Serving Whom? Serving Patients by Signing the ACA Pledge
N. Ray Tuck Jr., DC
When offered an opportunity to respond to Dr. James Edwards' February column, "Serving Whom? Why I Will Never Sign the ACA Pledge," I took pause. The last thing I want to do is start the type of tit-for-tat debate that has historically seemed to evolve between organizations in our profession. Unfortunately, these interactions cause unnecessary confusion and intraprofessional discord that has not served our profession well, and our patients have suffered. After all, don't our patients want us to be caregivers as opposed to fighters?
As current ACA chairman and member of a regulatory board that licenses a multitude of providers, including DCs, MDs, DOs and DPMs, my goal in responding is simply to clear up some facts that might be helpful for readers.
The Brand
The ACA has taken a purposeful effort in the past few years to look within our association to ensure we are serving our members to the best of our abilities and helping them to serve their patients. This started with some self-evaluation. ACA has always had a "brand," if you will, but we wanted to determine if it was the kind of brand that was helping us effectively and efficiently accomplish our goals.
Based on the extensive feedback we received through hundreds of hours of interviews and surveys with people both inside and outside of the profession, we felt we could do better.
The first reality was we all became chiropractors to serve others. Chiropractic is an amazing healing art that should be utilized more in today's health care world – especially as we deal with public health issues such as the opioid crisis. The U.S. health care system has many challenges, and there is a great need for options that are safe and cost-effective. For many conditions, data continues to mount that chiropractic is one of the best initial care options.
The ACA's new brand puts quality patient care at the center of everything we do. This includes continuing our advocacy efforts, such as expanding Medicare. It also means committing to our patients, and the overall health care community, that we keep their best interests in mind with all our decisions.
We are also committed to providing tools and resources for our members so they can serve their patients to the best of their abilities, and so they can not only survive in today's health care world, but thrive. We also strive to lead by example and move the profession in a bold new direction toward a more successful future.
The Pledge
This is simple: The pledge is a commitment to our patients we serve and the larger health care world that we promise the best possible care.
The ACA's new Pledge of Professional Values does reference ACA standards. Our hope is that all members who can commit to keeping patients at the center of every decision, and who will use the most up-to-date information to do so, will happily take this pledge.
We realize that ACA might not be for everyone. We are creating a community of like-minded chiropractors – those who want to serve their patients to the best of their abilities and want to position the profession for the future. We are not saying anyone is wrong. We are simply striving to hold ourselves to a higher standard and making our intentions known to the public.
As an aside, this is not about stating that an ACA chiropractor is superior to any other chiropractor – which would be against most state regulations across the country. This is about ensuring the public knows what values the ACA member has and committing to them.
"No Authority"
Dr. Edwards is correct that ACA leaders do not have regulatory authority. In fact, we do not want to have that authority. That is what regulatory boards are for. The ACA's goal is to focus on cultural authority.
There is a clear difference in the missions of a regulatory body and a professional association. One of the primary missions of a regulatory body is to protect the public. One of the primary missions of a professional association is to position its members for success by speaking through a collective voice on advocacy issues and providing tools for them for their day-to-day practices. These are two very different and distinct types of missions.
The ACA is not attempting to do the job of a regulatory agency policing the profession, nor should we. The ACA is attempting to inspire a profession through a commitment to patients everywhere that they will be our primary focus of all our decisions. In doing so, we believe we will not only be able to serve more patients, but also will inspire an entire health care system.
Choosing Wisely
Most of the confusion about Choosing Wisely seems to be centered around the misconception that the ACA is against taking X-rays. This could not be further from the truth. I have had the opportunity to speak to many chiropractors, as well as read several commentaries on this topic. In my clinical opinion, almost every scenario I've heard chiropractors use to emphasize the irresponsibility of the X-ray recommendations would have fit within the recommendation's exception regarding "red flags."
If a proper history and physical exam are performed and a "red flag" presents itself, then performing an X-ray would be the appropriate action. I am for taking X-rays when indicated. I am not for taking X-rays when not indicated. This is about giving our patients the appropriate care based on their clinical presentation.
Overall, this program, which includes more than 60 different health care provider and specialty groups, is about educating patients to be informed so they can ask better questions of their doctors. No caregiver should ever be concerned about an informed patient. Ever.
Final Thoughts
Although Dr. Edwards does have a deep history in the ACA as a past chairman, as well as in many other roles, I respect his right to disagree with our new brand and his refusal to sign our pledge, especially considering his current role.
As we are creating this movement, we realize not all will join us. This is about ACA chiropractors knowing our values and committing to be the best we can be for ourselves, our patients and the public at large.
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