Pride and
Prejudice
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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.”*
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.
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