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Collaborative Care

By Molly Dickinson

How DCs and MDs can work together for the benefit of their practices, their professions and, most importantly, their patients.

It’s easy to envision MDs and DCs as opposing teams—Mechanists vs. Vitalists, Intervention vs. Innate. When Chiropractic was first fighting to establish itself in a society that had long accepted the medical model, us vs. them thinking was not only natural, but useful. It allowed chiropractors to distinguish themselves as passionate believers in the power of a philosophy that was fundamentally different from medicine and to inspire an ever-growing community of equally passionate supporters. With Chiropractic now claiming one of the fastest-developing health care sectors in the nation and continuing to spread across the globe and deeper into mainstream culture, the battle lines drawn more than 100 years ago are also evolving—into lines of communication. The us vs. them mentality can only take us (and them) so far. More and more, today’s doctors—DCs and MDs alike—are thinking in terms of collaboration, not contention. The result is a win-win for both professions and for the patients they serve.

 

Separate and Distinct Professions

From the beginning, much of Chiropractic’s identity has been based on distancing itself from medicine. The founding definition of Chiropractic—that it was not a new branch of medicine, but “a separate and distinct” profession—formed the successful defense of a majority of suits levied against chiropractors for “practicing medicine without a license.” This definition allowed Chiropractic to establish itself as a truly alternative form of health care and necessarily brought into question the fundamental philosophies and practices of medicine that had long been simply accepted by the public.

 

Today, the philosophical differences between medicine and Chiropractic can be summed up as opposite sides of a flash card: Medicine intervenes, Chiropractic removes interferences. Medicine teaches that the educated practitioner can cure diseases, Chiropractic teaches that the innately intelligent body can heal itself. Medicine’s most powerful tools are medication, surgery and radiation, and Chiropractic’s most powerful tool is the spinal adjustment. Medicine can rescue the injured or diseased body in crisis, Chiropractic can empower every body to function more optimally.

 

As Dan Yachter, D.C., co-founder of Elevation Health, explains, these differences should make direct competition between DCs and MDs all but impossible. “Chiropractic is a separate and distinct profession. It’s not medicine,” he says. “I don’t see myself necessarily competing with a medical doctor. I make it very clear to my patients … if you have a broken bone, a severed artery, a laceration, a contusion, if you have an abrasion in your eye—I’m not the guy for you. I don’t do emergency crisis intervention.” What Yachter does, and what he believes chiropractic care alone has the power to do, is locate and remove subluxations in the nervous system, allowing the body to recover and maintain health. 

 

This fundamental difference in applied chiropractic versus applied medicine—along with watching it in action as his father’s lifelong migraines disappeared following adjustments by Yachter’s brother (then a Life University student, now Yachter’s practice partner)—made all the difference in Yachter’s decision to leave the pre-med program at the University of Florida in favor of LIFE’s Doctor of Chiropractic program in 1993. It’s also the one difference, he says, that is most critical to communicate to your patients. “The biggest issue is for patients to really understand why they are coming to you [as a chiropractor] and what they’re coming for.” 

 

When chiropractic philosophy is clearly understood and communicated, first by the chiropractor, then by the patient and then within the broader health care community, both chiropractors and medical doctors are in a position to feel empowered by the unique applications of their professions, rather than encroached upon. Only then can the two professions begin to focus on their similarities.

 

Common Ground

Even the most philosophically opposed chiropractors and medical doctors may find themselves walking very similar paths. To name a few: Both medicine and Chiropractic are scientifically based in the life sciences. Both professions insist on a similarly rigorous educational curriculum. Both are supported and regulated by accredited schools of higher education and professional licensing boards. Doctors in both professions can choose to practice independently or as part of a larger care organization, demonstrate a wide variety of specialties and modalities and often emerge as leaders within their communities.

 

While the similarities between their professional journeys are significant, what’s even more powerful is the possibility that the destination for both MDs and DCs may be exactly the same. Like Yachter, Joe Forese, M.D., D.C., DAAPM, also had plans to become a medical doctor. His, however, were realized in 2007 when he earned his medical degree from the University of Health Sciences, St. John’s—five years after earning his Doctor of Chiropractic from Life University. 

 

“I wanted to broaden my understanding of diagnosis and treatment options,” says Forese of his decision to enroll in medical school after two years in chiropractic practice. “I wanted the ability to render critical care and the broader scope of practice.” Today, the Lost Mountain Chiropractic practice he founded in Acworth, Ga., in 1996 draws on this diverse clinical experience and training, as does his role as Division Chair of Basic Sciences at Life University, where he began teaching in 2007. 

 

Forese believes that, at their hearts, both medicine and Chiropractic share a common goal: “Both wish to help the patient obtain the best quality of life. The means of how to do that,” he stresses, “differ widely.” The idea that the ultimate destination (better health for more patients) is the same for both medical doctors and chiropractors, and that their differences lie instead in the diverging paths (different philosophies of care) they take in order to reach that destination, is somewhat revolutionary. While Yachter believes there are “MDs who really want to give, love and serve like I learned from Dr. Sid Williams, I’d say the vast majority … do not. If you can find the MDs who are really like us—chiropractors who are serving—they would have the attributes of being very caring, loving, wanting to do what’s right for their patients and having a burning desire to see their patients well.”

 

While the idea of a shared mission for MDs and DCs is still controversial, what may be less debatable is the idea that operating under the conviction that “the other guys” care less about their patients than they do about money, prestige or legacy, does nothing to advance either profession. On the other hand, finding and fostering willing partners in both disciplines who share a passion for helping patients live healthier, fuller lives is the first step toward meaningful collaboration.

 

Bringing It All Together

Even doctors who don’t actively seek opportunities to work together for the purposes of enriching their practices or professions must do so in the course of good patient care. As Yachter points out, there are conditions that he as a chiropractor is not trained to treat and would not attempt to—just as there are limits to the care a medical doctor can provide. It’s in the best interest of his patients (and his role as their practitioner) to maintain a list of local medical doctors and specialists for referrals. It’s also important to ensure patients understand why they are being referred. Yachter uses referrals as opportunities to clarify the benefits of chiropractic care in the context of medical care. “There are drugs and surgery for a purpose,” he says. Because he, like many chiropractors, believes that medication is not a long-term solution for most patients, Yachter also collaborates with medical doctors to help patients who want to stop taking medication do so safely. In those cases, he says, “many of them need supervision, especially from the [MDs] who may have put them on it.”

 

By building actual relationships with MDs rather than just passing their names on to patients, DCs like Yachter increase the opportunities for those doctors to refer their patients for chiropractic care as well. If chiropractic patients do opt for medication, surgery or radiation, establishing a relationship with acting medical doctors and specialists allows chiropractors to both support the intended benefits of these treatments and mitigate their side effects through chiropractic care and lifestyle choices. 

 

Another enormous benefit that can come from collaborating through referrals and coordinated care is that medical doctors can see the effects of chiropractic care on their patients’ bodies and in their testimonials and be positively affected by those impressions. The more positive experiences everyone—patients, MDs, the general public—has with Chiropractic and chiropractors themselves, the faster the lingering misconceptions about Chiropractic will be replaced by genuine understanding.

 

The simple act of collaboration can also help dispel negative stereotypes surrounding both professions—perhaps the most damaging being the perception that both medical doctors and chiropractors are focused on volume and profit over quality care. By demonstrating professional confidence in the other discipline’s approach through referrals or further collaborations, doctors can give more equal weight to the separate-and-distinct values of medical and chiropractic care in the minds of patients. The result? A more cooperative health care community that encourages a view of medicine and alternative care models as balancing, rather than competing with or seeking to undermine each other.

 

Reaching Out

There may be no better time for chiropractors to increase collaboration efforts. Chiropractors can capitalize on the growing national desire for more diverse—and less invasive—health care options by connecting with the medical community to improve not only the overall level of care chiropractors can provide, but also the perception of the value and authority of that care as being equal to or greater than that of the allopathic model. Additionally, notes Yachter, health care reform may encourage more MDs to rethink the way they practice. “I think it’s going to be even easier to collaborate with MDs … because many of these MDs are going to try to be out of the system and many are going to go into cash.” Given more freedom in how they practice, he believes more MDs will choose to work with chiropractors, naturopaths and other alternative practitioners, rather than against them.

 

Beyond referrals, there are many ways to bring more such collaborations into a chiropractic practice. Yachter recommends inviting a local medical doctor to lunch or for an office visit. Those who are already treating many of one’s regular patients are an excellent place to start, as are pediatricians, he says—especially if one operates in a practice that sees lots of children and families.  

 

Chiropractors can also reach out to larger medical organizations. In 2009, Steven Barnett, D.C., approached DeKalb Medical Center in Decatur, Ga., to establish a program wherein chiropractors could refer their patients to medical specialists and imaging services within the center’s network, thus building relationships with the center’s medical doctors. By keeping abreast of both medical and chiropractic research, and participating in and publishing research when possible, DCs can help build a more robust canon of health care literature that both they and MDs can use to improve their knowledge, their practices and the way they work together. Simply presenting a collaborative attitude when discussing care with patients by describing medical and chiropractic care in context of the values and limitations each offers and encouraging patients to take an active role in their health care can change the way chiropractors and medical doctors care for their patients for the better.

 

It all starts with a personal commitment to extend a hand across the field; to stop thinking strictly in terms of us vs. them; to remove the “versus” altogether; and to recognize what really stands between MDs, DCs and mutually beneficial collaboration—ourselves.