If you have been following this column, you will recall an initial article that addressed "signs of the times." That was followed by a discussion of cultural authority. In the last article, we examined matters associated with "critical mass" and the chiropractic profession. In this article, I would like to review the benefits and consequences of having achieved critical mass.
The background on this matter involves the concept of the "100th monkey" by Keyes, Naisbitt's discussion of the introduction of a new idea or product into our culture, and Eisenberg's data regarding the percentage of the population that routinely uses the services of a chiropractor. When these perspectives are assimilated and examined in the light of our present circumstances, we soon realize that Eisenberg indicated approximately 11% of our population were regulars when it came to chiropractic care; Naisbitt suggested that market penetration of 11-15% was necessary to achieve introduction of an idea or concept; and Keyes outlined a phenomenon that occurred when these levels were approached or achieved.
If we make the assumption that we have achieved critical mass, then we must be aware that a number of things need to be updated in our minds, as they have already been updated in the public's mind.
At this point in time, we are a part of the fabric of American society and a part of the fabric of American health care. We need to give up the "outsider" perspective and role and adopt an "insider" attitude and viewpoint. The public views us as a part of health care, even though they are largely unaware of the details of our relationship with managed care and other health delivery system realities of the day, let alone the politics of health care. As a result, when we wear these issues on our sleeves and separate ourselves from health care, we look foolish in the eyes of the public and we leave them scratching their heads.
If you have been around the profession for more than a decade, you will be able to relate more readily to the change in public understanding. A decade or more ago, we had to argue for our very existence. We were required to defend every word we said and every action we took. Today, we see a different reality. We have achieved a level of public, social and cultural recognition that exceeds our belief about where the public sees us. As a result, the public very often views us as more accepted than we view ourselves. Our failure to recognize and adapt to this reality can cause us to look and sound foolish.
Let me offer you some examples of the public's acknowledgement of us and our role. Remember the "20/20" TV piece from a few years ago? It aired on a Friday night and on Monday morning you had a patient or two that was cautious and sensitized due to the segment; but in an almost overwhelming fashion, patients' comments were along the lines of, "Did you see that crap on TV last Friday?" Why? Because the producers were making a pre-critical mass argument in a post-critical mass environment. It didn't work. They were the ones that came off looking silly and foolish.
Think back a few decades and consider how much common sexist and racist humor was in our day-to-day lives. It still exists, but it is neither funny nor acceptable anymore. Remember the comedian Foster Brooks? We howled at him as a drunk. You don't see him anymore because he isn't funny now. Those attempts at humor were the dying remnants of pre-critical mass thinking in each of the social areas involved.
Similarly, we are going through a comparable transition. It isn't in vogue to attack chiropractic any longer. The worth of our care has been established and the public understands that we have value in the health care market. Go back through your files and dig up a few older articles about chiropractic. You will note that the person who was asked to comment on chiropractic was the orthopedic surgeon. Today, the person commenting on chiropractic is the chiropractor. The requisite comment from the MD is there, but rather than being the lead comment, it is buried in the closing paragraphs.
The nature of comedy and entertainment related to chiropractic has changed significantly as well. Beginning with "Jacob's Ladder," where in the allegory presented, the chiropractor represented God, to less striking comedic references, on simple fact is being evidenced. The humor is related to funny things about chiropractic care and not about making fun of chiropractic. Again, this change is very significant in the public's understanding of us and what we do.
The post-critical mass reality of our circumstances can be evidenced in the ties being drawn to the profession from other areas. Consider how references to chiropractic have been worked into everyday advertising for products completely unrelated to chiropractic care. From high-end automobiles to fishing wire, we have seen appropriate references to chiropractic in advertising circles. This should tell us something important. Major automobile manufacturers do not advertise on a whim. They study their market and they study the ties they bring into their advertising and how those ties impact their target market. They have a reasonably accurate grasp of the thinking of the American public. For chiropractic references to be used as they have been, it means the advertisers understand we have reached critical mass. They understand we are in the public's favor and they want to make the tie in the public mind.
Let me offer you an example of a pre-critical mass reaction versus a post-critical mass response. A number of months ago, the Department of Health and Human Services (HHS), through the Bureau of Health Professions (BHP), decided it would be a good thing to publish the names, addresses and colleges of those persons who defaulted on HEAL loans. When this occurred, there were newspaper articles, radio and television interviews regarding the defaults. Life West was contacted by a local TV station that wanted to interview someone about the matter. I agreed to the interview.
The question posed was, "Why are there higher default rates among chiropractic graduates?" I proceeded into a two-step, razzle-dazzle discussion of how the program was set up, how it was based on a medical model of education and training, how the licensing sequence differed from other disciplines, the lack of residencies, etc. It was okay, nothing great, but nothing totally embarrassing. Later, I saw Dr. Williams of Life University address the same question. His response was short, to the point and irrefutable. "It's damned embarrassing. We need to do better." Dr. Williams gave a post-critical mass answer; I gave a pre-critical mass answer. What is there to say after an answer like he gave? The follow-ups to mine could have been endless, based on the issues I raised and the doors I opened.
Please do not think that based on these ideas, I am of the opinion that we have arrived, a red carpet has been rolled out for us, and our traditional enemies have awakened to the error of their earlier views or anything of the kind. The challenges before us stand to be greater than ever in the past. Let me relate something my father once told me. He explained that when you owe someone a little money, you are a pest or annoyance, but when you owe someone a great deal of money, you are a partner, a stakeholder -- silent or vocal, desired or not -- you are a partner!
The days are behind us when our enemies or detractors could simply dismiss us as an annoyance or as pests. The public recognizes us as a "stakeholder" in the world of health care. We need to see ourselves as "partners" in the effort, albeit minority partners. This status means the general partner is going to do all it can to hold its position and we will need to do all that we can to enhance ours. Being a partner does not mean being shy, reticent or weak about your views. It means you have a right to the views, you have the right to vocally express them in course of day-to-day events, and most importantly, it means you have the base from which to begin to offer another view, a dissenting view without being disregarded as inconsequential.
The profession must understand clearly what the public knows on an innate level about us, what we do and how we can help them. When we are in concert with them, they will begin to resonate with our thoughts and our thinking. They want something other than the status quo. They intuitively understand the weakness of the model of health care under which they were raised and they are looking for allies in the pursuit of a new style and approach to health care. We can provide it as long as we will make the move to a post-critical mass understanding within our own ranks.
One of the exciting spinoffs of this position deals with the effect of doubt or discord when a concept or subject has been fully culturally integrated and accepted. It works in reverse. An 11-15% amount of doubt begins to set in motion the public's will to dismantle a widely accepted practice or belief. More about that next time!
Gerard Clum, DC
President, Life Chiropractic College West
San Lorenzo, California
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