"Have you tried chiropractic yet?" How many times have we asked that question, only to be answered with that look that says, "Thanks, but no thanks"? Unfortunately, more than 100 years after the first adjustment, chiropractic still lacks the cultural authority of traditional American medicine. Although we are gaining authority with every patient we treat, this trust has yet to permeate the American consciousness. This is primarily because our patients have come to trust chiropractic care based on the results they have received. This is what I call the "chiropractic conversion experience." While seeing results in our patients is arguably the most rewarding aspect of practicing chiropractic; it is also the best advertisement we can ask for. Our quest to gain cultural authority will be slow-going indeed, if we are to gain it one patient at a time.
Cultural Authority Defined
Before I explore how to gain cultural authority, let me first explain what cultural authority is. Cultural authority is the ability to impact public perception and influence the public, based on the perceived authority behind the person, institution or profession making the recommendation. There's your textbook definition. But what does that mean to you, the practicing physician? It basically means your opinion matters. It means you have gained widespread acceptance. It's about having a critical mass of influence in your area of expertise. I am not talking about chiropractic cultural authority on anything else but the health and wellness of human physiology, and the potential for our positive impact on the health care system.
How to Establish Cultural Authority
I don't claim to have the final word on this issue, but I do believe I can sketch a realistic route to growing our authority. It's a process that requires moving chiropractic from the realm of "conversion experiences" to the realm of common knowledge. For example, it is common knowledge that dentistry is the accepted choice when one has tooth pain; that orthopedics is the answer when one needs a broken bone set and cast; and that a cardiologist is the one to see when experiencing chest pain. There is no conversion experience or word-of-mouth advertisement involved. These specialties are accepted as the solution to specific health problems, whether or not personal experience has confirmed it. I would like chiropractic to be yet another accepted specialty in the vast arena of health care.
Today, I'm going to set the groundwork for a few ways that we can expand our cultural authority. It involves knowing what cultural authority actually is, and understanding why our efforts so far haven't made us accepted experts in American culture. In part two of this article, I'll talk about where authority comes from and how you can build it in your community.
Two Important Premises About Cultural Authority
First, we need to be aware of how cultural authority is not attained. Like respect, cultural authority is not given - it must be earned. Many DCs rely on their chiropractic degree to bring them respect in their community. This is a misguided sense of entitlement. No one owes us anything, including those patients whose lives we have changed. Patients alone aren't going to give us authority, because it's not theirs to give. As I said earlier, chiropractors build successful practices around individual patients. However, the successes of individual patients do not create widespread acceptance and reliance on chiropractic. Our cultural authority can only come through organized and focused work on a larger scale.
Which brings me to my second premise: Cultural authority is a local as well as national phenomenon. This is evident in the rights that chiropractors have won in some states that remain restricted in others. There are many places where chiropractic has earned respect for its efficacy, and just as many places where chiropractors remain on the fringes of their health care community. As I travel throughout the country, I am constantly reminded of the disparagement. While the difference in the way we practice is not so great; the political efforts that we put forth on a local level are. It is important to know that what you do in your community can improve our prospects of cultural authority, provided you are sending the right message to the right people.
Big Fish in a Small Pond
Our profession is rife with authorities whose influence does not extend beyond their little kingdoms. While this may allow them practical success, if their message is not reaching outside the chiropractic community, it is not helping in the fight to gain cultural authority. Thus, we have many techniques that have been refined again and again for the past 40 years, with blood and ink spilled in trade publications over the best application of a particular line of drive. Unfortunately, in most cases, those messages aren't reaching outside of the chiropractic community. If this information were published, peer-reviewed and intelligible to experts outside of the chiropractic community, we would gain an incredible amount of authority.
The same is true for our internal case studies, clinical trials and conference presentations. While this is positive work, it doesn't address the hierarchy of research or the importance of outside investigation to our claims. Essentially, it's the right message being delivered to the wrong ear. On the occasion that it does get us attention from the outside, we need to be prepared with a united front to bring those newcomers into the fold. What we don't want is those outside the chiropractic community to find us at war with each other, pushing our own agendas instead of seeking opportunities to expand the influence of the greater chiropractic community.
Small Fish Against the Current
For those of you who have been fighting the good fight to gain authority for chiropractic, you may feel like a small fish struggling against the current. The work to be done in the public sphere is difficult. We want to make progress and we're in the right place to do it. Without the proper tools, though, we're dead in the water. A DC trying to build rapport with general practitioners and specialists without having top-notch documentation, research or credentials is destined to fail. Without the proper documentation, DCs sometimes resort to calling attention to the deficiencies of medicine, rather than touting the efficiencies of chiropractic. This tactic will only serve to further alienate chiropractic from mainstream medicine. Instead, we must learn to swim with the current and learn how to integrate our message into the public arena.
The Bad Apples
Of course, nothing hurts our chances of establishing greater chiropractic authority more than the bad apples who bring the spotlight on our profession for doing the wrong thing. These are chiropractic hucksters, fraudulent schemers who, for obvious reasons, do us harm. The best thing we can do is hope their prosecution will deter others from ruining what good we've done, and to become a spokesperson for the good chiropractic can bring.
A few months ago, I had the opportunity to talk about the problems facing chiropractic and suggest a few ways to increase our credibility. Some suggestions included: curbing our hype, defining ourselves as a profession (not a trade) and proving ourselves in integrated health care situations. This issue of cultural authority is really just the other side of the coin, as authority is only earned by those who have credibility. Now that you understand a few of my working premises about cultural authority, I'll get into the details of how we can earn this authority in my next column. I believe our future survival as an accepted, independent health care profession depends on it.
Click here for previous articles by Arlan Fuhr, DC.