From multidisciplinary to Interdisciplinary--it's all about patient outcomes.

For a few years I, along with Dr. Kopansky-Giles, have been fulfilling my CMCC faculty role at the outpatient chiropractic clinic integrated into the Department of Family and Community Medicine, St. Michael’s Hospital (SMH). Besides caring for patients referred by SMH family physicians, HIV Positive Care Clinic, and Employee Health, we collaborate in patient education programmes with our physiotherapist colleagues, participate on hospital projects and committees, and provide in-service presentations about chiropractic and musculoskeletal (MSK) conditions. With other allied health practitioners, we conduct interprofessional teaching (captured in the terminology of interprofessional education, IPE) of family practice residents about interdisiciplinary collaborative patient-centred care (ICC), and, at the request of their SMH family practice rotation co-ordinator, of medical clerks about assessment and chiropractic management of common MSK presentations. Medical schools have committed to introduce the knowledge, skills and attitudes for ICC in the curriculum by 2009.1,2 Governments have budgeted for development and implementation of models of ICC and for corresponding research.3 International conferences and journals are dedicated to ICC and IPE. SMH has been in the forefront of “walking the talk” by facilitating related staff training and promoting the integration of IPE and ICC in departmental programmes. It may therefore appear that many knowledgeable people are convinced that IPE and ICC can really deliver the goods: better patient outcomes. Like the kid who always gets chosen last when teams are being picked in the playground, chiropractors have long contended to the uninterested snobby star players that they have a lot to contribute as a member of the health care team. It appears that the climate is changing, and we may now be valued as bona fide team members. Of course, some are slower to embrace interprofessionalism. We haven’t yet arrived at Nirvana. Last year I supervised a CMCC student investigative project on chiropractic management of patients with ankylosing spondylitis (AS). As Dr. Shaikh mentions in his excellent overview in this issue of the JCCA,4 symptoms of AS can have the patient present initially to a chiropractor, yet the strongest published evidence on chiropractic