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Dynamic Chiropractic Canada – May 1, 2010, Vol. 03, Issue 03
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Can You See the Big Picture?

By Allan Freedman, LLB

Having been on both sides of the journey into a profession - as a student and a teacher - I credit myself with the ability to comment on what must be one of the most difficult challenges: being able to finally and fully comprehend the "Big Picture" and remain focused on it through decades of professional practice.

Let's start with the definition of the Big Picture as it relates to the chiropractic profession. There are three major components similar in substance to other professions, particularly those related to health care.

First, a student of any profession is going to have to come to grips with the ability to diagnose or analyze the issue brought to their office by the patient. It may well be that the problem presented by the patient is lacking in substance or may well end up as a difficulty quite different than what was first thought of by the patient. The problem may be miniscule on a scale of potential problems or of such magnitude as to require additional intervention by other health care practitioners.

The second major component of the Big Picture is your ability to deal with the problem as diagnosed. The treatment may be long and complicated. It may involve a referral to another health care practitioner, or a determination that the patient does not require treatment. In any event, you must be able to deal with the diagnosis in accordance with the accepted standards of your profession.

Third, the environment in which the professional practice is being carried out is an important consideration. For many chiropractors, or for that matter, professionals of all ilk, cultivating the practice environment can be the most difficult of tasks. It is unlikely that a future chiropractor, future dentist or future lawyer gains entrance into a professional educational institution with the thought that they might have to spend hours upon hours of their precious time dealing with such matters as human resources (hiring, firing and managing staff), economics (arranging loans, dealing with banking and accountants, and ensuring that the financial accounting systems are operating correctly), regulatory issues (licensing renewals, insurance forms, WSIB bureaucrats), office maintenance (leasing, equipment acquisition, repairs) and even practice marketing. In fact, a student might well think at the beginning of their journey that the simple premise is, "Start the practice and they will come."

It is amazing how different life can be from the day a student naively and happily enters their first day of chiropractic college to the day reality sets in and they realize that chiropractic, like medicine, dentistry, law and many professions, are businesses. They are enterprises that require funding to sustain the environment in which appropriate care can be provided.

The "office environment" is of such major concern to the overall validity of a practice that if the office procedures, including such matters as economics and staff relations, are kept in "check" and are not allowed to fall below what is required to maintain the sustainability of the office, you will be able to do what you have been taught to do and to deal with what was the basic premise for entering chiropractic college - treating patients. On the other hand, any practice that is delinquent in its operation, an economic failure, and/or lacking in office protocols and procedure is basically a disaster waiting to happen.

It does not matter whether you are the most competent practitioner in terms of diagnosis, recommendation and treatment. If you are incapable of operating a business, then you are a ticking time bomb for yourself and the profession. And if you are unable to keep your emotions in check and understand professional boundaries, it is only a matter of time before the bomb will explode.

In the legal profession, the joke has been that the "practice of law would be great if it weren't for clients." In the chiropractic profession, I have heard over and over that the practice of chiropractic would be great if "all that a chiropractor had to do was practice chiropractic." Unfortunately, motivation for patient well-being is not enough to sustain a practice.

Many years ago, I came across a study on professional misconduct. The study showed that somewhere in the neighborhood of 90 percent of all professional misconduct complaints arise for matters that have nothing to do with core competency. The complaints dealt with overbilling, inappropriate communication and sexual abuse; matters that malpractice insurance providers have spent almost 30 years advising the profession on via risk-management programs (in most cases speaking to the converted).

The message to be garnered from a review of the Big Picture is that all practitioners have to step back from the trees to see the forest. Take some time to determine whether your practice is built on a proper professional foundation. Is your office well-staffed? Are all policies in order? Do you have a problem with excessive consumption of unnecessary expenses? Are staff professionally appropriate and well-trained? Each of these practice components, while not directly related to your competency to diagnose, recommend and treat, is essential to establishing excellence in patient interaction.

A failure to perceive the Big Picture and maintain the proper practice environment does nothing to enhance your competency or the reputation of the chiropractic profession. Fortunately, in my experience, most chiropractors are aware of the importance of and even excel at ensuring that the patient experience, the environment of the practice and the Big Picture are taken into account as a vital part of a professional practice. However, for those of you who do not seem to be able to see the forest for the trees, it may be time to evaluate how you can improve your practice. And if you know of colleagues who are equally guilty, consider doing a good deed and bringing some enlightenment to their professional practice. It will be good for everyone.


Allan M. Freedman graduated in 1974 with a law degree from the University of Western Ontario and has been an instructor at the Canadian Memorial Chiropractic College since 1976. He can be contacted with questions and comments at www.allanfreedman.blogspot.com.

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