Definition of professionalism

Medicine

Adherence to a code of ethics, at the end of the day, is what separates the professional from the second-hand car salesman. Must you sell at any price?

Only recently we have seen how Pfizer Bextra have fallen foul of the profit at any price drive; fraud on a grand scale.

Not only does Pfizer have to find $2.3 BILLION in fines but the realisation that they have brought the whole MEDICAL PROFESSION severely into discredit, must be causing pain that not even the best anti-inflammatory drugs can alleviate. Your sins will surely find you out is how it is put in religious terms; and they surely do.

"I have lived a great deal among grown-ups. I have seen them intimately, close at hand. And that has not much improved my opinion of them."

- Antoine de Saint-Exupery

Chiropractic

So, how do we in Chiropractic shape up? Whilst my experience of the average DC has been of a highly professional, ethically motivated person, there have been enough rumblings to suggest that we too need to be reminded of those qualities that will enable each and every one of us to continue to hold our head up high.

The following definition of professionalism is a synopsis of what two great Chiropractors have said. The reminder, a call to strive for a higher place, is in order. We dare not slump as Pfizer caused Medicine to do.

In acknowledgement I report these wise sentiments of Drs Ralph Miller and James Winterstein.

Definition of Professionalism

1. Altruism

"Service to humanity is placed above personal gain and profit."

Every Chiropractor has to pay the rent and put bread on the table; there is nothing unprofessional about that. Yet the unbridled greed seen in so much of society today is not what characterised our colleagues in the early days.

Our forebears went through deprivation and humiliation in order to serve humanity; it is disturbing that our leaders have to remind us that the get rich quick motive is not what Chiropractic is about.

As the great Dr Jo Janse said;

Look after your patients, and they will look after you.

Of course the average patient knows full well when his Chiropractor is trying to squeeze an extra treatment or two out of him. But the sick and the elderly are considered fair game for those with no heart for any definition of professionalism.

Deliver solutions with value, was the way Charles DuBois, president of Standard Process, put it to one graduating class.

2. Specialised service

"Professionals must have a unique, definite service to perform."

Whilst Chiropractic and Osteopathy undoubtedly have much in common, having a common ancestor, the bone-setters, we still use differing techniques and have a different philosophy. Ask any patient who has consulted both, and they will tell there is a great difference.

More complex, our techniques have been copied by Manipulative Therapists and Physical Therapists. Simultaneously, Chiropractors have utilised many physiotherapy techniques.

Yet I believe that Chiropractors still provide a unique and definite service.

3. Specialised training

"Entry into a profession is characterised by a long period of preparation, typically many years."

It has been well demonstrated that manipulative techniques can be taught in a relatively short period, perhaps even less than a year. Various schools turning out "Spinologists" and the like have cropped up periodically, and there have been bitter tirades against certain unscrupulous Chiropractors who have peddled our techniques at weekend courses, especially in Germany, turning out what can best be described as dangerous lay-manipulators. Witness the deaths seen in that land. Is it any wonder that they have the poorest legislation in Europe?

Adherence to educational qualifications comparable with allopaths and osteopaths is vital to Chiropractors claiming to adhere to a definition of professionalism.

4. Body of knowledge

"A comprehensive body of knowledge is only derived through research and experimentation."

The body of knowledge from which we Chiropractors draw must increase rapidly to allow us to safely perform the unique special service we provide. The rapidly expanding body of knowledge provided by researchers today has had enormous benefits to the profession, enabling us to serve humanity with far greater confidence, knowing there is hard science confirming our expanding theories.

This demands an Intellectual Honesty on the part of those claiming to adhere to the definition of professionalism, both rank and file and researchers as they serve to give the best possible care at the least possible cost.

Making a fast buck is not what Chiropractic is about, that is if we wish to call ourselves professionals.

Many of the notions of Chiropractic (and of course Medicine) were born in the Nineteenth Century. Some of them have been found wanting, and a willingness to reject ideas and concepts, however revered, found to be rooted in dogma alone, is vital in those propounding any definition of professionalism. This would include the use of words and actions that are known to be anti-scientific.

• Chiropractic Research ...

• Immobilisation Arthritis ...

5. Continuous study

"Only a culture of life-long learning could possibly cope with the innovation, specialisation and the development of new knowledge that we have seen in the last fifty years.

"Continuing education, willingly embraced by those working at the coalface, and taught in a relevant and engaging manner by professional educators is the hallmark of any mature profession. We are getting there but we still have a way to go to make the courses taught on the Chiropratic Continuing Education seminars on Friday, Saturday and Sunday relevant on Monday morning.

Perhaps the most important factor in Continuous Study is what happens when the enquiring mind encounters something unexpected, as in the success of Chiropractic in the management of ankle joint pain, say.

6. Autonomy

"Professional work requires independent thought and action with appropriate subsequent decision making."

The professional, by the very nature of the work, cannot and should not be controlled by others in the day to day application of his or her unique skills. Yet they remains accountable to their peers, and of course their patients.

Despite this, as Chiropractors we do find ourselves controlled by third party payers. With most insurances paying for around eight to nine treatments, in part, in the Netherlands, the DC is expected to do miracles.

It is ludicrous that Insurance, controlled as it is by Medicine, will happily pay out tens of thousands for advanced procedures, when independent research clearly shows that Chiropractic is more effective for many musculoskeletal conditions. The paltry few hundreds paid out grudgingly to DCs remains an enigma.

"Miracles we do at once. The impossible takes a little longer."

Dr Unity Lewis, DC

7. SELF-GOVERNMENT and a CODE OF ETHICS

"Self government implies that the Chiropractic profession must establish standards for

• entry into and exclusion from their ranks, and
• must seek higher standards of practice."

This adherence to the definition of professionalism pertains to a responsibility to their patients is to ensure ethical practice and conduct of those who aspire to being a professional. Peer review remains vital.

Society looks to the professions to provide leadership and exemplary conduct, and professional codes of ethics, in keeping with the higher fees they charge. And so it should be.

• Professional Codes of Ethics ...
  
• SIX GOLDEN RULES FOR CHIROPRACTORS ...

8. CONTROL of the MEMBERSHIP

"A board of examiners, or suchlike, as well as disciplinary bodies that enforce the definition of professionalism ensuring that standards of ethics and practice are adhered to."

Thus, high on the NavBar of the Netherlands Chiropractic Association, one finds the heading "Klachten" whereby dissatisfied members of the public may register their "Complaints". 

Six pillars of character

Lombard Village president, William Mueller, in his commencement address at NUHS encouraged young graduates to follow the six pillars of character:

1. Trustworthiness
2. Respect
3. Responsibility
4. Fairness
5. Caring
6. Citizenship.

"These are the basic basic values that define ethical behaviour. They should be part of your personal and professional life."

The epitome of professionalism

• Journey of Scott Haldeman

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