The Norwegian Secret

A recent study¹ revealed that doctors of chiropractic in Norway enjoy a much greater referral relationship with the medical community than do DCs in the U.S. The study particularly looked at what barriers could be restricting the number of referrals and what might be done.

The first thing that catches your eye is that each of the MD respondents "reported having made at least one referral to a chiropractor." Wow! Think what could happen if all of the 598,000² U.S. MDs referred at least one patient to a doctor of chiropractic. That works out to about 10 referrals per DC in the U.S. This prospect is probably even more attractive in the other 90 or more countries in which DCs practice.

The study found that 20 percent of the MDs "often" refer patients to DCs. Doing some quick math, 20 percent of 598,000 U.S. MDs is 119,600. If these MDs referred just one patient per month to the 59,184 U.S. DCs, it would result in a steady stream of 1,435,200 medically referred new chiropractic patients per year!

The Norwegian study further revealed the experiences of its MDs in communicating with and about chiropractic care:

 

• "...only five percent claimed to have a good knowledge of chiropractic."


• "Patients who had undergone chiropractic management for some complaint were the primary source of information about the therapy for the overwhelming majority (84 percent) of GPs (general medical practitioners), whereas half of the respondents had also obtained information through the medical literature."


• "Twelve percent reported problems with terminology."


• "Ninety-three percent of the GPs were either currently communicating with a chiropractor or expressed an interest in doing so in the future. However, infrequent contact was associated with nearly two-thirds of current communications."
• "Overall, 67 percent of those GPs who had previously communicated with chiropractors reported this as positive or very positive experience."
• "Fifty-eight percent of respondents believed that the standard of communications could be improved, although 10 percent stated otherwise."
• "Two thirds of the respondents were interested in learning more about chiropractic. Six percent were not interested in receiving further information. The main areas of interest were the indications for chiropractic treatment (75 percent), techniques (62 percent), effects and safety (60 percent), and the difference between chiropractic and manual therapy (52 percent)."

These conclusions direct our attention to communication as the touch-point between the two professions. While this is true of all working relationships, it is even more so when the professionals involved are competitors.

At this point, U.S. DCs may be asking, "But what about the AMA's attempt to 'contain and eliminate chiropractic' in the United States? Are we supposed to just ignore that?"

This is about relationships between health care professionals, not about political medicine. While the AMA's efforts to destroy chiropractic will never be forgotten by our profession, it has been almost 15 years since the AMA was found guilty of trying to eliminate chiropractic. (The lawsuit was originally filed in 1976, with the court finding in favor of the chiropractic defendants on August 27, 1987.) Thousands of new MDs have been licensed since then, and many of the perpetrators are either dead or dying.

Chances are many medical doctors don't even know about the lawsuit. This is probably true for medical doctors in many other countries. They don't necessarily remember or care about the actions taken by their political leaders. Many are probably open-minded.

The study reports that some of the Norwegian physicians failed to communicate and provide progress reports after the referral was made to the DC (something that is mandatory in Norway), and what qualities the MDs were looking for in these communications:

• "Ninety-nine percent of respondents expressed a wish to receive a report on the referral of a patient. However, approximately one third of the GPs had never received a report after referral of a patient to a chiropractor."


• "A written format was favored by most (75 percent) of the GPs."


• "With regard to what information should be contained in the report, diagnosis, advice given, examination findings, and treatment administered were of greatest interest."


• "Two thirds (62 percent) of the respondents expressed a wish to receive the report after the last treatment, whereas approximately one half (48 percent) preferred to leave it to the discretion of the chiropractor. Thirty percent, however, stated a preference for regular reports."

The formula is this:

(Communicate the Value of Chiropractic) + (Educate MDs One-on-One) + (Explain Terminology) + (Seek an Initial Referral) + (Send Reports as Requested) + (Continue with Quality Communication) = More Referrals

Even considering the fact that the communication efforts of Norwegian DCs could be improved, they have made some considerable inroads into the thinking and referral patterns of their medical counterparts:

"There was consensus (97 percent) that referral to chiropractic care was appropriate for patients with low back pain, although the opinion was less certain about the appropriateness of referring patients with neck and/or shoulder pain (59 percent), cervicogenic headache (56 percent), and tension headache (44 percent)."

While these opinions are not 100-percent, they do represent a dramatic difference over the opinions of U.S. MDs and those in many other countries.

The Norwegian "secret" appears to be constant, high-quality communication.

References:

 

1. Langworthy JM, Birkelid J. General practice and chiropractic in Norway: How well do they communicate and what do GPs want to know? J Manipulative Pysiol Ther 2001;24:576-81.
2. Statistics per United States Department of Labor - Bureau of Labor Statistics, based on figures for 2000. http://www.bls.gov/oco/ocos074.htm.

Donald M. Petersen Jr., BS, HCD (hc), FICC(h)
Editor / Publisher of Dynamic Chiropractic
don@mpamedia.com