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.
Be well,
David Edelberg, MD
Hi James
Unfortunately all the training an MD gets doesn’t seem to improve health care. Chiros get a great deal of training in Functional Medicine which is really far more useful than the deluge of short-lived “facts” that medical students obsessively memorized. Read this Health Tip on the Cleveland Clinic’s experience with their own Functional Medicine Clinic and then click to the original article on JAMA Networks. Basically, you’ll see that much of an MD education is seriously misguided
https://wholehealthchicago.com/2019/11/04/the-cleveland-clinic-and-wholehealth-chicago/
Dr E
“Chiropractors are physicians, and, with the exception of pharmacology and surgery, they receive the same training in science as medical doctors….”
Seriously?.. first of all pharmacology is one of the key reasons to have a PCP. Second of all what about all of the medical specialties? Chiropractors are not specifically trained in pathology, histology, immunology, gastroenterology, genetics it goes on and on. Medical doctors undergo extensive training through residency and fellowship that Chiro’s are not required to do and require much more training to reach board certification. This is rubbish.
James
How many nerves are in the spinal column? I wonder where all those silly nerves go, and what their role is, in our bodies. Who needs a well oiled, fine tuned body, when you can go see Dr. who can prescribe some magic pills to treat the SYMPTOMS, not the cause. Not to mention all the cool side effects that come with these drugs, that are often far worse than the actual problem itself.
pk
Yes we are, actually. If you’re that concerned about our training, look up the curriculum at the chiropractic school in IL (National University). And to be clear, we actually do get a good education in pharmacology, we just do not prescribe drugs.
R
Hi Jason
Actually several health insurers, including one Chicago based HMO, are encouraging their enrollees to use chiropractors as their primary care providers. If you ever were to review the curriculum of a chiropractic college, it’s very much the same as that of a medical school, with more emphasis on diet and healthful lifestyle and less on prescription drugs and surgery. Since correctly taken prescription drugs are the third leading cause of death and it is estimated that 60-70% of elective surgery is unnecessary, chances are you’ll live a longer and healthier life with a chiro as your PCP.
If you were an M.D. as many years as I have been, you’d appreciate that being a patient in the conventional health care system, especially in the huge medical centers with lots of medical students calling the shots, can be pretty risky business
Dr E
How much have they paid you to write such misleading nonsense Dr. E? Why would you irresponsibly encourage the public to see a chiropractor, who specializes in bone alignment, for their medical care? Would you encourage people to see an OBGYN for spine alignment or even better how about a cardiologist for hip alignment! That’s how foolish your rhetoric of equating a chiropractor with a medical doctor is! Thanks for providing bogus and nonsensical information.
jason
Hi Dr. R.:
Obviously, I am very sorry about what occurred with your mother. However, in my own experience of first being a conventional internist, and later working with chiropractors on a regular basis, I have actually never heard of any reports of serious chiropractic misdiagnosis. If you were to visit a chiropractic school (as I once did), you’d think you were sitting in on med school lectures.
When you consider that correctly taken prescription drugs were reported as the fifth leading cause of death, and medical “errors” the third, we need to think about the risks patients face when they walk into the office of the family doctor.
Your mother’s chiropractor was both arrogant and ignorant, two traits of which the medical profession is not immune. I wouldn’t castigate a whole profession based on one incompetent individual
Dr E
My mom, a couple of decades ago when she was “healthy” (i.e., no previously diagnosed medical problems), used to see a chiropractor as her PCP. She would get various musculoskeletal adjustments and homeopathic remedies periodically, and things were going just fine… Then she developed new onset (unstable) angina. For the non-medical readers, angina is chest pain due to myocardial ischemia. The chest pain would come and go, she characterized it as an intense tightness associated with nausea and some difficulty breathing, generally brought on by exertion and alleviated by rest, but sometimes occurring at rest. She described her symptoms to her chiropractor and was immediately admonished: “Do you think this is related to your heart?!” “Yes, I’m worried about it,” my mom replied. “Well stop, because it’s not!” was her chiropractor’s reply. My mom was prescribed some homeopathic remedy for gastrointestinal health and sent home. Not long after that, my mother suffered a heart attack — fortunately she received treatment at a hospital with a team of medical doctors/surgeons working together, underwent urgent CABG (coronary artery bypass graft surgery) for multi-vessel coronary artery disease. After a prolonged hospital stay (that could have potentially been prevented with appropriate primary care and timely referral to a cardiologist) and extended rehab, she made a good recovery. She now sees a Family Medicine MD for primary care.
So to the author of this highly irresponsible and misleading piece: I think it is fine for someone like you, with robust medical training, to choose a chiropractor for your routine health follow-up. My personal suggestion, as a board-certified Internal Medicine physician, for the general public who may not be able personally to differentiate benign symptoms from life-threatening illness: Find a fully licensed physician (MD or DO) for your primary care needs. A chiropractor is not, as the author suggests, a medical physician — they may go by the title of doctor, but they are not licensed medical doctors. To say they are physicians is misleading. If you want to see a chiropractor in conjunction with your PCP, I think that is reasonable. A team-based approach to care can be quite helpful in reducing the burden of healthcare cost and ensuring our patients are cared for in a holistic manner. But don’t expect your chiropractor to be able to diagnose or treat any serious medical conditions you may have or develop in the future.
~ Damien Ricklis, M.D.
Damien Ricklis, M.D.
Very interesting post! I am a pediatrician and though I love chiropractors and one day hope to have a clinic like yours with integrative therapy, I do have to say that for children I do not believe chiropractors have the necessary training to be a PCP for them. I suppose if one could do a pediatric residency this may be different? But I don’t know much about that option. I suppose this is like any other specialty in medicine and not the case for an adult PCP. I also love our NNPs and PAs in our clinic but I strongly disagree with you that they should “take over” primary care. Why did I go through so much more training if I didn’t learn any more than they did? Also pertaining to preventative medicine, maybe this is new but in my medical school our preventative courses were many more hours and much more focused on than pharmacology. I still strive to speak mainly about lifestyle changes and healthy food options where pertinent. Being a pediatrician I am likely to only write a few prescriptions a day. Also maybe I’m just a young dreamer but I truly believe most physicians still want to heal people and are not in this just to make money.
Megan Galaske
Great information for anyone looking to improve their health. Great piece Dr. E. I am a chiropractor in New York in my 29th year strongly agreeing that when you apply healthy habits to people before they get sick, the need for more dangerous interventions like drugs and surgery just aren’t needed as often. I wish more people understood what chiropractic really was, and the power of diet, exercise, and high quality and highly absorbed supplements that can and will allow anyone to enjoy better health throught their life.
Henri Rosenblum DC
I am incredibly honored to be part of the health care community. I love playing the role of PCP. I enjoy referring when necessary and appropriate. I’m blessed to be a chiropractor. I identify as non-medical, not anti-medical.
Dr. Rice
I love my chiropractor. She does all of the treatments you recommend and I consider her and my pharmacist important people on my health care team. I even know my pharmacist on a first name basis. We lost that with mega drug stores.
These people also recommend less costly alternatives, will phone any prescribing MD and review all treatment plans. So I get noninvasive, more affordable options and now great suggestions on medicare options as I plan my retirement.Medical care requires a team!
Love you Dr. E.
Donna dufner
About 15 years I half-jokingly asked my chiropractor if he could be my PCP. I saw him at least monthly. I saw my PCP yearly. He thought that was a funny question, stating, “Some insurances barely consider me a doctor”. I am overjoyed to see that has changed. I will need to check my benefits, but sadly I don’t think I have that option. Hopefully, in the near future, we will see more insurances recognizing not only the benefit for the patient, but also their own savings in health costs, by permitting a chiropractor to act as PCP.
Cyndi Cunningham
Dr. Rubin is a healer in the true sense.
fmichaelsmith
Your posts are always so interesting. I will look into my options in Massachusetts. The whole idea of medicine being a big, self serving union is especially thought provoking. I remember reading in college about how male doctors regulated midwifery midwife away from women in the 1800s because of money. Women and children were hurt because of it. There needs to be a medical revolution.
Teresa