Trust as a Challenge in Chiropractic Medicine
Robert Hartmann McNamara, Ph.D.

Abstract
This article explores how the sociological concept of trust, both externally and internally, presents challenges to the legitimacy and credibility of the chiropractic profession. This ethnographic study consisted of systematic observation and interviews of 40 chiropractors in South Carolina from Fall 2016 to Fall 2017. Additionally, interviews were conducted with staff members, patients, and other medical providers, such as physicians, physical therapists, massage therapists, and representatives from the insurance industry, about their understanding and experiences with chiropractic medicine. Phone interviews were also conducted with deans and provosts at seven chiropractic colleges around the country. In total, over 100 interviews and informal conversations occurred during the course of the project. All identifiers of participants and chiropractic colleges in the study were removed to ensure anonymity. Instead, pseudonyms were created that were known only by the author of the study. Additionally, data from the South Carolina Department of Labor, Licensing and Regulation was obtained to document changes in the number of chiropractors who are no longer in practice in the state between 2016 and 2017. The data from this study suggests that there may be a number of trust issues between the public and chiropractors, between chiropractors and physicians, and among chiropractors themselves. For example, comments and observations from respondent interviews suggests many patients do not fully trust their provider. Additionally, physicians claim the reason for the lack of trust is due to the absence of any meaningful accountability measures to control rogue chiropractors and the wide variance in types of treatment they offer. Among chiropractors themselves, there appears to be an absence of trust, as many providers see their colleagues as competitors and potential threats. Trust is a key component to the success of any social relationship. Given the inability or unwillingness of the chiropractic profession to hold members accountable for questionable practices, along with the perception that chiropractic treatments may not be effective, the public, patients, and the medical profession will likely continue to view chiropractic medicine with suspicion.

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