Dr. Larry Merritt, DC
Today at Google alert on spinal manipulation for back pain I read a posting: “What’s the evidence for spinal manipulation for long-term back pain?” The conclusion of the article was that manipulation was only slightly better than bed rest. The author quotes four references to support this conclusion.
This got me thinking about all the other studies that show the benefits of chiropractic care. Some health care professionals will never change their attitude, no matter how many positive studies there are. This means that as a profession, we must work harder, publish more, and produce better quality studies. We need a larger number of top quality research studies leaving no doubt that what we do does work. We must try harder.
I graduated from Canadian Memorial Chiropractic College in 1972, when research was almost a foreign word. The knowledge that we acquired was handed down from years of clinical practice. There were a few case studies and occasional bits of research being published. If you did research, you were considered “different,” and you (the researcher) had to fund your own research. Today we have fulltime researchers at chiropractic colleges and researchers at several major universities in Canada and around the world.
In spite of this improvement in the quality and quantity of research, we have our detractors. There are still a group of critics that will do all that they can to discredit chiropractors and their work, regardless of the facts.
No matter how negative our detractors are, we can take pride in the positive results we see in our offices every day. A recent Ipsos – Reid poll from British Columbia stated that chiropractic utilization in British Columbia rose from apprximately 14% in 2001 to 24% in 2008. What makes this so amazing is that this has happened even though the B.C. government had de-listed chiropractors from the Medical Services plan. It seems that paying cash for a service that works is not a financial deterrent when the traditional free (to the patient) medical service is not getting results.
Patient results tell a more positive story. Chiropractors must be helping because patients can get free care through their MD but are paying cash to see the chiropractor. Something is sending them to chiropractors, despite the cost. They are seeking chiropractic care in increasing numbers. This would not happen if the results of chiropractic care were negative.
This profession is constantly under attack from other health care professions, who seem to be trying to undermine chiropractic health care. This is a concern, but the biggest danger to the profession comes from within.
We have major problems to overcome. First, we must overcome the problem of professional infighting. We are constantly fighting battles within the profession. This takes a considerable amount of time, energy and money that could be better used to promote the profession, fund much needed research, and increase the utilization closer to 50%. Just imagine the positive results that could be achieved if, we worked together instead of trying to tear each other apart. Although we have differences in our approaches, we are all chiropractors with one goal: to improve the health of our patients. No matter what your chiropractic stripe, good patient care is the goal. Taking pot shots at each other does no good. No matter what you think of your colleague, he is in practice because he is getting patients better. If he was not, he would not survive in practice. No chiropractor or chiropractic technique has all the answers to all the patients’ problems and the sooner we, as a profession accept this, the better off our profession will be.
Apathy is another major problem for the chiropractic profession. Apathy can be defined as an absence or suppression of emotion, feeling, concern or passion. According to Wikipedia, apathy is a psychological term for a state of indifference. Many chiropractors appear to have a form of apathy – not necessarily apathy toward their practice or patients, but toward their profession. According to Dr. D.P. Towle, we have too many “office potatoes.” The office potato puts in time at his office for his patients and then goes home. There is no reinvestment into his profession.
Professional apathy can be manifest in many ways:
Not keeping up on the latest information.
Not getting involved in professional activities.
Not voting on association issues.
Avoiding association activities, (AGM etc.).
Not communicating with governing bodies or associations or colleagues.
If you sit back and do nothing, then nothing is what you should expect. “We must do more than set goals and dialogue. We must take action! No longer can we idly stand by and wait for someone else to do it for us.” (The Chiropractic Century by Daryl Willis)
Two papers that try to address some of these problems are “The Relevance of Joining,” by Dr. Arlan Fuhr, Dynamic Chiropractic Oct.6 2003 and “Something Worse than Apathy” by Dr. Terry Rondberg. Both of these papers are important to the state of the chiropractic profession. Although they are talking to the profession in the USA, it is the same in Canada. In “The Relevance of Joining” Dr. Fuhr talks about the importance of joining the state (provincial) or national association. All too often we “let the other guy do it.” The activity of your association is often what influences the direction the profession takes, such as relations with WCB, third party payers and the government.
Not only is it important to join the association, but it is equally important to participate in the association. Dr. Rondberg’s paper, “Something Worse than Apathy” suggests that you only join an organization if it stands for what you stand for – a noble idea. Unfortunately, this can lead to a multitude of small self-serving organizations. Dr. Rondberg says, “Those doctors, who don’t care one way or the other, really shouldn’t join anything more political than their local country club. It’s far better for them to be “apathetic” – at least they’re less likely to do any damage that way!”
This approach does nothing to solve the problems that face this profession. In fact it may be preferred by our detractors. If we form several groups and have no focus, we would have less influence and diluted resources because of infighting. Dr. Rondberg states, “If, like the majority of the profession, you want chiropractic to retain its identity as a drug free health care system geared to correcting vertebral subluxations, join the WCA and ICA.” The significance of this statement is that the majority needs to become involved with our professional association. A minority can only control a situation through default. If the majority are apathetic and do not get involved, a minority can then hijack any association and use it for their special interest.
I believe that we, as individual chiropractors, owe it to our patients to not only help them with their health needs, but to ensure the survival of a strong and vibrant chiropractic profession. This can only be accomplished if chiropractors get involved. We need to put service above Self. (Willis)
There are many different levels of involvement.
Becoming involved with your association or college.
Communicating with your association. Let them know your ideas and thoughts.
Voting on all issues.
Publishing case studies. (A first step in developing research.)
Participating in and publishing research.
Supporting research by others.
According to Dr. William H. Dallas DC., “Research is more than an academic exercise. It is the key ingredient in establishing chiropractic’s role in an evolving health care system.” Research – the search for knowledge, or as any systematic investigation, with an open mind, to establish novel facts, usually using a scientific method. The primary purpose for applied research (as opposed to basic research) is discovering, interpreting, and the developing methods and systems for the advancement of human knowledge on a wide variety of scientific matters of our world and the universe.
Using this definition, we can see the importance of research to a vibrant and evolving profession. In this day of evidence based care, the need for research is paramount to a profession’s survival. If we do not do the research, others will and we lose our identity.
Long term acceptance of chiropractic by our patients, policy makers, the scientific community, and other health professions will depend on us doing the research. We are talking about our survival as a profession!
So what does this have to do with you the field practitioner? First, get involved in supporting research. It has been stated that less than 1% of Canadian chiropractors directly support research. This is totally unacceptable for a profession trying to improve its utilization numbers. If, you are happy with 14% utilization and happy with other professions doing what we do and researching what we do then change nothing. If on the other hand, you think we should be proactive and advance the chiropractic profession so that we can continue to provide our patients with the best possible care, then you need to get involved. Make a choice, make a difference. “get involved!”
Support the Canadian Chiropractic Research Foundation and support Chiropractic research at Canadian Universities. If you do nothing else for the profession, you can join the CCRF and support others doing research. At this time there are approximately 15 researchers associated with major Universities and a similar number working on their PhD’s. It is your future, invest in it!!! Invest in them!