Distrust In Chiropractors And Their Trade Is More Than Justified

This article explores how the sociological concept of trust, both externally and internally, presents challenges to the legitimacy and credibility of the chiropractic profession. This ethnographic study consisted of systematic observation and interviews of 40 chiropractors in South Carolina from Fall 2016 to Fall 2017. Additionally, interviews were conducted with staff members, patients, and other medical providers, such as physicians, physical therapists, massage therapists, and representatives from the insurance industry, about their understanding and experiences with chiropractic medicine. Phone interviews were also conducted with deans and provosts at seven chiropractic colleges around the country.

In total, over 100 interviews and informal conversations occurred during the course of the project. All identifiers of participants and chiropractic colleges in the study were removed to ensure anonymity. Instead, pseudonyms were created that were known only by the author of the study. Additionally, data from the South Carolina Department of Labor, Licensing and Regulation was obtained to document changes in the number of chiropractors who are no longer in practice in the state between 2016 and 2017.

The data from this study suggests that there may be a number of trust issues between the public and chiropractors, between chiropractors and physicians, and among chiropractors themselves. For example, comments and observations from respondent interviews suggests many patients do not fully trust their provider. Additionally, physicians claim the reason for the lack of trust is due to the absence of any meaningful accountability measures to control rogue chiropractors and the wide variance in types of treatment they offer. Among chiropractors themselves, there appears to be an absence of trust, as many providers see their colleagues as competitors and potential threats.

Trust is a key component to the success of any social relationship. Given the inability or unwillingness of the chiropractic profession to hold members accountable for questionable practices, along with the perception that chiropractic treatments may not be effective, the public, patients, and the medical profession will likely continue to view chiropractic medicine with suspicion.

In the paper, the author (Robert Hartmann McNamara, Ph.D. Department of Criminal Justice ) makes several further valuable points:

• The need for autonomy is a critical component to understanding why so many providers are unwilling to allow their profession to be regulated. It also seems apparent that there is no collective conscience, no real sense of solidarity, and there remain questions about the trustworthiness of chiropractors by patients, the public, the medical community and even among chiropractors themselves.
• Chiropractors point to some level of persecution by insurance companies—indicating that others in medicine engage in inappropriate billing and fraud, but that insurance companies target chiropractors because of their limited ability to stand up to them. While there may be some truth to these criticisms, there is also evidence to indicate that the identification of chiropractors for audits may be justified. For example, in a 2016 report by the Office of Inspector General, a division of the U.S. Department of Health and Human Services, the agency responsible for overseeing health programs like Medicare and Medicaid, of all the providers who were cited for fraud, abuse, and errors in Medicare billing, chiropractors were overwhelmingly the largest set of offenders. In fact, the report showed that for 2013, an estimated $359 million in Medicare payments for chiropractic services did not comply with Medicare requirements. Thus, one of the primary reasons for the creation of Medicare accountability teams is because the data indicated that chiropractors are at the center of the problem when it comes to inaccurate and fraudulent billing for treatment.
• The sociological literature points out that the development and enhancement of trust is a crucial component to establishing and sustaining social relationships, and thereby creating a sense of solidarity and morality. To the extent that chiropractors can better foster the development of trust, they will likely earn the respect of their colleagues in medicine and not be seen in a negative light by the public or their patients. This is accomplished, of course, by setting reasonable expectations of what chiropractors can legitimately do and holding the members of the profession accountable in adhering to those standards.

All of this ties in well with many of my previous posts on chiropractic. I might therefore just add this:

What can you expect from a profession that was founded by one of the most infamous snake oil salesmen in US history?