There was some recent news that roused my curiosity, because it had to do with what seemed to be the destruction of a long-established industry supermarket - more specifically, Winn-Dixie, a mostly southern grocery chain once ranked among the most profitable in the nation.
Winn-Dixie recently filed for bankruptcy court protection and is expected to close a number of its 920 stores.
Apparently, the entire supermarket industry is struggling today, and the future is very uncertain for many huge chains that had previously seemed unstoppable. This trend is not only happening in the food industry; many well-established companies of the past have fallen by the wayside. The May Company's problems and the recent Sears/K-Mart merger are other clear signs of the changing and challenging times facing many long-established companies.
Financial analysts say the supermarket industry is just beginning a decline as the $550 billion supermarket world takes "one-two" punches from consumers. Further analysis has determined that those "supermarket brands" in the middle of the spectrum are really in serious trouble. Competition from the low end of the market (e.g., Wal-Mart Supercenters) and the high, trend-setting end of the market (e.g., Whole Foods) has virtually wiped away the segment of the competition that lacked a distinctive identity. We're not talking here about small mom-and-pop stores on the brink of collapse, but such substantial corporations as Penn Traffic (about 100 stores in Pennsylvania) and Eagle Food Centers (which also filed for bankruptcy protection in 2003).
David Orgel, editor of Supermarket News, made an interesting observation: "If your only goal is to be lower in price than Wal-Mart, you don't have much of a future."
Deeper review of Winn Dixie's plight suggests that the store had a stodgy image. Other chains had virtually no image, or the image they had was out-of-sync with the consumers they were serving.
Advice to the supermarket chains from industry experts includes:
In our generation of mass marketing, mass communications and mass consumer movement, a supplier of goods or services must decide what part of the market it desires (and is best suited) to tap, and how it is going to present itself. Image and identity are important.
What an interesting parallel for chiropractic! What our profession can learn from retailing today is there are two strong places to be in marketing ... either at the bottom merchandising price, or at the top-selling quality and service. The consumer doesn't have much interest in the hazy, lazy, hard-to-identify middle ground.
Fortunately, there has been some interest generated on this very subject of late. Recent articles have appeared in the chiropractic press concerning the identity conferences of the World Federation of Chiropractic (WFC). There have been two international meetings, which culminated in a survey sent to thousands of chiropractors around the world. The results represented by a statistically significant number of practitioners seemed to confirm the profession's interest in agreeing upon a common identity. The results of this survey suggest where the practitioner is relative to his or her view of the "image" of chiropractic, and what the practitioner thinks the public image of chiropractic is. (You can view the findings of this survey at www.wfc.org.) The entire WFC Congress will discuss and vote on the identity issues at its Sydney, Australia meeting in June 2005.
The Campaign for Chiropractic is a new public relations effort designed to foster a positive image for the profession, and is the brainchild of Kent Greenawalt of Foot Levelers, Inc. Mr. Greenawalt launched this campaign after recognizing that all previous studies addressing the question of "What is the public image of chiropractic?" had come to startlingly similar conclusions. Thus, this new campaign is intended to overcome the "outdated," "obsolete," "archaic," "ill-defined" and often implicitly charlatan imagery the profession currently suffers in the minds of the public.
Finally, a recent study by the Institute for Alternative Futures (IAF) updated its 1998 exhaustive study on the future of chiropractic. The latest findings can be viewed by visiting the IAF Web site (www.altfutures.com). This is a must read for every practitioner because it provides insight into the future possibilities for chiropractic. Viewing these resources, we can ask what lesson we can learn from the recent litany of middle-of-the-road supermarket bankruptcies.
Editor's note: We reported on the IAF survey, The Future of Chiropractic Revisited: 2005 to 2015, in the March 12, 2005 issue. To read the full article, visit www.chiroweb.com/archives/23/06/13.html.
The supermarkets had no identifiable image, and thus the public had no attachment or connection to the "value" of the supermarkets. The grocery chains became little more than a commodity in the minds of the public. When competitors came along to steal the market's "high end" (e.g., Whole Foods) or "low end" (e.g., Wal-Mart), there was no place for these valueless supermarkets to go. Well, guess what? They went bankrupt!
They did not carve out a niche, as the industry analysts had advised, and in the minds of the public, they didn't represent a "value-added proposition." There simply was no identity the public could link to these middle-of-the-road entities. They were neither high-end value nor low-end bargain price. So, the public did what the public does ... it simply did not patronize these companies.
Meanwhile, the chiropractic profession has been stumbling along for many years with a tarnished image, a confusing image or no image. The AMA's long-standing conspiracy worked its magic upon the profession by painting chiropractors as unscientific cultists, frauds and quacks. The "lingering effects" of political medicine's conspiracy are felt even today, more than 15 years after Judge Getzendanner handed down her ruling in the Wilk case and more than 40 years after the AMA established its Committee on Quackery.
During the same period, chiropractors have continued to fuel these negative images by attracting headline-grabbing stories of fraud and abuse schemes in dealing with insurance companies and other third-party payers. The not-so-subconscious message here for all to see, including legislators, is "watch out for chiropractors - they cannot be trusted."
Still other images disseminated by the profession have often been confusing or internally inconsistent. Many messages we place in various newspaper, radio and television advertisements have no valid research to back them up. Our public rhetoric all too frequently offers unsubstantiated claims for the clinical art or misrepresents legitimate research. Many of our ads shout about economic gain for the practitioner or border on the metaphysical - and the list of offen-sive imagery, from the silly to the egregiously unethical, goes on and on. Somehow we fail to recognize that these collective messages form the basis for public perceptions of chiropractic. Can anyone blame the public for being confused about or disenchanted with us? Unless and until we offer a coherent message that captures the moral high ground, is readily understood by the public and fits with its expectations, and is routinely reinforced by the individual doctor, we should expect continuing disappointment in the public arena.
The care and treatment of back pain patients is one important area of chiropractic imagery that the public can, will and does understand. Pain is the reason many people seek care from a doctor. Back pain, neck pain and spinal pain are all related topics, and the chiropractic profession currently has a huge advantage over any other group in claiming these areas as its "niche" - a niche to which the public can readily relate. Patient satisfaction surveys of our specialized care for these disorders repeatedly speak to the credibility of our services in this niche.
However, we face an enormous challenge as we move into the 21st century, and the window of opportunity we currently enjoy may not remain open indefinitely. Many other provider groups have begun to lay claim to our previously uncontested zone of expertise. How will we differentiate ourselves from this huge crowd of similar-service providers?
Perhaps we can take a lesson from Winn Dixie and recognize that the huge, undifferentiated middle is not the place to be ... not for grocery stores, and not for chiropractic. Establishing the uniqueness and special competence of the chiropractor in the minds of the public will make the critical difference between a bountiful profession vs. one teetering on bankruptcy; a financial ruin caused not by a lack of value of our services, but by our failure to establish our own unique brand. Our success (or lack of success) in establishing a credible, coherent, ethical identity in the minds of the consumer is the only and final arbiter of market share. Regardless of what we claim to be, unless our image is congruent with public perceptions - our customers - nothing else matters.
So, here is the challenge: Listen, at long last, to the PR experts, rather than to our fantasies about who we are and what we do. If we wish to establish a successful identity for ourselves, we must let the new image of chiropractic evolve from the data gleaned from the studies, surveys, research and focus groups.
The public needs our services. We need to convey our revised message to the people before they stop visiting us and before they opt to visit those other groups - high-end and low-end providers who will fill our niche if we squander it. Some in our profession may believe the bottom is the place to be ("We adjust you deeper and cheaper"). I do not happen to share that position in the health care marketplace. As I view it, there is only one secure place for chiropractic, and that is at the top, stressing quality and service.
I hope the next chapter in our history will not be chapter 7 or 11 ... both are losers.
Louis Sportelli, DC
Palmerton, Pennsylvania
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
Spearheaded by burgeoning scientific and clinical research literature, psychedelics have reached a level of media coverage and popular interest that has not been seen for over half a century. By “psychedelics,” we are referring to the unique class of substances that includes psilocybin (the active compound found in so-called “magic mushrooms”), LSD, dimethyltryptamine (DMT), ayahuasca, 5-MeO-DMT, and mescaline – each of which occurs in the natural world (except for LSD, which is a semi-synthetic compound).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
