Complementary Medicine (CM) is a broad term used to describe a range of health care medicines, therapies and products not generally considered within the domain of conventional medicine [1]. Reports of non-evidence based CM being used in place of evidence-based treatments for patients with serious but treatable conditions continue to cause unease among Australian health authorities [1]. Other concerns about CM include their efficacy, interactions between medically prescribed treatments and financial cost to the community [1, 2].
While CM therapies such as chiropractic and osteopathy are formally recognised as allied health professions in Australia [3] their role within the healthcare system is yet to be clearly delineated. Accompanying this uncertainty are general concerns over safety [4] and education [5–7]. Specific issues such as the status of teaching programs within the Australian public university system continue to be raised despite the requirement that all osteopaths and chiropractors undertake five years of tertiary education in government accredited university programs in order to be licensed to practice.
Notwithstanding concerns about safety and quality of education, the majority of chiropractors and osteopaths appear to be acting in a responsible and reliable manner [8, 9]. According to the Australian Health Practitioner Regulation Agency (AHPRA), in the period 2014–2015 notifications for chiropractors accounted for 1.5 % of the registration base [8] and for osteopaths 0.7 % of the registration base [9].
Instances have occurred where practitioners behaved in a manner that was unacceptable and ‘out of step’ with current models of good practice. The views of a small group of chiropractors on the issue of vaccination or the use of ‘prolonged water-only fasting’ by an osteopath are examples of this [10, 11]. These examples reflect management of non-musculoskeletal conditions by chiropractors and osteopaths. It is possible that general medical practitioners’ (GPs) attitudes towards chiropractic and osteopathy differ according to whether they are managing musculoskeletal or non-musculoskeletal conditions. There is a small but emerging evidence base for the effectiveness of chiropractic and osteopathy in the management of musculoskeletal conditions like persistent lower back pain [12], although a Cochrane review in 2011 concluded that there is insufficient evidence to confirm or say whether they were more or less effective than conventional treatments [13]. Treatments for non-musculoskeletal conditions like asthma, dysmenorrhoea and infantile colic, however, have only limited or no scientific evidence to date [14, 15]. One of the issues with studies on the effectiveness of chiropractic and osteopathy is that many of them have been conducted on single treatments that fail to capture the complexity of chiropractic or osteopathic interventions [14, 15].
Despite the publicity generated by unacceptable behaviour of a few practitioners, the demand for chiropractic and osteopathic services continues to remain high [16–18] with some evidence to show that GP attitudes may have played a role in producing this outcome. Three separate studies conducted in 1997, 2000 and 2013, reported high levels of support for both chiropractic and osteopathic services from GPs in Victoria, Tasmania and rural and regional New South Wales [19–21]. A similar result was recorded in a national survey conducted in 2004. The authors of that study concluded that chiropractic was “truly complementary rather than alternative to conventional medicine and (could) be considered mainstream in Australian general practice” [2].
Reports of collaboration between chiropractors and medical practitioners have appeared in the scientific literature. In Canada and the UK, chiropractors work alongside medical practitioners in public hospitals and multi-disciplinary medical centres [22] while in Norway, high referral rates from GPs to chiropractors has been credited with improving patient outcomes and reducing costs associated with treating certain musculoskeletal conditions [23, 24].
In 2015, AHPRA reported that there were 4998 chiropractors and 2000 osteopaths registered in Australia [8, 9] and yet similar reports of collaboration between chiropractors or osteopaths and medical practitioners have not been recorded in the Australian arena. This represents a failure to translate the positive views held by GPs into clinical practice. One possible explanation for this failure may be that the views of GPs towards chiropractors and osteopaths have changed. In light of the absence of any large scale collaboration between the professions and the recent comments made by senior Australian academics doctors and scientists who labelled CM courses such as chiropractic as ‘non-science’ and ‘pseudo-science’ [25–27], it would be presumptuous to assume that the opinions expressed in 2004 were still current without producing some evidence to support such a claim. Furthermore, with an increase in public awareness about CM the views of GPs towards popular types of CM may influence the way they discuss other types of CM with their patients. This has the potential to impact the doctor-patient relationship as management strategies are becoming increasingly patient focused.
The aim of this study was to assess the current views of Australian GPs towards two types of CM: chiropractic and osteopathy. We adopted a two stage process with this manuscript reporting the results from stage one, a cross-sectional study designed to test the feasibility of a large-scale study, including the effectiveness of the recruitment strategy to achieve the required response rate and sample size and to produce an indication of the current national view. These results will be used to inform the design of stage two, a large-scale survey on the views of Australian GPs towards chiropractic and osteopathy.