MD, PhD, FMedSci, FSB, FRCP, FRCPEd

Not much is known about the interactions of real doctors (by this I mean people who have been to medical school) and chiropractors who like to call themselves ‘doctors’ or ‘DCs’ but have never been to medical school. Therefore this recent article is of particular interest, in my view.

The purpose of this paper was to identify characteristics of Canadian chiropractors (DCs) associated with the number of patients referred by medical doctors (MDs). For this purpose, secondary data analyses were performed on the 2011 cross-sectional survey of the Canadian Chiropractic Resources Databank survey which included 81 questions about the practice of DCs. Of the 6533 mailed questionnaires, 2529 (38.7%) were returned and 489 did not meet our inclusion criteria. In total, the analysed sample included 2040 respondents.

The results show that, on average, DCs reported receiving 15.6 (SD 31.3) patient referrals from MDs per year. Nearly one-third of the respondents did not receive any. The type of clinic (multidisciplinary with MD), the province of practice (Atlantic provinces), the number of treatments provided per week, the number of practicing hours, rehabilitation and sports injuries as the main sector of activity, prescription of exercises, use of heat packs and ultrasound, and the percentage of patients referred to other health care providers were associated with a higher number of MD referrals to DCs. The percentage of patients with somatovisceral conditions, using a particular chiropractic technique (hole in one and Thompson), taking own radiographs, being the client of a chiropractic management service, and considering maintenance/wellness care as a main sector of activity were associated with fewer MD referrals.

The authors concluded that Canadian DCs who interacted with other health care workers and who focus their practice on musculoskeletal conditions reported more referrals from MDs.

One could criticise this survey for a number of reasons, for instance:

  • the response rate was low,
  • the sample was small,
  • the data are now 4 years old and might be obsolete.

Despite these flaws, the paper does seem to reveal some relevant things. What I find especially interesting is that:

  • the level of referrals from doctors to chiropractors seems exceedingly low,
  • dubious chiropractic activities such as maintenance therapy or treatment of non-spinal conditions led to even less referrals.

To me, that implies that Canadian doctors are, on the one hand, willing to co-operate with chiropractors. On the other hand, they remain cautious about the high level of quackery in this profession.

All this means really is that Canadian doctors are responsible and aim to adhere to evidence-based practice…in contrast to many chiropractors, I hasten to add.

14 Responses to Chiropractic quackery is not appreciated by real doctors

  • “taking own radiographs”
    To find the ever elusive subluxation or something they aren’t qualified to treat or, for that matter, even render an opinion on?

    The problem, as always, is that if a “profession” can’t decide what it does and how it does it, why would anyone have any trust in them?

  • I would add that the permission to use the title “DC” is a nice illustration of what Jim Hacker said: that politicians are elected *because* they know nothing.

    It should also be added that utter lack of knowledge might not be a very good basis for decision making.

  • “Canadian DCs who interacted with other health care workers and who focus their practice on musculoskeletal conditions reported more referrals from MDs.”
    So communicating with doctors and focusing on musculoskeletal generates referrals! So what this article is saying is that doctors are well aware of how chiropractors practice and the differences within the profession and refer accordingly. Or to put it asnother way, Canadian doctors refer to chiropractors who adhere to evudence based practice. 80% of my new patients come from medical referrals and I work in a medical centre so this is nothing new. The critics could learn from the doctors!

  • Chiropractors need to communicate better with doctors. Developing a medical referral network took me years. Additionally, there is a lot of historical baggage attached to the word chiropractor and a lot of assumptions. Communicating with doctors takes effort and persistence. However, your reputation does get out there and I get referrals from doctors on a regular basis who I have not had any prior communication or interaction. If the subluxation based true believers believe that they can practice in blissful isolation then they are deluded! Doctors are well aware of the factions within chiropractic and refer accordingly!

    • @Thinking_Chiro
      I read this after your comment on the “Suffering from low back pain?” thread. My response to you there is every bit as relevant as it would be here — perhaps more so.

  • !!!! NEWS FLASH !!!!

    Chiropractic Quackery is not appreciated by “Real’ DCs either!

    However. and curiously(?), ……the MINORITY(less than 18%) of the profession gets the MAJORITY/ALL of the attention here.

    Why the misrepresentation?

    • @nobs
      There’s no misrepresentation. Look all over this blog and you’ll see people pointing out how every school of chiropractic seems to sustain all the metaphysical woo that Palmer pulled out of his arse to start chiropractic. And how would you react to “Fewer than 18% of orthodox medical practitioners now believe that bleeding patients with leeches is the best approach to curing disease.”?

    • @ nobs

      The 18% would appear to be the misrepresentation. The study it came from (McGregor et al http://www.biomedcentral.com/1472-6882/14/51 ) stated:

      QUOTE
      “As with any investigation, this study has limitations. First, although the response rate was good at 68%, it remains unclear what practice perspectives and behaviours are associated with non-participants. Also, although the sample was randomly selected and stratified according to the number of licensed practitioners in each province, the sample represented only approximately 12 percent of practitioners from each province. As always, there is the possibility that despite the randomization scheme, a unique sample was selected, and generalizability is a possible concern.”

      Certainly, the results do seem somewhat inconsistent with the other available data:
      http://tinyurl.com/pts2ns5

      Most significantly, McGregor’s 1st, 3rd, 4th, 5th, and 6th subgroup descriptions don’t seem to exclude the unethical chiropractor element. IOW, 5 of the 6 subgroups could easily indulge in chiroquackery – (1) “Wellness”, (3) “general probs”, (4) “organic-visceral”, and (5/6) “subluxations”.

      Indeed, according to Science Based Medicine author, Jann Bellamy: “The survey was of Canadian chiropractors, most of whom graduated from the Canadian Memorial Chiropractic College, which appears to have a more orthodox orientation than, for example, Life or Palmer…the groups not included in the unorthodox category doesn’t mean the others are necessarily free of unorthodox views.”

    • @nobs,
      What is a “REAL DC”?

  • I don’t follow the point you are trying to make.

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