What are the barriers inhibiting medical referrals? unfamiliarity – if they want to have family physicians to choose to recom-mend them to their patients for care. By example, consider the barrier of a physician who hesitates to make an appropriate non-pharmaceutical refer-ral, and the consequential impact on our patients’ health, stemming from his or her lack of understanding of our profes-sion. The most current example centers around the opioid crisis. It is well un-derstood that most of our opioid over-dose victims began as medical patients receiving medically prescribed and “appropriate” prescriptions of opioids for pain relief. Many of these patients cndoctor.ca received opioids for MSK pain that was severe. That prescription choice oc-curred because those physicians in-volved were more familiar with, and more comfortable with, prescribing narcotics to their patients with lower back, shoulder, knee, or neck pain than recommending chiropractic care. Today, and every day, 11 people die in Canada from opioid toxicity. Many of the 9,000 victims, since 2016, who received those initial opioid prescrip-tions were experiencing MSK pain. As we are all aware, MSK pain and disa-bility are the number one reason people seek out chiropractic care. It is a public health issue, and yet, safe, effective chiropractic care is simply not a top of mind option for most physicians. Collaboration on patient care is of-ten lauded as a desired practice by many professions, but this is not yet a standard and cannot be until we incor-porate interprofessional education. This year at the University of Ottawa, the faculty of medicine has created electives for second, third, and fourth year medical students to observe chi-ropractors, naturopathic doctors, and physiotherapists in Ottawa. This pro-gram is being received well by students who participate and hopefully we will see it continue. Originally planned for May 2020, at the University of Ottawa, the faculty of Medicine has incorporated mandatory interprofessional education for all 160 second-year medical students to study together with students of chiropractic, naturopathic medicine, occupational and physical therapy. (This will now take place in about a year’s time due to the COVID-19 pandemic.) These stu-dents will experience a one-day sympo-sium about MSK approaches from various disciplines, including chiroprac-tic, so that they have exposure not only to various non-pharmaceutically based approaches to health care, but also to the students of those health disciplines. The success of this programs and programs like the program of chiro-practic at St. Michael’s hospital in To-ronto, led by chiropractor, Dr. Kopan-sky-Giles, are important steps to the improvements in patient care that medical students should know and understand. For any referring medical physician, this collaborative model of patient-centered care, should never be a leap of faith, but rather a reasonable decision based on knowledge and ex-perience of what other treatment part-ners can bring to the table. Knowing this, when a medical or other health care student asks you to observe your practice for a day or for a week, please go ahead and invite them. If you, or someone you know, are already in-volved in Inter-professional education, please let me know. Let’s work together to change the medical student’s com-fort zone from prescribing dangerous opioids to something safe and far more effective, like chiropractic. May 2020 Chiropractic and Naturopathic Doctor 27
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