Chiropractors—Knocking At Your Door?

Stephen Barrett, M.D.

Reprinted from Private Practice Magazine
May 1982

What if a chiropractor refers a patient to a physician? What if he wants a report, a lab test or an X-ray examination? What if a patient wants his records sent to a chiropractor? What should you do?

Today's chiropractors claim they can determine what lies within their scope of treatment and the rest they refer to other practitioners. They back these claims, not with scientific evidence, but with the specter of legal action against anyone who gets in their way.

The Nature of Chiropractic

The "discovery" of chiropractic is attributed to Daniel David Palmer, an Iowa grocer and "magnetic healer." In 1895, so the story goes, Palmer restored the hearing of a deaf Janitor by "adjusting" a bump on his spine. After further study, Palmer theorized that the basic cause of disease is nerve Interference caused by misaligned spinal bones. The basic treatment was, therefore, adjustment of the spine—by hand. The word chiropractic is derived from the Greek words cheir (hand) and prakttkos (effective).

Because Palmer's theory is utter nonsense, medical doctors have traditionally regarded chiropractic as an unscientific cult. Today's chiropractors claim they have gone far beyond Palmer's theory: but many chiropractic documents suggest otherwise:

At a subsequent hearing, the chairman of the Pennsylvania State Board of Chiropractic Examiners and faculty members from three of the nation's 16 chiropractic schools endorsed the ads as accurate and representative of what is taught in chiropractic schools.

During the past 10 years, I have collected chiropractic journals and textbooks. listened to chiropractic lectures, spoken and corresponded with hundreds of chiropractors. Interviewed many of their patients and conducted a variety of clinical research projects. As far as I can tell, chiropractors are unable to agree among themselves about whether to diagnose, how to diagnose, what to treat, how to treat. when to treat, when not to treat. how long to treat. when to make a referral, when to take an X-ray. how to take an X-ray, how to read an X-ray or how their treatments work. It is hardly surprising that most physicians want nothing to do with chiropractors.

A Legal Cloud

In the real world, however, strange things can happen. In 1976. chiropractors began a series of lawsuits against the AMA other prominent professional organizations and several individual critics. charging that all had conspired to deprive chiropractors of their legal rights. Because chiropractors are licensed, the litigants reason, conspiring against them is a violation of antitrust laws.

In the wake of these lawsuits. the AMA softened its official position last summer by removing the label of "unscientific cult" and permitting association with chiropractors when it is in the best Interest of the patient. While many physicians regard the new AMA position as a cowardly retreat, chiropractors hail it as "recognition." Actually, it is neither. Physicians do not shun chiropractors out of fear of harassment by colleagues. They do so out of lack o! respect for chiropractic. The new AMA position was suggested by attorneys who think that defense of the antitrust suits will be simpler if name-calling is stopped.

There has been a more serious side-effect of the suits. Some defense attorneys have also advised their clients to curtail anti-chiropractic activities until the suits are resolved. As a result. many physicians who want advice on dealing with chiropractors are not getting it from their professional organizations. They are being told to think for themselves.

About a third of the nation's 21,000 chiropractors still cling firmly to D.D. Palmer's basic doctrine. Most of the rest acknowledge that factors such as germs and hormones play a role in disease. but still view spinal problems as the underlying cause. A few chiropractors—probably fewer than 100—are free of delusion, practice a conservative form of physical therapy, do not pretend to be primary providers, and refer quickly when they sense that a problem is outside their scope. Medical cooperation with this type of chiropractor may well be in the public interest—and indeed, it has been taking place for years in many communities. When a medical facility cooperates with a chiropractor who is delusional. however, the effect is likely to be political rather than medical. One chiropractor I know maintains a separate file of "referred patients" to demonstrate that he is "working closely with medical colleagues."

What Should You Do?

What are the best policies for dealing with chiropractors? I suggest the following:

  1. Unless you have personal knowledge that the chiropractor is nondelusional, requests for laboratory tests or X-ray examinations should be Ignored. There ls little reason to believe that giving medical information to a confused practitioner will enhance the patient's chances of getting appropriate care.

  2. Referrals for treatment should be accepted. If acknowledgements are given, they should be done by telephone.

  3. If a patient asks that existing reports be sent to a chiropractor, the reports should be offered to the patient. Patients have a legal right to see their records. Seeing a negative X-ray report may even protect the patient from a chiropractor who wishes to treat non-existent spinal problems.

  4. If a chiropractor wishes to discuss an X-ray he has taken such consultation should be provided only if the chiropractor agrees in advance that a report be sent to the patient's medical doctor if medical care is Indicated.

Will following these policies get you sued? I think not. There is no law that says you must take orders from a chiropractor. Until the antitrust suits are resolved. there may be legal risk for large health organizations to join forces against chiropractic. But independent action by individual physicians cannot create grounds for an antitrust suit. Despite the belligerent reputation of chiropractors, lawsuits against individual physicians are extremely rare. As far as I know, none has ever been successful.

If you need further Information on this subject, please feel free to contact me.

This article was posted on January 27, 2018.

Links to Recommended Companies