FEATURE LEADERSHIP LEVELLING THE PLAYING FIELD When bad things happen to good doctors A DR. GREGORY STEWART, DC conditions. Secondly, we learn how to identify those patients who exhibit various yellow and red flags and deal with them accordingly. We then add the complexities of treatment, we evaluate black flags and utilize various stratifi-cation tools. As we go through our careers we are inundated with helpful advice on risk management and how to deal with the unintended consequences of care. We are trained to be cognizant and mindful with ongoing evaluation of the risks and benefits of care throughout the treatment regime. There appears to be a gap in core chiropractic education, continuing education, and regulatory standards. Sometimes things “just happen” regardless of doing everything “right.” In my career, events have un-folded that have given me significant distress and concern. Sooner or later, undesired outcomes, regardless of clinical skill and prudent case manage-ment, occur. Chiropractic, as it is usually in a defensive position, accurately boasts about its safety and continually en-deavours to pursue ways in which to deliver care that is safe, and in most cases, much safer than other effective treatments, for the same given condi-tion. Paradoxically, the procedure of spinal manipulation is not in the public domain, and no chiropractor would recommend that the delivery of care be administered by someone not formally trained and educated in its delivery. Further, the departments of health in the various provinces have included spinal manipulation as a controlled procedure that is restricted to those in chiropractic, medicine, physiotherapy and naturopathy. It is therefore curious as to why we are hesitant to acknowl-edge the possibility of harm consider-ing the high level of requisite training and restrictive legislation standards. This may be due to all too frequent attacks from media and our detractors that inhibit our discussion of how to deal appropriately with deleterious events that arise from, or coinciden-tally, with our care. Certainly other professions experience untoward events, but the consequences to their practice/business, and the profession’s reputation on not put on trial, literally and figuratively. I once asked a journalist why the media makes little mention of prevent-able and accidental medical events. (It was estimated that there were ten thousand preventable hospital deaths in Canada yearly and adverse events were common, but largely unacknowl-edged by media.) At the time, the chi-ropractic profession was being associ-ated with a recent vascular event. He stated “medical deaths are like fatal car accidents on a summer long www.Cndoctor.ca patient states that they don’t feel “quite right” following a treatment. They sub-sequently call to can-cel their scheduled follow-up treatment. You wonder if they have experienced a deleterious outcome and the worri-some thoughts integrate your con-sciousness for several days. At their next presentation, the same patient expresses how well the previous treat-ment went as a feeling of silent relief sweeps through you. You wonder if this profession is a good fit for your person-ality type and whether you may have made a regrettable career choice. If you haven’t experienced this yet, you soon will. Negative thoughts are powerful. Who hasn’t ruminated on a personal con-flict, confrontation or bad news? The reason is that negative events have a greater impact on our brains than pos-itive ones. Psychologists refer to this as negative bias (AKA positive-negative asymmetry). Although this emotional imbalance transcends all aspects of life, its impact on a professional can be distressing and devastating. We spend a great deal of our educa-tion dealing with the diagnosis and standards of care for NMSK DR. GREGORY STEWART has held a full-time clinical practice in Winnipeg, Manitoba since 1986. He is past President of the Manitoba Chiropractors Association, the Canadian Chiropractic Association and the World Federation of Chiropractic. 22 Chiropractic and Naturopathic Doctor September 2020
Chiropractic + Naturopathic Doctor September 2020: Page 22
