Now Is Not the Time to Remain Silent

By Louis Sportelli, DC

Chiropractic safety, patient demographics and desires, medical community opposition and the ongoing research into reducing liability through communication are more relevant today than ever.

A recent article in the Annals of Internal Medicine, "Chiropractic: A Profession at the Crossroads of Mainstream and Alternative Medicine,"¹ offers some excellent observations.

This article is a basis for beginning any communication. Such articles are the greatest weapons in a chiropractor's arsenal: the ability to point to solid, well-designed, randomized controlled clinical trials, published in prestigious journals, that support manipulation as an effective therapeutic intervention for one of the most plaguing conditions of humanity - back pain.

On the heels of this recent article is one by Coulter, et al.: "Patients Using Chiropractors in North America - Who Are They and Why Are They in Chiropractic Care?"² This did not reveal much that many practicing DCs did not already intuitively know. More than 70 percent of patients specified back and neck problems as the health problem for which they sought chiropractic care. The study also suggested, albeit guardedly so, that patients seeking chiropractic care are substantially physically impaired and in pain, about on par with back pain patients seeking care from a medical doctor. The interesting finding, again with caution in interpreting the comment, is that patients with back pain seeking care from chiropractors have significantly and clinically worse mental health than those seeking care from medical doctors. The reasons are unknown, according to the authors.

On the issue of safety and the huge media coverage from the recent PBS program, to the newspapers in Canada covering the inquest of the death of Lana Dale Lewis, the issue of chiropractic and safety continues to emerge. (I will write more about the Canadian inquest, but at press time the inquest has not been completed, and thus it would be inappropriate to offer any commentary.) Chiropractors know the potential for a CVA from a chiropractic manipulation is infinitesimal, particularly when compared with almost every other therapeutic intervention. Does that mean the profession should not be concerned? Absolutely not! Even one mishap that can be prevented deserves as much investigation and research as humanly possible, and that is what the profession is doing.

What should each and every practicing doctor of chiropractic do in light of the current focus on chiropractic? The Chiropractic Research Review (CRR), distributed quarterly to all NCMIC policyholders and available by subscription to others, is an excellent way to break the communication barrier and begin a dialogue with other health care professionals in your community. Dr. Jerry McAndrews developed this sample letter as an introductory opportunity to get acquainted:

 

Date:   Dear Dr.________:   I have wanted for some time to make this overture in a sincere attempt to communicate with you about what might benefit patients we mutually care for. As an alternative, we can establish open lines of communication that may be useful for the inter-referral or co-management of patients we feel might need our respective services. With the advent of managed care, which some refer to as "mangled care," we may find other topics of mutual interest. Managed care, in some fashion, is inevitably going to fill every corner of the health care market. Evidence suggests it will dominate the health care landscape and change our practices - it's just a matter of time. Chiropractic has had some interesting and rewarding breakthroughs in recent years, not the least of which was the 1994 release of the Guidelines on Acute Low Back Problems in Adults from the Agency for Health Care Policy and Research of the U.S. Department of Health and Human Services. The Guidelines, rated with the best of the scientific literature, placed spinal manipulation as a preferred form of treatment for acute LBP. With low back pain constituting the second most common reason for office visits to primary care physicians, the most common reason for office visits to orthopedic surgeons, neurosurgeons and occupational medicine physicians, and the third most common reason for surgical procedures, I believe any improved dialogue between us could serve our offices and patients. I have enclosed a recent article from the Annals of Internal Medicine that you may find of interest, but I wanted to use this letter to begin a conversation with you and your office. I would like to know more about your philosophy and issues confronting medicine today. There may be several questions you have about such an expanded relationship, so I wanted to suggest that we perhaps have lunch (or dinner or a cup of coffee) together. This would give us an opportunity to discuss what form any possible resulting interprofessional referrals might take, facilitate a smooth handling of our mutual patients, and provide a level of comfort for them. If any of these suggestions interest you, please contact me and we can establish a time to meet and talk. I look forward to it. Whatever your decision, I hope the future will hold some opportunities for improved communications and professional bridge building. Regards, (signature) enclosure

With an introductory letter and a phone call in a week or 10 days, a dialogue can be established that will not only create a working relationship with your local family physicians and specialists, but will provide an opportunity to establish a referral for those difficult neuromusculoskeletal patients who are not obtaining the desired responses and outcomes.

Don't sit back and bemoan the plight of the chiropractic profession. Each doctor of chiropractic must make a personal effort to communicate with local health care professionals. Most of the problems facing the world today have a common thread - lack of communication. The opportunity could never be better for doctors of chiropractic because the amount of information and research available today is unprecedented. Health care professionals of all types want what is best for their patients, but many have little or no knowledge of what chiropractic is or what chiropractic can do. The articles I've mentioned provide clear, compelling and authoritative evidence, and are appropriately referenced.

Silence at times is golden, but today "going for the gold" means speaking out in a professional, well-reasoned fashion to break down old prejudices and begin the task of building bridges through dialogue.

References

1. Meeker W, Haldeman S. Chiropractic: A profession at the crossroads of mainstream and alternative medicine. Annals of Internal Medicine Feb 2002;136(3):216-227.
2. Coulter, et al. Patients using chiropractors in North America - Who are they and why are they in chiropractic care? Spine 2002;27(30):291-298.

Louis Sportelli,DC
Palmerton, Pennsylvania

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