Risk Management

by Stuart Hoffman,DC, President, ChiroSecure

When thinking of how to protect yourself from a malpractice claim, what comes to mind for most chiropractors are things they can easily see. Looking at improved record keeping, taking courses to increase diagnostic skills, technique courses to increase clinical excellence, new forms and new staff are all important elements when considering risk management in today's litigious society.

I would like to discuss one of the most critical components relating to risk management today. It is so highly overlooked it has almost become a lost art in the health care industry, including our chiropractic profession. This lost art is patient service. As chiropractors, we are very fortunate to have many service-minded consultants who create tapes and write articles with the intent to refocus on the chiropractic purpose. For example, one of my mentors, Dr. Sid Williams, has taught thousands of chiropractors at his D.E. meetings about the lasting purpose; to give for the sake of giving, to love for the sake of loving and to serve for the sake of serving. These are highly substantial concepts in many areas of practice and I believe it should be a focus of your risk management performance.

We are now in an information age where people question and research everything they are told before they make decisions about their health care, unlike years ago when treatment was never questioned or challenged. People have a choice. Why do they pick you? They like you, they trust you, and you have provided your patient with sufficient education to make informed choices for themselves and their families. Consumers do not purchase from people they do not like and generally will not sue people they respect and trust. Think back and reflect. Who has not returned to your office to follow your recommendations? What transpired during those visits? Let’s look at this more closely.

The Report of Findings - The human response is to see, hear and feel. Did your patient clearly see their condition on x-ray? Did your patient hear you and agree that your assessment and recommendations made sense? Did your patient feel the urgency to correct their problem? Let's now look at the possible adverse response. Can the report of findings not also overwhelm certain patients? Are they running out the door for a second opinion? Have you reassured your patient that they are in the right place and that there is no one better in our opinion then the chiropractor to address the correction of vertebral subluxation? Where do you see possible risk factors during your report of findings?

The First Adjustment - There are two possible scenarios with a new patient - they either have or have not had previous chiropractic care. When chiropractic is a new experience, will not many, if not most new patients have a natural inclination to fear what they are about to encounter? Have you addressed these fears? Do you encourage your patients to communicate any discomfort or concern during the adjustment? Now, let’s think of those patients who have had previous chiropractic experience. Would they not tend to compare you to their best and worst experience? Many “experienced” patients may also have trepidation about the care they are about to receive. Ask yourself, is it your common practice to explain your technique and what your patient should expect to experience during this visit? How far reaching can this communication impact either a possible risk factor or the successful experience of your new patient where they are sure to return to your office?

The Follow-Up - Most patients wonder what to expect after the first adjustment. Have you explained this? There are three possible responses - they are better, worse or the same. Which category do they fit into? How would you know unless you called them to find out how they responded? This demonstrates your sincerity and concern, as well as aids in documentation and clinical assessment of your patient’s response. A painful response to a first adjustment can trigger a fear reaction where the patient will not return. This follow-up phone call is a golden opportunity to help alleviate patient concerns about the chiropractic adjustment and their condition.

Financial Consultation - Insurance reimbursement as we know is never a guarantee and the patient’s individual policy will have varying limits. Therefore, it has become a task to accurately calculate what a new patient will owe out-of-pocket, providing your office bills insurance as a service on the patient’s behalf. Whether it be cash, private insurance, workmen’s comp or auto claim, how finances are communicated makes all the difference in the world. How many times have you had a patient respond to a billing statement, indicating they cannot possibly owe what you have billed them for, and it was never indicated that they would owe such an amount? These are the patients who will potentially threaten to sue you or report you to your board, etc.

Take inventory of your patient communication. Is what you are already doing or perhaps not doing putting you at risk or limiting the growth of your practice? There is no excuse for negligence or the lack of technical excellence at the craft you perform each and every day. There is also no excuse for not treating each and every patient as if they were a member of your own family. When each patient is that special, not only will you limit your malpractice exposure but you can rest assured that you will see patient referrals experience unlimited growth.

Challenge yourself: Take an anonymous survey in your office. Ask patients how they see you as a communicator. Ask them about their experience in these four critical areas of service.

Your feedback may alarm you.

by Dr. Stuart E. Hoffman

Reprint, ICA Review