Opportunity for change: Inter-professional education

Inter-professional education is one of the most important pathways that professions like chiropractic should now be pursuing. Growing up in a chiropractic family in the 1960’s and 70’s, I was always a bit surprised by the amount of negativity I heard, expressed by members of the public, and by the apparently ill-informed medical folk, as to the value of chiropractic. During this period, chiropractic had to overcome many obstacles and hurdles to cross the threshold of relative obscurity to eventually emerge and become a part of the public health system (OHIP in Ontario). Fortunately, despite our detractors, we had excellent leaders within the profession, along with strong supporters in key roles in government, who helped us secure a growing place in Ontario’s health care landscape.

We have continued to improve our level of acceptance by the public, and in many medical circles, but there is still a lingering lack of familiarity and comfort that prevents the family physicians from confidently and regularly considering chiropractic as a first choice for medical referral. Even more obvious is the complete lack of referral of post-surgical patients from surgeons or other specialists. Why is this the case? What are the barriers inhibiting medical referrals?

It is my belief that medical doctors cannot confidently refer to other practitioners when they do not have significant exposure during their formative years in medicine as to the fundamental basis and background of that profession. The practice of medicine may be considered by some of its practitioners to be an art, but even more so, it is a “science” with specific requisite treatment algorithms. Medical students then adopt, rigorously follow, and respect these approaches as part of their training. In essence, if a particular rational and reasonable approach to patient care is not part of the medical education and as a result, part of the treatment algorithm, then it (chiropractic) will not become part of that physician’s list of treatment options.

As an example, consider the physician’s prescription of certain medications. Young physicians learn about many medications but they eventually can only confidently memorize the indications, contraindications, dosages, interactions and applications of several dozen at most. Once they know and trust the type of prescriptive drugs that they need, they tend to stick to them and not “try” other drugs unless they are educated, or recommended to do so, by their colleagues or pharmaceutical agents. Many doctors of medicine are not comfortable prescribing drugs that are brand new, relatively unknown, or may have unpredictable complications and or side effects. The same might be said when it comes to referring to other health care disciplines.

I see their point, and I support it. I certainly don’t want a physician who experiments and likes to try new unfamiliar drugs on patients. That is a bit like something that was dropped decades ago – exploratory surgery!

As a result, chiropractors along with naturopathic doctors, TCM practitioners, and others are going to have to overcome the same issue – that of unfamiliarity – if they want to have family physicians to choose to recommend them to their patients for care.

By example, consider the barrier of a physician who hesitates to make an appropriate non-pharmaceutical referral, and the consequential impact on our patients’ health, stemming from his or her lack of understanding of our profession. The most current example centers around the opioid crisis. It is well understood that most of our opioid overdose victims began as medical patients receiving medically prescribed and “appropriate” prescriptions of opioids for pain relief. Many of these patients received opioids for MSK pain that was severe. That prescription choice occurred because those physicians involved were more familiar with, and more comfortable with, prescribing narcotics to their patients with lower back, shoulder, knee, or neck pain than recommending chiropractic care.

Today, and every day, 11 people die in Canada from opioid toxicity. Many of the 9,000 victims, since 2016, who received those initial opioid prescriptions were experiencing MSK pain. As we are all aware, MSK pain and disability are the number one reason people seek out chiropractic care. It is a public health issue, and yet, safe, effective chiropractic care is simply not a top of mind option for most physicians.

Collaboration on patient care is often lauded as a desired practice by many professions, but this is not yet a standard and cannot be until we incorporate interprofessional education. This year at the University of Ottawa, the faculty of medicine has created electives for second, third, and fourth year medical students to observe chiropractors, naturopathic doctors, and physiotherapists in Ottawa. This program is being received well by students who participate and hopefully we will see it continue.

Originally planned for May 2020, at the University of Ottawa, the faculty of Medicine has incorporated mandatory interprofessional education for all 160 second-year medical students to study together with students of chiropractic, naturopathic medicine, occupational and physical therapy. (This will now take place in about a year’s time due to the COVID-19 pandemic.) These students will experience a one-day symposium about MSK approaches from various disciplines, including chiropractic, so that they have exposure not only to various non-pharmaceutically based approaches to health care, but also to the students of those health disciplines.

The success of this programs and programs like the program of chiropractic at St. Michael’s hospital in Toronto, led by chiropractor, Dr. Kopansky-Giles, are important steps to the improvements in patient care that medical students should know and understand. For any referring medical physician, this collaborative model of patient-centered care, should never be a leap of faith, but rather a reasonable decision based on knowledge and experience of what other treatment partners can bring to the table. Knowing this, when a medical or other health care student asks you to observe your practice for a day or for a week, please go ahead and invite them. If you, or someone you know, are already involved in Inter-professional education, please let me know. Let’s work together to change the medical student’s comfort zone from prescribing dangerous opioids to something safe and far more effective, like chiropractic.

Dr. Dirk Keenan, DC, is a second-generation chiropractor practicing in Ottawa’s oldest clinic for the past 34 years. Dr. Keenan pursues an active interest in multi-disciplinary clinics, inter-professional education, and chiropractic practices abroad. Interested parties in international locums, multi-disciplinary practices, or inter-professional education can contact him at dirk@thespinedoctor.com.