Ian A. Grassam, DC
It's probably happened to all of us at one time or another: a "moment of truth." And while the specific circumstances may vary, almost every chiropractor has encountered such a moment; mine occurred at a casual social function.
I was sitting with a group of people I had just met, chatting amiably about a wide range of subjects. We were relative strangers; none of us had met before, and the question, "What do you do for a living?" had not yet come up.
The conversation veered toward the subject of health and injuries, and I found myself on familiar ground. Although I had not yet introduced myself as a chiropractor, I mentioned how the body is a self-regulating, self-healing organism: an organism that can recover from surprisingly severe affronts, provided its self-healing capabilities aren't inhibited or interfered with.
One woman quickly agreed with me, and added that my opinion was borne out by her professional experiences as a nurse in a traditional physician's office. She was quite vocal in agreeing with virtually everything I said about healing and health, including the importance of maintaining the integrity of the nerve system. When I talked about how nerves must be maintained in a health condition for other body systems to function normally, she agreed wholeheartedly.
I did not speak of adjustments or subluxations, but from the tone of the conversation, she soon recognized that I must be some type of health care professional. When I introduced myself as a chiropractor, however, her face fell; she literally took a step backward. Our pleasant conversation quickly degenerated, because she now disagreed with almost every point I made, even those she had endorsed only minutes earlier.
I'm certainly not the first chiropractor to encounter such a situation: it has happened to practically every chiropractor who's been in practice more than a few months. I'm also certainly not the first to wonder what the profession can do to overcome such reactions.
I was recently reminded of this event during the inaugural meeting of the Alliance for Chiropractic Progress. As reported in the June 16, 1997 issue of Dynamic Chiropractic, the Alliance for Chiropractic Progress is a joint public relations effort by the International Chiropractors Association and the American Chiropractic Association. In an unprecedented display of professional unity, the ICA and the ACA have begun working together, committing $750,000 to an initial public relations campaign that will ultimately grow into a multi-million dollar effort to jointly address issues facing the profession.
The focus group research presented at that meeting was a direct extrapolation of the issues we have all faced on an individual scale many times. Our public relations issues are not so much image problems as educational problems, reflecting a widespread misunderstanding of what chiropractors can do and can claim. As most of us have learned through experience, once a patient is educated about how chiropractic works, and thus how the body works, the image problems go away.
What makes all this especially critical these days is the rapid growth of managed care and the increasing control that their gatekeepers exert over the health care choices of patients. The battle for the hearts and minds of the American consumer has just begun, with patients and potential patients targeted by HMOs, PPOs and an alphabet soup of other organizations, all eager to add subscribers while simultaneously cutting costs.
The Evolution of Dentistry -- A Model for Chiropractic?
An intriguing answer to how to better educate the public about chiropractic was suggested to me in another social setting. This time, however, my counterpart knew me well. She's a dental hygienist, and the wife of my friend, a chiropractor. These dual roles give her unique insights into the two professions. She pointed out the historical similarities between dentists and chiropractors.
Like most profound insights, her observations were deceptively simple, yet the implications were enormous. Before we examine them, however, consider the validity of her observations. The similarities are striking. Both dentistry and chiropractic are health care disciplines that are "structurally based." That is, dentists focus their training and experience on the physiology of the teeth and mouth; chiropractors focus their training and experience on the physiology of the spine.
Both professions face similar financial pressures. While dentists have always operated primarily outside the typical insurance model, chiropractors are now beginning to face a comparable challenge. As traditional fee-for-service care disappears from the scene, it is being replaced by managed care plans which limit patients' access to chiropractic care. And in both professions, when insurance is available, patients are generally subject to caps that strictly limit the amount of care and how it can be provided.
Both professions have achieved general acceptance as providers of crisis care. Dentistry was oriented to crisis care in the very beginning, designed primarily to alleviate pain, usually by just pulling the offending tooth. Later, fillings, root canals and a variety of more sophisticated therapies were introduced, but for decades the primary emphasis remained palliative, and oriented toward crisis-care. This was not the case with chiropractic. Our profession began with a broad-based approach, but over the years we allowed ourselves to be portrayed as backache doctors.
Although our histories are different, the two professions faced a similar outcome: acceptance as providers of crisis care, rather than primary care. As the Alliance for Chiropractic Progress focus groups revealed, many patients now view chiropractors as excellent providers of quick relief from pain, but do not look upon them as primary care providers.
Building on these historical similarities, my friend's wife pointed out how the dental profession's success over the years can serve as an excellent model for chiropractors.
From Toothache to Oral Hygiene -- From Backache to Spinal Hygiene
The dental profession has done an admirable job of changing their image. They have elevated the discussion from "toothaches" to "oral hygiene." In the same way, it is now time for chiropractors to elevate our image: from "backaches" to a broader area I would call "spinal hygiene."
Using the term "hygiene" opens doors of investigation, and people's minds. Conversely, using chiropractors terms closes doors, especially when used in a heavy-handed manner.
Why is this so? It is simple human nature. When we approach the public, we can seem to be "giving to get." In other words, our message is misinterpreted, and perceived to be, "I am good at what I do, therefore, spend your health care dollars with me."
On the other hand, when the consumer is first led to understand the physiology of the neurospinal anatomy and how it impacts all bodily systems, we are now educating without selling. This is that familiar situation we have all encountered, like the conversation with that nurse I described earlier.
Rather than sell, we impart knowledge. When the realization that the empowering knowledge is being brought to them by the chiropractic profession, the connection is made and future health care decisions are influenced at that moment. We become the source of knowledge and information, giving people greater control over their health care, provided they are willing to take the responsibility.
Following the Dental Precedent
The dental profession was able to change the focus from toothaches to oral hygiene and elevate their professional image because they improved their services and the dental health of their patients, and that of their patients' overall health. As any dentist will point out, disorders of the mouth, gums and teeth can have a profound impact on a wide variety of other body systems. Sound familiar?
Dentists used terminology and concepts the public readily understood and accepted, elevating their role to a preventive, hygienic model, rather than merely a palliative role. So, too, can chiropractors.
As teachers of preventive care, dentists are especially welcomed in their efforts to reach young patients: the time when lifelong oral hygiene habits are being formed. Indeed, the dental profession's partnership with schools serves as an excellent model for our profession. Dentists also garnered the support of vendors and manufacturers, including makers of toothpaste, toothbrushes, dental floss and other oral hygiene products. The power and ingenuity of these world-class marketers has had a significant incidental benefit to the dental profession: keeping the concept of oral hygiene at the front of consumer's minds. Again, there are lessons here for us.
Dental patients play a prominent role in oral hygiene. Patients are taught how and why to brush and floss to improve their oral health. This message of empowerment is familiar to any chiropractic patient. In emphasizing oral hygiene over crisis care, dentists have history on their side. After all, it the simple, steady improvements in hygiene and prevention of diseases over the years that has brought about today's unprecedented life spans.
While medical miracles and high tech interventions get much of the attention in the media, most of us seldom experience them first-hand. And even when we do, our experience generally comes near the end of life, when modern medical science prolongs life by weeks, months, or perhaps years. Also consider the day-to-day role played by the real "heroes" of modern health care: refrigerators, disinfectants, antiseptics and the many other preventive tools that contribute to improved hygiene, as opposed to crisis care.
The Challenge to Our Profession
If we accept that dentists have done an admirable job of serving their patients and enhancing their profession, the obvious question is, "How do we emulate their success?" We can draw several clear lessons from our friends in dentistry:
First, our public emphasis must clearly be educational. In this, the Alliance for Chiropractic Progress can be a valuable tool. The funds already committed, and the funds anticipated in the future, can lay the groundwork for a campaign that educates the public about what spinal hygiene is, and why it is important to overall health. The public understands how poor oral hygiene can lead to infections, fever and a host of other problems that seem unrelated to the mouth. Likewise, they can be led to understand how poor spinal hygiene can lead to apparently unrelated malfunctions and disorders in other body systems.
Like dentists, we must focus on young patients, helping them to establish good spinal hygiene habits early in life. The Ontario Chiropractic Association undertook such a project a few years ago called "Inspector Spine." We can learn much from their experience. When Ontario chiropractors attempted to enter the schools with a chiropractic model that stressed the relationship between common diseases and spinal subluxation, they were refused based on a "lack of research." On the other hand, when the program was presented as education regarding spinal function in relation to other body systems, it was accepted with enthusiasm and open arms.
There is a strong message in this experience for chiropractic. Let medicine remain the nation's recognized educator on "disease," while we become the nation's educator on "health," especially health through improved spinal function.
We must form alliances with interested groups outside the profession. As noted, the importance of oral hygiene is consistently reinforced by makers of toothpaste, toothbrushes and other dental appliances. The effort has clearly been a two-way street: manufacturers have also benefited from endorsements through the American Dental Association's "seal of approval," which certifies their products are useful in oral hygiene.
In our profession, natural allies would include mattress manufacturers, exercise equipment, nutritional supplements, orthotic devices, weight loss programs, or anything that can contribute to total body health, good spinal hygiene, and nerve system integrity.
Finally, we must continue to emphasize the role of the patient in managing spinal hygiene and overall health. This should be an easy, natural step for most of us; in fact, most chiropractors already preach this message daily. The challenge now is to take it public, and proclaim this message to a wider audience.
The formation of the Alliance for Chiropractic Progress provides us with a golden opportunity, one that may not come along again in our lifetimes. Formed as a response to the crisis of managed care and the dramatic changes in the health care delivery system, the Alliance can emerge as a powerful force for good, enhancing our profession while educating the American public and improving their lives through improved spinal hygiene.
There should be no question whether it can be done: our fellow professionals in dental care have already shown us the way. Our next step is to formulate a plan to follow their example: to bring the message of spinal hygiene to the public through a combination of high profile educational programs; cooperation and outreach to reach young audiences; alliances with groups outside the profession; and continued patient education, both one-on-one, and to mass audiences.
If we respond to the challenges of managed care in this way, we can "turn problems into opportunities," and emerge as a much stronger profession. We must ultimately look beyond our own immediate concerns, and ask ourselves what will be our legacy. I believe that the concept of spinal hygiene, and the happier, healthier lives that result from it, could be our profession's greatest gift to the world.
Ian A. Grassam, DC
Stuart, Florida
About the author: Dr. Ian Grassam, a member of the executive committee of the International Chiropractors Association, serves as the association's southern regional director, and is a member of the steering committee of the Alliance for Chiropractic Progress.
