"Out beyond ideas of wrongdoing and right doing, there is a field. I will meet you there."
"Truth comes before unity. Unity without truth is hazardous."
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Unity is not opinions, public relations, unified action, education, insurance reimbursement, legislation, or public relations - separately or together.2 Unity is not defense against a common enemy. Such are mere shadows of true unity. What would chiropractors with "unified actions and common values" say to Wal-Mart or Congress? Would chiropractic speak with power and credibility, or just more of the political and the potential? Beliefs and opinions wilt under the glare of accountability and are blown away with the winds of change. There is no authority without facts. Without facts, calls for unity are empty calls to act unified. Only with the facts can there ever be unity.
Chiropractic education, unified action, and the like are serious concerns of day-to-day professional survival. But survival tactics do not inspire and cannot unify, except perhaps briefly during a crisis. Tactics are like items on a menu - mere symbols of food. Changing the menu has no effect on the food, does not make food, and the menu is not the same as the food. So it is with unity. Acting unified is not unity. Should chiropractors go to Wal-Mart, Sacramento, Columbus, Washington, the CDC, NIH, The Travelers and Cigna - and say in unity, "Chiropractors believe in the body's ability to heal itself?" Who doesn't? We need facts. We have facts.
Tactical advice is too weak to guide the profession through today's scientific and competitive health care industry. Chiropractors are well-trained to fight crises. Crisis thinking reacts, rather than responds; gives orders, rather than inspires; substitutes ideals for ideas; and teaches fear of the future, rather than explore new possibilities. Meanwhile, opportunities disappear while we indulge in suspicions and paralysis.
Without an agreed essence and identity of chiropractic, the profession will always be fragmented into multiple congregations built around strong personalities and communities of belief. But that is false unity; a graven image of the real thing. Real unity is recognized, not memorized. It is felt in our bones.
Armed with only opinions, everyone's voice is equally loud, equally "valid," equally authoritative, and equally divisive. The unified voice rests on facts. Opinions - as we all know only too well - are extremely plentiful and mostly wrong. The only way to adjust opinions is with new information. Common values and unified action then naturally emerge from facts - the facts that never replace wisdom, but sharpen it, refine it, and reduce the uncertainties of patient care.
Facts, even negative ones, build professional credibility. A chiropractic colleague once saw a new patient, a Stanford neurologist, suffering with severe headaches. After two weeks of care, she could not help him, and told him so. He graciously thanked her for her time and talents, paid his bill in full, and referred many patients to her over the years. Good health care does not mean a cure. It means telling the truth quickly. Those who say "always" and "never" are not friends of the human body and natural healing, since the healer must meet body, mind, and spirit on their own terms and turf, and not with a one-size-fits-all approach. Never and always are never facts, regardless of the number of publications or fortunes amassed.
Efficacy in chiropractic is not a matter of belief. Your profession is not that fragile. Contemporary chiropractors can and should cherish their profession's history, tenets, and subluxation theory as a rich source of inspiration and tools for diagnosing and healing, but ultimately, the "big ideas" must submit to the big questions. Suffering humanity wants to know if chiropractic helps. Humanity deserves an answer, not piles of speculation.
A profession based only on beliefs cannot grow, will only serve a few, and will scramble to recruit new patients and new members. A truly unified profession leads with a 50-year horizon and a clear direction. Thus, unity comes down to one simple, honest agreement: to share successes and failures to build clinical wisdom. Thus is built a legacy for future chiropractors. Thus is chiropractic a health care solution - a profession on an inspirational quest, building professional unity and immunity: unity for strength and immunity to hogwash.
Eventually, chiropractic will either prosper by facts or be torn apart with everyone's opinions. Legitimization only by power, money, position, or intimidation, or "because I say so," is exactly what evidence-based health care is trying so hard to stop. "Because I say so" is tactical; a new soldier does not need to know why, and could be dead by the time he does. But chiropractic is in a new era - an era of a profession - and leadership needs to catch up.
Chiropractic is ready for imaginative and strategic leadership that dares to ignore the never-ending chiropractic controversies and engages with all of health care by advocating for all patients, regardless of schools of thought and systems of care. We need leaders who serve the profession, rather than defend it. This kind of courage requires facts - estimating your parameters and knowing your limits, and then speaking from a position of strength, rather than as an abused stepchild of health care.
Clinical excellence through accumulating and communicating facts builds professional magnitude, nobility, agility, and dignity, which in turn, elicits unity from all stakeholders - even when we disagree over the technique for getting there. A fractured chiropractic is the result of too few facts, vested interests hammering research to conform to beliefs, and confusing inflated personalities with legitimate sources of information. A truly unified profession will use credible facts to settle professional disagreements, and thus become a source of pride and unity. Then chiropractic can surf the waves of change through understanding, rather than just tread water.
Reference
J. Michael Menke, DC
Department of Psychology
Program in Integrative Medicine
University of Arizona
Tucson, Arizona
menke@u.arizona.edu
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