Food for Thought 2007 - Gaining and Losing Trust

G. Douglas Andersen, DC, DACBSP, CCN

In this information age it is impossible to keep up, and I have often told friends and patients my goal is to simply fall behind at a slower rate than the competition. A Gallup Poll done in November 2003 did not come to my attention until late 2004. Since then I have kept my eye on these types of surveys. A 2006 poll by Harris on the most trusted professions didn’t include chiropractors, but to return to the Gallup poll whose theme was healthcare.

We all want our profession to thrive. The question is how? To me, the Gallup Poll results make it crystal clear what our educational and association leaders must address. The security of the profession can be summed up in one word: trust. In many areas of the United States times have changed for chiropractors. In general, practice income and practice volume are not what they were 5, 10, or 15 years ago. There are a number of reasons for this and they are best addressed in another article. The important question for chiropractic and chiropractors is why doesn’t the public trust us? Or to be politically incorrect, why does the public think we are dishonest? Why did we score well behind nurses, medical doctors, dentists, and veterinarians? Or to be honest, why are we the least trusted healthcare professionals?

To answer why we are not trusted, we must ask what makes a person trust a healthcare professional? The knee-jerk reaction would be clinical competency, but I believe there is a more important reason, and the results of the survey support it. Recall that the most trusted healthcare professional by far are nurses. Do people think they are smarter or are more educated than the doctors they work for? I doubt it. Had they asked in the survey why nurses were so trusted, I think the answer is obvious, “Your health before their wealth.”

Granted, patients normally are not billed directly by nurses and this undoubtedly is a factor in their high ratings, but no matter how smart a provider is, if the public feels a decision about their health is influenced by the financial gain of the provider, trust is severely compromised, if not destroyed. Let us assume, then, that our low ratings are not because people think we aren’t as smart as other professions, it must be what they perceive we care about.

The best way to guarantee a bright future for the profession is trust by the public. The consequences of becoming a highly trusted profession, both intended and unintended, are countless, and can range from an insurance claims adjuster (if adjusters feels chiropractors are very honest and ethical, the claims will be looked at differently no matter what their bosses tell them) to our elected officials (it is much easier to pass a bill harmful to a group with a poor reputation).

The question we must ask ourselves is how in the world could a natural, drugless profession that is over 100 years old have such a poor reputation? Why would a profession with a unique doctor-to-patient relationship, (the average chiropractor takes the history, performs the examination, and delivers the treatment personally without middlemen score so poorly?

Therefore, we need to ask ourselves what we are doing as a profession to make people believe that getting someone better is less important than getting them to return. The list below reinforces this perception, when a patient states, “My pain is gone.”

  1. You need to return because of your x rays.
  2. You need to return because your legs are uneven.
  3. You need to return because your muscles are weak.
  4. You need to return because of a lawsuit.
  5. You need to return because the injury was at work.
  6. You need to return because we have 10 more visits on the treatment plan.

The problem with the above list is that people come into our office for pain. Take a look in the Yellow Pages, Web sites, signs, brochures, or mailers, you name it. Our message is all about safe fast, effective, gentle pain relief. When we deliver as advertised, we then have a perfect opportunity to either build or destroy trust. “Call me when you need me” builds it. When most DC’s answer “I feel great”, with “You don’t need to return”, we will be chasing no one but nurses.

That leads us to examine the source of this harmful business model. This, too, is a no-brainer. We must get rid of the practice builders who teach doctors how to treat patients longer. It is wrong, it is professionally embarrassing, it ruins the public’s trust, and it is very harmful for the future of our profession. True incomes may decline in the short run, when a patient on a 12-visit plan is pain-free on visit 3 and, thus, is released. However, as an all natural profession that often espouses Thomas Jefferson’s “The doctor of the future who does the least does the best,” this will have an exponential effect on raising the perception and credibility of our profession as a whole. If chiropractic can take its rightful place as the most trusted profession, the benefits to ourselves, the public, and our acceptance by allied professionals would be significant and, most importantly, provide our profession with a great deal of security.

The Poll
A CNN/USA Today Gallup Poll preformed in November 2003 took a random sample of 1004 adults across America and questioned them over the telephone. Of the 23 professions included just under 1/3(7) were healthcare professions which was the survey’s focus.

Perceived Honesty and Ethical Standards
  Very High High Average Low/Very Low Opinion
Nurses 25% 58% 16% 1% 0
Medical Doctors 16% 52% 27% 5% 0
Veterinarians 16% 52% 27% 2% 3
Pharmacists 17% 50% 29% 3% 1
Dentists 11% 50% 34% 4% 1
Psychiatrists 8% 30% 44% 13% 5
Chiropractors 5% 26% 49% 15% 5


1 Winkelmayer, W.C., Stampfer, M.J., Willett, W.C., Curham, G.C. Habitual Caffeine Intake and the Risk of Hypertension in Women. JAMA. 2005; 294: 2330-2335
2 Cornelis, M.C., El-Sohemy, A., Kabagambe, E.K., Campos, H. Coffee, CYP1A2 Genotype, and the Risk of Myocardial Infarcation. JAMA. 2006; 295: 1135-1141


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