Do you see a potential spillover effect in terms of ways that chiropractic participation in settings like the Veterans Administration and Department of Defense health systems may change the chiropractic profession?
The VA and the DOD hospitals provide training opportunities (clerkships, internships, residencies, fellowships and research opportunities) to much of the medical profession. Having chiropractors present in integrated hospitals during the formative years of a physician's education will train the next generation of medical doctors to include chiropractors in their referral algorithms [flow charts that define appropriate care]. Other collateral benefits would involve inclusion in research projects, residencies and inclusion in healthcare decision making.
Do you find that there is an internal change in chiropractors (both yourself and others), who have practiced in these integrative settings?
One key change is that we are exposed to more critical appraisal. If I go sit in the orthopedics morning report observing case presentations, the orthopedists provide a strong peer review. "Why are you doing that? What's this? What's the benefit the patient will get from this?" I like this level of intellectual analysis. I think promotes healthy discussion and reflection. It causes me to reflect on my own treatment methods.
What we've always been looking for is a level playing field. And what you're describing is a level playing field, assuming that they are only being as hard on you as they would be with their own colleagues.
I'd say that in many ways they are even harder on their own colleagues than on me . . . I had a medical student following me around this morning, and during the course of the morning it was evident that most of my patients are getting better and had positive things to say. The medical student responded to this with, "Well, I'd like to see some more clinical research." So that opened the door and I said, "I'm with you, but fair is fair, and if NSAIDs [nonsteroidal anti-inflammatory drugs] are killing as many people as AIDS each year, shouldn't we look just as critically at that treatment? And we certainly don't have enough supportive research on spinal surgery. Wouldn't you like to see more clinical research on spinal surgery?" My point is if you are going to appraise us, we would like you to have the same critical eye upon all other care that is being provided.
How did he or she respond?
He was good with that. It's an unthreatening environment here, but, of course, he was also a student under my tutelage and maybe you don't want to argue too much with the person supervising your rotation. The opportunity to learn about chiropractic is good for him, it's good for us, and he will bring up things to keep me honest.
What other kinds of outreach have you personally done? I'm assuming that in your position, you have some special opportunities to speak about chiropractic and to reach out to other professionals as well as policy makers. Aside from patient care, what else do you do as part of your work?
We have medical students rotate to our clinic, and medical residents. We have chiropractic students rotate through medical specialties. They're here for about six months. On Tuesdays and Thursdays, the days I work in the Capitol, my intern will be rotating in neurology, radiology, neurosurgery, orthopedics, an inpatient ward, general surgery, rheumatology, podiatry, and PMR. He's basically like a medical student working under a specialist's supervision. We are not seeking to make pseudo-medical doctors out of our chiropractic students, but it certainly adds a rich clinical environment. While on a medical rotation, if there's a patient who can potentially benefit from chiropractic, the chiropractic student can say, "Doc, maybe this patient should come down to see us." And the doctor would say, "Okay, what would you do for him?" And he would have to, in a clear intellectual manner, share what we have to offer. And if the specialist agrees with the student, then we'll see that patient.