In a few weeks it will be Christmas. Thoughts naturally go to presents and shopping, food and family, and the joys of the season. For a few days, this hectic holiday activity will temporarily help to diffuse those challenges we have been subject to all during the year.I have a clear idea of one gift for which the profession collectively - and perhaps each individual within the profession - might think about asking, and hopefully receive, as we begin a new year filled with hopes and dreams, fears and anguish, and a sense of uncertainty. That gift for which I am hoping is revealed at the end of this article, I promise.
There is no denying it; our attitudes about everything are changing so rapidly that we have become desensitized and, almost worse yet, oblivious to what is happening around us. From politics to porn, from crime to careers, from the media to the military, our attitudes are impacted with an intensity never before experienced.
Last year, a sleepy little Amish community in Pennsylvania (about 20 miles from where I live) was shaken to the roots with a strange, bizarre assassination-type homicide. The media maniacally converged on this sleepy little town like a tsunami and that community will be forever transformed because of the zeal of the media to SHOW ALL, TELL ALL and BE ALL. And by all means, do whatever it takes to get an exclusive even if it means human feelings are ignored and privacy is trampled. More recently, there have been Columbine-type incidents in half a dozen schools and colleges around the country and again, the media has maniacally descended on these communities with unrelenting fervor. More celebrated cases such as Anna Nicole Smith and O.J. Simpson's self-proclaimed sting operation also received more than their share of obsessive 24/7 around-the-clock coverage.
I point this out to demonstrate the power of the media and the ubiquitous nature of the "press," as well as the realization that this same power of the press is unleashed when a DC does something that is bizarre and unprofessional. The entire world knows about it in a nanosecond and there it remains on the Internet in some blog for a lifetime.
We are less than a year away from the elections (Thank God the political pundits will be gone. Can I say God and elections in the same sentence?) Anyway, as you already know, the political arena has gotten as dirty and personal as it has ever been.
I am continually amazed by the speed in which communications are transmitted, such that we are virtually unable to synthesize the information into meaningful data, much less to take proper time to reflect on the consequences. That is why there are so many "READY-FIRE-AIM" scenarios occurring. There simply is no time to adequately process the data.
A number of years ago in a bestselling book, Megatrends, author John Naisbett dealt with the attitudes of changes in our society. He noted that the accurate information which was reported in the daily newspapers, and more importantly, what was left out of the same space in those newspapers the following day, was a key to obtaining accurate information and determining trends. Death tolls, commonly reported in hometown newspapers, were more accurate than government or military statistics. It was the inclusions and omissions in those newspapers over time that revealed societal trends. It's an old book now, but the concepts still are relevant and it is a worthwhile read.
If the chiropractic profession was sensitive to trends, we could perhaps stay on the "cutting edge" of changes taking place in our society. We could capitalize on changes in the health care delivery system and a host of other issues and attitudes from politics, media, research and consumers which affect our profession. Historically, chiropractic always seems to zig when we should zag; we litigate when we should negotiate; we openly criticize in public when we should professionally discuss in private; we condone certain behavior when we should condemn the process and the list of inappropriate behavior goes on.
Recent books such as Blink, Tipping Point, Freakonomics, Hard Facts- Dangerous Half Truths & Other Nonsense, provide us with some excellent concepts about which to think as chiropractic begins to develop its strategy for the 21st century. Where is that tipping point when people will be demanding chiropractic as an alternative to a surgical disc replacement? Where is that tipping point where policymakers begin to analyze cost-savings rather than curtailing spending? Where is that tipping point when we begin to view each other as colleagues rather than competitors? Where is that tipping point where we desire a sense of belonging rather than crave isolation?
As I travel (which I might add is getting more difficult with the new regulations of three ounces of liquid - no, not the little alcohol bottles - and one small carry-on), evidence of frustration from travelers is high. Not to mention inconveniences, which have become standard since 9/11. No driving up to the airport entrance to pick up passengers, elderly passengers struggling to carry bags to the airport curbside, even able-bodied people have trouble getting through security. The attitude of the TSAs seems to lack care or concern. Curbside luggage attendants are surly, cranky, irritable and downright rude and ticket-counter employees are overworked and frustrated. Customer service at its finest.
I stand in line and often reflect on what has happened over the past few years. Remember when you could drive to the curb of every airport in America and drop off your passengers and luggage? Remember when you didn't have to go through the "security checkpoint" and put your luggage on the conveyor belt to be X-rayed, hear some loud voice - "Off with your shoes," "Hold your boarding pass," "Show your ID" and then show it again five feet from where you just showed it? Remember when you did not have to turn on your computer to show the security guard that it was not an incendiary (nice word for bomb) device? When you could take a remote-control toy home for your grandchild and not have it confiscated as a weapon? Remember when you could go to Washington, D.C., and not see barricades in front of the White House and go into courthouses and public buildings without "Checkpoint Charlie?" I feel as if I should get a piece of cheese after I go through the maze of ropes, while "Disney World" people control barricades before I get to the check-in counter.
How about a convenience store or gas station or elevator or hotel lobby without cameras monitoring every move you make all in the name of safety? I do think we need some of these things today, but you all have been through this and it does create and fuel anxiety. Each of these little intrusions into our personal freedoms is an example of the systematic erosion of a quality of life which collectively will be felt and manifest as "stress" knowingly or unknowingly on each and every one of us; more importantly, on our patients! Are we, as a health care profession, recognizing this trend? Are we positioning chiropractic as a natural stress eliminator?
It's not a leap of logic that with all of these daily stressors imposed and inflicted on our minds and bodies, my thoughts would turn to our national health care system. Those practitioners who have been around and practiced in the early '80s truly remember "freedom of practice." You also fondly remember the economics of that time. Unlike the old phrase, "If you remember the '60s, you weren't there," if you remember the '80s, you long to return to those days when health care was essentially unregulated. Without a doubt, the '80s was a time of economic windfall for every segment of health care delivery - a time which, by its very nature, created the trend that we and others should have seen coming but didn't.
I remember that wonderful era as "freedom of practice" translated to "freedom of choice," which in most states, was won by the chiropractic profession from the '50s to the '70s in an effort to gain licensure, equality in health insurance and freedom to practice within our scope.
In the early '90s, along came "the 9/11 of health care," the initiative we now know as managed care! This was a trend we should have seen, should have understood and should have prepared for. This health care phenomenon has done essentially to every provider and every patient, the same kind of systematic removal of freedoms for which we fought in the '50s, '60s and '70s, except by the time managed care was recognized for what it was, this monster acted with impunity, speed and often reckless disregard for the consequences in human terms. It's here, so how do we deal with it?
Managed care has eroded our patients' freedom to choose their doctor. Patients, employers, providers and governments were forced by economic pressure to capitulate to the newly formed managed-care organizations in an effort to curtail the escalating costs of health care. You, the doctor, were denied the freedom to treat your patient with the care and concern that clinical necessity dictated. Your patients were denied the freedom to choose you as their provider and employers were denied the freedom to select a plan they wanted because of cost. In the end, this monster descended upon the country and now we have the luxury of viewing this paradigm shift in health care from a rearview mirror. Everyone is screaming "HELP" and there appears to be little in the way of halting the momentum of reform(s) which has escalated under the guise of "cost containment." These reforms collectively impose severe restrictions on patients and practitioners, employers and payers. What to do about it?
Well, my ramblings are but observations designed not necessarily to bring about answers, but to bring about awareness. To cause each of us to step back a moment and realize the enormity of the problems facing society, our government regulators and each of us, every day. In the end, this experiment of managed care failed - largely because of greed and reckless disregard to accept responsibility - but it resulted from a knee-jerk recoil to an unbridled system out of control.
A new model is emerging, and while we may not have managed care as we knew it in the '90s, we will never again have care that is not managed in some fashion. The new model and buzz words are: patient empowerment, best practices, outcomes measure, pay for performance, guidelines, evidence-based medicine and on and on. With all of this going on around us, and at a time when our interest and determination should be at an all-time high, we have apathy at the most pervasive level I have ever seen in my 46 years of practice.
What kind of an image are we projecting as doctors of chiropractic? More importantly, is it the kind of image we want? Is it an image of unity - professionalism, caring and ethical behavior - or does it fall considerably short of those wonderful and lofty attributes?
Chiropractic has proven itself to be very satisfying to patients for a myriad of reasons. Chiropractic is cost-effective, but we must validate that concept with solid data to support what every rational chiropractor knows instinctively. Chiropractic care has been demonstrated to provide a cost-shifting to occur because people utilizing chiropractic care have reported less hospitalization, less pharmaceutical use, less disability and a higher satisfaction with quality-of-life issues. Again, these concepts are well-known empirically, but now need to be validated with solid, defensible data. The advent of the baby boomers and the escalation of health care costs are out of control. The facts make it imperative to document these concepts.
One of the greatest challenges in health care is the fact that all three parties in the mix - the patients, the doctors and the health plans - rarely interact at the same time. Therefore, what each is doing and why, becomes something of a mystery to the others.
The health care industry wants to solve this problem and calls its efforts "transparency." It looks good on paper, but it's hard to put into practice because conflicting interests and agendas become obstacles to honest discourse and dialogue, and as a result, understanding is compromised. The patient is confused by the process, the provider is angered by the process, the government is driven to act on the issue, the payers are resisting efforts to alter their contracts and ultimately no one is happy with the process.
To compound the problem, we now have state associations and national associations warring in public with manifestos on who is to blame. We have charges that something could have or should have been done by someone to prevent GM or Wal-Mart from excluding chiropractic from their contracts. We have others who want to mandate "mergers" as if merging for merging's sake is the answer or will solve anything. We have national associations and state associations doing their best with limited resources and limited membership, while others sit back and complain. We have hearings and meetings and fundraising events and political rallies ... and nobody comes! We have functions where chiropractors are invited and not only do they not have the courtesy to send in an RSVP, they don't come even if they sent in a reply. We have requests for political action committee funds and our total dollars to contribute is embarrassing to publish, much less to become an effective force for political reform. We complain that our presidential candidates do not have a position on chiropractic. Why should they? What makes chiropractic compelling enough to want to take notice? We are rapidly becoming invisible.
In one word - participation is the key! Chiropractic collectively is small in numbers. Even if 100 percent of the profession participated, it still would be a small number, but when less than 5 percent of the entire profession participates in membership, political fund-raising, attendance at meetings and conventions, responds to any solicitation or makes any effort to help our colleges or organizations remain strong and viable, what can the only consequence of this profession-wide terminal apathy result in?
Chiropractic always has survived on patient satisfaction and that satisfaction largely was due to the encounter between the DC and the patient. The time spent building that marvelous thing we called pa-tient rapport - that communication connection that we now know is perhaps as responsible for initiating or not initiating a malpractice allegation.
So in the end, it's not about philosophy, it's not about discrimination, it's not about oppression, but rather about vision and leadership. Chiropractic needs to create the desire! We all know that everyone "NEEDS" chiropractic care, we must make people "WANT" chiropractic care. The objective for our profession should be to create that want! How do we do that? People are looking for quality today. Are we giving it to them?
- Are we projecting the image of true health care professionals?
- If not, what kind of image are we projecting?
- Is our image clear or confusing?
- Is our image consistent with the changing image of society?
- Is our "believability index" matching that of the public?
As a profession, we need to begin to consider that term we have heard over and over for decades - cultural authority - and we must begin to build it, one practitioner at a time, one encounter at a time.
So my Christmas wish this year is to wish for that magical present I will call an "antidote for apathy." A wish for each and every doctor of chiropractic, when they open their "Antidote for Apathy" present this year is to stop for a moment and make a New Year's resolution. That resolution need not be something huge. Just a small commitment to do something: Make one meeting, contribute to one cause, participate in one event, attend one function or join one group.
If every DC in America did that, we would begin to rebuild that esprit de corps that made our profession great in the early part of the 20th century. That transition from competitor to colleague, which makes all the difference in attitude and cooperation. That "knowing" feeling one gets when we deliver that right adjustment, and what better time to experience that "miracle" of professional satisfaction than this very special holiday season? I wish everyone the best Christmas and hopefully these holidays will be special and allow a time for reflection on the state of our profession and what we can individually do to help. Apathy is the cause. Participation is the cure!
Maybe in 2008 we can and will do something about it.
Click here for previous articles by Louis Sportelli, DC.