This article is on my observations during the Mercy Center Conference, January 25-30, 1992. The process of electing practice parameters for the profession of chiropractic was held in a fair manner, allowing all viewpoints equal, adequate, and unhindered expression. Through the process of consensus building, agreement was reached.
The enormity of the task will never be fully appreciated. That holds true for all who will benefit from the work as well as for those who have created the work. There has been so much done behind the scenes in preparation by so many groups and individuals, that trying to list them would take too much space. In terms of cost, if individual bills for service were rendered by the participants, instead of volunteered, it would likely be in the millions of dollars.
The Congress of Chiropractic State Associations (COCSA) commissioned the work three years ago. The leaders of the profession had recognized the need for a body of work that in reasonable measure captured the essence of chiropractic practice. Encouraged by the confidence in chiropractic expressed by men such as David Chapman-Smith, secretary-general of the World Federation of Chiropractic, who has championed "the exploding volume of literature from reputable sources worldwide testifying to the efficacy of chiropractic," and fueled by emerging data made available by the RAND Corporation and spokesman, Paul Shekelle, M.D., M.P.H., an idea began to take substantive form.
COCSA had witnessed firsthand a revival of the necessary spirit to begin the work. The men and women of COCSA had seen their own organization rise from the ashes and have their cooperative spirit fanned into flame. Supported by a growing list of state associations, COCSA asked for help. Neutral from national political polarizations, COCSA is perhaps the only organization that could have taken on this task. A welcomed rallying point for all philosophies, COCSA offers a free exchange of dialogue and consensus building. As time passed and yearly meetings grew in size and importance, the exchange of information across state borders grew in value. From sharing of our problems, from sharing of our successes, from sharing of ourselves, the realization of the real needs of the profession began to emerge. It was from this origin that the understanding of what the (chiropractic) world needs now became a common goal.
Without the development of a background document produced by members of our profession, against which measurement would be possible, the future would see the continued imposing of parameters surrounding and limiting chiropractic by those outside our profession. Unless the profession itself could come together and produce a set of practice parameters that meet with the approval of the majority of doctors, as well as satisfy the present and future need for assessment or outcome study, we likely would have to live with the work others had to undertake because we did not. Make no mistake about this, someone was going to establish this background data. I believe we avoided an untenable position of relegation by "outside" interests by delegating this responsiblity to our leaders. Always impressive, Scott Haldeman, D.C., M.D., Ph.D., led the group through a chapter-by-chapter consensus building process that tested the stamina. Champions respond to a challenge. The display of professional judgment, the concern for the practitioner, the level of cooperation, and the knowledge brought by the participants were inspiring. Our future growth is again unhindered and full of promise. And yes, there is still so much to be done. We have, however, passed a major milestone by producing this benchmark.
When the United Nations helps conduct elections in countries that have never had elections before, they send observers. The role of the observer is to ensure that the elections are held fairly. Linking the conduct of the elections to the worldwide media through the observers, the UN can buttress the expression of bias. Strong-arm tactics by former dictators can be reported and if necessary, the elections can be held a second time. The observers are there to just observe.
Sometime during the evening of the first day, I realized why I had been invited to the Mercy Conference. Although I knew I was an observer, I did not know what I was supposed to be observing. The making of a precedent is what I was witnessing. The process was fascinating. The design and protocol were of the highest order. I truly was watching history being made.
Here in the same room were the leaders of national groups that are still embroiled in working out their differences. Here were people that had never dreamed of getting into a small elevator together, let alone working on the same committee for four consecutive 14-16 hour days, and in some cases 20-hour days. Here were people who had to tackle questions as deep as the identity of the profession itself. With the diverse philosophical backgrounds of the 35 members, academic, clinical experimental, management, assessment, and review, no observer or handicapper could ever expect consensus. But consensus is what constructed. Consensus was built on a solid foundation of what is good for chiropractic. Self-interest was set aside. Political leverage was left at the door. The common focus of purpose was inspiring and gives great hope for the future. It is safe to say that no one who spent four days in that room in the south wing of a convent, on a hill in Burlingame, California, will ever be the same personally, or ever think the same about the men and women with whom they shared this enormous task. The investment they were asked to make cost them too much.
What will become of the "standards"? Will the profession embrace or spurn them? My expectation is that there will be almost total acceptance of this body of work. There will be vocal pockets of resistance to the fact that any group would propose to do this to the profession. This opinion will spring from an erroneous perception of the process and not the document itself. Anyone who takes the time to first read the work before forming an opinion, will save themselves unnecessary worry. Your leaders have served you well, doctors. They are to be congratulated on a job well done.
Jeffrey B. Prystupa, D.C.