I graduated from Palmer in Davenport in December 1982. After graduation, I associated in an established practice for 2 years and then struck off on my own. I began my practice with a typewriter and a copier.
Most of our bills were done by hand on paper. Mountains and mountains of paper. Faxes had not been invented yet. There was no email. The social media was called a telephone. Most people wouldn’t have modern “off-the-shelf” desktop computers for another 5 to 10 years or so. And when computers began to emerge for the public, their operating system (on “modern” TRS-80 computers from Radio Shack) used CMOS. Instead of colors and icons, you were greeted with a black screen and this: C:\.
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There were no clicking on icons or “copy and paste” shortcuts. There wasn’t even Solitaire or Mine-Sweeper. There were some naissant black and white T.V. video games (Pong and Tanks). Pac-man would soon arrive and add color! Video arcades were on the horizon. Bill Gates would start marketing Windows in late 1985, and I bought my first “real” computer in 1987. It was a little more powerful than a calculator today, with memory measured in kilobytes, not gigabytes.
Prior to then you made duplicates of things with carbon paper and typed on a manual typewriter. Word processing would come later. In that era, “white-out” was as close as it came to word processing. Billing was time consuming. Paper work was a chore that consumed most of your clinic time. It was a very different business environment. New graduates can probably not imagine a world without DVD or Blu-ray, but this was actually even before VHS! Family memories were preserved on super-8 cameras and usually without sound. Cars had cassette players or an 8-track player.
Palmer was also a different place. Lectures were illustrated by the professor writing on a rolling sheet of acetate while the overhead projector shone it’s weak light up on the wall.
My biggest clinical observation therefore is that the modern practice is as different in day-to-day operations in 2013, as airplanes have made the world since the horse and buggy days. Information is almost instantaneous. Phone books are arcane today. Even snail-mail is on its way out. Sending out the clinic billing now goes through a clearinghouse where it’s checked, corrected, sorted and instantly delivered via the Internet with a turn-around from billing to resolution of days, not months. Patient record keeping still usually involves some paperwork, but that also is being phased out for EHR and verbiage-generating software. (Not always a good thing, BTW.) We design our own forms on our own word processors. We print them on our own color printer. We fax records. Our phones are cordless. We digitize X-rays. We back up on carbonite. We email newsletters to all our patients with the click of a button, and we track our billing through the Internet. And sweetest of all, the computer re-paginates my typing automatically, letting me add, delete and spell check my work with a simple mouse click.
As with all invention-based revolutions, from gunpowder, to the steam engine, to the Wright brothers, to the repeating rifle, to the silicon chip, the world is not the same place that it was even just 30 years ago. Everything has changed. We can do twice as much in half as much time! Our modern world is amazing, and we can only presume that our grandchildren will look back on our “modern” era as quaint and archaic, as new inventions come along.
“Grandpa, you actually watched movies on a plain big-screen television instead of in the 3-D hologram portal chamber?” But the one thing that hasn’t changed, and hopefully will never change, is the need for ethics, morality, honesty, integrity and altruism that chiropractors must generate with their patients. No amount of technology can compensate for sham treatments, unethical care or short-cuts when it comes to patient care.
Patients are also more sophisticated now. They expect to know the “how” and the “why,” not just the “what” of the care you’re giving them. Sadly, with modernization has also come some short-cuts in patient care among some chiropractors. Junk science is sadly still too alive and well within our profession. Treatment plans that plan out a year in advance on the first visit are not ethical. Ignoring X-ray guidelines to generate a revenue stream into your clinic when films are not needed is dishonest and immoral.
We have been slow as a profession to modernize our thinking. We still fear guidelines and fight to find our own true identity as a profession. While we want to embrace the modern world, this does not mean we want to embrace a less ethical world. We cannot claim to be equal partners at the health care table when we still cling to outdated and implausible case-management habits. Differential diagnosis and critical thought has been slow in making a foundation for the chiropractic profession, which still relies on health models from the 1800s. We struggle to modernize ourselves, though we long ago accepted the modern world. We struggle with defining ourselves as a profession. We struggle with money, which risks compromises that can poison the chiropractic well for future generations.
To new graduates, I would urge you to be cautious on accepting every scam wind that blows through the chiropractic profession. If you want to be successful, above all else, be grounded in ethics, science and evidence-based care. The best way to make the most money is to make yourself the best doctor you can be. The rest will follow when the core is abundantly constructed. Practice gurus, bogus techniques and eternal treatment plans are also inventions of this modern world. But though we embrace shortcuts in our time-requirements, we need to also be wise enough to reject any shortcuts in our ethics. Ethics have never changed. Loving your patients more than yourself has never changed. And hopefully, they never will.
- Garth Aamodt D.C.