I’m not setting out to intentionally antagonize my fellow MDs and DOs who read these Health Tips. No acrimonious outrage, please, before I explain. Then feel free to splutter.
I’m not writing this for the medical profession. This is for the rest of you, living in a country that spends 17% of its GNP on healthcare but ranks 37th in the world in providing that health care for its citizens, behind Slovenia but proudly ahead of Syria.
We’re clearly doing something wrong and maybe one of our mistakes is who we’ve chosen for our primary care providers (PCPs).
After you finish reading, if you’re unhappy with your PCP–because of long waits in her office, inattentive and hurried encounters, too many prescriptions, always a referral to specialists–you might consider your other options.
Remember, at its core the American Medical Association is basically a very strong union, probably the toughest in the history of the US. Any good union, regardless of whether it’s made up of welders or physicians, tries to stifle the competition. Thus, in the guise of patient “protection” the AMA has historically blocked homeopaths, acupuncturists, chiropractors, herbalists, naturopaths, and midwives from patient care.
Not a radical choice
Today, selecting a chiropractic physician as your PCP is really not as radical as it sounds. On the Blue Cross/Blue Shield of Illinois website, answering the question “What types of doctors serve as PCPs?” it’s clearly stated “depending on your benefit plan, a PCP may also be a nurse practitioner, midwife, or chiropractor.”
I have yet to come across a BC/BS IL plan that doesn’t allow chiropractors to act as primaries. If Blue Cross is willing to pay for this kind of health care, they must have done some research.
Regarding nurse practitioners (NPs), it’s my thinking that they, along with chiropractic physicians, should take over primary care medicine everywhere in the US. We currently have two NPs at WholeHealth Chicago and this week I’m wooing a third.
When I was over at Weiss Hospital just a year ago this week, recovering from a broken hip and some annoying complications, I kept having to fill in a blank that asked for the name of my PCP and each time I would scrawl Paul Rubin, DC, my associate here at WholeHealth Chicago. (At least I didn’t have to struggle to remember his address and phone number.)
A couple of people noticed this and asked, “Do you, an MD, really use a chiro as your primary care doctor?”
When I heard the question, I was blissfully afloat in sea of morphine, and with breath that tasted like a hairy little rodent had crept into my mouth, slept for awhile, peed, and departed, I managed to mutter an affirmative.
Now I’m alert enough to explain.
- Chiropractors are physicians, and, with the exception of pharmacology and surgery, they receive the same training in science as medical doctors. Conventional physicians who have visited chiropractic schools readily acknowledge that they look like well-funded medical schools. Chiropractors are trained to recognize signs and symptoms of illness and can order blood tests and x rays, but if they’ve made a diagnosis or are seeing test results beyond their areas of expertise are also taught when to refer to medical doctors. Virtually all PCP chiropractors maintain a referral list of specialists who are in their patients’ insurance networks. The relationship between the PCP chiropractor and the specialist is one of mutual respect.
- Like MDs, DCs, spend a lot of time learning to perform a good physical exam, so they’re great for annual check-ups. To a regular check-up, they add very sophisticated musculoskeletal and neurological testing that I was simply never taught. A good musculoskeletal exam is more important than you might think because, as you age, the first systems in your body that start to crash are the bones, joints, tendons, ligaments, and muscles that make up your musculoskeletal system. If you’re basically healthy, odds are that your first encounter with the health care system may be for a strained back, pinched nerve, or torn ligament.
- In addition to ordering and interpreting routine blood tests, it was PCP chiropractors who introduced functional testing into health care. Those test kits from labs like Genova, MetaMetrix, and Doctor’s Data that evaluate your digestive function, measure hormones, or test for food sensitivities all got their start in US chiropractic offices.
- Because their training (and license limitations) keep chiropractors away from operating rooms and prescription pads, treatment for virtually any condition–from a bad cold to a bad back, from high cholesterol to high blood pressure, from heartburn/GERD to a bladder infection–begins with lifestyle changes and non-pharmacologic nutritional supplements. The mainstay of chiropractic medicine is prevention: high-nutrition eating, regular exercise, stress reduction, and nutritional supplements when needed.
- It’s unfortunate that when conventional physicians deal with any health issue, they skip benign interventions and reach for the prescription pad, speed-dial you a specialist, or schedule you for surgery. In a previous Health Tip, I called this rabbit-hole medicine, in which you become trapped in a system where more and more is happening to you and by the time you’re discharged, bloody but unbowed, you’re suffering a serious case of PTSD.
- So much intense medicalization of everything can be dangerous. Many MDs are too quick to offer overly aggressive treatments. You shouldn’t be shocked to learn that in the US medical errors are now the third leading cause of death and correctly taken prescription drugs are the fourth.
I’ve been working with my chiropractic associate, Paul Rubin, DC, both in a professional capacity and as my personal PCP for years. Our business partnership, creating WholeHealth Chicago, was the first in Illinois to partner an MD with a DC. Many of our patients actually use Dr Rubin as their PCP, and he regularly crosses the hallway when he needs a diagnostic second opinion.
Are there patients who should not be using a chiropractic physician for primary care? Yes, of course. If you’ve got a condition that requires intensive medical management (diabetes, heart disease, cancer, high blood pressure, asthma) with frequent adjustments to your meds, then a chiropractor as PCP is just not workable. But, thank heaven, most of us are healthy, needing only an occasional check-up, some fine tuning, and maybe an explanation for some annoying symptom.
If it’s crossed your mind to choose a chiropractic physician as your PCP, you’re not being unrealistic at all. Just be sure to ask if he or she has a medical doctor available for referral. In fact, the result will likely be health care that’s just as effective and just as thorough, but geared toward wellness rather than prescriptions, specialists, and surgery.
David Edelberg, MD