By Christine Goertz, DC, PhD
Recently I was invited to give the commencement address at my alma mater, Northwestern Health Sciences University (NWHSU). I would like to share that commencement address with you in this blog post, in honor of the NWHSU spring graduating class of 2018:
Good Afternoon. It is truly an honor to be with you today. As I began to prepare my remarks, I thought about my own graduation, which was also from Northwestern Health Sciences University, nearly 30 years ago. I figured that this would be an opportunity to borrow from the wisdom of my own commencement speaker. And then I realized that I could not remember a single word that he had said. So I started polling other health professionals, asking them what their commencement speakers had said at graduation. None of them could remember either! Probably the best advice I got was from a colleague who said, “It doesn’t matter what you say since no one will remember it anyway. The only mistake you can make is to talk longer than 10 minutes.”
Without more specific guidance to rely upon, I began to think about what I wish my commencement speaker had told me on graduation day. And that is what I want to share with you today. My Top 10 list, in no particular order, of the advice that I wish I had received 30 years ago.
1) Take an evidence-based approach to patient care.
This includes a commitment to life-long learning. There have been many significant advances in patient care since I graduated. As one example, let’s consider care for musculoskeletal (MSK) disorders. We now know that MSK conditions are the No. 1 cause of physical disability worldwide, impacting approximately 1 billion people at any given time. We know that in 2016 alone, 214 million prescriptions for opioids were written, translating to more than 65 prescriptions per 100 persons, resulting in more than 42,000 opioid-related deaths. This knowledge is leading to rapid change in treatment strategies. Just over a year ago, the American College of Physicians published a guideline that stated that physicians and patients should treat low back pain with nondrug therapies. The guideline specifically mentions massage, acupuncture and spinal manipulation. Both the Food and Drug Administration and the Joint Commission, which accredits hospitals, have similar recommendations. This example illustrates the fact that, although we may graduate with an excellent education based on current knowledge, that knowledge will grow with each coming year in ways that will have a direct impact on clinical practice.
2) Find a good mentor.
I can’t emphasize what a difference this can make in your life. There is no substitute for having access to the wisdom of others, those who have more experience than you do, and who are committed to helping you achieve your career goals. How do you find a mentor? Think about topics you are passionate about and then look to leaders in that field. Follow their work, make a point to meet them at conferences, and ask for their help.
3) Work closely with other health care professionals.
This include chiropractors, acupuncturists, massage therapists, primary care doctors, surgeons and mental health practitioners. You can’t do it all. Don’t try. Concentrate on what you do well and bring in other members of the team when it is in the best interests of the patient. For all of us, our overall goal should be to make sure that each patient receives the right treatment at the right time. Most often that will be treatment in your toolbox, but it is important to recognize when this is not the case.
4) Take good patient notes.
Whenever doctors ask what they can do to impact health policy as it relates to chiropractic, this is what I tell them. It is not very exciting to think about but critically important. Obviously this is very important clinically – to remind you of your treatment plan or provide guidance to a locum tenens if you happen to get hit by a bus and have to miss a couple of days at the office. But just as important, it is necessary that you have good notes if you are randomly selected by the government for an audit. The failure by chiropractors to document their services well has led to multiple negative reports from the HHS Office of the Inspector General and chiropractors’ documentation error rate within the Medicare Payment Program is currently five times the national average for all health care providers. In addition, good notes are critical when making or receiving a referral from another practitioner. Good patient records demonstrate that you are a competent and committed practitioner, part of a health care team.
5) Accept the fact that—obviously, only very rarely—you just might be wrong.
When it comes to a diagnosis, the right treatment, the right clinical care pathway…be open to new ideas and new evidence.
6) Ask for help when you need it.
Call a colleague or that mentor when you are concerned about a patient or don’t know what to do next. Even more important, get on PubMed and start reading the literature.
7) Trust your instincts.
If something seems off with a patient or you are just more worried than usual for some unidentifiable reason, pay attention to that feeling. Dig a little deeper with your history and examination procedures, start thinking about red flags, monitor that patient’s progress a little bit more closely.
8) Embrace quality efforts.
These include clinical care guidelines, the Choosing Wisely campaign and clinical data registries. In spite of commonly held fears, these efforts do not take away your ability to provide individualized, patient-centered care. All are intended to provide roadmaps through territory that can be difficult at times to navigate on your own. All have the potential to make you a better doctor.
9) Be bold in your efforts to change the world.
Margaret Mead once said, “Never doubt that the efforts of a small group of committed citizens can change the world. Indeed, it is the only thing that ever has.” I am warning you right now: This is not a job for the faint of heart. You have to show up. You have to work hard. You have to be more persistent than you thought possible. You have to learn how to do what needs to be done, even when it feels scary to try. Remember, courage isn’t about not being afraid. It’s about doing the right thing even when you are terrified.
10) Put the best interests of your patients first.
In just a few minutes you will be taking an oath to do so. Pay attention today as you say those words. It sounds so simple and easy, but it is really a commitment that you must make every day. One of the most common criticisms that I hear about chiropractic from those in health policy or other clinical specialties is that we put our own interests before those of the patient. The No. 1 question I am asked now about chiropractic is, “How do I find a good one?” I wish I had a better answer. Your focus on evidence-based care, the use of guidelines and taking good notes will make a big difference.
Chiropractic students today are graduating into a very different world than I did, with more responsibility, I think, but also more opportunity given the increased interest, visibility and perceived value of the conservative care you will provide.
Let me give you an example of how far we have come. I was so proud when I walked across that stage to accept my chiropractic diploma. The very next Monday morning, I went to my bank and told the customer service representative that I had just graduated and wanted to order new checks, putting the initials DC after my name. She got all excited and said, “Oh, that is wonderful! Congratulations!” Basking in the glow, I accepted her accolades graciously and filled out the required forms. When I was done, I handed them to her and she got all excited on my behalf once again. “This is just so nice,” she said as she collected the forms and I stood there beaming modestly. “Day Care!” The true blow to my ego occurred when I told her that DC actually stood for doctor of chiropractic. She had to go to her supervisor and ask if it was okay to add it to my checks. I like to think that today, in 2018, almost everyone knows that DC stands for doctor of chiropractic.
Why is this all so important? Remember the statistics that I started this talk with: those who are suffering from MSK conditions, those who are dying from opioid overdoses. These are not just statistics. Each one of these numbers represents someone’s mother, brother, child, neighbor, friend or work colleague. They are all counting on us—and now “us” includes all of you—to make a difference in their lives. In some cases, you may save their lives.
Welcome, colleagues, to this profession. We need you.
Dr. Goertz is senior scientific advisor for the American Chiropractic Association. She also serves as CEO of the Spine Institute for Quality (Spine IQ).