Author: Richard H. Adler

There appears to be a conspicuous attitude change between chiropractic and medical practitioners. The words of Leon Wiltse, M.D., delivered in his 1985 presidential address to the North American Spine Society, may best express the changing attitude of medical doctors:

Perhaps we can take a lesson from this in dealing with spinal manipulation. The explanation given as to how the manipulation works may be quite wrong by our lights, but its practitioners must be doing something right, or 10 million people a year would not be filling their offices. We need to at least learn about it.

Chiropractors and medical doctors have improved their interdisciplinary communication in recent years, fueled, in part, by published research findings validating the effectiveness of spinal manipulation. For example, an oft-cited text on cervical injury written by chiropractors has been well received by medical doctors. See Foreman S.M., Croft A.C., "Whiplash Injuries - The Cervical Acceleration/Deceleration Syndrome," Baltimore, Williams & Wilkins, 1988. Moreover, Paul Goodley, M.D., of the American College of Orthopedic Medicine stated in his letter to the editor of the Journal of American Medical Association (September 1988):

Manipulation does have scientific support but, because it is primarily an art in its delivery, as is surgery, we encounter problems in establishing unambiguous statistical evidence. Recent medical text (reference to Kirkaldy-Willis: Managing Low Back Pain, 2d ed., 1988) supports the efficacy of manipulation as a rational approach to certain conditions, and a long universal medical tradition supports it (citing Manipulation Past and Present, 1975, by renowned orthopedist James Cyriax, M.D.).

Additionally, independent and respected health science journals have begun publishing chiropractic research with more frequency. In recent years, journals published and/or endorsed by medical associations have dropped their anti-chiropractic editorial bias. In 1992, for example, the American College of Physicians, in its Annals of Internal Medicine, published medical research regarding chiropractic manipulation for back pain. Medical doctors were asked to reappraise the roles of spinal manipulation and the chiropractic profession because of "recent research favorable to the chiropractic treatment of patients with low back pain." ¹ The Journal of Family Practice of the American Academy of Family Physicians published an article by Peter Curtis, M.D., and Jeffrey Bove, D.C., from the University of North Carolina at Chapel Hill. The authors encouraged family physicians to "re-evaluate their relationship with chiropractors" and provided guidelines for referral.²

Other medical doctors have written editorials in medical journals agreeing that there is a "pressing need for family physicians to re-evaluate chiropractic in light of both the increasing role it plays in the treatment of musculoskeletal ailments and the epidemic proportion of low back pain sufferers." ³

Daniel Cherkin, Ph.D., of Seattle has published research in the United States⁴ showing that, with respect to back pain, there is a higher satisfaction level expressed by patients of chiropractors than those of medical doctors. Dr. Cherkin comments on his recent study of family physicians in the state of Washington showing "surprisingly little antipathy towards chiropractors." Thus:

• Only 3% dismissed chiropractors as incompatible with medical doctors.


• A clear majority had encouraged patients to see a chiropractor and indicated a desire to learn more about what chiropractors do.


• 25% viewed chiropractors as "an excellent source of care for musculoskeletal problems." ⁵

Dr. Cherkin urged more widespread cooperation in the interest of patients, medical doctors, and chiropractors.

The bridge-building between chiropractic and medical practitioners can be seen at the institutional level as well.

AMERICAN COLLEGE OF SURGEONS

• "There are no ethical or collective restraints to full professional cooperation between doctors of chiropractic and medical physicians."


• Such cooperation should include "referrals, group practice, participation in all health care delivery systems, treatment and services in and through hospitals, participation in student exchange programs between chiropractic and medical colleges, and cooperation in research and continuing education programs."

AMERICAN COLLEGE OF RADIOLOGY

• "There are and should be no ethical or collective impediments to interprofessional association and cooperation between doctors of chiropractic and medical radiologists in any setting where such association may occur, such as in a hospital, private practice, research, education, care of a patient, or other legal arrangement."


• "Radiologists are urged to be sensitive to and consider the legitimate radiologic needs of...doctors of chiropractic."

AMERICAN HOSPITAL ASSOCIATION (AHA)

• The AHA "has no objection to a hospital granting privileges to doctors of chiropractic for the purposes of administering chiropractic treatment, furthering the clinical education and training of doctors of chiropractic, or having x-rays, clinical laboratory tests and reports thereon made for doctors of chiropractic and their patients and/or previously taken x-rays, clinical laboratory tests and reports made available to them upon (patient) authorization."

Medical doctors are clearly becoming more interested in what chiropractors do. At the same time, many chiropractors have developed informal alliances with different medical practitioners, receiving referrals from medical doctors and, in turn, referring their patients to medical practitioners for consultation/treatment when the need arises. Practitioners interested in developing better interprofessional relationships may consider the following suggestions:

• Meet with a local chiropractor or medical practitioner and make arrangements to observe his/her practice for an hour or two.


• Talk with one of your colleagues who has developed a good medical-chiropractic interprofessional working relationship.


• When making a patient referral, remember that the goal is to achieve effective interaction by communicating successfully across professional or specialist boundaries; clarity and brevity are important.


• When making a patient referral, explain to the patient the reason for the referral, the expected benefits, and that the findings of the second opinion doctor will be reviewed by the treating doctor and patient.


• When referring a patient to a chiropractic consultant or medical doctor known only through his/her reputation, be sure to call the practitioner personally to ensure that the referral will be welcome and appropriate. Once the call is made by the referring practitioner, the patient can subsequently telephone to schedule the appointment.


• The referring practitioner should send a brief letter describing in mutually-understood language the reason for the referral, including any pertinent records and diagnostic studies.


• It is always important to clearly state whether the referral is for diagnostic purposes, analysis of reasonable and necessary care, or whether it is for treatment to supplement or replace care the referring practitioner has been providing.


• The referring doctor will anticipate a report from the consulting doctor on the results of the examination. It is a good idea to satisfy this aspect of interprofessional protocol.

We hope this information proves useful to you.

Very truly yours,
ADLER GIERSCH, P.S.

Richard H. Adler
Attorney at Law

¹ Shekelle G. Adams, AH, et al., "Spinal Manipulation for Low Back Pain," Annals of Internal Medicine Int Med, 1992, 117(7), pp. 590-598.

² Curtis P., Bove J., "Family Physicians, Chiropractors and Back Pain," Journal of Family Practice, 1992, 35(5), pp. 551-555.

³ Reis R., Borkan J., Hermoni D., "Low Back Pain: More Than Anatomy," Journal of Family Practice 1992, 35(5) pp. 509-510.

⁴ Cherkin D.C., Deyo R.A., et al., "Evaluation of a Physician Education Intervention to Improve Primary Care for Low-Back Pain I: Impact on Physicians," Spine 1991 16(10) pp. 1168-1178.

⁵ Cherkin D., "Family Physicians and Chiropractors: What's Best for the Patient?," Journal of Family Practice, 1992, 35(5) pp. 505-506.