The personality that is best suited for initiating a hospital chiropractic program may also be the personality that will destroy the process. The go-it-alone, "I can do it better myself" type of person is the one who will jump in and start getting the job done. This type of person believes, "If it is worth doing, it is worth doing wrong"; they just get started, and fix the problems later. The problem with approaching a hospital in this manner is that one early mistake may stop the process, and keep other chiropractors from being able to try again later. Getting the job completed is more dependent upon your knowledge of the many subtleties of hospital administration, politics, and pecking order. Small mistakes can make for big disasters.
Emergency medical technicians (EMTs) are among the most self-assured workers in a hospital. They have a limited scope, they practice their skills regularly, and they quickly become good at what they do. Many are young, and unfortunately, some are a little too enthusiastic. Some are so decked out in their simulated SWAT gear that they appear ready to jump from a helicopter behind enemy lines. While good at packaging and delivering patients, they are not always well-schooled in appropriate hospital behavior.
In the emergency department (ED), there is socializing and joke-telling, as in any office environment. The difference is that there are frequent visitors from the outside, and people are usually there for very important reasons. On one occasion, two EMTs had just dropped off a stroke patient. The ED nurses were taking a moment to exchange personal stories. In an apparent attempt to fit in with the ED staff, one EMT turned to a nurse and said, "I guess they won't have to order a dinner tray for the lady we put in bed four!" He then turned around to find the woman's husband standing directly in front of him. It was time for him to turn in his SWAT uniform for a place to hide.
A more subtle, and definitely more important issue for the chiropractor is understanding his or her place in the pecking order within a hospital. A chiropractor recently told me that he had gained hospital privileges and would be treated as an equal of the medical physicians on staff. I wished he had been standing next to me when an ED physician commented on my good fortune to be associated with a hospital that was willing to be the first in the world to place a chiropractor on call in the ED. The ED doctor went on to comment on the hospital's willingness to have podiatrists on call. He pointed out how the hospital's "liberal" policy even allowed podiatrists to perform ankle surgery. He said this was amazing, as ankle surgery could be quite complicated, and after all, "podiatrists aren't even MDs!"
At first, I was taken aback by the doctor's comments. He has been a steadfast proponent for chiropractors in the ED. He calls frequently for chiropractic consultations. He has promoted our ED chiropractic program to medical physicians in other hospitals. Our profession could not ask for a better friend from the medical community.
Yet, if my medical friend questioned the competence of podiatrists, what did he really think of chiropractors? With thoughts of formulating an argument, I first tried to analyze the topic from the physician's perspective. He was probably at the head of his class from kindergarten through college. He demonstrated the ability to grasp difficult concepts faster and more completely than most of his classmates. He was more fluent and imaginative during classroom discussions. When many focused their attention on sports or the hottest new rock group, he embedded himself in his studies.
Not only was this doctor a gifted learner, he also worked harder and longer than most other students. He earned the prize of admission to medical school. He was able to survive the trial by ordeal of his residency. All along his academic and professional journey, he was applauded by his family, and was rightfully proud of himself. He now finds himself in charge of an ED staff. He rattles off orders for others to obediently follow. His decisions may alter lives, and sometimes make the difference between life and death. He is confident in his abilities because of the difficult journey he was able to endure. His confidence is justified, but what about mine?
I was a state trooper between undergraduate and chiropractic college. The state police academy was very difficult. Only half the academy class was able to persevere to graduation day. We were told that only one police academy in the world was considered more difficult. The instructors warned us to avoid describing the physical training to others, as we would be accused of lying. No one would be willing to believe it was possible. Any recruit who was not willing to die during training did not have a chance of graduating. You can imagine the sense of superiority felt by the graduating troopers. Now, imagine how these troopers felt when the state's marine police were taken over by the state police. The marine police, who didn't go through the same ordeal of the academy, were now wearing the same uniforms. The public would perceive them as indistinguishable from the state troopers. This may seem unimportant to some, but the bond of having survived the academy helped make the troopers work as an unstoppable team, willing to put their lives at risk for each other.
The marine police were very good at their jobs. Few state troopers had a desire to work on a boat. Even fewer knew how to work on a boat. It was not necessary for the marine police to be state police academy graduates to do their jobs. I would not have had any difficulty working side by side with a marine police officer. I know I would have respected the marine officer more if it were made clear that he or she were an expert at marine policing - and not an imitation state trooper.
In the hospital, we don't have to be "imitation medical physicians"; we are first-rate chiropractors. The medical physicians don't do what we do. That's why they call us in to treat their patients. That's why an ED physician recently brought his wife to my office for treatment. If a patient, staff member or visitor thinks I am a medical physician, I quickly and proudly let them know that I am one of the hospital's chiropractors.
John Cerf, DC
Jersey City, New Jersey
