President's Report

Peter Werth

What Price Professional Credibility?
As I sit down to write this report the chiropractic profession (not the osteopathic or the physiotherapy professions) is again the centre of a media focus on questionable practices of certain members of the profession. Yes, this media attention is usually not done to educate the general public, but to provide a sensational story and generate increased ratings for the network in question. But the ammunition for the story is all too available.

In a recent Guest Editorial in Chiropractic Journal of Australia, Keith Charlton¹ raises the question “Could the future we are compelled to inhabit be determined not just by our actions, but by a lack of action on our part?” He notes the trust placed in the hands of professionals is at times abused by practitioners, and recounts the story of a patient whose chiropractor provided “over-interpretation of examination findings, shoddy radiographs, demands that they bring a spouse to the next encounter and then confront them, often in front of others in a group, to agree to a year’s chiropractic care for which they are pestered to prepay.” Many of the letters to the editor in response to Dr Charlton’s editorial rightly congratulated him on his comments and confirm the need to ensure that patient care is provided in an ethical manner based upon treatment which adhere the evidence, and is provided in the patient’s best interests, rather than any other drivers of patient management, in particular financial gain to the treating practitioner (however it maybe window-dressed).

Many other professions, whether they be involved in healthcare or other professions such as the law or accountancy have members that choose to practice with their patients/clients needs as a secondary concern. It would seem that chiropractic has more than its fair share of these members, given the relatively small size of the profession. Why is the profession at times considered the “used car salesman” of healthcare, where the message is they can’t be trusted to act in the client/patient’s best-interest. Whereas broad generalizations such as that above does an enormous disservice to the ethical and caring members of the occupation or profession the mud does stick to all, to some degree.

The obvious question is what can be done to address these unethical practices? It is within the realm of the functions of the registration boards in each state to review these practices, and I understand that some boards are investigating and addressing some of these matters.

At times we at COCA are asked what we are doing in regard to such matters and what role do we take. As an organization whose primary function is in continuing education, we have taken the approach of encouraging practitioners to approach practice in an evidence-based manner, utilising appropriate evidence and clinical practice guidelines to enable you to remain current in your knowledge. Although this would seem an obvious thing to do, some practitioners choose not to practice in this way, and substitute the lack of available evidence as an excuse to ignore and or misrepresent the current evidence. Even in the light of good quality available evidence, (eg management of acute lower back pain), some practitioners choose to put the patient’s interest behind pecuniary gain.

It is somewhat ironic and in fact timely that as you will have seen elsewhere in COCA News, COCA is introducing a Practice Accreditation Program, which has been developed principally by Dr Jo-Anne Maire with the assistance of a sub-committee of the College. It is apt that the program is released at this time, as it also promotes improving and maintaining the quality of how we provide our services to our patients. Many other professions in healthcare, most notably general medical practice and physiotherapy have had such programs in place for many years, and it is in my opinion, essential for the continued growth and maturation of chiropractic and osteopathy in Australasia, that such a program be available to the professions. The program is part of COCA’s contribution to assist the advancement of the professions’ establishment of standards and improvement of patient care.

Dr Maire, who has devoted countless hours to the development of the program, is to be congratulated on the production of such a high quality program that will now I believe set the benchmark for all practices within chiropractic and osteopathy.

In the era of accountability with respect to regulatory bodies and third party payors it is vital that we are seen to be proficient at self-regulation and benchmarking to demonstrate a level of maturity and continuing growth. The alternative is that in light of some of the self-serving members of the professions the regulators will step in and impose the standards for us, and the outcome may not be all that we would desire. For chiropractic and osteopathy to self-determine our standards we need to show that we are mature and insightful professions and hence worthy of being called professionals.

1. Charlton, KH. Silence is not golden: it’s consent [guest editorial]. Chirop J Aust 2003; 33:81-2.