The front page of Physician's Weekly of November 18, 1991 asks the provocative question, "Should doctors refer more patients to chiropractors?" Drs. Thomas Errico, assistant professor of orthopedics and neurosurgery at NYU, and Willibald Nagler, professor and chairman of rehabilitative Medicine, New York Hospital-Cornell Medical Center, aired their views in a point/counterpoint format.
Their two perspectives are interesting to the extent that they reveal the polarity that exist among MDs on the question of chiropractic referrals and on the subject of chiropractic in general.
Dr. Errico's Point
Dr. Errico expressed an open-minded, pro-chiropractic viewpoint, albeit with some reservations. He stated that chiropractic offers cost-effective relief for low back and neck pain for many patients. If one of his patients is seeing a chiropractor and he finds no underlying illness or medical contraindication, he advises the patient to continue seeing the DC. He adds, "In my experience, if a patient has no severe underlying structural abnormality but just generalized complaints of aching back or neck, referring to a chiropractor makes sense."
He amends his position by saying: "With major structural scoliosis of 30 degrees or more, a chiropractor is not going to help. But in postural scoliosis secondary to a muscle spasm, chiropractors can offer great pain relief."
He concludes: "When it's appropriate for my patients, I refer to chiropractors. I see no reason why others shouldn't do so.
Dr. Nagler's Counterpoint
Dr. Willibald Nagler takes a more omnipotent, stanch, narrow-minded attitude toward chiropractic. "Chiropractors do nothing unique that would warrant more referrals. Physicians who take enough time to examine and treat their patients' musculoskeletal complaints can handle almost any problem." Unfortunately, he informs us, many MDs don't have the time for such complaints! MDs in this category, he believes, should refer patients to ... (drum roll)... physical therapists. He explains: "Most of them (PTs) have more musculoskeletal training and experience than most chiropractors."
Wow! Can you imagine the scenario:
MD to patient: "Sorry, I don't have time to treat your back pain, I've got more important cases to attend to (get BMW waxed before afternoon golf game).
MD: "Here, take these pain killers ...you won't feel a thing." (I wouldn't know where to start on her back pain. What does she think I am, a chiropractor?)
Dr. Nagler then gives chiropractic "lip service" with a rhetorical 180-degree pirouette that offers this spurious comment: "There are many good chiropractors out there who have provided great relief to patients with backaches and neck pain. I do not want to diminish in any way their commitment to patients or their skills as diagnosticians."
Fine words, if only he believed and acted upon them.
The coup de grace is his last comment: "If patients want to go to chiropractors, that is fine. But they should know they'll be getting nothing special.
Steve Kelly
Assistant Editor
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