The Real World
Sadly, the world is not full of well-intended people all working for the common good. This is reflected in all walks of life, including research, medicine, bureaucracies and chiropractic.
I worked in medical research, in a public teaching hospital, for over 10 years, which culminated in completing a PhD in Medicine. This experience taught me many things about the research, pharmaceutical and medical worlds. Scratch the surface and what terrifies medical researchers is that someone has a simple, all-encompassing aid to positive health outcomes.
We are facing a true witch-hunt – natural healers have always been attacked by the "rational establishment" – luckily this time we do not face the burning stake like the midwives and herbalists of the middle ages, but it is sink or swim time nonetheless.
Sloppy and malicious scientists publish ignorant and misleading comments. It is a reality and far more common than the public would believe. Some people label themselves as sceptics when they are not. A sceptic is open to being convinced about something. A pseudo-sceptic is not. Their whole identity (and in their view, credibility and possibly livelihoods) relies on them never being convinced. Let’s not waste energy and resources pandering to them.
Some in the medical world see us as a threat. A growing minority see us as fellow health-care professionals, who specialise in diagnosing and treating conditions of neuromusculoskeletal origin. The tide is turning, including at government level.
Once we come to terms with the world in which we live we can focus on what we can do to develop and promote chiropractic with the people who matter.
The Failure of the Small Target Strategy
It seems this has been the approach of the associations and AECC over decades and it ‘hides our light under a bushel’. Small target translates to easy target. The "it will blow over" response means we are under regular attack. Every now and again there seems to be another crisis where somewhere, someone says something, fear reigns supreme, the number of new patients in our clinics drops, the press becomes chip wrappings, and all seemingly returns to "normal". But we should be watchful (or more truly careful).
Every time this occurs some people decide not to attend our clinics to receive care that would change their lives for the better. Every time people are scared into not consulting us the health of the nation suffers. It also sets us up for more attacks. In the words of George W "Our silence emboldens those that want to destroy us". Make no bones about it, the people gunning for us are scared that we are right. The ‘small target’ strategy does not develop or promote the profession, nor does it serve the public well. It makes us look and feel like cheese-eating surrender monkeys.
This is why I lodged complaints with the Press Complaints Commission when articles headlined "Chiropractic is a waste of Time and Money" appeared in the press. The articles were about a physio study in Australia that did not even mention chiropractic. People asked me why I put in complaints when the BCA and GCC would do so. I was disappointed that hundreds of chiro’s didn’t defend the profession by lodging complaints. Incidentally, the PCC process is a perfect example of how to facilitate and manage a complaints process. It was excellent.
Granted, on one level, there is no such thing as bad publicity, as Dr Jon’s example shows. However, I would like to see a much more robust strategy for promoting chiropractic in Britain. The latest press release from the BCA is closer to the mark – unequivocal, unapologetic – bordering on strident (dare I say even proud).
Last year I sent a detailed outline of a positive, pro-active strategy to the AECC. An acquaintance, who had managed regional newspapers, gave me tips on how to get the sort of relationship with the local Bournemouth media that some of our detractors enjoy with the national press. The strategy also emphasised the importance of links with the local community, using examples from the media unit of the hospital where I worked.
The AECC is in the perfect position to take a lead. For the college to accept it is the best chiropractic college in the world may be the first step. That is why I came from down-under to study there. Since starting practise in Australia I am more appreciative than ever of the education I received.
The training that most of the BCA 500 received was from the AECC. The training in paediatrics was exemplary (and evidence-based). The AECC should be looking to protect their patch in their autonomy to train well-rounded chiropractic clinicians. I am sure the clinical and academic members of staff will willingly step up to fight their corner for chiropractic.
The BCA is moving to a mode of endorsing free speech and debate. Bring it on. The number one topic of conversation is uniting the profession. Can we do it? Yes we can. Surely this is the tipping point.
The Australian Association went through a grass-roots up consensus building process and set ‘big hairy audacious goals’ (fair dinkum), which the executive continually evaluates. The theme of their conference this October is ‘Strength Through Diversity’. If the colonials can do it so can "we".
Implementation of the Act
After years of being told that any change to the operation of the Act would take forever, if not be impossible, it would be an outrage for the associations to agree to any change to be made without full consultation with and agreement by their membership. Do they have a mandate to do anything else?
The potential loss of income to the regulator will not occur for 6 months, so there is no reason for the associations to rush into any decision on this. There is time for rational and strategic thinking.
Any changes should be considered as part of a complete review. Items up for consideration should include: pro-rata fees, payment in instalments, budget allocation and schedule for promoting the profession, abolition of fees charged to change personal details, abolition of the practice of paying legal fees to help people develop complaints, appropriate contact with potential complainants by the regulator, the Principles of Natural Justice vs ‘kangaroo court’, tenure of the registrar, covert activities.
Read the Act. It is short and easy to understand. Don’t accept the interpretations of those employed to implement the act. Reading it for yourself is very powerful. It will shatter the mythology that has been constructed around it.
I support the actions suggested so far in relation to accumulating the published papers, writing up case reports (something I have failed to do I’m embarrassed to say), review files to compile stats on treatment outcomes in your clinic etc. For those in my graduating class a good place to start would be to submit the paediatric manual we compiled in 5th year at the AECC. Surely the BCA’s resources should be made available to collate the information and to present this data in support of "the BCA 500".
Also patients should be asked to prepare statements and ask them to be witnesses. An evaluation of ‘Patient Values’ must include testimony from patients … anything else would be a travesty, and as Richard has documented, that is a possibility.
One of the positives from this mass complaint is that individual chiropractors will not go through this process ‘alone’, as many others have before. It will put the processes of the regulator under a magnified spotlight for all to scrutinise.
What should be gained out of this complaint is an unequivocal endorsement from the GCC of these chiropractors and their practice principles. This is what the BCA must push for and should not contemplate anything less as a resolution of the situation. The 500 or so chiropractors named in this complaint are forever bound together by this action. They already have their place in chiropractic history. Whether that place in history is one of victory or defeat of the philosophy, art and science of chiropractic is yet to be determined. It could well be the making of the profession in Britain.
Use of the Term Doctor
I fully support all my colleagues in the use of the term Doctor. We deserve it. We diagnose with at least the accuracy of GPs. We deliver appropriate treatment that is both safe and effective. This title not only reflects our role as primary health-care professionals but our role as health coaches and teachers (the true sense of the term doctor).
The potential confusion arises because medical graduates have appropriated the title. The only people who have earned the title have research higher degrees (PhD, MD). For everyone else it is a courtesy title only. The regulator should be an advocate for the profession and resolve this issue with the ASA and others who obsess about it. As we know the people who come to see us don’t. The GCC should also provide accessible information that educates the public about the use of the title and outlines in detail the education we receive that makes us competent primary health-care professionals.
We all have had patients comment that the history taking, physical examination and report of findings we conduct are the most thorough they have ever had.
To Richard for his outstanding efforts on behalf of the profession. You must be incredibly frustrated that your colleagues have been sleep walking, relying on others (primarily you) to fight their corner. Then when you take on the GCC single-handed we leave you to hang out to dry. My apologies. I’m pleased to read that you and your partner can still laugh about the advice of your very wise Danish friend.
Reading this email may add to your frustration. It may seem naïve and simplistic. I have learned from the ‘economic rationalists’ of the 70’s (who were considered to be, and in my view continue to be, the ‘looney right’) that you keep asserting what you want to happen and don’t stop til it does. They now run the world.
The current situation is a generational opportunity for the profession to claim cultural authority. It will take hard work from all of us. Let’s be strategic, united and focused. We know we will be successful because the people we serve demand it.
Yours in Chiropractic