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Silos and Egos (inspired by the San Diego Pain Summit)

When I was just an idealistic, eager, young man I was interested in exploring chiropractic, as a profession due to a positive experience I had with a local chiropractor.

At the same time my cousin had had a great experience with a local physiotherapist, and decided to head off to PT school.

We both headed off to our respective post-graduate educational institutions completely unaware that we had chosen opposing sides in the health care "battle".

I was confused when I arrived at school and there was open hostility regarding PT’s. Likewise, my cousin relayed the PT’s view of those quacks that call themselves doctors. This was my introduction to the absurd position that collaboration with “the enemy” will not be tolerated (or at least be met with disdain). Hopefully we have advanced in our views since the mid-nineties and those sentiments don't still ring through the halls of these institutions, but I'm not certain they have gone the way of the flip phone.

Over the years I have become wildly unenthusiastic around the idea that patient care and practitioner’s education should happen in such isolated silos. Evidence supports interdisciplinary care (1) and I believe that learning together will foster a greater opportunity for collaboration.

The Dana on Mission Bay
Poolside in San Diego for the Pain Summit

Then, several years ago, I found a place. A Shangri-la of manual therapy learning. A gathering of like minded individuals who interact with patients/clients as well as researchers in the field of pain science.

For the past 5 years in San Diego I have been able to learn, debate and socialize with physiotherapists, massage therapists, rolfers, occupational therapists and chiropractors, etc... around the application of current evidence and theories on pain. This is one of the simple joys about this conference and it was echoed by many there… No one cares what you “do”, because we are all there to learn how to best treat the patients that roll through our doors every day. The conference is set up to reduce or eliminate silos and practitioner egos.

For example, the name tags...

Just your name...no titles or designations

not Dr. McIlmoyle, Dr Dick, BSc, DC


Richard McIlmoyle

The EGOs

This is an example of EGO mentality I have experienced in the recent past...

Me: Why do you think chiropractors shouldn't go to this conference???

Other Chiropractor: “I choose to avoid or not accept things THAT person (who is speaking at said conference) says because they said something biased about my profession (and by extension, me)”

What a ridiculous thing to do to yourself!

Here are some ways I have interpreted this statement. Take your pick

  • “I’m not going to learn something to help my patients because of my over inflated ego”

  • “I’m scared that they might say something that I agree with or makes sense and that will ruin my negative perception of them for saying something negative about my profession”

  • “I’m a delicate flower and my confidence in what I do is so tenuous that any challenge to what I do will cause me to break down into a puddle of quivering tears”

  • “The evidence they present contradicts my belief system, so I must find some other reason to not listen to this person”

Regardless of the reason, I feel it all comes back to a problem of ego. Letting a sense of perceived injustice which has been levied against us hinder our ability to grow as practitioners and help tear down the perceptions we have of each other. (as professions)

I suspect that it may be possible to experience something similar from PT’s, but I’m not in their inner circle to hear these comments.

The other, more obvious EGO piece is the belief that somehow our own given profession is "the one" that will provide the best quality care for patients. There are great practitioners in all professions and quacks in all professions. We need to seek out and work with good, critically thinking practitioners regardless of the title they wear. If they can help a patient, they should be part of your "tribe".

The Silos

One of the other wonderful things about the Pain Summit, is that the speakers don’t sit in their ivory towers delivering the knowledge from on high. They are mingling amongst

everyone, having a beer, sharing meals, helping to polish off bottles of wine well into the evening paired with in-depth discussions about how we can all do better.

I have been to and heard about other conferences where the speakers will grant the great huddled masses of practitioners a few moments of their time after their presentation. They then hurry off to… oh, I don’t know, maybe have a great orgy of intellect with the other educational deities.

Maybe they just go back to their hotel rooms and eat crackers and swill cheap merlot. I don’t know, but we don’t get to engage and ask them questions. Or get to know that they are human and are just trying to help everyone do a better job by exposing us to the knowledge they have spent their careers accumulating.

I feel like there is something to be learned in San Diego, other than the fantastic information being delivered by knowledgeable clinicians and dedicated, intelligent researchers.

What we need to work towards is breaking down the silos of care, communication, and education. Dissolving the egos of those who seem to think they are above others in their intellect and desire/ability to provide quality care.

I see a hierarchy of clinicians in the health care field that looks like this.

Specialists (ie Orthopedic surgeon)




Massage therapists.

(Some will debate my take on this)

I understand that by being low on this hierarchy, my rant against it may seem like sour grapes or the peons trying to rise above their class. But I have met individuals in each of these professions that would come together and agree that every profession has something great to bring to that table. That brings me hope.

Unfortunately, there are others who fail patients miserably by their lack of understanding regarding the potential therapeutic value that the different professions can provide for the patient experiencing pain.

So, can’t we dream BIG? I have a dream… my dream is that someday… we can break down the silos… and ignore our egos to place THE PATIENT at the centre of care.

1. Tousignant-Laflamme, Y., Martel, M. O., Joshi, A. B., & Cook, C. E. (2017). Rehabilitation management of low back pain - it’s time to pull it all together! Journal of Pain Research, 10, 2373–2385. https://doi.org/10.2147/JPR.S146485

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