Poisoning the Well

I've heard a story about a guy who goes up to every attractive woman he sees and asks bluntly in explicit language, "Do you want to have sex?" He notes that this method consistently results (for him, at least) in two outcomes: He gets slapped, kicked, hit and has drinks, food and other objects thrown at his face; and he also has a new partner every day he uses this approach. For him, this is a very successful marketing method. The rejection and pain is ablated by the single success each night. He notes that persistence is the key because he only needs one success despite many rejections.

Employing this "marketing method," there are only two outcomes in his mind: success or failure. But, if he looks outside himself, the truth is that there are a number of other outcomes. He only sees the implication of his actions in terms of what the outcome is for him; he lacks the empathy or vision to see what this abuse of women does to the women. He also doesn't really care, because the ultimate "success" of this method reinforces and encourages his behavior. If he weren't persistent, thus failing to have sex more often, he might be more likely to see what this treatment of women does to the women.

These women, whom he has treated with such disrespect, are most probably hurt by his method. It is even possible that the hurt can be so profound as to affect their interactions with other men. Thus, the detritus of his successful "pick-up" technique is a wake of women who distrust all men. One might say that he has poisoned the well after drinking his fill for those who come after. He has made it so those men after him have to prove themselves not to be pigs first and then maybe they can be seen as good guys.

I believe an analogous situation occurs in our profession with some of the methods that some DCs employ to attract new patients; that is, a doctor uses a method to attract new patients that successfully increases his income, but he has no idea or may not even care how it poisons the well, leaving the profession if not the professional worse off. These doctors might be responsible for the negative opinion people have about the ethics of the chiropractic profession - in a survey conducted a few years ago, only 31 percent rated our profession as having high or very high ethics and honesty.¹ There is a moral shortsightedness to the effects of these methods. That shortsightedness might be due to high debt load, or one's philosophy or greed. Here are a couple of examples of questionable marketing tactics that might be poisoning the well for the rest of us:

• I know a doctor who was a member of an organization that took up a collection for the family of a member who had died recently and unexpectedly. A bunch of members stood up with offers of cash. This doctor offered to donate one half of all money received from members of the club who became new patients. I know the doctor thought that this was altruistic, however, some of my patients who were there said that many members of the club they had talked to were appalled that he was trying to increase his business by using sympathy for the deceased individual's family. Of course, he also got new patients from this, so the negative impressions of his actions were transparent to him, but I heard some state that his actions represented poor ethical standards of chiropractic.
• There have been doctors at a huge outdoor fair, here in Connecticut, with a booth offering free adjustments. I have asked my ethics classes over the years what they thought about this. There are those who think it is a good marketing idea. In fact, one student worked at the booth and said how wonderful it was, because 25 people who had never experienced the wonders of chiropractic were now chiropractic patients.

However, the unknown is, while 25 became patients, did 100,000 others decide that chiropractors were snake oil salesmen? Was this booth all good? The student who worked at the booth said, "Sure, it's OK to turn off 100,000 as long as 25 are now subluxation-free." How long can the profession survive if, for every 25 new patients, 100,000 are turned off completely?

If one does a Google search for "chiropractic" and "fraud," one will find many cases of chiropractors charged or convicted of insurance fraud, especially related to personal injury. Of course, a search for "medicine" and "fraud" would yield similar results, but this isn't a column on medical ethics. Think about those doctors who ran "PI mills" and who had "runners" getting them patients. What impact do the stories about a doctor's arrest have on the public's perception of chiropractic?

I could go on and on about the various practice-building methods that the public views as unethical. We know that they work, but what is the cost to the reputation of our entire profession? This is the reason large corporations do market research. Such research has shown that advertisements hurt our public image in the eyes of the majority.² So, while some of these marketing methods might increase sales in the short run and thus, help the profession, they probably pollute the well in the long run and harm the profession.

References

1. CNN/USA Today/Gallup Poll, Nov. 14-16, 2003.
2. Moser HR, Johns HE, Kitrell LM. How consumers view chiropractic advertising. Health Mark Q 1995;13(2):43-54.