In part 1, we discussed how it is abundantly clear that the Canadian “disease-care system” is dysfunctional.
In part 1, we discussed how it is abundantly clear that the Canadian “disease-care system” is dysfunctional. There is no hope of recovery if we use the same concepts, and look at things from the same perspective, that put us in this position in the first place. The more we continue to spend in the ways that we have been, the sicker we become as a nation. The statistics are there to prove it. Furthermore, there is no doubt that if we continue in the direction we are currently going, we will be unable to afford this system. This is supported by numerous studies, commissions and books that are readily available from credible sources. In part 2, we will examine how the profession of chiropractic, and its patients, might be able to contribute to a solution.
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| Chiropractors should create a forum with their patients, in their individual practices, to discuss health care that includes chiropractic. Advertisement
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Our medically based care system focuses on the removal of disease. This has its place and is important. But, no distinction is made between curing and healing. Healing is what the body does to keep and/or make itself well – health is being able to do so. This receives very little attention in our current system. Curing is what the pharmaceutical industry and medical profession mostly do to relieve symptoms and/or attempt to halt disease once severe problems have occurred. Funding only this approach is a losing proposition and, furthermore, results in a system that does not provide nearly the number of good outcomes, or overall good health, that should be expected.
It is not acceptable that the chiropractic profession – a discipline that a growing body of evidence suggests could play a valuable role in maintaining health and restoring function – is not an equal partner in our national health-care program. Our profession is present and legislatively recognized almost everywhere in Canada and yet our position in national and provincial health is determined by the medical profession and by the medical lobby at all levels of government. We have no say in this matter. What do I mean by this?
Medicare was always intended to be strictly for the conventional practice of medicine – there is no room for alternatives that consider the body’s ability to heal. Even MDs who have a more realistic view of what health care is, and practise more holistically, risk losing their practice privileges or are severely sanctioned. Furthermore, in anticipation of a 2014 federal Health Accord, the CMA carried out a “national public debate” in its “Health Care Transformation in Canada” by “engaging as many people as possible in an open discussion of what Canadians envision for our health-care system and how to achieve this.” I have no recollection of being invited to participate in this open discussion, nor do I recall any invitations from the CMA to any of our chiropractic organizations to hear from our profession.
But, having said all this, it would not be acceptable, either, for the medical profession to speak for chiropractic and for our patients. This is because, outside of very basic manipulation concepts, that which conventional medicine knows about chiropractic is not nearly enough to properly describe what we do.
Furthermore, it has been our problem all along that we are not heard because we are only whispering. No matter how much we advertise on television and radio, promote lower back pain success, provide excellent symptom relief of a myriad of common conditions, provide public-service announcements, attend dinners with provincial premiers and grow our practices, we are still removed from public health-care funding because we have not done the things that would build the kind of credibility that creates a demand for our health-giving services.
Now, as our health-care system is being reshaped – either through a federal accord or via strategies that will be entirely provincial – we need potent political action coming from grass-roots sources that are supported by our national and provincial associations. To the best of my knowledge, this has never been attempted as long as I have been in this profession (50 years). In order to make progressive changes to the current system, and to open the door for a real health-care system, we need to be heard at all levels of government and from as many angles as possible.
WE HAVE MET THE ENEMY…
To do this we have to first establish some basic operating principles among ourselves. Our profession has, for many years, engaged in an internal cat fight based on philosophical misunderstandings. We have a “them” and an “us”! “I am principled and you are not,” “You are not scientific believing in this innate stuff.” And on and on, ad nauseum.
I can speak about this openly and with absolute integrity. I have been on both sides of the fence and still find myself jumping the fence all the time. Here is the bottom line: we are all chiropractors…period. It is OK to have differences of opinion based on our whole-person life experiences and this happens, all the time, in other professions. (Including medicine, by the way.)
Both sides of the coin are valid. As one who has been on both sides, I realized, very early in the game, that the bottom line is that our profession is inherently multifaceted and we all have a right to be who we are in the practice of our profession. As long as we are practising in honesty, integrity and within our code of ethics, we are all on the same team. What matters most are the outcomes we are getting in relationship to what we are offering our patients.
And, the truth is that we are all getting results and our patient populations are being well served. This is a message we have to get across during this period when our health care, in Canada, is being reshaped.
The philosophy by which we choose to guide our practice is simply one means we use to understand what we are doing. The last word has not been said on anything concerning chiropractic as we are still in our infancy as a profession. We need to find the concept and the principle that unites us if we are going to play with the big boys!
FIRST PRINCIPLES
One thing that is vastly important is that all elements of chiropractic – such as philosophy, concepts, choice of techniques or practice direction – are certainly not based on the notion that the absence of pain and disease is equal to health.
If we embrace this one concept among ourselves, and respect our differences by dropping the prejudices and emotionally-based opinions, we can still be constructively critical of ourselves and grow together as one healing art.
TAKING IT TO THE STREETS
The next step in the process, that of developing strong political action, should begin in DCs’ offices across the country and, then, proceed on to our governments through the involvement of our national and provincial organizations. This has to take place from the ground up, but it has to be organized so that it is efficient and directed towards building credibility.
Chiropractors should create a forum with their patients, in their individual practices, to discuss improving the system to provide health care that includes chiropractic.
We then organize public forums, where a larger audience is invited to share their concerns and ideas for the development of a health-care system based on better health and wellness.
Within the context of these forums with our patients and the public, the concept of a public health account that recognizes and supports the patient’s right of choice of regulated health professions, with provision for extraordinary financial support where appropriate, is introduced. Any other concepts and ideas to improve the system should also be noted.
Petitions need to be advanced to support what the forums have been saying. Furthermore, petitions can also be strategically placed in health-food stores and supermarkets to be presented to MLAs and MPs.
The information and support from these meetings should then be collated and submitted to a provincial association for later assimilation into a national consensus from grass-roots chiropractic patients and interested citizens. This is tapping into the fact that we have more support than we think or that the governments think we have.
Individual DCs can encourage their patients to write letters to the editor to the many newspapers in their communities along with letters to their local MLAs and MPs. The directing of letters to politicians can easily be orchestrated by the provincial associations.
PROVINCIAL ASSOCIATIONS
The provincial associations can play a major role in all of this. They can help organize and facilitate this process in every chiropractic practice in their jurisdiction. This means that employees of the provincial association would be available to chair private office and public meetings and to gather the information and support for public health accounts and other suggestions coming from our patients and the public.
The provincial associations could then embark on a mission to contact and connect with their provincial MLAs/MPPs, and then with MPs, to convey the information gathered from the forums and petitions held in that province. The point, here, is to demand support for proposals offered as a result of our forums and the goal is to elicit the support of those elected representatives. This can be done at the association level, with local DCs being involved.
Provincial associations need to make affirmative connections with all media sources, provincially, to make sure that the results of these forums are known to reporters, editors and columnists. (This last has to be carried out in co-operation with a national plan spearheaded by the Canadian Chiropractic Association (CCA)). Provincial associations may require assistance by outside professionals to help to deliver this aspect of the strategy.
ON A NATIONAL LEVEL
The CCA needs to be involved in this process as this health “Accord” proposal involves the federal government who, at the present time, appears to want to escape the responsibility of developing a new health-care plan. The CCA needs to provide the leadership necessary to put a plan into action by providing a concrete public relations (PR) plan to support the provincial associations.
The CCA PR plan should be along the lines previously developed in the early 1980s, when two years of working with a PR consultant saw the incidence of media feedback go from a few negative comments and articles in Canadian newspapers to over 1,500 positive comments and articles in approximately three years. The plan was abandoned, and was replaced by ads promoting the relief of lower back pain. The profession, at that time, missed the opportunity to continue to influence Canadians in a way that could have been very positive for our present-day challenge.
I strongly feel that the CCA needs to bring on a progressive PR firm to bring back this approach. We need to do what the PR arm of the CMA is doing to promote itself to the Canadian public. The CCA also needs to deploy organizational development strategists to support individual provinces in the development of the provincial strategy described above.
The CCA also needs to be in a constant and efficient lobbying position with the federal minister responsible for health and to also be in touch with all ministers that have an influence on the PMO and the federal caucus. We do not have the support of “big pharma,” but we have a population that demands chiropractic inclusion in a system based on the restoration of health. This may require additional funds that could be negotiated with individual DCs and provincial associations.
I do realize there is a lot more to this than what can be described in this article. The author is not pretending to be the expert on organizing a massive social plan to create a change in the attitudes of the various agencies currently controlling expenditures for medicare. The author contends that this is a preliminary plan of action. Refinements are needed to work out the kinks and to develop a strategy to enlist the participation of patients and their doctors – an initiative that should come from our national and provincial associations.
What is most evident to me is a serious need to rethink the paradigm that continues to keep the profession and our patients from the health care we can provide. We must have a paradigm shift internally, in order to accomplish a paradigm shift in our governments and “medicalized” institutions. We need to come together to harness the voice of our patients and combine it with the evidence that is evolving in favour of our ability to restore function in a variety of clinical situations, including hospital settings. We need to establish recognition that symptoms are evidence of failed health; that managing them is only one part of the process for improving quality of life; and that the medical approach, though valuable in a number of scenarios, is not always the best, or most cost-effective, line of defence. If we are going to make a difference in the health of our country, and in the depth of our contribution as a healing art, the time to start is now. And we need to be committed to doing this no matter how long it takes.
The question is…what are you willing to do as a chiropractor to become an equal in a system truly based on better health and wellness? Are you ready to commit yourself to bringing chiropractic into mainstream health care?
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Dr. Henri Marcoux graduated from CMCC in 1966 and was one of the
founding members of The College of Chiropractic Science. He is a Fellow
of the College of Chiropractic Orthopedists and past president of the
Manitoba Chiropractors Association. He was also previously a member of
the Board of Directors of the Canadian Chiropractic Association and a
member of the Guideline Development Committee of the CCA and CFCREAB.
Dr. Marcoux is a well-known lecturer and teaches a seminar titled The
Neuro-Dynamics of Posture, Stress and Subluxation Patterns.
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