The perception of selected chiropractors, medical doctors, health maintenance organisation representatives and chiropractic patients regarding the integration of the chiropractic profession in the Israeli health care system

Abstract

Chiropractic in Israel has become a more integrated part of many aspects of health care policies, in that it is practised in multidisciplinary medical teams, is now included in HMOs and hospitals services, and has contributed to research and military programmes. However, the chiropractic profession still has its problems. Without laws or legitimate recognition to protect chiropractors, the playing fields could never be levelled for all chiropractors in Israel. Patient use and demand for complementary and alternative practitioners, including chiropractors, is gradually increasing. However, there has been no research to investigate the perceptions of chiropractors, medical doctors and chiropractic patients (i.e. key stakeholders) regarding the integration of the chiropractic profession in the Israeli health care system. The purpose of this study was to explore and describe the perceptions of a selected group of stakeholders about the integration of the chiropractic profession in the Israeli health care system. Such an exploration might help the profession to secure its position and claim a higher status in society. This is desirable to educate the public and the authorities on the many positive advantages of chiropractic, include access to chiropractic services for people who traditionally have not been able to use these services because of economic barriers or internal government and authorities limiting laws, as well to enhance its public image such as honesty, integrity and objectivity in the health care, and to avoid any criticism of organized medicine. It therefore stands to reason that the factors that might contribute to this type of development should be considered as soon as possible in those countries where chiropractors practise. This type of investigation is important not only in the Israeli setting, but indeed in every country where the profession is aiming toward increased recognition and awareness of the contribution of chiropractic to health care. Chiropractic now has the opportunity to expand its influence and take a more active role in health care issues. Therefore, although geographically removed, South Africa stands to gain interesting and useful information from an investigation of this nature. The investigation was carried out within a post positivist approach close to that of critical realism, using an interpretive methodology. The sampling was purposive as individuals were targeted for their knowledge in three main topics, these being the scope of chiropractic practice, inter-professional relations between Doctors of Chiropractic (DCs) and Medical Doctors (MDs), and developmental issues. The participants included five chiropractors, three medical doctors and three chiropractic patients, who all resided in the metropolitan area of Tel Aviv. were presented in tabular form in order to facilitate analysis and interpretation. Although there were some discrepancies regarding the knowledge and background of the participants about the topics discussed, all the participants met the inclusion criteria. The results show that chiropractic stands at the crossroads of mainstream and alternative medicine. Therefore it is important to establish a leading statement on identity, which must be clear, concise and immediately relevant to both the public and the profession. Although inter-professional relations between MDs and DCs in Israel are improving, further research should be conducted to provide suggestions on how chiropractors can overcome barriers and improve communication with MDs and other health care professionals in the Israeli health care system. In general, the participants agreed that governmental legislation, recognition and support are important endorsements with respect to the societal relevance and development of the profession. Therefore issues such as public awareness of chiropractic education and scope of practice, research and evidence-based practice must be emphasized accordingly in order to facilitate the development of chiropractic practice in Israel.