Integrative medicine research: What medical physicians look for in a doctor of chiropractic

Journal of the American Chiropractic Association, Nov 2002 by Menke, J Michael

Chiropractic Research

A recent study reported 76 perent of medical physicians have patients visiting a doctor of chiropractic. Fifty-two percent of medical physicians say they are questioned about chiropractic. Thirty percent of medical physicians surveyed stated they were likely to recommend chiropractic care. Thirty-six percent of conventional physicians receiving education about chiropractic referred patients to chiropractors, while only 19 percent of those with no education about chiropractic referred to chiropractors. This difference was significant at p = 0.003. Sixty percent wanted to learn more about complementary alternative medicines in general, with over 90 percent reporting the primary reason was to "dissuade if the therapy is unsafe or ineffective."1

In May and June of 2002, 40 medical physicians from the United States and abroad enrolled in a 40-hour chiropractic course through the program in integrative medicine at the University of Arizona. I designed the course to inform conventional physicians about the usefulness of chiropractic intervention, based on clinical trial research and practical clinical evidence. The course also contrasted chiropractic with physical therapy and osteopathy in therapeutic emphasis and patient care. It was one course of three included in the manual medicine module for the associate fellowship program, a two-year, on-line training curriculum for conventional physicians on alternative therapies. Other modules offered courses on nutrition, botanicals, energy medicine, mind-- body medicine, acupuncture, spirituality, massage, traditional Chinese medicine, osteopathy, and homeopathy.

Qualitative and quantitative assessments were built in to assess pre- and post-module attitudes toward chiropractic and to measure changes as a result of taking the course. Preliminary qualitative findings were not too surprising, but point to improvements that can be made in training chiropractic professionals to be compatible within the integrative health care environment.

Among the top issues mentioned in working with a doctor of chiropractic, 40 medical and osteopathic physicians reported the following as areas of concern:2

* Lack of written communication or failure to communicate

* Long, mandatory treatment duration not linked to subjective or objective outcomes

* Repetitive x-rays without health risk indications

* Clinical models too disparate from the medical model, including those that use upper-cervical manipulations for non-neck-related conditions

* Diagnosing non-musculoskeletal problems by applied kinesiology muscle testing

* Anti-vaccination stance

* Everything is seen as treatable by chiropractic

* Fostering over-dependency on the chiropractor

When asked to name the top attributes sought in a compatible or integrative DC, these were the ones most commonly reported:

* Must be open to paradigms of healing outside their own (chiropractic) training

* Patient-centered, rather than chiropractic-centered, care

* Recognition of continuity of body, mind, spirit, and community in health and illness

* An in-depth knowledge combined with excellent skills in their own field of therapy, i.e., historical, philosophical, technical

* Takes initiative to communicate with the patient and referring medical physician

* Patients report good results from chiropractic care

* Encourages patient self-care.

Like it or not, most people still rel on medical physicians as their primary health knowledge resources and providers.3 In the coming years of physician and nursing shortages, chiropractic has the potential to play a greater role in conventional health care delivery. Findings such as these can guide chiropractic professionals toward enhancing interprofessional referrals. This is an endeavor that could avoid unnecessary surgeries, improve public health outcomes, help alleviate the health care delivery crisis, and help the doctor of chiropractic prosper.

References

1. Winslow LC, Shapiro H. Physicians want education about complementary and alternative medicine to enhance communication with their patients. Arch Intern Med, May 27, 2002. Vol 162:1176-1181.

2. Collaboration for Healthcare Renewal Foundation, CHRF News File #29, July 11, 2002.

3. Teitelbaum M. The role of chiropractic in primary care: Findings of four community studies. J Manipulative Physiol Ther. 2000 Nov;23(9):601-609.

BY J. MICHAEL MENKE, MA, DC

Dr. Menke is a technical consultant for the University of California Osher Center for Integrative Medicine and a technical expert for the manual medicine program in integrative medicine at the University of Arizona School of Medicine. He leads the postgraduate courses at the National University of Health Sciences and is an adjunct research faculty member in behavioral statistics and research methods at Palmer College and the Palmer Center for Chiropractic Research in Davenport, Iowa. He may reached

at 650-324-3207 or jmmenke@aol.com.