Recently, I was interviewed for an article that appeared in the Toledo Blade on 8/14/22 titled “Chiropractors see themselves as adjuncts to mainstream medicine, not as competitors”. I realize that there is not an unlimited amount of space in Toledo Blade to fully flesh out the story and I also realize that the writers at the Blade are under pressure since they are as short-staffed as many other businesses and need to boil down topics. So with that in mind, I figured that I should probably expand a little bit on the story and how I see things. I can’t say that anything was completely misquoted in the Toledo Blade story, but I think that there are areas that I can clarify.
In the interview, we talked about many things, but a couple of the focus points involved the people who chiropractors could help and whether or not the chiropractic profession got the respect that it deserved. The evidence for the effectiveness of chiropractic in treating back pain, neck pain and headaches is plentiful. There are many other things that chiropractic can help with, but there is not as much evidence as I would like.
I help people with a multitude of sports injuries, frozen shoulder and runner’s knee using not only chiropractic adjustments but a handful of other techniques to help get people better. There is a lack of good research on many procedures in physical medicine modalities that are regularly used, but what most people would be surprised to learn is that most major medical interventions do not have studies to prove they work either. Many routinely prescribed medications, injections and surgeries have no proof that they help people.
One issue discussed in the article that occurs regularly is that a patient may ask their primary care physician whether or not chiropractic can help. If a PCP is open to chiropractic, research has shown that most medical doctors do not know a specific chiropractor to refer their patients to.
They generally will say that chiropractic might help their condition, but they do not refer the patient to a specific chiropractor and just leave it in the hands of the patient to find a good chiropractor. A study in 2006 showed that primary care physicians usually have the patient find a chiropractic provider and have the patient initiate contact themselves 87% of the time. However, primary care providers initiate the referral 99% of the time when referring to other medical specialists, which ends up being directed at a specific provider or provider group. There are some different reasons that chiropractors do not get referred to directly. One reason is that they do not know any chiropractors. Another reason is because there is no financial incentive for the primary care physician to refer outside of their medical system. Anybody dealing with healthcare knows that in the Toledo area, a ProMedica physician is not going to refer you to a Mercy health provider. Part of their compensation package is determined by the referrals that they make within the system and how much money they generate for the system itself. Procedures like lab test and imaging (x-ray & MRI) are done in house. The research supports these ideas in that primary care physicians who are in private practice (and not affiliated with a system) are “more likely to show positive referral attitudes towards chiropractors”
As I stated in the article, I do think that there are bad apples in our profession just like there are in every profession. One of the distinctions is that in bad apples in chiropractic tend to reflect on the profession as a whole. I have heard of some ridiculous instances where patients are told that they need care three times a week for six months or more and they want the patient to prepay with a hefty “discount” of 20% if you pay today.
Scare tactics get used by some chiropractors to convince patients to start or continue care. In my opinion, a patient should not feel like they are being sold a used car by their chiropractor or anyone else on their medical team. Aggressive sales pitches have no place in chiropractic, as far as I’m concerned. Don’t get me wrong people need to be educated on why they need the care they get recommended.
Every health care professional needs to bring in new patients or clients for them to stay afloat and many healthcare professions get regular referrals. There are some branches of medicine, like primary care, that can get to the point where the practice closes itself to new patients but that is not most healthcare providers. Neurosurgeons, physical therapists, audiologists and psychologists all need a continuous referral stream. One of the issues with the unethical practices that a few chiropractors participate in is that chiropractors are outside of the medical referral system. As shown above, chiropractors don’t get referred to directly by medical providers and are always looking for new patients. If you know that you have to run a radio ad or have a billboard to keep the patients flowing in, a person who is only thinking about their bottom line may be more likely to try to squeeze all of the juice out of that grape. That is not a patient-centered practice.
Another issue is that chiropractors tend neglect fail at communicating with other healthcare providers. Partly because we do not develop in a hospital system, we act more like lone wolves and don’t send communications to our patients’ primary care physicians. As it follows, many of these PCPs don’t hear about the resounding recovery chiropractic patients experience or how satisfied they are with their chiropractor. Some patients don’t even want me to contact their primary care provider to let them know that they are being treated by a chiropractor.
Other healthcare providers have similar biases because they don’t hear about our success stories. Earlier this year, I was at a continuing education event where I was one of two chiropractors surrounded by 45 physical therapists. I firmly believe that I need to improve as a healthcare provider and because of that, I try to get more tools for my tool bag. If you only have a hammer, every problem looks like a nail.
At one point during a break, I was talking with one of the physical therapists who confidently let me know that chiropractic care doesn’t seem to work for his patients. It was kind of amusing to watch the smile drop from his face when I told him that I see patients all the time where physical therapy has failed them. I told him that the reason he doesn’t see chiropractic working is that we never see each other success stories and we only see each other’s failures. The ones that stick in your mind are the ones that you got better when they had been to multiple rounds of physical therapy and multiple medical doctors. Not everybody gets better with physical therapy and not everybody gets better with chiropractic care. Some people need surgery no matter what. I definitely took it as a small victory when he said that he had never thought of it that way and that I was blowing his mind right then.
I talk a little bit about how to find a reputable chiropractor in the article, but for more specific information take a look at my article “How to Choose a Good Chiropractor”.
Who is a Doctor?
The last thing that I will discuss, which multiple people have brought up, is that in the article, I am referred to as “Mr. Royer” repeatedly, as are the other chiropractors. This is something that I thought about bringing up with the author of the article in our interview but in text communications, he had referred to me by Dr. Royer and I didn’t think it was going to be as much of an issue. When I was featured in a Toledo Blade article in 2009, I was referred to throughout as Dr. Royer. Ironically, much of what we talked in my interview about was how chiropractic doesn’t get the respect that it deserves, but yet I am referred to as Mr. Royer.
Some might think that it’s an unintentional slight by a journalist, but it is rampant throughout journalism due to the Associated Press’s Stylebook. It is systemic disrespect codified by the Associated Press.
The AP Stylebook specifically states that only six different types of licensed healthcare providers are eligible to have “Dr.” used as an honorific/title: Doctor of Dental Surgery (DDS), Doctor of Medicine (MD), Doctor of Osteopathy (DO), Doctor of Podiatric Medicine (DPM), Doctor of Optometry (OD), or Doctor of Veterinary Medicine (DVM). I find it interesting that all of them at least have limited prescription rights. Other doctorate level professionals do not meet the criteria and may be referred to as Mr. or Ms as their title instead of a title they have earned and may possibly use every day.
Here is a list of professional degrees who do not qualify according to the AP:
- Doctor of Philosophy (PhD)
- College Professors
- Researchers
- Psychologists with PhD
- Doctor of Chiropractic (DC)
- Doctor of Naturopathy (ND)
- Doctor of Audiology (AuD)
- Doctor of Education (DEd)
- Doctor of Pharmacy (PharmD)
- Doctor of Nursing Practice (DNP)
- Doctor of Physical Therapy (DPT)
- Doctor of Psychology (PsyD)
Take that Rev. Mr. Martin Luther King (since he only had a PhD). Why is it that one of the best-known science popularizers that has a PhD is a man only known as Neil DeGrasse Tyson while another television personality is known as Dr. Oz?
Each of these degreed professions listed above is an expert in their field that should be recognized, in my opinion. I do think that it makes sense to identify as experts based on their degree and specialty, as I don’t think experts should be misrepresented. Identify them as a doctor if they have the credentials and expertise related to the story. Dr. Smith, the molecular biologist, need not be referred to as a doctor when discussing his love of flying model airplanes.
Having a doctorate degree does not make someone an expert in everything. A gynecologist should not be clearing high school athletes to return-to-play after a concussion (but they can in Ohio).
I think that there is a good amount of discretion allowed by the editors of a newspaper regarding how tightly this rule is followed. It should also be noted in speaking of all this, that attorneys have the degree of Juris Doctor (JD) as some have pointed out. One major difference is that they are not referred to with the title of Doctor within their profession.
Anyway, that is enough rambling from me today. Have a great day.