William E. Morgan, D.C.

What can you expect on your first day of seeing patients in a hospital or multidisciplinary setting? After setting up three integrated outpatient clinics and two hospital-based chiropractic clinics, I have found that there are common trends at each of the facilities.

In the early 1990s, I began working in a hospital in central California . The first patient referred to my clinic was a tetraplegic; he was wheeled into my treatment room on a gurney. I still wonder what the neurologist who had referred this patient was thinking. Either he thought I was a miracle worker or that I could not possibly make the patient any worse. Unfortunately, it was probably the latter.

After my tetraplegic patient, I was inundated with every chronic old arthritic and stenotic back in town. The other doctors were dumping their chronic and refractory patients on me. I took them all and did my best. In time, many of these patients with reoccurring conditions were returned to their referring physicians as completed cases. This must have impressed the physicians because I then began receiving all sorts of referrals. Eventually, I began seeing family members of the physicians and, finally, the physicians themselves. By this time, I had been accepted as a member of the team by most of the physicians, and I enjoyed a strong collegial relationship with them.

This story repeated itself at the other medical clinics where I have practiced-patient dumping followed by acceptance and more thoughtful referrals. "Punting" chronic back pain patients is a common practice and frequently is directed at the new pain, rehab or physical medicine practitioner in a clinic.

While every medical clinic or hospital where I have worked has been supportive of chiropractic in time, there are always one or two physicians who feel it is their responsibility to repress the new upstart chiropractor. Normally, they grumble to patients and other staff about the indignation of having a chiropractor on staff.

Occasionally a doctor will come forward and actually confront me. He usually starts out with an attack using the most horrendous story about a chiropractor he has ever heard and expects me to defend it. Of course, I never attempt to defend the indefensible. I usually agree with his opinion about the inappropriate behavior or treatment methods he has mentioned, but I may retort with an equally indefensible story about medical mismanagement. I then attempt to dispel his misconceptions about chiropractic and try to arrange a time to lecture at his clinic. With time and perseverance, most of these detractors can be persuaded to recognize chiropractic as a legitimate health care field.

On the other hand, if a fellow hospital staff member continues to maintain an adversarial and unprofessional demeanor toward you to the point of damaging your credibility, there are options. The bylaws of most hospitals clearly prohibit malevolent gossip directed at harming the reputation of another credentialed provider. If a staff member attacks you or your profession, you have recourse through the governing body of the hospital-which could cost the offending party his credentials.

If another practitioner maintains a strong negative opinion about chiropractic but voices her concerns in a professional format, then you cannot ask for the hospital to intervene. I have some medical colleagues that frequently disagree with me on chiropractic health care, and we have been known to have some very animated discussions. We keep our discussions on an intellectual basis, and usually I grow from these deliberations.

Practicing in an integrated setting is rewarding on many levels. It is especially rewarding to treat patients that otherwise would not have had the opportunity to see a doctor of chiropractic. If you do decide to take on the challenge of practicing in a hospital, be aware that you will need to have patience and be willing to spend many hours educating other departments and staff about your profession.