| | Rick Kirschner, Author of Click! on the Debate over ABIM and the MD's Integrative Medicine Specialty | |
Summary: Best-selling author and speaker Rick Kirschner did not know, until I told him, about the debate over the Arizona Center for Integrative Medicine's decision to create a formal MD specialty in integrative medicine. For 25 years Kirschner has made his living through teaching communication and relationship strategies. He's written such books as How to Deal with Difficult People and, most recently, How to Click with People: The Secret to Better Relationships in Business and Life. Kirschner has skin in this game. A 1982 graduate of then National College of Naturopathic Medicine, Kirschner is a licensed but non-practicing doctor of naturopathic medicine. He'd heard from others about efforts of family practice docs, in a coincident irony, to keep naturopathic doctors from practicing at full scope. I asked Kirschner for his perspective on "clicking" in a context like this. Here is his column.
Other articles in this series:
 Rick Kirschner, ND: Author/speaker
Kirschner is a best-selling author and speaker to such groups as Toyota, the US Army and the Young President's Organization. He has made a living over the past 25 years through teaching communication and relationship strategies. In the mid-1980s, he co-authored a set of best-selling audio tapes, How to Deal with Difficult People, which offered lessons on communication in challenging situations. This was followed in the early 1990s by the international best-selling book, Dealing with People You Can't Stand: How to Bring Out the Best in People at Their Worst. Then came 7 more books, including his recent work on influences, "Insider's Guide to the Art of Persuasion." Some focused on people in workplaces, others in their families, and one with one's self. Kirschner's most recent is How to Click with People: The Secret to Better Relationships in Business and Life.
I shared with Kirschner my dismay that the antagonism between the integrative practice disciplines can still hit such a furious pitch as was the evident in the responses to the news. Kirschner shared that he had recently learned of the resolution from the American Academy of Family Physicians against full scope naturopathic practice such as is practiced in Kirschner's homestate of Oregon where he maintains a license.
I invited Kirschner, a non-practicing 1982 graduate of the then National College of Naturopathic Medicine to consider contributing his perspective. Learning to click seemed a good message for discomforted disciplines. Here is Kirschner's column.
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"Recently, I learned that some
frustrated colleagues were talking about pursuing a public campaign to
challenge the claim to authority of conventional medical doctors regarding
ownership of the title of 'doctor.'
 Kirschner's business logo
"But what is the best strategy? Maybe it's one that is done in the open,
that invites other potential stakeholders to choose sides, but I don't think
so. The concern I have regarding this idea of a public campaign at this
moment is that a direct and open challenge is probably the least effective
response possible. Because it's bound to be expensive, and it's bound to
require bodies and minds willing to participate, and I just don't think there's
enough of either to get it done this way. So what possibility remains if
we rule that out?
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"When somebody doesn't make the
choice
to talk to somebody who is opposing them,
I'm guessing it's
a lack of confidence ..."
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"More likely, strategies for further integrating healthcare and relieving
harassment of natural medicine practitioners will, for the foreseeable future,
be done behind closed doors and behind the scene, leveraging political networks
and social capital for positive change. And there's only one strategy that
I'm certain about, and it's the personal one.
"Whenever I hear that some natural medicine doctor is being sniped at by
conventional docs to whom they've sent a referral, are being denied access to
conventional med services on behalf of their patients, or are being
brought up on charges by the conventional medical establishment due to a weak
legal arrangement and overreach by practitioners, it occurs to me that the most
obvious next step for the person seeking change is to reach out to the people
engaged in the bad behavior, and find out what exactly is going on with
them.
"The fact is, people do what they do
for a reason. Sometimes, lots of reasons. People have their
reasons, and if someone is doing things that interfere with you, a prudent
choice is to attempt to find out what their reasons are. That requires
connecting, relating, and communicating purposefully and successfully with
someone who, at the face of it, is hostile to you. That hostility means
they are protecting something they value, something they deem important.
And the deeper you go, the more meaningful it becomes, and the less effort is
required for change.
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"If really changing the health care
paradigm
has even the remotest chance of success,
doctors must leave their silos, and start
clicking with people,
start building
positive relationships."
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"When somebody doesn't make the
choice to talk to somebody who is opposing them in this way, I'm guessing it's
a lack of confidence that is holding them back, along with a sense of
isolation. Otherwise, I think they would first reach out to the person
calling them out, instead of hiring it out to attorneys.
"Reaching out is the human thing to
do when you're building bridges and knocking down walls. It is through our
connections that we create healthy communities and alliances, by facing,
surfacing and addressing problems when they arise. And as things change,
problems do arise. Whenever there's an interpersonal or interprofessional
problem, finding out what the problem is has to be the top priority.
"If someone feels under siege, and
they're not thinking of finding out what's going on from the people besieging
them, it likely means that they are uncomfortable with making contact and
asking questions. Perhaps they don't think they can stand up for what
they're doing in a personal challenge, or perhaps they fear they're going to be
lacking in some sort of comparison. I get it, that makes perfect sense. I
know that if I don't think I can hold my own on a subject, talking to someone
about it in a respectful and authoritative way just isn't going to
happen. Most people are that way.
"But avoidance is not an effective
response when dealing with a challenge, not if progress and positive change are
the desired result. In other words, getting together with antagonists and
talking about the antagonism and what's driving it has to happen. I think
that at least you have to try. It demonstrates self respect. It
demonstrates integrity. It very likely may create some trust, and a
little trust is a great beginning.
 Click: Kirschner's most recent book
"If someone is standing in your way,
don't walk away, walk towards. Embrace the opportunity of it. And
get clicking. Because time is passing, and the need for a
paradigm shift has never been greater. It is unlikely to happen because
of a mass movement. It is far more likely to happen in relationship,
changing minds one at a time, until we reach a threshold of mutual
understanding and respect. It will happen through our relationships with
other health care providers. It will happen from the commitments we make.
It will happen one click at a time. And that time is now.
"I'm
reminded of the words of wisdom found for so many years on the Dr. Bronner's
soap label: 'If not you, who? If not now, when?'"
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Comment: Kirschner's human and humane message can seem terribly naive amidst the vicious guild behavior in medicine. I think there is a place here to apply the therapeutic order, to use a concept expounded by Kirschner's discipline. By this I do not mean: Step 1: feel victimized. Step 2: sue the MFs.
Step one in these guild issues is optimally self-care in the form of meditation and reflection. The next move is meeting with the other. I agree with Kirschner that a lack of confidence is often in the way of communication. On all sides. Did the AAFP meet with the NDs before they passed a resolution against them? No one wants to expose their weaknesses or those of their own discipline. Each has them. Antagonistic parties have a great ability to spit out the history of the other's shadow. As Kirschner says: "It demonstrates self respect. It
demonstrates integrity. It very likely may create some trust, and a
little trust is a great beginning."
I believe in steps of trust, even itsy-bitsy ones, and in the planting of seeds even when the ground seems barren. Deserts sometimes bloom.
Later steps in the therapeutic order of political relationships represent the -ectomies of medicine. If the other does not respond reasonably and one is still threatened with senseless harm, more severe courses are asked. The courts are appropriate sometimes. Consider the opening to human discourse and integration forced by the very expensive Wilk vs. the AMA that put a muzzle on the AMA's efforts to kill chiropractic. Similarly, kudos to a group of family doctors that presently suing the federal government to break the stranglehold the AMA's specialists have on a health-focused reimbursement policy.
Here is my sense of the application of Kirschner's recommendation to the move by the Arizona Center. I have sought to model this in my management of the dialogue. Engage the issues. Put yourself in the other's shoes. For licensed chiropractors and naturopathic doctors who seem the most upset: Urge that the vision of these new MD-BCIM specialists include demonstrating expertise in how to work with integrative practitioners whose education in integrative approaches is deeper and more thorough than is likely to be required of the MD-BCIM. Urge them to tilt the meaning of MD-BCIM away from know-it-all-do-it-all to a models steeped in interprofessional education and respect. Urge them to put this in training and the examination that leads to board certification.
Start with the attempt to clarify and to click. Hope that Kirschner's wished for transformation of medicine, promised by the integrative MD community, manifests there.
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