(Editor's note: In the last issue, Dr. Wilk was the first of the five chiropractic leaders you voted for to express his vision for "Our Virtual Chiropractic Association." In this issue, it is Dr. Guy Riekeman's turn. Each of the five doctors will be highlighted on the front page - one per issue. Their order of appearance is based on the chronology in which we received their articles. Dr. Christopher Kent will appear in the next issue.
For years I've read an article about a guy who drives up to one of the 17 tollbooths on the San Francisco Bay Bridge. Inside the tollbooth is a young man who's playing loud music and dancing. The exchange goes something like this:
"What are you doing?" the driver asks.
"I'm having a party," responds the tollbooth manager.
"What about the rest of these people?" the driver demands, pointing out the other tollbooths with cars backed up.
"They're not invited. What do these look like to you?" the tollbooth operator asks, pointing down the row of tollbooths.
"Like tollbooths. What do they look like to you?"
"Vertical coffins, and I can prove it. Every morning, live people get in them, and they die for eight hours. Then, like Lazarus from the dead, they re-emerge and go home. For eight hours their brains are on hold. They're dead on the job; they're only going through the motions."
"But why is it different for you? Aren't you bored, too?"
"I don't understand why anybody would think my job is boring. I have a corner office, glass on all sides. The view is great: the Golden Gate Bridge, San Francisco, and the Berkeley hills. Half the western world vacations here. I just stroll in every day and practice dancing. It's wonderful!"
This toll taker has always meant a great deal to me because I draw three lessons from him:
Lesson One: You Can't Determine Who or What Is Going to Show up at Your Tollbooth
Who could have predicted or planned most of what occurs in our lives? Did Nelson Mandela envision spending three decades in a South African jail? Did the Dalai Lama plan to be an expatriate? Did B.J.or Drs. Reaver and Wilk relish the medical opposition they encountered? And who would have predicted that in one year I would be named the president of Palmer, and that in the next year a medical error would take my daughter, Alexis?
Lesson Two: You Can't Determine How People Will React to You as They Wait for Their Receipt and Change
Chiropractic is gaining public acceptance at a rate not even imagined 20 or 30 years ago. When my father graduated in 1948, there was no thought of insurance coverage, government funding of research, student loans, inclusion in the Armed Forces or on government health commissions. Yet today, we have all of these. This year Palmer received almost five million dollars in commitments from the federal government to expand its research facilities and build a new library/learning resources center. And while we will match this with almost $10 million, it was the first time a chiropractic school had ever been specifically named in a line item in the national budget.
Have chiropractic principles changed dramatically in the last 40 years, or has the public changed as they rolled up to our tollbooth? It's clear from Eisenberg's statistics at Harvard that the quantity of yearly visits to "alternative" practitioners has far surpassed those to medical doctors. We haven't changed our principles, but society's reaction is sure different today.
Lesson Three: While I Can't Control Who Appears at My Tollbooth or Their Response to Me, I Can Control What My Behavior Is Going to Be
Will we choose to be involved, work with excellence, hold to our core values, plan for leadership roles in health care, have a common voice, enhance our schools, and support our future practitioners? These are the questions posed to our profession. The answers, however, are not dictated to us. We get to choose our behaviors. But how do we come together as a young and developing profession, while respecting differences of opinion and scope of practice realities?
Palmer is a model for this professional dialogue. We haven't found the perfect solutions, but we have designed the rules of engagement. Here is what we have done to bring a broad spectrum of people and diverse independent thought to the same table to enhance individuals, the institution, the profession and the future.
Step One: Agree on a Common Vision
At Palmer, we spent almost two years creating four "givens" or "visions" that would guide our efforts:
Vision One (see diagram): We agreed that the philosophy of Palmer (chiropractic) stated that the body was an intelligent adapting organism that was self-healing and self-maintaining. We also recognized that patients and chiropractors use chiropractic care for conditions, nonsymptomatic health care and lifetime family wellness/development care. We agreed our students must be prepared to practice all three. Finally, at the core of our clinical care is the subluxation. This does not restrict other modalities; it just defines what is unique and at the forefront of the chiropractor/patient relationship. Vision Two: We set an expectation that in education, clinics, student services and business affairs, we would function with excellence.
Vision Three: We committed that our relationships would be based on open dialogues and integrity. This implies a high degree of tolerance of personal views, intellectual openness to idea, and trust.
Vision Four: We made a pact to creatively reinvent the future of Palmer and the profession. Implicit in this process is letting go of past injustices and ways of doing "business."
These four visions were followed by strategies resulting in projects that have enlivened the Palmer community of students, faculty, staff, alumni and administrators, and have propelled us into a growth/expansion mode unparalleled in many decades. Examples of this growth include: a $28 million expansion of the campus; a new innovative curriculum; a new campus in Port Orange, Florida; an increase of $10 million in endowment; the joining of Palmer and Palmer West; a potential new campus at Palmer West; expanding our research facility by 400 percent; a planned museum for chiropractic; the creation of the Lyceum (the largest gathering of chiropractors in the last two years), and our largest new student classes in five years.
Step Two: Learn How to Take the Best from Each Other
We knew we needed everyone to accomplish our dreams. As long as they agreed with the four visions, there was a vital role for everyone to play, a common language and accountability for our commitments. Look at our leadership and you will discover the following:
president - Palmer graduate
vice president for academic affairs - LACC graduate
vice president for clinical affairs - Western States graduate
vice president for student services - non-DC
director of research - Palmer West graduate
director of alumni - Palmer graduate
Need I say more? Our issue is not about unity to discover if it would increase impact (we know we need each other); it is about working toward common goals with a common set of beliefs and values.
Step Three: Make People/Profession Big
My mentor, Walt Disney, had this sign over his door: "Make People Big." We can focus on the pettiness of our profession, or on its glorious history, its coming of age and, most importantly, its impact on the lives of patients. We need to do more research about subluxation and patient results, but we can't let this developing arena be used by HMOs to limit optimum patient care. We need to be guided by our vision and make our politics serve our principles, not compromise them to accomplish our political endeavors. We must make patient concerns our primary focus, even above our own concerns. From a patient who gains relief from life-altering headaches in California, to a four-year-old child who walks for the first time in Brazil; for the AIDS patient whose CD4 counts increase; and the asymptomatic family who's maintaining health with regular chiropractic, these are our reasons for being. Let's not forget what made us great these last 105 years!
Making the profession big means translating the "big idea" into something the general public can understand and embrace. We need to market chiropractic intensely to the general public, which will bring more patients into our offices and have a significant positive impact on the health of people around the world. The profession needs to figure out a way to define chiropractic and market it to the public in a big way. We need to figure out how to increase not only market share, but share of mind, too.
Step Four: Involvement
We are all members of a profession that should be asking how involved its members are. I believe there are four levels of involvement that denote higher levels of social consciousness:
Level 1: "It's not my issue or responsibility." This is the person who sees a crime committed and walks away. This level is represented by the "NO-C.A." segment of our profession, (those that belong to neither of the two most powerful chiropractic groups: the ICA and ACA).
Level 2: "I'll get someone else to do it." This is the "policeman" mentality. In the profession, for example, we pay our dues to ICA and ACA, but expect them to "get it done."
Level 3: "I'll be part of regulating myself and my peers." This level implies that my actions and the behavior of others affect us all. I'll be responsible for how I live and will hold others accountable to a professional standard.
Level 4: "I'll do the right thing just because it's right." This self-regulation is a moral commitment that surpasses legal or professional rules. The bottom line is that a profession that is not involved will be run over by others.
Step Five: Leadership
For too long our educational, political and professional organizations have engaged in a dictatorial/autocratic leadership model that gained ground by suppressing those of other thought. It hasn't worked. We must move to a model of moral leadership in which we lead by example. We have the "ACC Paradigm" that most major chiropractic organizations have adopted. Yet we still go to Washington, D.C., and legislate chiropractic without the terminology and scope (subluxation) as defined by our agreed-upon document. This is incongruent. We must learn to translate our statements into congruent actions and take the moral ground versus the expedient or compromised road.
The old health care system has collapsed and is being recreated. We are equipped and, perhaps, destined to lead this revolution. History will judge whether we rose to the challenge. As Lech Walesa wrote:
"There will come a time, which I won't see, when narrow (human) problems have been brushed aside, replaced by harmony and peace over our entire planet, and I expect that our children or our children's children will then be able to sing another, more positive song. Until that time, we have work to do."
Guy Riekeman,DC
President, Palmer College of Chiropractic, and Palmer College of Chiropractic West
