"You can focus on things that are barriers or you can focus on scaling the wall or redefining the problem." — Tim Cook, CEO, Apple, Inc.
As the chiropractic and medical professions tiptoe down a path of increasing collaboration, it has become clear that one of the major factors inhibiting this process is a lack of adequate understanding by MDs of what chiropractors do and why chiropractic care is so valuable to health and wellness. That said, many DCs have made inroads within the medical community, forging professional relationships that not only maximize patient care, but also generate referrals.
To help you enhance your practice and increase your bottom line, we ask practicing doctors of chiropractic like you for ideas and solutions that have been tested in real-world environments. Our latest question focuses on DC-MD networking: "What strategy would you suggest (and/or have you adopted) for networking with local medical doctors to increase MDs' knowledge of chiropractic and promote referrals?" Here's what your chiropractic colleagues had to say when asked for their candid input.
Action Step: Educate
Educating medical doctors about what doctors of chiropractic do is a vital step in building collaborative relationships, according to several of your colleagues. For example, Dr. Chris Sherman, an Indiana DC, suggested:
"When meeting with a [medical] provider, highlight the benefits and effectiveness of using chiropractic when treating neuromusculoskeletal conditions such as acute or chronic low back pain, neck pain, headaches, and sciatic pain. Chiropractic may be the solution they're looking for when traditional medicine and prescriptions are not working as expected."
"While working in an integrative practice with MDs, DOs and PAs helps, I find I am still promoting myself to the physicians to help educate them on the type of patients I can see," said Nevada chiropractor Dr. Vishal Verma. "As a CCSP, I find that showing them evidence-based protocols rooted in orthopedics and sports science regarding treatment of injuries other than back and neck helps. Using functional motion and orthopedic testing to establish treatment plans, and then reporting back to the physician those findings, promotes communication and confidence in chiropractic treatment."
Action Step: Communicate
Communication is key in any relationship, personal or professional. When it comes to building a productive professional relationship with a medical doctor, your colleagues emphasize that communication can help build trust:
"I have found that if you are an MD's patient and you tell them about chiropractic, over time they will gain the trust in you that they require to ask for an adjustment," said Dr. Nicole Dowling from California. "Their profession requires standing for long periods, with head flexion leading to neck pain in a surgeon, for example. My advice is get to know them and they will want to know you. You would be surprised how much they will appreciate your care and concern. It is a win-win!"
Dr. Sherman echoed Dr. Dowling's sentiment: "[N]ever miss an opportunity to show physicians how chiropractic care can help with their patients. ... If they trust you enough to treat them, then they will send you patients."
"I send a Shared Patient Advisory to the family MD (with the patient's permission) for every new patient to foster open communication; and to invite them to share any pertinent health information as it relates to that patient's general health – particularly their spinal health," said Dr. Stacey Rosenberg, a chiropractor practicing in British Columbia, Canada. "When the patient has been referred by their MD, I send a Referral Acknowledgment form with a report on what they presented with, what I found (examination, etc.), diagnosis, and treatment plan. This is exactly what a specialist would send to the MD after a referral for their services!"
For Dr. Donald DeFabio of New Jersey, the "gold standard" of communication is "a prompt, succinct written report (not computerized notes) about mutual patients. Include a few business cards; if you can drop off the report and meet the staff, even better. Then send a follow-up note as the patient responds. [It's about] creating rapport – one patient at a time."
Dr. Sherman offered similar advice: "In the medical community, all specialists send a report to the referring provider detailing treatment plan and observations. Keep this approach simple, documenting who, what you saw them for, what objective findings they had, treatment plan, and most importantly, how they reached their treatment goals.
"Emphasizing the goals achieved is imperative to build the relationship with the physician," he continued. "This should be measurable, such as patient self-reported pain went from 8/10 to 2/10 in six visits or neck disability index decreased 10% from 25% to 15%. These communications should be short and to the point."
Dr. Verma suggested communication with patients and MDs helps build a foundation of trust that will lead to referrals:
"Communicating all my findings in layman's terms to the patient and then getting results in a shorter period of time allows them to relay their success to their physician. Too many times, we begin the chiropractic 'story' too early without establishing credibility by giving the doctor what they are looking for. In my experience, I find that all of our physicians had little to no idea about chiropractic, and even less knowledge of musculoskeletal issues. They are looking for any reason to refer those cases, but they need to be confident in that referral. In so many words, I kill 'em with their own science."
Action Step: Find Common Ground
"If you are thinking of getting more patients from MDs and DOs, you need to show that you understand their approach and how you can complement patient care," suggested Florida DC Dr. William Molesky. "This basic concept has allowed me to join a large orthopedic surgery group, which, in turn, has increased my knowledge and resulted in overall acceptance of orthopedic and chiropractic practices and philosophy."
"Use the right lingo," urged Dr. Sherman. "Medical providers use medical terms and are not necessarily familiar with chiropractic terms. Make an attempt to relate to their frame of reference. For example, instead of using subluxation, use restricted segment or misalignment."
Added Dr. Chris Wilkerson, a California DC: "What we have in common with MDs is technology and the need for proper documentation. This subject should be exploited."
Action Step: Stay Relevant & Reasonable
Setting reasonable treatment goals and providing patients – and their medical doctors – with a clear timeline for recovery is another important consideration when building bridges with MDs, according to your colleagues. It's all about staying relevant and reasonable:
"Keep the treatment plans relevant," emphasized Dr. Sherman. "Physicians routinely refer to physical therapy for everything neuromusculoskeletal. Physical therapists give patients reasonable treatment plans with clear objective goals and outcome measures. Physicians are used to treatment plans that may be 6-12 encounters over the course of one or two months. Patients see this as reasonable if they continue to see their objective goals being met. Physicians and patients are more skeptical when suggested a treatment plan of three visits per week for 50 visits. This does not match the expectation of the physician for necessary care.
Dr. Sherman continued: "Release patients to PRN. One of the biggest concerns about chiropractic care shared by physicians is that patients never get better because they are not told to discontinue care. Flare-up care from time to time is still acceptable, but physicians are concerned with ligament laxity and hypermobility from overtreatment. It's important to set goals that can be measured so the physician and patient know when further routine care is no longer necessary."
Editor's note: Interested in joining our focus pool and sharing your perspectives on chiropractic practice with your peers? Email editorial@mpamedia.com. Every few months, we send out a new question and request your input / insights.
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