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.