The Fundamentals of Professionalism

"Act like a professional and you will be treated like a professional. Act like a clown and you will be treated like a clown."

A few years ago, I observed chiropractic interns from NYCC staffing an informational booth at the Senate Health Fair. These interns wore professional business attire and provided professional and sensible information. Their booth stood in stark contrast to another booth manned by an unshaven chiropractor wearing sweat pants, athletic shoes and a T-shirt. He was giving free spinal exams on exposed backs with an electronic subluxation detection contraption, behind a makeshift partition. The literature he was distributing would have been an embarrassment if it had been at a shopping mall, let alone in the Hart Senate Office Building.

What message did this chiropractor unintentionally send to those national leaders? That chiropractors are desperate, slovenly and unprofessional? It is behavior like this that has prevented chiropractic from moving into full integration. How can anyone take us seriously if we have members of our profession who appear to be competing to be the most absurd and tacky?

The results of chiropractic treatment are great; it is the promotion of chiropractic that I worry about. In the arena of public image, we are our own worst enemy. After interacting with probably hundreds of chiropractors on the topic of professionalism, I have come to the conclusion that we chiropractors need to remind ourselves of what it means to behave like a professional. So, here are some pointers on presenting ourselves as professionals:

Never solicit from your patients. Your patients come to you to be ministered to, not to be solicited. Recruiting patients into multilevel marketing ventures or any other business is a violation of their trust. We all have patients who have some sort of influence, but it is unethical to exploit them.

Your scope of knowledge should exceed your scope of practice. Your patients will benefit from your knowledge past the minimum required to be a chiropractor. Seeking knowledge from within and outside of chiropractic sources of education will keep you fresh and relevant. Having a broad base of knowledge also will keep you from being narrow-minded in your thinking. Every patient expects their doctor to have a broad and current knowledge base.

Dress professionally. In your practice, social settings or a hospital, dress tastefully and prudently. Avoid standing out as underdressed. Your motivation should not be to impress, but to show respect. When I spent time working in welfare clinics, I always dressed in a long-sleeved, pressed shirt and tie; not to lord over my patients, but to honor them. I remember one little boy who was about 5 years old tell me that I looked like a TV star. Those who have met me are probably laughing, but in this little boy's life, the only men who wore ties were on TV. He was dear to me and I chose to honor him with my dress.

Of course, professional dress is relative. I would not expect a chiropractor working on the rodeo, beach volleyball or other athletic circuits to dress in slacks and a tie, but I would anticipate their dress to be neat and professional.

Do not be overly familiar with your patients. Most chiropractors will develop varying degrees of familiarity with their patients, but we should maintain a filter of trustworthy concern and avoid relationships that are overly intimate. Paradoxically, your professionalism will invoke a greater degree of trust from your patients and will deepen your relationships, rather than alienate them. There are factions in chiropractic who feel that being a patient's buddy is the secret to success. These doctors usually like to be called by their first names, such as Dr. Betty or Dr. Jimmy. I feel that this practice reduces a patient's confidence in a chiropractor.

Use appropriate touch while respecting your patient's dignity. Appropriate touch is a hallmark of chiropractic (chiro - hand, practice - treatment), but we need to use our touch with the pure motive of healing. Of course, fraternization with patients of the opposite gender is always unacceptable.

Do not be a jokester. I love a good joke as well as anyone, but health care is serious business. I remember going to a medical doctor with a health concern and being perturbed at his inappropriate attempts at humor. While we do not want to be viewed as old cranks, we should avoid excessive humor, especially off-color humor.

Make all clinical decisions based on the patient's need, not the doctor's greed. Avoid both over- and undertreatment of patients. Refer when appropriate. Don't play head games with your patients. Be transparent and honest in your patient communication. Do not use hidden meanings or subtle manipulations within your words. I realize that practice management groups like for their clients to use scripts to influence patient's decisions; but I would resent my doctor resorting to scripted lines rather than honest communication.

Do not speak ill of another provider. People with low self-esteem seem to need to belittle others in an attempt to elevate their own self-image. This practice is an attempt to promote the image of a diminutive, insecure doctor. Furthermore, it is my experience that whatever ill you speak of another eventually is told to that person.

Do not gossip. I am convinced that gossip is the most divisive and destructive force in our society. If you want to be respected as a professional in society, do not gossip or even listen to gossip.

Do not lie or use hyperbole. State the facts we do have that support chiropractic, but do not extrapolate into areas research has not supported. It is acceptable to share theories as theories; it is not professional to tell patients or other providers that a theory is a fact. It is equally deceptive to pull snips from various research information out of context and piece it together in a manner that inaccurately supports your care. Likewise, we should not exaggerate the effectiveness of treatment or trivialize the risk.

We have a wonderful profession with so much to offer our society, but according to polls, society sees us as unprofessional and untrustworthy. We have an image problem and frankly, our image problem is not undeserved. As a profession, we need to take a good look at ourselves and identify unprofessional and unprincipled practices, and then eliminate them.