Tidsskr Nor Laegeforen. 1992 Sep; 112(23): 2981-4.

[Norwegian physicians and referral to chiropractors]

Kilvaer A, Rasmussen G, Soot T, Kalvenes S.

Norsk Regnesentral, Oslo.

Two comparable surveys were carried out, one in 1979 and one in 1989, to study the practice of medical practitioners as regards referrals to chiropractors. Norway is the only country where reimbursement for chiropractic treatment from the National Health Insurance depends on referral by a medical practitioner. The survey investigated the attitude towards this system of referral, whether or not a uniform standard of practice existed in regard to musculoskeletal disorders, and what types of conditions are referred. A substantial percentage, 41.6, of the patients had not been examined by their medical doctor before the referral, and 23.9% had received their referral after the chiropractic treatment had started. A medical diagnosis was given in 84.3% of all cases, and x-ray findings were communicated to the chiropractors for 35.5% of the x-rayed patients. The surveys indicate that the present system of referrals does not function properly and may not be the best way of organizing the working relationship between medical doctors and chiropractors. The practice of referral had changed during the ten year period. In 1989, chiropractic was the first choice of treatment for patients with musculoskeletal problems more often than in 1979. Low back pain was the reason for the majority of referrals both in 1989 and in 1979. An apparent lack of standardization of diagnostic and therapeutic measures was demonstrated by comparing different regions of Norway. A marked discrepancy was found between rural and urban areas in the use of sick-leave and drug therapy.