Making the Best Better

You have heard the old saying, "If it isn't broken, don't fix it!" This is not bad conventional wisdom, but I am told that in the Orient, the saying is, "If it isn't broken, make it perfect."

I like the second way better. It suggests that one should always strive for improvement. The chiropractic profession should always do the same, and it is to that end that I often express my opinions.

Chiropractors frequently say that this is the best profession in the world. We are emotionally attached to what we do, and that is part of what makes us better doctors than some. That same emotion however can tend to blind us to the need for professional progress. It can blind us to the potential changes which could, in my estimation, cause millions of people who do not now use our services to see our profession in a different light.

A profession is defined as, "A body of qualified persons of any specific occupation or field." Professionalism is defined as, professional status, methods, character or standards." It is generally accepted in our society that those who are members of a profession will meet a higher level of accomplishment than those who are not members of a profession in areas such as education, knowledge, public decorum, objectivity, and dedication. It is also anticipated that professionals will generally deserve a higher level of compensation than those who are not considered to be in the same category.

How do we measure up as a profession? To answer that question, one must define the parameters. Using the criteria for professionalism mentioned in the previous paragraph, let us take a closer look while we remember that people see us as a group, but they also identify the group by the actions of its members.

1. Education: As we look at ourselves, we must remember that comparison is inevitable. We do not exist in a vacuum. As we compare ourselves to other members of the health care professions, we encounter an accepted model of educational level which is described by the United States Department of Education as a "first professional degree." This degree, at its minimum level, requires the holder to have completed 60 hours of undergraduate education and no less than four academic years of clinical education. In this regard, the chiropractic profession qualifies, but our health care colleagues in almost all instances exceed the minimum requirements. About 99 percent of the matriculants at medical schools hold the baccalaureate degree. A slightly lower percentage of the matriculants at osteopathic and optometric schools do also. Essentially all podiatric matriculants hold the baccalaureate, as do most dental matriculants. It is true that there are about 25 medical programs that provide pathways for high school graduates to complete medical school in six years; however, these programs accept only those students who have very high grade point averages.

In short, we as a profession can only say that we require the minimum education for a health care professional. This, of course, does not take into effect the fact that all other primary care providers must complete a residency prior to entry into practice.

2. Knowledge: Many individuals within our profession are very knowledgeable and that is good. There are still many however who eschew any knowledge that does not support or further the individual dogma or even the collective dogma of our progenitors. For us, as a profession, to put on the cloak of "knowledge," we must strive always to be intellectually honest. That requires that we engage in critical thinking and in self-criticism. We must be willing to add to the total volume of knowledge even that which does not relate to our primary concerns as chiropractors.

Again, I say that many individuals within the profession meet this mark, but I do not think that society in general and the image makers and the decision makers in particular see us as a highly knowledgeable profession to whom they can turn for information on a wide range of health concerns. This is evidenced by the fact that we are often forgotten in legislative and media events in which health care people are gathered for some specific purpose. We continue to be relatively invisible as a profession.

3. Public Decorum: This is a matter of my personal opinion, but here is how I see us. When I speak to people who are outside of the profession but who are not our patients, they still tend to refer to us as "bone crackers" or "back crackers" and, even worse, ambulance chasers. If there is one complaint that I have heard from patients all over the country, it is that "once you start with a chiropractor, you have to go back forever." We don't help this image by all of the "unprofessional" advertising we do. These ads range from those that imply that spinal adjusting is the panacea for all ills, to those that suggest that the panacea lies in the use of crystals. In my experience, when members of the general public see such things, their belief that we are on the fringe is simply reinforced.

It doesn't end there. I continue to believe that one of the worst things that chiropractors do is adjust people in public places with little or no patient examination and more often than not, through the clothes. This kind of approach to patient care simply bespeaks an unprofessionalism that is expected of people who are not "real doctors." I think in this respect we could learn from the optometrist, the dentist, the podiatrist, and yes, even from the allopath. One does not usually see these professionals "hawking their services" as some of us do. We will gain credibility only when we earn it.

4. Objectivity: Objectivity and dogma do not coexist well. One could say that juxtaposing these two words produces an ultimate oxymoron. In our profession, at this time some members are thoroughly dedicated to the dogma that has been part of chiropractic since its beginning. I am not suggesting that all that D.D. Palmer proposed was dogma, but some of the early principles have been turned into contemporary dogma by the zealots of the profession. On the other hand, there are those that refuse to recognize anything that has not been validated by strictly controlled studies.

I think the public at least has the right to expect us to be critical thinkers and to provide health care that is based in reality -- a reality that is defined by objective evaluation of what we know from our study of anatomy and physiology and by objective investigation of our hypotheses. We are wrong when we promote a particular chiropractic concept simply because we "know it works." If we say "it works," people have the right to ask how we know it works. We must provide some answers that are more than just "I had a patient," or even "I had a hundred patients and they all got better."

5. Dedication: I doubt that there are few professions that are more dedicated than our own. In the final analysis, I truly believe (I cannot prove it) that the majority of chiropractors are dedicated to helping people gain and maintain health. This is a worthy cause and is, in fact, the single most important reason for the existence of any health care profession. For this reason, it is imperative that the chiropractic profession remain viable and, in fact, grow considerably in recognition and utilization. We have so much to offer the people of this planet.

Indeed, those of us who have spent years caring for people through chiropractic recognize the potential benefits for many millions of others who have yet to experience this healing profession. I believe that the opportunity for this to happen may well be directly linked to how well we as a profession strive to measure up in our education, knowledge, public decorum, and objectivity.

Can the best be made better? I think it can, and I think the above commentary could provide some direction for the process.

J. F. Winterstein, D.C., DACBR
President, The National College of Chiropractic
Lombard, Illinois