”Don’t judge me, but I saw a chiropractor”, says my friend.
Last time we discussed her lower back pain, I had advised her to keep moving, avoid opioids and see her doctor for a care plan to access up to five free sessions with a physiotherapist.
“Tell me more”, I reply – if only to prove that I value friendship over judgment.
She exclaims that finally she understands what has been ailing her all this time: her spine is abnormal and her pelvis is tilted. After “drawing all these lines” on an X-ray, the chiropractor has prescribed a prolonged course of spinal adjustment followed by “maintenance” sessions. What’s more, the first treatment has made her feel better!
Doctors infamously interrupt patients after 18 seconds. I listen to her explanation for 10 times as long before my dam bursts. “I am glad you feel better, but the chiropractor’s explanation makes no sense.”
I tell her that all spines have a natural curve and most women have a pelvic tilt. Her pain was real, but the overly earnest attempt at explaining its aetiology had veered into pseudoscience.
A day’s leave and $120 out of pocket later, my friend is unimpressed. Pushing my luck, I reassure her that most lower back pain is cyclical; she will improve. The next day she is in pain again – and irate.
“The chiropractor called to check up on me – I told him that my doctor friend had issues with his explanation.”
My hand flies to my mouth.
She relates that he had then tried to walk back his opinion and imply that she had misunderstood him. But when she reminded him of all the lines he had drawn and all the time he had spent justifying the rationale for spinal adjustment, the chiropractor ventured that like her friend, he, too, was a doctor.
“It’s not the same thing!” retorted my loyal friend, familiar with the 15 years it took me to obtain just my initial specialist recognition.
Next, she receives an essay via text. The chiropractor says that after reflecting on her doctor friend’s concerns, he believes she has a “mechanical disadvantage”.
The final straw is a radiology report that contains the word “normal” three times and “unremarkable” twice. My friend cancels her remaining appointments and joins me for a long unhindered walk.
Meanwhile, caught between staying in my lane and asking questions in the public interest, I turn to a neurosurgeon, who examines more spines in a week than I will in a lifetime. For an hour, he teaches me about how surgeons assess spinal pathology and when they decide to operate. Weight loss, exercise, and physiotherapy feature prominently in his advice.
The aftermath of the event leaves me with two questions, the first of which my friend asked in a moment of exasperation.
Because lots of things alleviate pain. Massage, analgesia and heat – but also a provider who listens, empathises and bothers to examine a patient.
Then there is the placebo effect. For centuries, doctors have recognised that different interventions with unclear pathways result in clinical improvement. Among the benefits patients attributed to placebo 100 years ago: “I sleep better; my appetite is improved; my breathing is better; I can walk further without pain in my chest; my nerves are steadier.”
Nothing has changed. Pain is a universal assignment; no one has a monopoly on its relief.
The chiropractic industry owes its existence to a ghost. Its founder, David Palmer, wrote in his memoir The Chiropractor that the principles of spinal manipulation were passed on to him during a séance by a doctor who had been dead for half a century. Before this, Palmer was a “magnetic healer”.
Today, chiropractors preside over a multibillion-dollar regulated industry that draws patients for various reasons. Some can’t find or afford a doctor, feel dismissed, or worse, mistreated. Others mistrust the medical establishment and big pharma. Still others want natural healing.
But none of these reasons justifies conflating a chiropractor with a doctor. The conflation feels especially hazardous in an environment of health illiteracy, where the mere title of doctor confers upon its bearer strong legitimacy.
Chiropractors don’t have the same training as doctors. They cannot issue prescriptions or order advanced imaging. They do not undergo lifelong peer review or open themselves to monthly morbidity audits.
I know that doctors could do with a dose of humility, but I can’t find any evidence (or the need) for the assertion on one website that chiropractors are “academic overachievers”. Or the ambit claim that most health professionals have no idea how complicated the brain is, but chiropractors do.
Forget doctors, patients deserve more respect.
My friend’s back feels better for now. When it flares, I wonder if she will seek my advice – and I am prepared to hear no.
Everyone is entitled to see a chiropractor. But no patient should visit a chiropractor thinking that they are seeing a doctor.
Ranjana Srivastava is an Australian oncologist, award-winning author and Fulbright scholar. Her latest book is called A Better Death
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