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Letter to the editor

Editor, In Professor Murtagh's article (Aust Prescr 1994;17:33-6), he says' It is incumbent on the practitioner to provide competent care from the onset with appropriate referrals where necessary so that the patient remains in mainstream medicine and is not tempted to gravitate to alternate practitioners who may confuse management'.

May I ask two questions. Does the training of medical practitioners equip them to provide 'competent care' in this area? Why shouldn't there be interdisciplinary consultation with chiropractors to eliminate confusion of management?

In exactly 50 years I have seen cooperation between doctor and dentist change from virtually nil to full consultation and courteous referral. Surely everyone in their own field should be free to consult and cooperate with others throughout the medical world.

Gordon Hartenstein
Dental Surgeon (retired)
Beverly Hills, N.S.W.


Author's comments

Professor J.E. Murtagh, the author of the article, comments:

Although there is obviously considerable variation in standards within the medical profession, I would expect that most general practitioners are able to provide competent care in the management of back problems. The modern general practitioner is much better educated in this area and several hundred have attended courses on 'Back pain and spinal manipulation' conducted by the Royal Australian College of General Practitioners, the Australian Association of Musculoskeletal Medicine and the Australian College of Physical Medicine. Many are skilled at providing complete care for back problems including use of physical therapies such as spinal mobilisation and manipulation.
If the practitioners lack the skill of physical therapy and other areas of management, they should refer wherever appropriate. However, I am recommending that they should stay in control of management and avoid the situation where patients move completely out of medical management and drift around among alternate practitioners.

This strategy means that general practitioners may cross refer to medical specialists, physiotherapists, osteopaths or chiropractors or any practitioner known to the patient's doctor as a competent caring artisan who is prepared to 'share care'. After all, a successful cost effective outcome to the patient's problem is the primary concern of the general practitioner.

Gordon Hartenstein

Dental Surgeon (retired), Beverly Hills, N.S.W.

John E. Murtagh

Professor of General Practice, Monash University, Melbourne