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Chiropractic Professionalism, Part 2


June 3, 2013
By Lloyd Manning

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In part 1, we defined professionalism and explored why it is important to health-care professionals. In part 2, we will discuss how chiropractors and the chiropractic profession can pursue an optimal level of professionalism to best serve their patients.

In part 1, we defined professionalism and explored why it is important to health-care professionals. In part 2, we will discuss how chiropractors and the chiropractic profession can pursue an optimal level of professionalism to best serve their patients.

THE STARTING POINT
So where does this leave us? Wherein lay the problems and what can be done about them? The causes are readily identifiable. The solution – well, that’s a different matter. Professionalism must start with the chiropractors themselves, insisting that all practitioners uphold the tenets of true professionalism, and disciplining, perhaps even eliminating, those who do not. There is a crying need for all chiropractors to make a strong commitment to uphold the values of the profession. Until this occurs, acceptance of your professionalism by society and by other health-care practitioners will never be attained. This commitment means to consider the interests of the patient as the number 1 priority. This does not mean you need to sacrifice your own welfare to attain this end, but means that you need to demonstrate care and concern by providing genuine assistance and appropriate expertise. It also means not merely giving lip service to the ideals of professionalism or obtaining continuing education credits for having taken an ethics course, but making a genuine commitment to work within the utmost levels of ethical conduct.

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The greatest challenge will be the elimination of unprofessional conduct from all unethical and incompetent chiropractors.

CAN PROFESSIONALISM BE TAUGHT?
In a recent article in the Canadian Medical Association Journal, the authors do not come out with an emphatic “No”, but they do address the notion of whether professionalism can be taught. The answer they themselves arrive at is, “Probably not.” Added to their recommendations are many other elements that would provide advantages in practice, and in life, but that cannot be taught: competitiveness, intelligence, curiosity, creativity, persistence. They wonder if medical professionalism is an essential topic and if it can really be taught in a classroom.

We would pose the same question to Doctors of Chiropractic. Many of the consequential qualities of professionalism go far beyond practice expertise or the use of the latest of techniques. These are the virtues that cannot be gleaned from books or learned in a classroom. As altruism cannot be taught, the individual must be a good person of high moral character to start with. It is a given that the teaching of ethics starts in the cradle and advances with age. It is not a case of going from standing still to full knowledge and practice in one lecture or seminar. It is a case of “hitting the ground running.”

CODES OF ETHICS
What can be taught, however, are codes of ethics, the guidelines that if adhered to, would optimize a practitioner’s professionalism in patient care, while protecting him/her from the legal/professional/moral consequences of unethical behaviour.

The intention of the chiropractic Code of Ethics, as developed by the Canadian Chiropractic Association, and as emulated by most provincial bodies, is essentially the same throughout North America. It is intended to ensure that chiropractors are treating their patients, the public and their colleagues with respect, fairness and honesty. The codes are enforceable and violation of any of them garners consequences. It is my suggestionthat it should become a requirement for these to be formally taught to each practitioner throughout the profession, without exception, and with some mechanism worked in to glean whether the concepts have been effectively assimilated by each learner. Only then can the profession be assured that the optimal groundwork has been laid for professionalism in practice, and by extension, establish a baseline from which to proceed to deal with aberrations committed by individual practitioners.

However, passing an ethics course, attending the required continuing education seminars, keeping one’s licence current and paying association dues does not make one a professional anything.

It is my understanding that the penalties – not only those levied by chiropractic associations but those handed down by the courts of the land – are not as severe as many highly ethical chiropractors would want. The public is seldom advised about the misdeeds of the unethical. It is always to be borne in mind that chiropractic is a self-regulating industry that holds itself out to maintaining high standards of practice and conduct. Autonomy follows the professional distinctive relations of trust that practitioners are expected to have with patients. Chiropractors set their own standards and define the behaviour that constitutes professionalism.

WHAT THE LAWYERS ARE DOING
Ethics courses are generally looked upon, by professionals in a variety of fields, with skepticism or frank disdain. One medical doctor is quoted as saying, “Courses on professional responsibility are about as useful as a valentine to a heart surgeon.”

Student lawyers regard the mandatory ethics courses as the dogs of law school, hard to teach, disappointing to take and often presented to uninterested classes with vacant minds. In most law school programs, professionalism is still being taught the old-fashioned way. The teacher talks, the student is supposed to listen and then, buoyed with this new knowledge, play by the rules. This is passive learning and it seldom works. It is well known that preaching to the masses can take one only so far.

To make professional responsibility more prevalent and palatable to their students, some law schools are introducing an innovation in teaching – they have moved to modelling and bringing into the class real life examples. To reach higher levels of moral accountability – as well as to make the courses palatable and useful in a practical sense – students must personally be engaged in the resolution of ethical dilemmas.

When this is lacking in ethics courses, critics note that the material is far too abstract and difficult – and so, it’s easy to see why chiropractors resent having to submit themselves to courses in professional ethics. My question, then, is why not incorporate this innovative, more interactive teaching model into chiropractic programming, both in core curricula and for purposes of continuing education to maintain licensure?

WHAT IS THE BOTTOM LINE?
Most professional organizations are of the opinion that professionalism can, in fact, be taught. However, this cannot be done in a lecture format, nor can it be achieved by role modelling alone: a balance between the two may help. Learning should be mostly by observation and the example set by chiropractors and the profession as a whole following the guideline of the golden rule and following the example set by their professional and ethical peers. However, the negative role models, those who obtain new patients by any means, fair or foul, may be more potent than the positive ones. This creates the challenge to not follow the example of the bad actors among us and this is where the profession as a whole must support each member in making ethical choices with respect to their patients. Ethics will only win out when there is a transition, by all chiropractors, to becoming active learners and recognizing the actions, both positive and negative, that reflect on the professional behaviour of the members of our chosen profession.

WHAT IS NEXT?
So where do we go from here? Where will chiropractic be in five years – or 10 or 20? How do you ensure it becomes a profession that is composed of dedicated professionals who have committed themselves to being honest, ethical, competent and altruistic? What will it mean to be a doctor of chiropractic in the future?

For most professions, the failure of self-regulation has contributed to many of the problems. We assume this to be equally true of chiropractors, some of whom are reluctant to identify incompetent or unethical colleagues. Such behaviour undermines the public’s confidence in the profession. Until miscreants, in all professions, start trading in their greed for improved ethics, these problems will never be solved. It is by recommitting ourselves to traditional values that the challenges at hand will turn into opportunities to further the profession and safeguard our patients and the public. This will not happen only through schools having more classroom exercises or by preaching to gospel of ethical behaviour – although if done correctly, theses strategies can be effective in supporting the cause – but also through everyone upholding the values of a profession and thus doing no harm. This will happen when we not only give lip service to professionalism but place the interests of our patients and our colleagues front and centre. This involves having a genuine desire to serve others, an emphasis on values and purpose, a sense of responsibility for the long-term consequences, and knowledge of both the pros and cons strengths and weaknesses of being regarded as a professional.


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