Back pain; if my doctor was evidence-based, shouldn't he have sent me to a chiropractor first?

A call came on a Friday afternoon from a family member who was wanting their father to get treated asap.  Their insurance plan said they required a referral from their primary doctor.  The doctor refused to give it and wanted the patient to visit him first. For many patients, jumping through hoops to get the care they need is common.   Upon seeing his family doctor, the doctor refused to give the referral saying he doesn't believe in chiropractic care and that he should take pain medication and see a physical therapist instead while waiting for x rays of his lower back so that the doctor can get an MRI of his lower back. A week later, our office again received a call from a family member who is frustrated that the doctor refused to refer their father and that the medication and physical therapy did nothing to relieve his pain.  Finally, out of desperation the patient came in and paid out of their pocket for the visit. During the initial history and examination, the patient said he was a pastor for a local church and needed to be functional for Palm Sunday services and he couldn't stand without pain in his right leg.  He explained he visited his primary doctor refused to refer him and wanted him to go to physical therapy, take an x-ray and take medication, none of which helped him. Our evaluation showed that he had an imbalance in his feet that required foot orthotics and that his pelvis was distorted resulting in his right hip and leg pain and his inability to straighten up.   Tests for neurological pain from a disc were inconclusive. Treatment consisted of myofascial release since his legs and midsection were extremely tight, mobilization of his hips, and manipulation of his lower back.   He was given Mckenzie protocol and told to walk and follow up the following Sunday before church services. Ironically, as I was working on him his pills were falling out of his pocket. The patient had a marked improvement in his ability to walk and function with greatly reduced pain in his leg but he still rocked from side to side when he was walking. I had suggested he visit his doctor again to demand a referral and to show him how he was now able to walk with greatly reduced pain after seeing a chiropractor.

Discussion.

The Annals of Internal Medicine in 2017 made recommendations for lower back pain which said the science told us that movement, manipulation, exercises, and mobilization should be used for problems such as the ones this patient was experiencing.   Their guidelines also said to avoid drugs, tests such as MRI, and higher-level specialists as they were not supported by the latest evidence. There is growing evidence, especially with workers' compensation carriers that chiropractic care when used initially will reduce the use of low evidence and unhelpful medical tests and procedures while improving outcomes.  From the healthcare consumer's point of view, this means faster relief while avoiding harmful delays in care that can prevent chronic lower back problems years later. It has been years since I have heard anyone say they don't believe in chiropractic.   I am not sure what that means although it is a physician's responsibility as a public servant to help guide their patients to the most effective and scientifically based care.   This provider failed on all these accounts.

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Physicians are public servants. We work for you.  Like any other public servant, we should be trying our best to help you.   In the world of lower back pain, chiropractors receive praise from Consumer Reports and most importantly, other patients. It is difficult to find great people in any profession.  In the world of chiropractic medicine, a great chiropractor can be a huge asset to you and your family.  Many medical physicians have found this out for themselves after seeing a local chiropractor. For lower back pain, the evidence shows you should see a chiropractor first.   Book online here.