1. Use terminology that has already been taken, and give it a new “chiropractic” meaning.
For example, the word “subluxation” really means “partial dislocation”. It does not mean “spinal bone pressing on spinal nerve that destroys your life”. What a DC (Doctor of Chiropractic) really means when s/he mentions a “(vertebral) subluxation” or the VSC (vertebral subluxation complex) is, segmental dysfunction or joint position error (that’s the vertebral-bone-out-of-place part) and aberrant afferentation (that’s the resulting general decline of health that the bone-out-of-place contributes to).
2. Neglect to learn (and own) functional neurology.
Chiropractic is awesome and it does help countless people in ways that can’t necessarily be explained. Many people come in to have their “back/neck popped” and over time, their digestive distress mysteriously clears up or they have more energy or they sleep better. Typical traditional DCs explain this in a variety of ways, but they all end up at the same (outdated and less-than-accurate) conclusion/theme: your spinal bones (vertebrae) are pressing on the nerves in your spine, cutting off communication to the rest of your body, and an adjustment relieves the pressure, restoring communication and thus function.
The big problem with that explanation is that, while it sounds good, it has been disproven. That explanation emerged early on in chiropractic history, with DD Palmer – probably 1910s-1920s-ish or so – and was completely dashed in the 1950s with conclusive, definitive research studies. Functional neurology, on the other hand, explains what is really happening during a chiropractic adjustment, and how the changes happen at the level of the brain. The truth as illuminated by the most current research is so much cooler than the explanation lazy DCs are using.
3. Bash other practitioners, adopting an “us vs them” mentality.
It’s perfectly OK (and in fact, a huge service to a DC’s patients) to point out differences between natural/alternative/complementary medicine vs conventional medicine. It helps people understand the truth: that they are indeed being underserved by conventional medicine, and that their unaddressed or unresolved health problems are not all in their heads. A patient’s chronic illness isn’t a character defect that lies with them (i.e. psychosomatic, or whatnot); it’s a shortcoming of conventional medicine, as they lack the tools to effectively manage chronic or mysterious disease/dysfunction.
However, when the bashing/difference-emphasizing becomes excessive, using strong inflammatory language or labels, coming across as too passionate or fringe, or starting to make irrational claims, the DC has gone too far.
At this point, patients start to feel alienated. There may come a time when they need conventional medical attention, and they’ll either 1) be afraid to seek it, having been brainwashed (by the DC) about how bad it is, or 2) they’ll get the medical attention they need and be afraid to tell their DC. Chiro docs may ultimately shoot themselves in the foot, too; only 25% of the public has ever sought chiropractic care in their lives, and only 6% or less are current chiropractic patients.
Meanwhile, almost everybody has sought conventional medical care in their lives, and many people are frequent customers. By setting themselves too far apart, almost insinuating a “DC or MD” ultimatum, guess which one the patients will choose if/when push comes to shove?
4. Establish themselves as an island.
People are pack animals. We work well in groups. Yet, DCs have this unspoken phobia about teaming up with other professionals, either fellow chiro docs or other types of healthcare providers altogether. The most common choices a graduating chiropractic student makes is whether s/he is 1) going to work under another (chiro) doc, or 2) start his/her own practice from scratch (usually as the sole doc). Note: I don’t necessarily count working under another doc in their practice as teaming up, as the balance of power is nowhere near equal.
Going solo is expensive and worrisome. It’s all you; you’re it. All of the pressure to generate revenue, and 100% of the responsibility to meet your expenses and pay your bills falls on you. When DCs go it alone, they’re much more likely to get in over their heads and fail. You don’t see too many solo practitioners of other types – MDs, DOs, PTs, etc practice mostly in groups.
Smart DCs do, too – and when they do, they end up looking more professional. They look less like a shopkeeper-business and more like a legitimate practice the public can trust. And they save money, lowering their individual overhead by sharing space and resources–along with their costs.
5. Subconsciously believing they’re entrepreneurs first and doctors second.
It’s actually the other way around. Speaking of shopkeepers, DCs often tend to act like them. You can tell a struggling or not-quite established small business owner – they’re always looking for another way to make money. Sure, we all are to some extent, but generating revenue consumes these people. You know the type – their wide-eyed, trying to be cool and confident, trying to be something they’re not, the epitome of “fake it till you make it”. When their landlord jacks up their rent, they freak out, even going so far as to work their worry into conversations with patients during patient visits. And then they start micromanaging their staff, pressuring their existing patients to bring their friends/family in (i.e. new patient referrals), and resorting to gimmicks. Yes, that exact scenario actually happened to us, when we were patients, and the guilty party was indeed a DC. Not cool. The doc actually lost our business over that. When the fit hits the shan, make lemonade, but don’t start making your staff’s and patients’ lives miserable with knee-jerk reactions.
6. Allow boundaries to become thin, or cross them altogether.
And #5 leads me to my next point again. Some DCs become complacent, lose their professionalism, get lax, become chummy/chatty with longtime patients with whom they become more familiar, what have you. It’s never a good idea to become too familiar or friendly with patients. Yes, patients become like second family, and it’s OK to become close. Chiropractic is a touchy-feely profession, because to touch is to heal and vice versa. I get that.
What’s not OK is to start getting too personal in conversation or too complacent during visits, letting the chatting start to overtake the treatment and become the perceived focus of the visit. People are handing over hard-earned money to get well, and they’d like the doctor’s focus to be 100% on what s/he is doing, especially while adjusting the neck. Be completely present and focus. And for the love of Goddess, never date the patients or start talking financial/business issues or personal problems. Ever.
7. Resort to gimmicks.
Incentives are a slippery slope. Some are more dignified and legitimate. Others cross the line and become stupid or even counterproductive. It’s OK to offer a small discount when paying in cash at the time of service, to cut down on credit card/check processing costs or the time it takes to file the health insurance invoice. I can understand giving away the first adjustment or discounting a comprehensive new patient package. But there is a line.
Some DCs see no problem with running “referral races”, or contests among their patients to see who can refer the most new patients into the practice (by talking to their friends, family, and co-workers, or handing out the doc’s business cards). I think that’s one of those things that if done with dignity, can be pulled off effectively – but it is indeed easy to mess up. If the prize is too big proportionally to the practice, it spells desperation. If there’s constant pressure on patients to refer and that pressure never lets up, that’s a problem.
A DC we had stopped seeing about 6 months prior actually sent us a letter in the mail with one sock with a face drawn on it. The letter said something along the lines of, “the sock is lonely and looking for its partner. The partner is here at the office. Won’t you come back to us and join the socks together?” Or something. It was meant to tug at our heartstrings, but we just threw the sock into our giveaway pile, hoping someone in need could pair it up. We actually thought even less of the DC after that.
8. Strong-arm sales / hard-selling.
And that brings me to my next point (I swear I didn’t plan this!) DCs are great salespeople. After all, just how do you take an inaccurate theory, use it to justify an odd experience (from the patient’s point of view, of having their spine cracked), and convince them they need to have this done 3x a week for life (I’m talking about the “principled, wellness” chiropracTORs here), and pay for it out-of-pocket (I’m talking to those adamant about remaining “all cash” here). To add fuel to the fire? The patient’s results plateau after the initial improvement, and we all know it.
To combat this, many DCs have resorted to throwback hard sales tactics from the 1950s. Many are offering pre-paid 1-year or multi-year plans (collectively known as year-o’-care plans among those of us who believe this approach is ridiculous, including myself). These chiro docs figure this improves their patient compliance because it’s a lot tougher for the patient to get their money back once they’ve already paid. (Hint: the first part is true – patients do comply – but the second part is completely false – patients can indeed get their money back for unused visits if they discontinue care before the year is up.) Oh and one more thing – I really would rather not see a single chicken dinner for the rest of my days. WLP affiliates, I’m talking to you!
9. Try to make someone in pain “value” their adjustment by not adjusting them today.
Don’t drag out the ROF 2, 3, 4 visits or tell someone in pain that they have to wait until the 2nd/3rd visit to get adjusted, especially if for no other reason than to make them “value” the adjustment.
Here’s a thought – imagine you wrecked your back. You can still walk and control your bladder and everything, but it hurts like hell. You’ve heard horror stories about chiropractors but you figure you’ll take your chances, because after all, the aspirin isn’t working. You call around, you schedule a visit, you show up, and the DC does an exam, maybe x-rays, and spends an hour and a half babbling about the subluxation complex and how he doesn’t treat pain, but he promotes WELLNESS.
Meanwhile, you haven’t gotten any relief yet. Oh, and today’s visit will be a couple hundred. And? “We don’t adjust on the first visit.” No reason given, other than maybe something about value and/or compliance…if you’re lucky enough to get any explanation at all. You want to scream. You want to pull your hair out. Hell, you want to pull his/her hair out. Don’t be that doc. Seriously. Attempting to indoctrinate patients, especially before giving care, reeks of cultish antics.
10. Inadvertently refer to themselves as “chiropractors” and MDs as “doctors”.
Used in a sentence: “chiropractors don’t prescribe medications – you’ll have to go see your doctor about that.” Wait a goddamned minute – we’re doctors too, right? Didn’t we go through 8 years of hell (the same 4 years of undergrad with the same science prerequisites, followed by the same 4 years of intense academic hell, complete with residency/internship?) Hmm? Did we not all take our multi-part board exams and our state jurisprudence exams and obtain state licenses? Does our degree not say “DOCTOR of chiropractic”? Do we not refer to our clientele as “patients”? (Please tell me you’re not one of these “Practice Member” hooligans…please.) Alrighty then. In fact, I correct people. I say, “Doctors of chiropractic prescribe nutritional supplements, but not pharmaceutical medications; you’ll have to see your medical doctor about getting a drug prescription.” Doesn’t that sound more dignified and professional? We teach people not to think of me as one who plays second fiddle, and every DC should do the same.
11. Have an open adjusting room.
Oh my, this is one of my pet peeves. Like it or not, DCs are doctors who render treatment to patients. Because many of them have acted strangely (making advances toward attractive patients or adjusting side-posture on a GOWNED patient, just to name a couple), we tend to get sued or at least live in fear of being sued.
Enter the open adjusting room, accompanied by the misconception that it solves all potential legal problems. It doesn’t. What it does do, however, is make patients feel open, vulnerable, and uncomfortable, because others can watch them be adjusted. It does make a patient feel self-conscious, and it does make them tend to avoid telling you about important information, such as the migraine accompanied by diarrhea that came on the night after their previous visit. You might want to know that. But with an open adjusting situation, they may not want to tell you. We’re doctors – be professional and have private treatment rooms like patients expect at doctor’s offices.
I’m not trying to rip on DCs. Really, I’m not. It’s a fantastic profession, known to produce miraculous results. It wouldn’t have survived 115 years if there hadn’t been something to it. To this day, people swear by their chiropractic doctor. I’m proud to be one.
Today’s tirade was brought on, however, by all of my experiences, as well as stories other people told me. This is by far not an exhaustive list. I’ve heard of DCs adjusting strangers while drunk in Vegas bars, causing permanent serious damage and then disappearing into the night without a trace.
For every one of those stories, there are hundreds of others about people walking without canes, sleeping through the night for the first time in 30 years, digesting their food better, watching their child’s ear infections or asthma/allergies evaporate, recovering from colds and flues faster, or their migraines disappear.
It is my heartfelt desire to see DCs fit more into the last few sentences of the previous paragraph and the annoying habits in the rest of the post become a thing of the distant past.