for the state of tomorrow have any merit, it will not be brains alone that will do it, but vision. As Proverbs 29:18 states so well: "Where there is no vision, the people perish." Those men and women in our profession with the vision to see the invisible, to achieve the unthinkable, and to conquer the impossible, will be the hope for our profession's future.
We can never look into the future with eyes of fear. Rather we must look with eyes of optimistic expectation toward the next 10 years as our decade to grow, mature, and flourish as the health care profession that provides the safest, most conservative, most effective health care procedure in the world.
Louis Sportelli, D.C.
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