It was an interest in Sidney Crosby's rehabilitation that first sparked a connection between Edmonton-based neurologist Dr. Ken Makus and chiropractor Dr. William Farrell. Dr. Makus is a lifelong learner and curious clinician, always looking for options to serve his patients better. After reading of Crosby's success with functional neurology in the media, inquisitively, he reached out to see if Dr. Farrell offered those same services in Edmonton that he had read about in Crosby’s care. During their initial conversation, there was a fruitful exchange of ideas and discussion over their shared patient experiences.

Based on mutual respect for one another and their commitment to patient care, their collaborative relationship has grown over the past decade. "We are two willing people who want to help people to the best of our abilities," says Dr. Makus. "We have different strengths and skill sets, both grounded in science. At the end of the day, we take the same approach; we render a diagnosis and establish a treatment plan. We are seeing satisfied patients being helped by chiropractic care because it just works. And that is why I keep referring my patients for chiropractic care."

Dr. Farrell began to establish some referral relationships within the Edmonton medical community, contracting as part of a multidisciplinary service for Alberta Child and Family Services, helping pediatric patients with complex sensory motor development issues. Those early connections helped to open the door to relationships with pediatricians and medical doctors. Dr. Farrell estimates that ~50 percent of his practice is from medical and allied health referrals.

Dr. Makus remarks that patients can wait 12 to 18 months for an appointment to see him. He acknowledges a frustration on both his part and that of a patient when having to tell a patient that there is nothing that he feels the current medical system can do for them, or that they have been referred to the wrong person. After carefully excluding neurological pathology, Dr. Makus feels there can be benefits for such patients through the hands-on nature of chiropractic and visit structures that allow more one-on-one time with patients. When he advises, 'I have a friend who may be able to help you', it is often better received by patients in these circumstances, and a referral is made. Dr. Farrell can then reassure patients who sometimes feel as though they have not been helped that, in reality, they are being viewed by a wider spectrum of professionals with different skills who are equally interested in their problem.

Dr. Farrell will often stress to such patients that it is actually a good thing when specialists like Dr. Makus don't feel they require treatment at that level. These patient conversations instill confidence over despair, validate a patient's symptoms, provide an alternative treatment approach, and offer continued convenient monitoring, acting in concert with specialist oversight should something in their symptoms change, and further specialist review felt to be necessary. Both Dr. Makus and Dr. Farrell feel this approach has benefits for all involved. Dr. Farrell states, "I feel better taking on more complex patients, knowing a specialist has reviewed them."

One of the key elements highlighted in their collaboration is the importance of effective communication. Both practitioners emphasized the significance of transparent dialogue, whether it be through letters, texts, or direct consultations. A common language based on science has been key to breaking down silos and sharing insights. Both clinicians feel this shared language allows for the provision of more comprehensive care to their patients.

"You rarely see the other guy's wins; if the only thing physicians hear is ‘chiropractic didn't help’ from patients who didn't respond to care, we can’t blame physicians for not being more open to referring to chiropractors,” says Dr. Farrell. Rather than let patients describe their chiropractic consultations with their medical doctor, when Dr. Farrell does not have an established relationship with that physician, he ensures that he communicates directly on a patient's behalf.

Dr. Farrell highlights what chiropractors know by demonstrating a complete patient history, thorough exam and diagnostic considerations in his communications over patients who did not respond to care. He will respectfully offer clinical insight as to why their response is not as was hoped and provides recommendations for a physician's consideration. Through these communications, he can express a desire to work collaboratively to a patient's benefit and highlight the role chiropractic can play in a specific patient's care to a physician who has unlikely had the opportunity to see what chiropractors can offer various conditions. Further, as a profession, chiropractors do not do hospital residencies as physiotherapists do. Dr. Farrell feels the physician's familiarity with physiotherapy is likely why, as a profession, physiotherapists enjoy many more physician referrals.

Dr. Farrell acknowledges the common concern medical professionals have over the safety of manipulation, particularly as it relates to stroke. While there are studies that suggest this risk is minimal, Dr. Farrell works to ensure these concerns are recognized in care recommendations that are made specific to the individual patient. To do so, he includes vital stats like blood pressure, heart rate, medications, and pre-existing vascular conditions, along with postural assessment findings and neurological and orthopedic testing results."If we do a good work-up on our patients and communicate well, people will start to realize that you are reasonable with your approach and have considered these things in your treatment," says Dr. Farrell. "If you speak the same language and make an effort to communicate, I think it goes a long way with anyone in the clinical realm."

Both Farrell and Makus say their approach has, at times, been met with skepticism. When Dr. Makus writes a letter to a primary care practitioner letting him know that he has referred the patient to a chiropractic colleague, often the reaction from both patients and doctors is that ‘this is unusual’. Dr. Farrell has had patients relay their physician's view for him to 'stay in his lane' after receiving his communication.

Both doctors acknowledged existing barriers. Professional bias and barriers are noted in addition to financial constraints for patients wanting to use chiropractic services, which are not covered for patients under 65 without private insurance. Financial constraints are a genuine consideration for a medical doctor wanting a patient to have a chiropractic opinion and professional biases. The financial aspect of healthcare often presents challenges, especially for patients with limited resources. Moreover, ingrained stereotypes and historical divisions between medical disciplines can hinder effective collaboration.
Patients can wait months to see their family doctor. Dr. Farrell was pleased that publicly funded diagnostic imaging privileges were returned to the chiropractic profession and more so to learn that the Alberta Medical Association supported the Chiropractic Association of Alberta’s lobbying efforts. "It's not right to just park a patient with a musculoskeletal disease to wait for a test to occur when it doesn't have to be that way," says Dr. Farrell. "You need to investigate as you treat them in a timely manner for the best care, and it's great when both the medical and chiropractic associations can act together for the benefit of patients."

"The fact that we are working in silos is very taxing," says Dr. Makus. "Why not work together and collaborate rather than see each other as the competition? We're both curious bulldogs who really dig deeply and ask a lot of questions. We don't have all the answers, but we can have an open discussion and approach the patient's treatment in different ways. At the end of the day, patients are going to make the decision as to who they want to see." Dr. Makus and Dr. Farrell agree it's possible for patients to have the best of both worlds if professionals are willing to talk and work together.

By overcoming barriers and embracing a patient-centred approach, Drs. Farrell and Makus have demonstrated how chiropractors and physicians can work together to address complex health issues. Their partnership has not only improved patient outcomes but also fostered a culture of learning and growth within their respective fields. By sharing knowledge, conducting joint consultations and embracing interdisciplinary dialogue, they set an example for healthcare professionals seeking to enhance collaboration and improve patient care.

Biographies: 

Dr. Kenneth Makus is a neurologist and Associate Clinical Professor in the Department of Medicine in the Faculty of Medicine & Dentistry at the University of Alberta Edmonton. He is renowned for his expertise and is known to be a caring and professional doctor. He has a special interest in epilepsy, multiple sclerosis and concussions. He completed his medical education at the University of Alberta in 1994. He also consults at the "dizzy clinic," better known as the Vestibular Clinic, at the Glenrose Rehabilitation Hospital's Syncrude Center for Motion and Balance and maintains a private practice. He resides on a farm where he raises cattle and enjoys gardening with his wife.

Dr. William Farrell completed his chiropractic training at Macquarie University in Sydney, Australia, in 2008. In 2010, he completed a two-year sub-specialty neurological rehabilitation training program offered by the Carrick Institute (DACNB). Dr. Farrell is also a chiropractic orthopedic specialist, having completed the two-year International Advanced Neuromuscular Training Program (DIANM) in 2022. He gained fellowship status with the Canadian College of Chiropractic Orthopaedic Specialists, FCCOS(C) in 2023. He has a special interest in complex musculoskeletal presentations involving lower back pain, headache, vertigo, neck pain unresponsive to treatment, TMJ pain and concussion. He is an active yogi, who also loves to cook.