How the World Sees Us

Each of us has a self-perception, but doctors' perceptions of the work they do may not be shared by those around them: colleagues, patients, friends and foes. That self-perception impacts us and our profession. It stands in juxtaposition to the perceptions of others who define us in their own terms. The result: a generational perspective of chiropractic.

On occasion, a self-perception is in accord with how others perceive us, but some self-perceptions are distorted and unrealistic. The self-perception of a flaw may be debilitating to an individual, but that flaw may not even be visible to you and me.

Recently, there was an article in the Archives of Internal Medicine by Kaptchuk and Eisenberg: Chiropractic: Origins, Controversies and Contributions, Nov. 9, 1998, vol. 158, pp. 2215-2224. It offered chiropractors a reality check on how the world perceives us. This particular example is interesting because it comes from the ranks of our traditional adversaries in health care.

How many chiropractors would think to advance to the outside world the idea that "Chiropractors have maintained a unified profession with an uninterrupted commitment to clinical care"? I fear few chiropractors would feel confident or even honest about making such an assertion. Yet that is how we are perceived by Kaptchuk and Eisenberg, and that is how we have been reflected to the world of internal medicine.

The conclusions of the authors become stronger. Consider if you will: "Yet, despite external conflicts and perhaps partly because of them, and despite the intraprofessional disagreements and uncertainty about its scope of practice, chiropractic has found an internal coherence that has allowed it to become an enduring presence in the United States."

It gets even better! Kaptchuk and Eisenberg offer yet another observation about our circumstances when they note, "Adjusting with the hands -- the signature chiropractic gesture -- is the unifying activity that allows chiropractic to transcend its internal discord and create a coherent profession."

"Unified profession" and "internal coherence" are not the phrases I hear when dealing with my colleagues in education, or even in the discussions with the leaders of our professional associations. Our unity or coherence is never applauded. The adjustment is never the focus of our discussions; it is never acknowledged as eloquently and as simply as "the signature chiropractic gesture!"

Is it our sense of isolation that has caused us to fail to see these attributes in our own profession that are so readily noted by outsiders? Could it be that other professions have an equal or greater amount of internal conflict than us, and that we simply are unaware of the realities of their world? Could it be that the adjustment is a transcendent act for us?

Like the pretty woman who sees herself as ugly because of a flaw others would not even see, have we become so self-absorbed that we have lost sight of our beauty, contribution and impact?

I like the idea of being seen as offering the world a "unified profession," not homogenous, but unified. I like the idea of presenting the world with a sense of "internal coherence." After all, our goal as clinicians is to provide our care in such a way that it leads to a state of "internal coherence" in the lives and circumstances of our patients. And I love the idea of the chiropractic adjustment being identified as the "signature chiropractic gesture."

Kaptchuk and Eisenberg are absolutely correct that the adjustment represents a transcendent act to this profession. It is what separates and defines us from all of health care. It has been the sole and singular intervention we can point to with unquestioned clinical supremacy and universal public awareness. It is the one "thing" in our world about which we can establish a baseline and from which we can move toward the 21st century.

Our view of ourselves as a "unified profession" offering a clinical approach characterized by "internal coherence" might be well served by our individual and collective attention to the "signature chiropractic gesture." In this time of managed care, changing delivery environments and shifting public expectations of health care, we might return to the basics -- the delivery of the adjustment -- as a curative element for our professional woes as well as our patients' ills.

The widespread recognition of the effectiveness and clinical utility of what chiropractors do has caused some to embrace us and others to embrace our methods. Our prior rights are clear; our future rights will be assured only by our ability to be the most effective, efficient and knowledgeable about our "signature gesture." The market will purchase the service. If we are the most effective provider, they will come to us, otherwise the market will turn to another party. Our unity and internal coherence will depend on our continuing recognition of and attention to what has brought us from the 19th to the 21st century -- our signature gesture.