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Dynamic Chiropractic – September 1, 1992, Vol. 10, Issue 18

Enforcing Ethics, Quality, and Standards of Care

By Chester Wilk, DC

In recent months, chiropractors have received some bad press in some states. The scenario goes something like this: First, some abusive practices occur on the part of a few chiropractors, whether it be overutilization, fraudulent misrepresentation, or some other questionable practices.

Second, the entire profession gets tainted, particularly if the investigative reporters on the story find out that the state chiropractic organization is involved, because it didn't do what they thought it should have done. Finally, the legislature overreacts by passing restrictive legislation, and the chiropractic profession and its patients suffer.

In one state where chiropractors got into trouble, the legislature added insult to injury by requiring that if a patient needs more than the maximum allowable treatments, that they will need a letter from an MD indicating that additional treatments are necessary.

No group of doctors is without offenders and chiropractors are no exception. But, as a minority group, we need to be better because of unfortunate double standards in health care. For example, some MDs may get exposed for improper professional conduct and the public reacts saying, "An MD got into trouble" and the matter closes. The medical profession doesn't have to get permission from chiropractors to treat patients. No one thinks less of the medical profession. If a chiropractor does the same thing then the message will be that chiropracTIC is in trouble. If a pharmaceutical house gets involved in a scandal, the company may fire the employee or employees and the entire industry is spared the bad press. This seems to be human nature; its not fair, but then no one ever said life was always fair.

On the other hand, patients can try 10 different MDs for an ailment and if they don't receive help they will try an 11th one. They will simply say, "I just haven't found the right MD who can help me." But, if they go to one chiropractor and don't get results, the patients will say, "We tried chiropracTIC and it didn't help me." They are much less likely to try another chiropractor, even though the approach to healing varies with chiropractors, and they should try someone else.

Every so often there is a scandal involving hospitals, drugs, and surgery, yet it is confined to the institution or doctor. Part of the solution for chiropractic lies in getting better public education so it does not generalize or characterize the entire profession. This is just another strong case for why we need to become much more media oriented.

A top priority in every state chiropractic association should be establishing a nationally standardized code of ethics, quality, and standard of care, then having the commitment to enforce it thoroughly. This may provoke outcries from some chiropractors who will rationalize that is "brother against brother" and that we should live and let live, but this is pure nonsense. For a state association to look the other way and ignore illegal conduct within its ranks is to become guilty of a conspiracy of silence. It would, in effect, be getting in bed with the prostitute.

We are living in an era of "investigative reporting." Reporters within the media are always looking for that special story in which they can make a name for themselves. These reporters are not "for" or "against" you or anyone else. They are looking out for themselves and the more sensational or spectacular they can make the story, the better they look; and if you happen to fall on the negative side of the story that becomes your problem. Our job is to take away any ammunition that they can use against us. Failure to recognize this situation or assertively enforce the ethics standard will invite a recurrence of what has happened in these other states.

Chiropractic has become an adult profession and the public expects adult behavior from an adult. When our profession was a young and growing upstart and we dirtied our pants it wasn't news, but now that we are adults it is intolerable. It brings to mind the story of about how the higher up a monkey gets up a flagpole, the more exposed is its bottom. As we move up the flagpole, we better keep our bottoms clean, or some enterprising investigative reporter will most assuredly bring it into public attention.

We can learn a lesson from the McDonald's hamburger chain who is at the top of that proverbial flagpole. There are thousands of investigative reporters that would love to get something on the McDonald's chain. Their fame and fortune would be made. But McDonald's is much too smart to ever allow this to happen by running a much "tighter ship" than any state of federal regulations on food handling. As we grow, and continue to grow in stature and in numbers, it is a natural requirement that we place upon ourselves or pay the consequences.

States keep a profile on how many chiropractic adjustments it takes to correct different ailments. They keep these profiles for many years and they can predict from their files just how many treatments it takes on an average to correct specific ailments. Let's say that the state's records show that in 1980 it took an average of eight and one-half treatments to correct a specific ailment, and that it cost $200. Let's further suppose that in 1991 it takes an average of 40 treatments to correct the same type of ailment and now the tab is thousands of dollars. This tells us that there are two possibilities. First, that the quality of care has gone down and the profession had better return back to its old and more effective methods, or second, and more insidious, that there are exploitations and unnecessary treatments being given. We can argue the case that we are more prevention-oriented but the state only understands the basic statistics -- the number of treatments it took and the cost it took to remove the symptoms. This is why establishing a standardized quality of care and standard of care is so critical and deserves top priority.

Besides running a "clean" organization, we must utilize the public relations tactic of telling the radio, TV, and the newspapers that we are acting in an honorable and exemplary fashion. We should send letters to the Department of Registration, attorney general, insurance companies, legislators, and other interested parties. Make sure we keep copies of every letter that was sent so that if a problem should arise with a member it cannot reflect on the entire organization. If the state's attorney's office is negligent in not doing its job, then the chiropractic organization can properly assess the responsibility on the state and not our organization. Hence, besides running a clean operation, it is only smart public relations to brag about it and document it.

Click here for previous articles by Chester Wilk, DC.

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