Why are MD’s Still Hesitant to Refer to Chiropractors?
The looming implications of a nation in the throes of an addiction epidemic along with the overwhelming amount of evidence emerging in support of chiropractic care make it undeniably imperative that Medical Doctors and Chiropractors set aside their historical differences and work together for the greater good of the patient.
However, even as a growing number of medical doctors ARE getting over some of their major hang-ups around referring to chiropractors, there seem to be three big hurdles standing in the way of what could be a flourishing cooperative healthcare partnership.
Three BIG Reasons
1) They don’t trust you.
You’ll steal their patients. Whether it’s a fear that you will try to “talk them out of” medical care, convince them to not vaccinate their children, or that you seek to take over as the patient’s PCP (primary care physician), there are many MD’s that are afraid that once they refer to a chiropractor they will never see that patient again.
2) They Don’t Know What They Don’t Know.
a. They don’t know you want to work with them…or that you’re willing to work WITH them.
b. They don’t know how you operate – MD’s speculate but aren’t really clear on how you work. How can you help their patients? How do you determine an appropriate care plan? Does chiropractic care require that a patient see you twice a week forever? Indefinitely? How will you know whether or not your care is effective? What if it isn’t? Will you refer the patient back to them?
3) You Stink at Communicating.
According to The Evidence-Based Chiropractor, “Research shows that between MD's and DO's, case notes are exchanged nearly 90% of the time. When a DC gets added to the equation the case notes drop to 60%.”
This coupled with #2 is most likely the double whammy keeping you from getting referrals from medical doctors.
Getting past “the BIG three” to Land More Referrals
Landing patient referrals is all about building relationships of trust between providers. It is up to you, the chiropractor, to make contact and to communicate in ways and with information that develops a solid professional rapport.
Many chiropractors have already begun to integrate with other health care professionals to offer more comprehensive patient care. By being proactive and addressing these concerns upfront, you will ease the mind of any potential referring MD and position yourself and your practice as a trusted asset.
1) Put Yourself Out There.
a. Meet with MD’s in your area. Let them know you are interested in working WITH them.
b. Ask permission to contact the PCP of your current patients. Meet with the doctor. Explain the patient’s care plan.
**The Document Plus software has built-in comprehensive narrative reports specifically designed to communicate with your patients’ Personal Care Physician.
2) Let Them Know How You Operate As a Chiropractor.
What type of patients are you interested in working with (patients with chronic, intractable headaches, patients with acute low back pain and a prescription for opioids, only the most chronic of patients being prescribed opioids for low back pain)?
How will you help the patients?
Which treatments will be used?
How do you determine an appropriate plan of care?
Do you support trial plans of care?
How will you determine whether or not your care is effective?
How often should they expect to see updates on the patient's progress?
What if your care isn’t effective?
Do you refer when necessary?
**Consider creating an Elevator Speech or something similar, for face-to-face encounters and a template for email communications outlining the things listed above. Include anything else you feel is relevant and important on this topic.
3) Therapeutic Trials.
Medical doctors don’t like to refer patients to a chiropractor if they feel like they are just setting them up for a treatment plan of 3 times a week for the rest of their lives. A trial plan of care should allow enough time to see whether or not chiropractic care will be effective and beneficial for that particular patient.
**Initiate trial periods of treatment. Following the trial treatment period, re-examine the patient to determine the effectiveness of your treatment and how to proceed from there.
4) Show Effectiveness of Treatment.
Determine accepted measurements you will use to gauge and track the effectiveness of the chiropractic treatment.
Assessment of daily living measures using validated Outcomes Assessment Questionnaires (Revised Oswestry Back Disability Index, Roland Morris Back Disability Index, RAND 36, Neck Pain Disability Index)
Improvements in strength, endurance, flexibility, etc.
**Document Plus Examination and Daily Checklists include Orthopedic tests, ROM Assessments, Pain Scales, Pain Diagrams and areas for documenting improvements.
**Outcomes Assessment Checklists are scored upon entry and appear in narrative reports. Results are compared side-by-side in Final reports to show functional progress (effectiveness of treatment).
Send updates on patient findings and progress regularly. This not only helps the doctor monitor the treatment and progress of the patient, but it also shows that you are a skilled clinician with documented results and the best interests of the patient in mind.
This type of professionalism goes a long way toward conveying to the PCP that you view them as a member of the same team rather than a competitor. The next time the doctor needs to refer a patient to a chiropractor you’ll likely be the first to come to mind.
**The Document Plus software was designed to assist in fostering clinician relationships. Summary reports and SOAP Notes are at your fingertips as well as comprehensive narrative reports specifically designed for communication with Attorneys, Insurance Companies, and other Physicians.
**For ANY patient (with their permission), utilize the built-in Initial “Personal Physician” narrative report to initiate contact with the PCP. This is intended to convey professionalism, cooperation, and your willingness to coordinate care and will likely set you up to receive referrals from that provider in the future.
**For REFERRED patients, utilize the built-in “Referred From” narrative reports to communicate with the referring physician. This will also convey professionalism, cooperation, and willingness to coordinate care, easing concerns and facilitating trust in the partnership.
**Initial, Re-Eval, and Final reports along with daily visit SOAP Notes are available for communicating throughout all phases of care
6) Refer when Necessary.
It is a common misconception amongst medical doctors that chiropractors seek to position themselves as “end all be all” medical experts or that the chiropractor shuns or denounces traditional medicine. It may be worth mentioning that patient care is your top priority and that you do not hesitate to refer in the following situations:
When chiropractic care has not proven beneficial for the patient.
When you feel the need to collaborate with another healthcare provider for optimal results. (e.g. massage therapist, physical therapist, orthopedist) When further diagnostic testing or imaging is necessary to rule out a more serious condition.
When there is the discovery of a condition or potential condition that is outside the scope of chiropractic treatment.
**The Document Plus Examination checklist includes a comprehensive referral section with many options for referral to other physicians and providers as well as options to refer the patient for further diagnostic testing.
**For patients you are REFERRING, utilize the built-in “Referred To” narrative reports to communicate with the physician you are referring to.
The Opioid Epidemic
The opioid epidemic in America rages on. There is no question that opioids are largely overprescribed in the United States.
The real tragedy is that opioids are prescribed FIRST for conditions like back pain, low back and neck pain, headaches, musculoskeletal, neuromusculoskeletal and other related conditions.
Many of these conditions could be aided or resolved without prescription medications by referring the patient to a healthcare provider who specializes in musculoskeletal and neuromusculoskeletal conditions.
Enter the Chiropractor.
Two years ago, we published a blog post discussing how Chiropractic, with highly effective non-pharmacologic interventions for pain treatment, was uniquely positioned to affect the opioid epidemic in a HUGE way.
The Results Are In
The results are in and they are nothing shy of what we expected.
A Medscape article from March 2019 states that new research suggests “Chiropractic care for musculoskeletal pain is associated with a significant reduction in opioid prescriptions compared with non-chiropractic care.”
"Chiropractors provide many of the treatments included in the clinical guidelines for the initial treatment of low back pain, neck pain, and osteoarthritis of the hip, knee, and hand.”, says Kelsey L. Corcoran, DC, VA Connecticut Health Care System and Yale Center for Medical Informatics, Yale School of Medicine, New Haven.
A new study also shows that patients who visited a chiropractor for a musculoskeletal pain condition were 49% less likely to receive an opioid prescription than those who went to other healthcare providers.
It took a nationwide epidemic to get us here, but clinical guidelines have been revised and recommend many non-pharmacological options to be considered PRIOR TO the prescription of any medication.
So the research commences, and the evidence continues to be brought forth that chiropractic is one of the best first lines of defense in combatting the opioid crisis.
There has been a long history of opposition between medical doctors (M.D.) and doctors of chiropractic (D.C.).
Many MD’s haven’t referred patients to chiropractors in past years due to either misinformation or simply a lack of information about the safety, efficacy, and benefits of chiropractic treatment.
In recent decades, the prevalence of back, low back and neck pain, and the documented role of non-invasive, drug-free chiropractic care to alleviate pain and successfully address these conditions are prompting providers in multiple disciplines to advocate chiropractic care as a leading alternative to the conventional, drugs-first model of medical care.
More medical doctors are beginning to sit up and take notice.
Due in part to the opioid epidemic, more (and larger) studies are being pursued, therefore more and more evidence is emerging demonstrating the effectiveness of chiropractic care. More and more MD’s are opening their minds to the possibility that chiropractic can be utilized to complement traditional medicine for better patient outcomes.
As conservative pain management becomes more accessible and you begin to generate more referrals, you’re going to want to be ready.
To be able to receive and successfully manage referrals, you’ll want to have systems in place to communicate effectively and coordinate patient care with M.D.s and other providers.
Document Plus is not only a complete documentation solution but enhances quality of care with built-in ways for you to track functional progress and communicate professionally with other physicians.
Document Plus is easy to use and an effective way to present yourself as the first stop for the treatment of patients with appropriate presenting conditions.
Across the nation eyes are opening to the effectiveness of Chiropractic and other non-drug approaches to pain management. With quality documentation and communication, you will position yourself to be ready to help a tremendous number of new patients.
If you currently have Document Plus and would like to further discuss how to use your system to embrace this historic opportunity to generate more referrals, serve more patients, and take chiropractic to the next level, Call Melanie at 800-642-0600 Ext. 113 or click to request a training session.