Your credibility as a doctor is conventionally based upon such qualities as competence, reputation, character, professionalism, trustworthiness, and credentials; however, do not be misled, for a diploma on your wall does not automatically confer unconditional or everlasting credibility. There was a time, not that long ago, when having earned a degree guaranteed a reliable measure of competence. This, unfortunately, is no longer true. A number of educators have suggested that today's college diploma does not generate the confidence it once enjoyed in the public mind. Just as a diploma from an accredited medical school is no guarantee that the graduate doctor will have a good bedside manner, this same kind of inference could be applied to our own profession, i.e., a diploma from an accredited chiropractic college is no longer a guarantee that the graduate doctor can administer a competent adjustment.
There are several kinds of credibility. Initial credibility precedes and acts as a basis for any referral, i.e., what a potential patient was told about you beforehand. Derived credibility pertains to what a patient discovers about you on that first visit, e.g., your attitude, values, and beliefs.
Credibility, once conferred, is not immutable. Because it is transactional in nature, it can be rescinded at any time. An indiscrete act or an unethical remark could easily invalidate previously assigned credibility. Conversely, initially low credibility can be either erased or elevated by eliminating a patient's symptoms.
From the moment you put out your shingle, your credibility in the community is activated. Do you look like a doctor, act like a doctor, speak like a doctor? Does your office look professional? These and countless other verbal and nonverbal characteristics act as the building blocks of your credibility. To repeat, credibility is an earned distinction -- not one conferred by ink marks on a piece of paper.
Let us now assume that you share an office with another doctor or that you are a member of a chiropractic group. Is your credibility transferable? What if you had to be out of your office for a few days and your patients were treated by an associate? Would your credibility be reinforced or jeopardized by the other doctor? It is essential that your therapeutic routine be afforded the utmost respect. The other doctor should be admonished to follow your treatment procedure as closely as possible. So as to avoid the possibility of any misunderstanding about the patient's condition or treatment, a minimum of conversation is advisable.
Beyond personal credibility, there is the credibility of the entire chiropractic profession. Surely, you have heard the remark, "Once you start going to chiropractors, they keep you coming for the rest of your life." Where do people get such ideas? Is our professional credibility in jeopardy? Perhaps, we had best think very clearly about the role each of us plays in the course, character, and outcome of our collective credibility. Every patient we treat carries an impression of us, individually, and of the profession as a whole.
Credibility cannot be switched off and on. It requires a constant vigilance. Each patient has family, friends, and acquaintances; hence, your credibility could be discredited with lightning speed. People talk.
Our collective credibility is presently on the line. In previous litigation involving members of our profession, chiropractic testimony carried little or no credibility. The courts commonly deferred to orthopedic opinion. This deference by the courts is known as the "halo effect"; i.e., an expert in one field is automatically taken to be an expert in another field. Today, things have changed, for in matters involving chiropractic, the courts are now soliciting chiropractic expert witnesses, not orthopedic.
Earlier, I mentioned that credibility was not restricted to people. Our profession reaches a great many people via the printed word. Dynamic Chiropractic, alone, has a readership of 64,981. Then there are other journals, periodicals, magazines, and books being generated by the profession. Each is assigned a degree of credibility by its subscribers and critics. What criteria are being used to judge them? Are the types of advertisements they carry used as indicators? Might a researcher from another discipline look for experimental design, appropriate terminology, proper citation format, conventional instrumentation?
Each profession uses field-specific criteria to judge credibility. For example, when the Chiropractic Institute of New York applied for certification by the State of New York back in the '60s, an on site inspection disclosed that its library had an insufficient number of volumes. Because there were no other accredited chiropractic colleges in the state at the time, they had no basis for comparison. So, they used one of the leading medical school's library as a standard. In this way, the institute's credibility was impugned and accreditation was denied.
The famous communicologist, Marshall McLuhan, argued that we now live in a global village; information travels around the world in seconds. An individual's credibility can sustain world-wide discredit by a single television expose. Exploitations in medicine involving adverse drug reactions, unnecessary surgeries, ethical misconduct, and Medicare/Medicaid abuses have done serious damage to its professional image over the past four decades. In short, the presence of a mass media has made every profession's credibility more vulnerable than ever before.
What I have attempted to demonstrate here is that the credibility of chiropractic as a whole is often judged by its parts. As chiropractic becomes more acceptable as a bona fide branch of the healing arts, each and every one of us has become more visible. When a chiropractor in one state is found guilty of a crime, we all, figuratively, share the guilt. Professional survival depends upon credibility.
Abne M. Eisenberg, D.C., Ph.D.
Croton On Hudson, New York