When I have the Medical Resident in my office and there is an interesting case of ligamentous instability or a large central herniation, I sit and review the MRI with them. I always put myself in a position of teacher, but I also ask a ton of questions. That is how I learn, too. I try to learn as much about the medical-education model as possible. That only helps me to reach out to local treating MDs because now I know how they think.
When the MD and I talk chiropractic, I split it into two very simple sections. First, there is the simple biomechanical lesions side: we provide specific chiropractic adjustment to the area of fixation to break adhesions, increase white blood cell proliferation, reset the muscle spindle reflex and circulate synovial fluid. I tell them those are generally the patients that we see the least. I then discuss the patients that I may see for the rest of their lives for chronic pain management. They understand pain, so that is where I start. I discuss stimulation of the central nervous system and how we can modulate pain at that level without drugs or surgery. I show them that these are patients not unlike those that they prescribe blood pressure medicine or diabetic medicine to for the rest of their lives. We are not curing them; we are managing them. The cool thing is they get to see firsthand the difference between a specific segmental chiropractic adjustment versus one that is generalized for maximum central nervous system stimulation.
Their eyes always seem to get larger with an aggressive adjustment, even more so when the patient stands up and says, “Oh, my God, thank you so much. I feel so much better!” That creates a very visceral understanding in the medical resident about what we do.
Dr. Cory Littman: What is the most interesting thing a Medical Resident has said to you?
Dr. Owens:The most interesting thing came from the very first Medical Resident that I had in my office, and when I asked him why he was here, he said, “For a few reasons. First,” he said, “I want to see your physical exam, and second I want to see how your patients react to your treatment.” That was pretty profound to me because that represented the most fundamental aspects of the doctor/patient relationship. All the bells and whistles we try to hold onto and all the fancy techniques we spend thousands of hours learning, and that was what he wanted to see. Interestingly enough, he said at that end of that first day, “Wow, that is a pretty in-depth examination, I never expected that you would have been that thorough.” Regarding the doctor/patient relationship, he said, “I cannot believe how many of your patients said thank you, and many felt comfortable hugging you. I have never experienced that before. That is amazing.”
Dr. Cory Littman: How do the Medical Residents see chiropractic fitting into their practices?
Dr. Owens: The residents have many concerns about managing chronic conditions. After all, they are the most time consuming, costly and difficult to manage in a primary care office. Those conditions are the big three: cardiovascular disease, diabetes and musculoskeletal conditions. The musculoskeletal patients essentially clog up the flow and disrupt their day. Imagine the primary medical doctor walking into a treatment room to check on a blood-pressure reading, and the patient says to the primary doctor, “I hurt my back last night, and my right leg is giving out and numb.” That is commonplace for us but throws a real monkey wrench into their day. They are looking for qualified professionals to be able to be the portal of entry for those patients.
Dr. Cory Littman: You mentioned something in one of our earlier conversations that I feel is important to bring up here. You said, “Nowhere in their training, medical school or residency are primary care medical doctors instructed to refer musculoskeletal conditions to physical therapy only.” Can you expand on that for the readers?
Dr. Owens: Yes, that is a great point. When I have conversations with the Medical Residents, I ask as many questions as possible to learn from them. Since musculoskeletal conditions are so common and have been such a burden on the healthcare system, I was interested to learn what they as primary care family physicians are taught to do when that patient walks into their office. I was always under the impression that they were instructed to “send to physical therapy” first. That turns out, at least in my experience, to not be true at all. In most cases the Medical Resident asks the attending what to do. My point is that they are being taught to, when needed, refer to the most qualified, conservative care provider. That may be a physical therapist; it may be chiropractic or others. How you position yourself and how you can help them relieve the burden is the important part. Providing them with research on chiropractic care is a very big step in this process. I should also point out that the Medical Residents really see chiropractic as different than any other profession. That is the reason in the past that they were reluctant to refer, and it is the reason when they are educated that they refer and refer often.
Dr. Cory Littman: Why are the Medical Residents so interested in research?
Dr. Owens: Great question. Readers have to understand that published, peer-reviewed, indexed research is what protects patients from crazy and potentially dangerous treatments, directs the path of future discoveries and protects against malpractice claims. In basic terms, if there is no research to show that a treatment is a standard part of the daily management of these conditions, the MD runs the risk of being sued should something go wrong. They will not refer for untested treatment, which in the past has really hurt chiropractic. Our academic institutions are publishing more and more research on the clinical and cost effectiveness of chiropractic. That is why we are enjoying more referrals from the medical community. That is how we are gaining access to the 93-97% of the nation that has not experienced chiropractic care. That is how chiropractic will thrive and secure our future.
Dr. Cory Littman: What do you have on the horizon?
Dr. Owens: I’ve been invited to lecture to the second-year medical student in December on the chiropractic perspective on the management of chronic spine pain. I will be there with a physiatrist and an MD that practices acupuncture. The point that I made prior to be being invited to speak was that I would like to address the concerns and questions the Medical Residents have on conservative spine care while they are in still medical school. It seems that it would be much more effective for these concepts to be introduced early on in their education as opposed to six months before board certification. We need to shed some more light on the fact that musculoskeletal conditions are often the number-one reason a person will see their family doctor, and what they are doing with those patients now is clearly not as effective as it could or should be with chiropractic as a first-line referrer. There are plenty of places to get drugs and surgery but only one place to have a provider with the education and skill to handle any conservative spine care case. We are different, and that is our strength if presented in a truthful and educationally centered manner.
I will tell you that I did review my statistics over the last six months, and 90% of my new patients have never been examined or treated by a doctor of chiropractic.
Dr. Cory Littman: Looking into your crystal ball and based on your experience, how do you see chiropractic and medicine working together into the future?
Dr. Owens: In my experience, the Medical Residents that I work with have a genuine curiosity about chiropractic that certainly starts out as skepticism. Their understanding about chiropractic as both a science and an art is based on me teaching and them learning. I focus on current scientific terminology, current research and case studies; that is the only way. I envision every chiropractor presenting continuing medical education to the MDs in their community to share our successes and create an open dialogue. I think it is critical that chiropractors be willing to learn from the MDs in their communities as well. A relationship is a two-way street, and everyone loves to teach. Allow the MD to teach you some things, and you will be surprised how quickly you can build a relationship.
Dr. Cory Littman: How has this affected your practice?
This has had a profound effect on me as a doctor, as a chiropractor and as a part of a larger and expanding healthcare community. I will tell you that I did review my statistics over the last six months, and 90% of my new patients have never been examined or treated by a doctor of chiropractic. My compliance is as good as it gets because their MD told them to see me, and I am spreading chiropractic outcomes to the medical community. That is important because many DCs are not as successful as they could be because they are all competing for the now 4.12% of the population that is looking for a chiropractor. I want to clarify, though, chiropractors do not have to start a chiropractic elective to enjoy referrals; all they have to do is reach out and build relationships with the local medical community. Teach and be open to being taught; it is that simple.
William J. Owens, DC, DAAMLP, runs the first chiropractic elective rotation for primary care medical providers at the State University of New York at Buffalo, School of Medicine and Biomedical Sciences.
Dr. Cory Littman is a 1997 graduate of National College of Chiropractic.(National University of Health Sciences). He is currently chairman of the medical documentation committee of the American Academy of Medical Legal Professionals. He maintains a private practice in Lockport, NY where he focuses on treating families and traumatically injured patients. He can be reached at dr.corylittma[at]gmail.com