Who’s Responsible?

calvin

I am fortunate to have known, worked with and met many successful and intelligent chiropractors during my years as a student and in practice. Some have been my own chiropractors, my practice partners, fellow board members, local go-to resources, mentors and profession leaders. Some of them stand out as doctors worthy of entrusting the referral of any family member without reservation; those who are held in the highest esteem; those who show chiropractic in its best, most positive light. For these doctors, the term “responsible chiropractor” partially describes the model of practice they embrace. Most of the time, this term is plainly understood. For example, telling a colleague you are looking for a responsible chiropractor in the Los Angeles area will usually lead to the desired recommendation. The problem is that “responsible chiropractic” lacks a solid definition and the circumstances and practice styles of these doctors seems as varied as any group of chiropractors can be. Or is it? Upon reflection, it is obvious that there are some commonalities among responsible chiropractors and I have set out to answer the question, “What makes someone a responsible chiropractor?”

The dictionaries were of minimal help. They brimmed with definitions of responsible like “able to answer for one’s conduct and obligations” and “trustworthy”. Eh. Not specific enough. The concept of responsible chiropractic like that phrase turned by US Supreme Court Justice Potter Stewart in the 1960’s when he attempted to define a threshold of obscenity: “I know it when I see it.” Responsible chiropractic is nearly as difficult to define but I’m sure I know it when I see it. Good enough? Hardly. I am not willing to leave this definition up to an entirely subjective Stewartian standard. To do so would be far too intangible for a manual provider like myself. Therefore, we must first define this obscure concept and attempt to determine, with apologies to Stephen Covey, what in fact are the habits shared by these highly responsible chiropractors.

Let’s begin with what responsible chiropractic is not. Lest you think otherwise, it is not simply practicing the way I do, dressing the way I do, thinking the way I do, etc. I have no desire to see the entire chiropractic universe a clone of this Rochester chiropractor though I’d like to think I fit into the definition. Responsible chiropractic is also not simply being science oriented and evidence based, although both surely are a strong facet of the big picture. And it is not about being ethical — though show me a chiropractor who is responsible and I’ll show you one who is ethical. Responsible chiropractic is neither driven by a specific technique or school or organization or state or shape, size or color. So what attributes are shared by the responsible chiropractors I’ve known?

First, responsible chiropractors do not readily embrace concepts that will not pass the sniff test. The application of this informal reality check to an idea, product or new technique combined with a healthy dose of common sense leads responsible doctors to determine when something about an idea smells foul. And if it can’t pass the sniff test, responsible chiropractors throw it away. You won’t find disproved techniques or questionable diagnostic devices in their offices unless they are hidden in the closet collecting dust. Untested and off label procedures, if applied, are slathered first with a thick layer of skepticism and explained to patients.

Both the fees and treatment plans of responsible chiropractors are reasonable. The doctors make a comfortable profit in their offices but do not take advantage of their patients financially or temporally. Their treatment plans are based on clinically reasonable guidelines or at the very least are not based on a treat ’em till their spine falls out protocol. The patient’s best interest is at the center of nearly every clinical and business decision. Prepaid treatment plans are not part of their standard practice. The use of radiological procedures in the absence of red flags is avoided by responsible chiropractors as is the use of x-rays as a marketing device. A lifelong reliance on passive care is avoided by responsible chiropractors and moving patients to active, self-care is encouraged in general.

When explaining procedures and diagnoses to their patients, responsible chiropractors use accurate, scientific descriptions, simplified perhaps, rather than using the opportunity as an excuse to confer unscientific, antiquated concepts simply to make it easier to ‘sell’ a patient on a treatment plan. Responsible chiropractors don’t actually sell patients on anything — they educate, inform and provide the patient with options, assisting the patient in making health care decisions rather than scaring the patient into treatment. Any marketing done by responsible chiropractors is devoid of hyperbole, exaggeration, half truths and blatant lies. Marketing that might embarrass the profession is abstained from entirely. And they eschew poisoning the public well, the practice involving aggressively selling to large groups of people with the hope that 1 or 2 out of every hundred will become patients while the other 98 or 99 will never consider chiropractic as a result.

The disparaging of other practitioners, both within and outside of the profession is avoided by most responsible chiropractors. This does not mean that dangerous or unethical behavior is ignored. Responsible chiropractors, upon witnessing irresponsible behavior from colleagues, will attempt to protect the profession of chiropractic and the public by informing the offending practitioner or the appropriate authorities.

Living in a protective bubble is not acceptable to the responsible chiropractor nor will they allow themselves to exist on an unsocial island devoid of other professional contacts. They communicate with and learn from colleagues both in chiropractic and in other professions. They seek opportunities to meet with others in person, by telephone and via electronic means in order to learn and exchange ideas. When possible, responsible chiropractors embrace interdisciplinary practices, events and educational opportunities. Referring out of patients to other practitioners if the patients are not responsive or are not good candidates for chiropractic is done readily and without delay. Responsible chiropractors have a list of people they trust to take care of their patients if the patients need something they cannot provide or the patients have failed to improve rapidly.

Continuous, lifelong learning is central for successful responsible chiropractors. This includes learning how to honestly build and maintain their practices so they can stay in practice and continue to help patients. More learning time, however, is spent determining what is new in the field, what works and what doesn’t. And the material that is read always includes high quality journals since responsible chiropractors can tell the difference between good research and poor. In short, responsible chiropractors strive to become the most effective clinicians or educators they can be…and then attempt to surpass that level.

There is a great deal of leeway in defining a responsible chiropractor and thankfully there are many to emulate. I do feel the paradigm shifting in our profession and it is getting easier to find the people who are practicing responsibly. I do not mean this article as an attack or a diatribe on what is a good or what is a bad chiropractor but rather it is an exercise in the identification and illumination of the beneficial portrayal of our profession by a collection of doctors with whom I am acquainted and with whom I am proud to be associated.

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