Pride and Prejudice

As much as I hate to admit it, my favorite fictional work is Jane Austen’s classic Pride and Prejudice.   It portrays the lives of the gentry in eighteenth century England with the two main characters beset by mutual misunderstandings and misconceptions about each other.  Pride and Prejudice refers to the manner that the feisty Elizabeth and snobbish Darcy view each other.  As the story unfolds they each realize that their pride and prejudice has blinded them to the deep qualities and character that is embodied in the other.   As they overcome their own pride and prejudice, they realize their mistake and fall hopelessly in love.

I present to you that Pride and Prejudice, the character flaws, not the book, have created most of the interdisciplinary strife that we see affecting the practice of healthcare.  The pride of one profession boasting its superiority over another; the prejudice that another profession is in some way inferior has created great divisions that have inhibited integration and synergistic patient care. 

Professional Bias

We all have it, the belief that we are in some way superior to other professions.  After all, look at all of the patients you helped that the physical therapist, surgeon and pain clinic treated and did not help.   What about all of the patients who got worse under traditional medical care?    The fact is that you may rarely have seen a patient helped by another profession.   Why should you?  The patients who got better never came to see you.  The same is true in regard to how other professions view you.  They never see a patient that you heal.  They only see your failures, so they believe that you do not help anyone.  After all, how often does a well patient walk in to a medical office to tell their doctor that the chiropractor cured them?   Studies by Dr. David Eisenberg have revealed that most people do not even tell their physician that they see a CAM provider such as a chiropractor.

If we were to base our beliefs solely on the patients who walk in our doors, we would conclude that spine surgery never works and physical therapists continue to have patients schedule long drawn out treatment programs without benefit.  Unfortunately, that is just what happens.   Professional bias views the world in a myopic manner, developing unfounded prejudices.   These prejudices impede professionals from implementing the best approach for most conditions: the interdisciplinary approach.

Humility and Open Mindedness are the Remedy

“Every man’s way is right in his own eyes.[1]” This ancient biblical quote illustrates that bias is an age old concern.   We are all biased and need to be held accountable for our predispositions.  By humbling ourselves to a peer review process and to allowing our dearest beliefs to be challenged in an intellectual manner we can over come our prejudged beliefs.    I recommend joining or forming a multidisciplinary Journal Club.   This will not only help you overcome your bias, but will help other specialties to overcome their biases about chiropractic.  Some of the spine specialists at our hospital have formed a very social journal club that not only analyzes and reviews journal articles, but has solidified an interdisciplinary referral network.   The club meets once a month at a restaurant and has helped to create friendships among open minded colleagues.

Cross pollination in training chiropractic and medical students is another way that we can overcome bias.   When chiropractic students interact and work with medical students while performing hospital rotations, both groups are changed and old biases are done away.  This type of cross pollination can prevent a lifetime of misunderstanding and bias.

Another way to overcome medical prejudice is by sending progress reports to patient’s physicians.   Every specialty sends progress notes back to the patient’s primary care manager (PCM).  Chiropractors should too.  Use standardized outcome measurement tools to honestly appraise the patient’s response and to inform the patient’s PCM.   This should introduce the PCM to the types of responses that can be expected when he refers to a chiropractor.

In Pride and Prejudice Jane Austen uses irony to entertain her readers.  In real life it is ironic that chiropractic is both the victim of prejudice and the perpetrator of prejudice.  As the chiropractic profession matures we need to purpose in our hearts to overcome our own prejudices and to seek to end the prejudices and bias beset against us.