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Dynamic Chiropractic – June 3, 2008, Vol. 26, Issue 12

How to Build an Evidence-Based Practice: Part 4

By David N. Taylor, DC, DABCN

In my last article (April 22 issue), I spoke of the value of utilizing evidence to substantiate and defend your care and diagnostic decisions in the face of improper attacks. In this article, I would like to discuss how to utilize evidence to network and form referral alliances.

Today's health care market has created a new paradigm for many established health professions.

The medical physician still controls the majority of access to patients. Your local medical physicians can be competition or they can be an ally. Most of your local medical physicians know very little about the science and art of chiropractic. Their knowledge often consists of what they have seen in the newspaper or Yellow Pages advertisements, heard on the radio, seen on the television or heard from some of their patients. Some information is positive, but a lot is negative.

So, why not create your own positive input to your local medical physicians and start building some relationships? If you can project an image of an evidence-based physician who is primarily concerned about the health of the patient, you will be viewed as a trustworthy professional to whom they could refer patients. However, they need to know which patients could benefit most from chiropractic care. How do they triage their patients to achieve optimal outcomes when referring? Whom can they work with in a cooperative fashion? How can they be assured their patients will obtain the appropriate care?

There are a number of ways you could introduce yourself to medical physicians and answer their concerns. I have read previous articles in Dynamic Chiropractic about inviting MDs to lunch, so we do not need to discuss that. One method I have found successful is sending a personalized bimonthly newsletter that provides information to answer all the above questions (and more) that come up in my discussions with MDs. These newsletters provide the latest evidence and are well-referenced, should the MD wish to follow up. They include information on: which patients respond best to chiropractic care; when it is best to refer for the optimum outcome; delineating the appropriate pattern of treatment in an integrated multidisciplinary system; chiropractic best practices; when the patient should receive medical versus chiropractic care and vice-versa; why there are variations in outcomes; and for which conditions a chiropractic physician might provide beneficial care.

By providing this evidence, you are creating name recognition in a respectable and concise fashion to allow the MD to obtain the information at a glance, with the literature-based references to support the information. It is not advertising. It is informative, professional, fosters a better understanding and improves your referral base. This can be reinforced when you begin sending narrative reports on your patients to their respective primary care physician.

When there is concurrent care or complicating factors requiring medical care, a personal call to the physician is better received. Eventually, you find yourself integrated into the local health care community. Now, when patients ask their PCP about chiropractic care, the doctor is not opposed to the option and advises the patient to see you. The MD feels confident the care will be rational, evidence-based and at your office, and that you will keep them informed with regard to progress.

You soon will find your network expanding in your local community by targeted networking, and the cost is much less than those newspaper advertisements. If you choose not to write your own newsletters, many companies offer them for a fee and they can be personalized for your office. Just make sure you read them and are familiar with the references. Then make copies, maintain your own Excel database and deliver it with the copies to a mailing company. No overburdening of staff, no extensive costs, no long-term contracts and just a small effort can reap you great rewards. In fact, if you are reducing your external marketing costs, you might even be able to reduce staff salary costs.

There are numerous benefits to incorporating evidence-based care into your practice. It can work to improve patient care, to defend your care to nonchiropractic inquisitors, and to initiate public-relations networking.


Dr. David Taylor, a 1983 graduate of National University of Health Sciences, is a past secretary of the Massachusetts Licensing Board and a past FCLB representative to the CCGPP. He is currently director of the Multimed Center, Inc., in Greenfield, Mass., and president of Healthcare Review & Consulting, Inc. Contact Dr. Taylor with questions and comments at .


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