When asked why they do what they do, be it go in to work each day or specifically why they recommend a certain treatment, most health care professionals will say (or at least should say); the patient. Everything we do and will ever do as members of the health care professions should center around the patient’s best interests, yet this has not always been a reality. Up until recently the idea that “doctor knows best”, has been the modus operandi of western health care, usually benefitting the patient, but always benefitting the system (2). This paternalistic system-centered health care model is thankfully transitioning out of favour, opening opportunities for chiropractic and other complementary forms of health care such as acupuncture and naturopathy to integrate into mainstream health care (2).
The transition from the paternalistic family doctor as gatekeeper and captain of the ship model of health care is due to many factors, however Haldeman et al suggest that a critical factor may be one of patient choice and not due to internal changes (2). As patients become more aware of their own health, and health care options, they are independently choosing the method of care and the providers they visit, perhaps in response to a discontentment with the limited options recommended by family physicians (2). While a patient’s willingness to pay out of pocket for chiropractic care when other federally provided options exist speaks volumes for the patient-perceived value of chiropractic, an integrated, cooperative health care system would further support patient choice, opening chiropractic care to all citizens, regardless of their ability to pay out of pocket.
According to Haldeman et al there are three main models of integrated health care: direct access, where chiropractors maintain current autonomy not requiring a medical referral; physician-gatekeeper, where patients require referral to access chiropractic services; and nonphysician-gatekeeper, where referrals for chiropractic care my come from nurse-practitioners, physician-assistants or claims personnel (2). While direct access is certainly the most desirable model form a chiropractic perspective, and likely the most beneficial for the patient, the real possibility of the gate-keeper models is likely responsible for the reluctance of many within the chiropractic community to integrate, or in many cases even communicate with medical doctors (2).
Another significant challenge to full integration is determining where exactly chiropractors fit into mainstream health care and particularly the hospital setting. These concerns however, will likely not last as every interaction between medical doctor and chiropractor will only further demonstrate the abilities of chiropractors, be it in the ER and diagnosis, consulting with the orthopedic surgeon or performing research in the neurology department. According to The Chiropractic Report, having Doctors of Chiropractic increasingly imbedded into health education in medical schools, universities and as researchers in hospitals, as seen in Canada and Denmark, is quickly moving Chiropractic from a CAM profession which many medical professionals only recently refused to associate with to an important element of current mainstream health care (1, 2). This recognition of the skill set possessed by chiropractors and their usefulness in the traditional medical setting has recently been highlighted by the professorship in spine biomechanics established at the Memorial University of Newfoundland College of Medicine currently held by Dr. Diana De Carvalho, DC (3). The continued support of medical schools for chiropractic research and the willingness to hire a chiropractor as an instructor in a medical school setting will not only introduce and familiarize more and more new MD’s to chiropractic, but increase the availability of chiropractic to Canadians.
1. Haldeman S. Principles and practice of chiropractic. 3rd ed. Norwalk, Conn.: Appleton & Lange; 2004.
2. CAM or Mainstream: Where is the Chiropractic Profession, Why is This Important? [Internet]. Chiropracticreport.com. 2009. Available from: http://chiropracticreport.com
3. Professorship in Spine Biomechanics established at Memorial University [Internet]. Med.mun.ca. 2015 [cited 4 December 2016]. Available from: https://www.med.mun.ca/Medicine/Communications/News-at-Medicine/November-2015/Professorship-in-Spine-Biomechanics-established-at.aspx