St. Crispin's Day - Activism For Patients

"But what about the HMOs?" That was the response I got at a recent postgraduate class I taught on ethics. I had been talking about our ethical duty to patients to be up to date in our clinical knowledge. The doctor's lament was about the fact that HMOs often seem to choose the most restrictive interpretation of what the literature tells us. For example, if a study found that the average patient improved in eight visits, the HMO might say, "We'll give you eight visits, period." Obviously, allowing only eight visits will ensure an average of eight, but this is neither the same nor is it fair. But what can we do? Complain to the insurance commissioner? From what I have heard around the country, many of these commissioners seem to be little more than rubber stamps for the insurance industry from which they came, and to whom they hope to return for a high-paying job.

What can we do? Sit in our offices and bemoan the horrid state of affairs. Reminisce about the '80s when health insurance was almost a blank check to DCs, who were newly added into insurance plans. Lament to our patients that there is nothing we can do; the HMOs are out to get us, as if they aren't out to get everyone in health care. (Just hang out with some MDs and you'll see they fell the same way.)

What can be done? Advocacy - political activism! Chiropractors have always been advocates for our patients. Back when chiropractic was not a lucrative career, but more of a calling, chiropractors went to jail to ensure their patients had access to chiropractic care. Those same jailed chiropractors even went so far as to provide for their patients' chiropractic care, even while incarcerated for providing that care. That was advocacy, and it was advocacy in service to patients, not to preserve the chiropractor's income.

I was astonished to find that of the 75 doctors at that postgraduate program, fewer than 10 had gone to Washington to lobby Congress, and even more astonishing, fewer than 10 knew about the American Chiropractic Association's National Chiropractic Legislative Conference (NCLC). Not only weren't these doctors advocates for patients, they didn't even know about what their own profession was doing to advocate for their patients.

In the past, when times were tough for chiropractic and our patients, chiropractors banded together to advocate for licensure, equal access to insurance, etc. Now, it seems that as times have gotten tough, chiropractors have retreated into the shell of their office and ignored their responsibility to be advocates for their patients. If we don't work for improving conditions for our patients, who will?

NCLC was really very inspiring. On the first night, many of the leaders of the ACA talked to students who had come to the conference. The students were told that they were the leaders of the chiropractic profession. These 500 students and doctors took the time and money to come to work for our patients and our profession. Those speeches reminded me of Shakespeare's Henry V (Act IV, Scene iii, 51-66). In his speech, Henry rallies his troops before they go to meet the far-superior French forces at the bloody Battle of Agincourt (which the British win). Henry says:

The next day, we exercised our First Amendment rights to "petition the government for a redress of grievances." When the day was done and I was leaving Capitol Hill, it came to me that we were in some ways like a swarm of ants all clamoring around on an anthill. It could be depressing to note that all of us from the ACA were just a small company in the army of ants exercising their First Amendment rights.

Then a thought struck me that put it all in perspective. There are approximately 300 million Americans. Of that 300 million, how many have come to Washington to exercise those rights? How many of the 300 million have met with a legislative assistant, legislative aid or legislative director for a congressman/woman or senator? How many of the 300 million have come and sat and talked with a congressman or congresswoman, or a senator? Very, very few. Remembering that a day before, the ACA leadership had commended the SACA contingent for being the leaders of the chiropractic profession (and they are), it was really only a half-truth. In fact, those students and doctors alike who came to Washington are in fact leaders among Americans. So, to those who did not come to NCLC this year, let ye not think yourselves accurs'd that you were not in Washington, and join us next year advocating for our patients' and future patients' access to chiropractic.

Stephen Perle, DC, MS
Bridgeport, Connecticut