What does the American Medical Association Think of Chiropractic | Podcast Episode 139

Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid, research and marketing in the time it takes to get to your practice every Monday. And this week episode is Back to the Research. And it is about essentially what do medical doctors think of chiropractors? This was an editorial that was pulled out of the American Medical association in 2017. It was brought to my attention by Dr. Brian Garrett out in San Diego, California, who works with me at the Evidence Based chiropractor. So thanks, Dr. Garrett, I appreciate it. And it's a great editorial that we're going to touch on, kind of hammer through some interesting aspects of it. And it's a piece to have kind of in your back pocket for knowledge as you get out there, build and grow your practice. So this week we are talking about an editorial piece that was written by Dr. Richard Deyo. He was a medical doctor and has a master's in public health. And its title is the Role of Spinal Manipulation in the Treatment of Low Back Pain. And specifically with his editorial, I know the title says spinal manipulation, but the whole thing is about chiropractic. So he's basically which is the truth, the hallmark of chir? You know, the hallmark of chiropractic care is the spinal manipulation or the adjustment. And he is really doesn't even bring it into the therapy realm as far as that's concerned. It's really focused on chiropractic. And there's some great tips, there's some great insights that I think we can draw from this because as you get out there, build and grow your practice. You know, at the Evidence Based Chiropractor, we're all about building and growing practices. B2B, right? Business to business, taking your skillset and showcasing it to other healthcare providers in your community in a systematic way to build referral relationships. That's what we're all about at the Evidence Based Chiropractor. And research like this is always interesting because it really gives a real world analysis, so to speak, as far as what is the other side saying, what are these medical doctors thinking of chiropractic? So I've had the fortunate privilege of practicing as an associate doc. I owned my own clinic. Then I went to a hospital based orthopedic group. Then I went to an outpatient spine surgery center. So I've seen it firsthand, just interacting day to day with orthopedists, with, you know, interventional spine, with neurosurgeons, you name it. But for a lot of docs out there and Certainly me, before I gleaned that experience, there was a lot of unknowns when I was going out and reaching out to medical doctors. So there's some really interesting points in this paper. I also have it linked in the show notes, but let's hammer through a few of them. So to give a little bit of context, there's no question nearly over 90% of people deal with some form of back pain at some point in their life. A vast majority of those individuals are seeking some form of care. So in this article it is quoted quote, in a 2013 survey by Consumer Reports magazine involving 14,000 subscribers with low back pain, chiropractic care had the largest proportion of highly satisfied patients. So we always hear about chiropractic having highly satisfied patients. This looked at over 14,000 people said that they were of the study found, you know, they were, they're highly satisfied with chiropractic care. Among approximately 4,000 respondents who had seen a chiropractor, 59% were highly satisfied, compared with only 55% who saw a physical therapist and 34% who saw a primary care physician for their back pain. To me, this makes sense, right? When we look at primary care and back pain, often they're not doing much. What I mean by that is their skillset and tools aren't really in that wheelhouse. They're prescribing medications, referring to physical therapy or referring to another specialist. Now if you remember the aerospace chiropractor. And obviously what we're trying to do is get chiropractors as that primary referral source. But by and large, with many primary care doctors, they, they are prescribing medications which are largely ineffective, using physical therapy just by default or sending to somebody who's maybe more up the chain, so to speak, like a pain management doc, which is typically unnecessary. I think that that has a lot to do with the low satisfaction because patients are going there for answers and quite frankly, they're not getting them very often. Right. Additionally, Dr. Dayeux cited the American College of Physicians guidelines, which basically supported spinal manipulation and by default, chiropractic as spinal manipulation adjustments being the hallmark. And he says the guideline concluded that most patients with acute low back pain improve over time regardless of treatment. Thus, therapy is often directed simply at symptom relief while natural healing occurs. Wow, what a revolutionary thought. He goes on to say, quote, the guideline also concluded that patients with acute or subacute low back pain should consider non pharmacological treatment with heat massage, acupuncture or spinal manipulative. Therapy. None of the trials in the study by Page or, or the American College of Physicians systematic review suggested that SMT was less effective than conventional care. So he's saying, hey, there's no question based upon previous guidelines, including the new one from the American College of Physicians, that medications should not be the first line treatment in acute or subacute low back pain. That is basically medical fact at this point in time. He's also pointing out that adjustments or manipulations have not been proven to be less effective than anything else out there. So he's obviously not exactly taking the strong statement of saying it is better, but he's saying it is definitely on par with anything else that is out there and could not be considered, quote, unquote, worse. And we all know safety is always a concern of medical doctors. They don't know chiropractic. They don't see how we practice day in and day out. So for them, and rightfully so, safety is a concern because they're not familiar with exactly how we go about our practice. So he touches on that as well, saying another concern is the safety of spinal manipulation. Although there are case reports of serious complications such as cauda equina, these are extremely rare in the lumbar spine. None of the randomized trials or large observational studies reviewed by Page identified any serious complications. In contrast, renal and gastrointestinal adverse effects of NSAIDs are common. For instance, among patients taking non steroidal anti inflammatories, renal function abnormalities occur in approximately 1% of patients in superficial gastric erosions or asymptomatic ulcers. Ulcers can occur from 5 to 20% of users. Furthermore, low back pain is among the most common reasons for prescribing opioids. And 5% of opioid users will go on to become dependent and have addiction issues and potentially overdose. So listen to this again. I'm gonna kinda go back through that a little bit regarding the safety. He basically says, hey, there are potential for serious complications. He cites the scary one there, cauda equina syndrome. He says they're extremely rare. Then he goes on to say, well, as a matter of fact, there's no studies showing at all any serious complications. However, there are an abundance of literature showcasing that with NSAIDs there is renal function issues in 1% of those individuals, which is people using NSAIDs are in the millions by the way, so 1% is a large number. He's talking about ulcers and gastric erosions. 5 to 20% of users. That's astronomical. And then he cites of course opioids as well, which are frowned upon thankfully at this point in time, at last and all of the issues that come with that. So there is no question when looking back at this paper, when looking at this editorial, that head and shoulders, it is not even close the safety of an adjustment or chiropractic care compared to medications. It's not comparable. It is just an open and shut book. No question about it. And additionally at the end he cites, quote, this is an area in which a well informed patient's decision should count as much as a practitioner's preference. So he's talking about in essence the fact that, hey, a lot of medical doctors are not using chiropractic care as much as probably they should. If I base that just on what he said during his editorial, however, patients decisions should be kept in high esteem and their preferences are also part of that decision making process. This just harkens right back to the research that I've cited multiple times. A paper came out that showcased 90% of medical doctors have been asked about chiropractic and you know where I'm going with this, but only 11% had initiated a formal referral to a chiropractor. That gap, I'll say it again, is opportunity. It is a shame that it is only 11% of medical doctors have made formal referrals to chiropractors. But if you're listening to this, that should also be inspiring. That means that there are medical doctors in your community, 90%, nearly every one of them has been asked about chiropractic care, but they haven't taken that step to make that referral. Well, how do you make that happen? It certainly is not by doing nothing. You have to be able to take action and that's what we do at the evidence based chiropractor, as you well know, monthly research briefs, that's the marketing that gets your name in front of them in a consistent fashion. Case notes doesn't flood your office with referrals, but an important foundational component we coach on that there's a whole module based upon that, reports, templates, guides, you name it, to make sure that your case notes are effective. To showcase the social proof that you exist and the results that you get and kind of that patient testimonial as I call it, which are the results that you get in your practice. Showcasing that through case notes, absolutely essential. And the third component, building trust and rapport with a meeting going through. How do you set up that meeting? How do you find out and learn use a Socratic method to understand the other provider's practice and how can you make it easy for them to refer to you in a way that you don't need to be an extrovert and you don't need to be salesy to make it happen. So that's what we do at the Evidence Based Chiropractor, as you well know. But this paper I thought was a really interesting one. It's a great editorial. It was produced by the American Medical association just last year and there's this is a different tone. I think if this was produced in the 70s and the 80s, perhaps even in the 1990s, this paper would have a drastically different tone than it has today. So there has been huge strides in the MD and DC relationship space, but we need to take that onus continually on ourselves to get out there. If patients are not coming into your practice, we all know they are going into medical doctor practices and I don't want to see people led down the road of ineffective medications, dangerous medications, injections that are off label and provide temporary relief at best, or ultimately surgeries that could have been prevented earlier on if they would have gotten the right and the best care. And in my opinion, the research has showcased time and time again that is in your office as a chiropractor. So I hope you have a great week in practice and I will talk to you soon.

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