One great benefit of having a regular column in Dynamic Chiropractic is that I get letters from doctors all over the world because one topic or another sparks them to write. The fact that someone's words or thoughts could prompt others to act is undoubtedly the highest reward most writers could ask for.
On Jan. 18, a columnist by the name of Joseph H. Brown wrote an article titled "King Stressed the Need for Self-Criticism," that appeared in the Tampa Tribune. Dr. Greg Hollstrom was significantly inspired by that column and wrote me a letter, paraphrasing the significant points made by Mr. Brown and analogizing them to chiropractic. He sent me his thoughts, and they are worthy of our collective consideration.
Last August, around the time of the 40th anniversary of the 1963 March on Washington, where Rev. Martin Luther King delivered his famous "I have a dream" speech, Dr. Hollstrom reflected on how that speech corresponded to chiropractic in America. Yes, there is much success and progress that can be noted, but disappointment and frustration within the profession are also evident.
Many believe, like Dr. King with the black community, that chiropractic needs to become introspective if a dream like Dr. King's is ever to be realized for the chiropractic profession. If a profession could be selected to fit the model Dr. King expressed, chiropractic would certainly be appropriate. In his 1958 book Stride Toward Freedom, Dr. King outlined the strategy of his crusade for equality. His nonviolent crusade also contained a critical view that is not often quoted. He said, "When the white man argues that segregation should continue because of the negro's lagging standards, he fails to see that the standards lag because of segregation."
One could easily paraphrase his critical views in chiropractic terms: "When the AMA argues that segregation should continue because of chiropractic's lagging standards, it fails to see that the standards lag because of the segregation." Yet, chiropractic physicians must be honest enough to admit that our standards often do fall short. One of the sure signs of maturity is the ability to rise to the point of self-criticism. Whenever we are objects of criticism from the AMA and others, even though the criticisms are maliciously directed and mixed with half-truths, we must pick out the elements of truth and make them the basis of constructive reconstruction. We must not let the fact that we are victims of injustice lull us into abrogating responsibility for our own profession.
In his last book, Where Do We Go From Here?, Dr. King re-emphasized the need for introspection. We should ask the same question for our profession. It is not a sign of weakness, but a sign of high maturity, to rise to the level of self-criticism. Unfortunately, self-examination is considered taboo by many within the chiropractic profession. Those who have the courage to "stand up and speak out" receive comments that they should have their license revoked and their membership in the profession suspended for "airing our dirty laundry" or "speaking about sensitive issues that require debate and discussion."
One might ask the simple question: "How can dirty laundry get clean if you leave it in the hamper?" Some suggest that the profession must maintain a "code of silence" (so they - our enemies - do not have ammunition to use against us). Others suggest we need to learn to "live and let live" within the profession ... and often times, these are the very groups that subscribe to discriminatory and inaccurate propositions about the need for high educational standards and the necessity for adequate evidence before making claims that cannot be substantiated. Frankly, these groups have always been around, and until we stop worrying about what "they" think, we will never arrive at a truly equal status for the chiropractic profession.
Self-criticism of the profession does take place, but it is mostly heard at the level of a whisper in the hallways at homecomings, in vendors' booths at conventions, or in small gatherings of chiropractors during social functions. It rarely rises to the level of full-blown public debate. Anyone who attempts or suggests such a discussion is sure to be criticized, perhaps even ostracized, for "putting down the profession," "blaming the victim" or "doing the AMA's dirty work." These individuals are deemed not to be chiropractors. Why else would they advocate such actions?
As a result, problems continue to exist in our profession, such as doctors who suggest that diagnosis is not a part of chiropractic; or that an adjustment for life is a valid proposition to suggest for all patients; or that raising educational standards is bad for the profession; or that chiropractic affiliation with universities is a medical model; or that - you fill in the blank with the issue or unsubstantiated claim. These issues, as much as the AMA ostracism, are responsible for the persistent inequality that exists today.
The "identity crisis" facing the profession in 2004, after more than 109 years, is due, in part, because these tough questions have not been answered, and the profession is left to feign an identity suitable to the group or individual who creates it for their specific purpose. The complex health care system and the reforms now being debated in the halls of Congress will demand that those professions included in any new health care program in the future maintain a level of accountability, responsibility, evidence-based procedures, integrity and proof of self-governance.
The reflexive rejection of self-criticism can short-circuit dialogue that produces long-lasting change and permanent improvement. That is why in 2004, Dr. King's 1963 warning can be paraphrased for our profession: "We will have to repent in this generation, not merely for the vitriolic words and actions of irresponsible doctors, but for the appalling silence of good doctors."
The profession has made wonderful strides in the past 25 years, as evidenced by the recent ACC-RAC conference. How appropriate to have Murray Goldstein, DO, who directed the first-ever conference hosted by the National Institute for Neurological Diseases and Stroke in 1975, deliver a keynote. He opened his remarks by saying, "Everything I was going to say is already in your workbook." What a difference 25 years has made: from virtually no research and/or researchers; to the cadre of young, energetic and qualified researchers; to the recent announcement that the Florida State University College of Chiropractic is now a reality.
It was also energizing to see almost 300 young, bright, enthusiastic and professional students travel to the ACA's legislative conference and once again lobby at the very grassroots of our legislative process. We have now come full circle.
Yes, there was a dream by some of the early pioneers in this profession. That dream has been severely impeded by the actions of a small minority in this profession who are only empowered by the silence of the majority.
Perhaps it is time to speak out against those who would retard the growth of a profession because of a determination to adhere to dogma. Perhaps the growth of our professional associations, coupled with a renewed determination to speak out against oppression, regardless of the form it takes, will truly make our dream a reality.
Speak out with your voice, your membership, your checkbook, and your personal involvement in any aspect of activity that advances our profession. Most of all, however, as I continue to suggest to those who are fed up with the status quo of the profession, "One person can make a difference." Will it be you?
Louis Sportelli, DC
Palmerton, Pennsylvania
