This once a month, 50-minute live broadcast, "Medicine in the '90s," has aired regularly since 1989 during the lunch hour of the MDs on staff at Kaiser on the West Coast. The idea is to allow the MDs to view the programming and receive continuing medical education (CME) credits in a convenient and inexpensive way.
Internist Dr. Helen Hammer, moderator of the show and director of graduate medical education for Kaiser, told me in a pre-production teleconference that because the program is shown at lunch hour and is so easily accessible, more than a thousand staff physicians in Washington, Oregon, and California would view the show live on television. Dr. Hammer explained that a videotape of the production would be made available and distributed for CME credit to the more than 10,000 Kaiser physicians employed throughout the U.S.
I also learned that the show I was to appear on would be the first in the eight year history of the program whose topic was not medical, but would specifically address chiropractic, because it is the largest and most popular of all alternative health services.
The chiropractic TV program follows Kaiser's first offering in their health plans of direct access to chiropractic services after more than 50 years in business. As was noted in Dynamic Chiropractic (October 9, 1995), Kaiser began offering chiropractic in its new health plans in Southern California (January 1996) and in Northern California (August 1996) through a contract with American Specialty Health Services (previously the American Chiropractic Network). About 400,000 of Kaiser's five million members now have plans that include chiropractic care. This number is expected to greatly increase in the immediate future.
Kaiser's decision to cover chiropractic, as described in the introduction of the television program, was clearly market-driven: that is, patient and employer demand for chiropractic has dictated that to stay competitive, Kaiser felt compelled to offer this benefit to attract more members and enhance customer satisfaction.
On the Set
I arrived at 9:30 a.m., Thursday, August 14, armed with a briefcase crammed with data on the latest outcomes, practice guideline recommendations, and patient satisfaction surveys. I craned my neck to glimpse the name of Kaiser emblazoned in bold, colossal, raised steel letters across the very summit of the towering edifice, a landmark of the Oakland skyline that houses both the regional offices of Kaiser Permanente and the television studio.Once inside, after having successfully negotiated security check points, a uniformed guard, and prominent warning signs ("Do not go beyond this point without pre-approved clearance)," I was warmly greeted by Dr. Hammer in a modern, spacious suite. Dr. Hammer, Dr. Wickham and I reviewed the agenda for the show and rehearsed on the set. The set had a central circular desk ringed by three office chairs, with blazing lights glaring overhead, promptly heating us to what can best be described as well done. We were surrounded by a bustling crew consisting of about 10 cameramen, editors, producers, a director and other various support staff. The well-equipped studio and its large control room were brimming with the latest technological advances in television production. Clearly, Kaiser was not suffering a pressing financial crunch.
The program agenda included: a review of the history of chiropractic; educational requirements and curricula; licensure; postgraduate education; definitions and distinctions of manipulation versus mobilization; definitions of subluxation; differences between the practice of chiropractic and medicine; grounds for referral of patients; contraindications and complications of care; research-based evidence of effectiveness; and reasonable treatment plans and outcomes.
The rehearsal went very smoothly, despite my inadvertently inhaling some of the make-up used to powder my nose and dampen the shine of my balding and ever-expanding forehead.
A pleasant luncheon buffet was offered to us an hour before the live shoot. All of the staff and MDs involved with the production were exceptionally gracious, accommodating, and respectful. Dr. Hammer told me that one of her best friends was also her personal chiropractor, whom she went to regularly. She said she'd grown up in a very small desert town in Southern California, and one of the most respected and admired members of the local community was a chiropractor. She vividly recalled how the chiropractor had successfully treated her mother after a serious neck injury.
Showtime
Showtime finally arrived. The background music commenced, our introductions were completed, and a lively, informative and engaging discussion began as we launched into the show's agenda. Oh yes, I forgot to mention one point of interest. Prior to the live program, Dr. Hammer reminded us that MDs viewing the program could call in with questions. I asked how many calls were usually received during a show. She said they usually got one or two; that the most ever was five calls.Of course, they had never done a program on chiropractic, and this topic, presented in the "belly of the beast," if you will (that is, at the headquarters of the oldest, largest and one of the most conservative bastions of managed care in America), turned out to be just a wee bit more controversial than the usual topics discussed. Instead of one or two politely phrased inquiries, we received 14 impassioned questions charged with the agitated emotions of sometimes resentful, and occasionally aggressive, physicians. The medical profession's autonomy, influence, reputation and income have been progressively eroded by the sweeping changes in managed care, evidence-based guidelines, malpractice litigation and the ever expanding threat and encroaching growth of alternative care. It felt as if the mounting frustration among MDs, as members of an embattled profession, had surfaced and was directed at me as a symbol of an old and thriving adversary.
As a result, the original agenda was quickly abandoned, replaced by incessant questions; our responses which filled the remainder of the program's time. We also answered a number of calls off the air, as the show ended with several insistent doctors clinging tenaciously to their phones to pose their own pressing questions. The contrast between the warm acceptance of the more enlightened MDs involved with continuing education, and the raw contempt of some of the field doctors who called, sums up the experience for me.
There's no question that many health providers find themselves amid the most unsettling changes in the history of health care. Medical domination of the health care market is crumbling, and alternative approaches are achieving far greater recognition than ever before. Employer and consumer demand for chiropractic care has become a major market force. The number of practicing chiropractors has been projected to double by 2010, and is considered to be a factor in the expected excess supply of MDs.1 Current meta-analyses and government sponsored practice guidelines consistently endorse the use of spinal manipulation, acknowledge its efficacy, and study after study reiterates its safety.
It is critical for the well-being of our mutual patients, for the acceptance and growth of our profession, and for the opportunity to serve the tens of millions of patients covered by managed care, that an ongoing, candid and constructive dialogue be maintained between medical doctors and chiropractors. We offer managed care patients a unique approach (and an often very welcome alternative) to the limitations of the biomedical model of disease and its narrow focus on biological markers of pathology. Instead, we deliver care that focuses on enhancing human potential, quality of life, well-being and function, and provide services which address patients' desires to have doctors that "deal with their personal life as well as their pathology."2
Regardless of the dogged resistance we sometimes encounter from intolerant and often arrogant MDs, the dissemination of the ever increasing body of evidence substantiating chiropractic's clinical value must continue. It is only through our dedicated and persistent efforts that the many bridges being built between enlightened MDs and DCs can be strengthened to broaden the expanding role chiropractic can play in health care.
Unfortunately, the format and time limitations of "Medicine in the '90s" was not the ideal forum to educate a large medical audience about chiropractic's unique approach and clinical outcomes. The priority given to phone calls forced the show to skip randomly from one topic to another in a disjointed, abrupt fashion, eliminating the potential to develop the type of clear and consistent presentation necessary to inform and describe the current evidence on the effectiveness of chiropractic. It is, nevertheless, important that we educate the medical profession about chiropractic and the data substantiating its merits.
Too often, I have found that MDs' inflexible and cynical opinions concerning chiropractic were formed in a distant past heavily colored by the distorted and biased misinformation intentionally disseminated by organized medicine: back in the "bad old days" when the AMA conceived, carried out, and was eventually convicted of a conspiracy in restraint of trade against chiropractors in its concerted effort to discredit and destroy the profession.3
Despite our previous conflicts and past deceptions, it is essential to improve communication and enhance cooperation if we are to supply patients with the best that both medicine and chiropractic have to offer.
References
- Cooper RA, Stoflet SJ. Trends in the education and practice of alternative medicine clinicians. Health Affairs, 1996;15(3):226-238.
- Gordon JS. Am Fam Phys, 1996; Nov 15: 2205-2212.
- Getzendanner S. Permanent injunction order against AMA. JAMA, 1988;259(1):81-82.
Malik Slosberg, MS, DC
Pleasanton, California
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