FEATURE weekend. We expect them. It’s just a news item stating whether it was an above or below average long weekend. In contrast a chiropractic misadventure is akin to someone jumping off an of-fice tower during rush hour. It is news because it is novel and unexpected.” What other profession would literally have their interventions or its very ex-istence in question from a temporane-ous association? Even the best profes-sional liability cannot protect the practitioner from emotional harm of such an event. The impact on health, relationships, respect and practice can exist long after an event is a distant memory to other parties. Confidence can be degraded, doubt about compe-tence can linger, and interprofessional judgement can be isolating. The chiro-practic profession is not alone in this. It has been estimated that preventable and accidental misadventures are sim-ilarly devastating to medical physicians. Chiropractors, appropriately, con-sider themselves as being a member of a caring and compassionate profession. These traits are integral in patient care and are greatly impactful on a patient’s health and wellbeing. There is, unfor-tunately, a downside. We are in a “rela-tionship-grounded profession” in which we are often involved on a per-sonal level. However, perhaps too in-volved and to our detriment. The caring leaves us vulnerable on an emotional level. It is not surprising that a profession that intrudes on per-sonal space, is hands-on, and is sup-portive of psychosocial nuances, is susceptible to an emotional investment in the patient’s outcome of care. This same personal investment, that is so integral in a compassionate profession, is a double-edged sword when this same care leads to a deleterious out-come. No chiropractor or healthcare pro-vider of any ilk goes to work to cause harm, but sometimes it “just happens” regardless of skill or experience. Patient co-morbidities will be present influenc-ing the outcome or perhaps psycholog-ical issues will be expressed clinically. Although clinical practice guidelines can assist in delivering the standard of care, patient variability is a fact or practice life that no guideline can fully account for. With spinal manipulation now “On a more level playing field, we can be less defensive and open regarding our care.” identified as front line care for spinal care we can shed the ‘alternative’ label. When something has no evidence of effectiveness, there is no level of risk that is deemed acceptable. Compari-sons to established therapies, medica-tion, and interventions regarding risk are moot. Unfortunately, risk/benefit ratios require robust evidence of bene-fit using accepted evaluation tools, in-cluding blinding and comparators. We can change the dialogue to being that of direct comparisons, including the number needed to help and the num-ber needed to harm. On a more level playing field we can be less defensive and open regarding our care. This change has to happen at several levels. Our advocate associations must change the dialogue and boldly face the challenges and career detractors. A defensive position is counter to the reality as well as the relative safety of our care. We should demand that in-formed consent not just exist in the domain of chiropractic, but rather with all interventions with the potential of harm. The statement: “no effective therapy is safer than chiropractic care” is true and this should be courageously presented to government, stakeholders, and policy makers. This would lessen the guilt and fear of a real or apparent transgression. Our profession is not alone in this. I have heard many chiropractors state that medical practitioners appear cold and impersonal in their patient inter-actions. We have to keep in mind that there may be a reason for this and it may develop for self-preserving rea-sons. We must keep in mind that, like us, they first wish to “do no harm” and have entered a profession with the in-tent to help others. The medical pro-fession has to deal with dire outcomes, adverse events and accidents at a high frequency. The residency programs expose the doctor to situations in which their emotional vulnerabilities are open and transparent. Unfortunately, the chiropractic programs have almost no exposure to deleterious outcomes and the resultant emotional sequelae. Studies have shown that surgeons, who are often portrayed as dispassion-ate and cold, experience suicidal idea-tion three fold more than the same population cohort. Studies have found that one in sixteen surgeons suffered suicidal ideation over the previous twelve months. [ https://www.ncbi.nlm. nih.gov/pubmed/21242446] Further, studies have demonstrated that ten percent of medical students experience suicidal ideation during professional training. I am unaware of chiropractic students being evaluated for this salient danger. [ https://annals. org/aim/article-abstract/742530/burn-out-suicidal-ideation-among-u-s-medi-cal-students] The chiropractic profession has very infrequently utilized mentorship as a priority. All too often, it is positioned as simply a way for chiropractors to facilitate wisdom in care delivery and business practice. A more practical use may be to ex-ploit the experience of practitioners who have successfully “navigated the waters” of eroded confidence and rep-utation. This could be as practical as learning how to deal with patients and family who make both fair and unrea-sonable queries without it necessarily involving a formal complaint or litiga-tion. Your protective association is an excellent resource in many situations but does not have the time to deal with the nighttime restlessness of worry and anxiety. Likewise, our regulators man-date to advise in these matters as it may jeopardize their objectivity if a com-plaint does come forward. The profession could benefit from a forum that is confidential, available 24/7, and provides the chiropractor assistance in these matters. It is purely a matter of maturing into a profession that recognizes its shortcomings while concurrently placing that in perspec-tive with the significant service we provide. www.Cndoctor.ca 24 Chiropractic and Naturopathic Doctor September 2020
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