Oh, my aching back! A chiropractic dilemma

Oh, my aching back! A chiropractic dilemma

A request for a referral to a human chiropractor to treat two patients with sore spines leaves this veterinarian with a major headache.
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Oct 25, 2016

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Lisa Goodwin had two dachys that she absolutely adored. The dogs were inseparable and shared everything from pampered lifestyles to—you guessed it—bad backs. As is the case with many dachshunds, both dogs had several bouts with intervertebral disc pain.

Fortunately, the dogs were not severely afflicted and responded well to rest and conservative treatment. Their veterinarian, Dr. Higgins, recommended prescription medication in conjunction with holistic support, weight control and limited vigorous physical exercise.

Now the dogs were getting older and their owner wanted to explore additional therapies to ease their senile arthritis and back pain. Recently Ms. Goodwin had spoken to a friend who’d had excellent results when her dogs were treated by a chiropractor.

Ms. Goodwin put a call in to Dr. Higgins and told him that she wanted to take her dogs to her friend’s chiropractor because her friend’s dog was much improved after recent visits. In order to do this, she needed a letter for the chiropractor stating that her dogs did not have any conditions that would make chiropractic manipulation contraindicated. On the surface it seemed like a simple request. In reality this created a big dilemma for Dr. Higgins.

Dr. Higgins practiced in one of the scores of states that prohibits the practice of chiropractic medicine on animals by anyone who is not a licensed veterinarian. The chiropractic doctor that Ms. Goodwin chose for her two dogs practiced just across the river in a neighboring state. In this state the practice of animal chiropractic by a licensed human chiropractor was perfectly legal. Two different states, two different veterinary practice acts and a well-intentioned client.

Dr. Higgins called Ms. Goodwin and explained that in their home state human chiropractors were not allowed to treat dogs. He suggested putting her in touch with a veterinarian trained in animal chiropractic manipulation. He referred her to the website of the American Veterinary Chiropractic Association. Unfortunately the closest member veterinarian was 50 miles away from Ms. Goodwin’s home.

Dr. Higgins was at a crossroads. As a licensed veterinarian in his state, a referral to a human chiropractor could be interpreted as a violation of state regulations. On the other hand, he had made an effort to locate a veterinary chiropractor for his client and none was available within a reasonable distance. Ms. Goodwin maintained her desire to have her dogs see a chiropractor and did not see an issue in using the services of the chiropractor in the neighboring state.

Dr. Higgins considered his patient’s needs, his client’s preference and his mandate to provide written prescriptions for drugs or referrals when requested. He provided the referral letter as required from the neighboring state chiropractor and asked Ms. Goodwin to see that he got copies of any treatments her dogs received.

Did Dr. Higgins make the right call in referring his patients to a nonveterinary professional for medical treatment, or should he have refused based on his state’s practice act mandates?

Rosenberg’s response

There is no doubt that Dr. Higgins wanted to assist his patients and satisfy his client. He certainly made an effort to direct Ms. Goodwin to a veterinary chiropractor in his home state. When all failed and faced with conflicting state mandates, he made a judgment call. I would have done the same thing. This being said, I know that just as many colleagues would agree as disagree with my decision.

Difficult decisions and conflicting regulations are part of a veterinarian’s constant challenges. If these decisions are made in a well-intentioned, ethical manner, we have done our job. An old mentor once said to me, “You are trained to think, not react—that’s why they pay us the big bucks.” I would  guess we all know which part of that statement is true

Dr. Marc Rosenberg is director of the Voorhees Veterinary Center in Voorhees, New Jersey. Although many of the scenarios in “The Dilemma” are based on real-life events, the veterinary practices, doctors and employees described are fictional.