Risk Management Tips September 22, 2015

Risk Management Tip – Patient Reactions

Hi, Dr. Stu Hoffman, President of ChiroSecure and back again with another risk management tip for you.
Recently, I was speaking at the Orthospinology Conference in Atlanta on the topic of risk management. While there I had the opportunity to listen to Dr. Scott Rosa. He was speaking on a number of topics to the group but he addressed how to address patient care when the patient responds poorly to an upper cervical adjustment. With specific upper cervical adjusting he discussed never using the same vectors again. He recommended going back, reevaluate, reanalyze the patient to see what may have been missed or what was different than originally considered. To all of this, I totally agree, not only for upper cervical care but for all of the care in your office.
If a patient responds poorly, always go back and reevaluate the patient, their history, medications and any other influences including the care that you have rendered thus far. Then proceed with your care from a different perspective or even consider referring them out to another chiropractor who may specialize in a different technique that may be better suited for that patient’s health issues.
This approach is quite similar to the recommendations I offer chiropractors who share similar stories with me. Chiropractors who opt to continue down the same path by performing the same adjustment over and over and over again, even though it was poorly received the first time, find themselves forcing an issue that I have seen result in injury as well as unhappy patients.
My advice is to you to always follow these simple rules when working with patients whether they are responding well or responding poorly to your care.
1. Always keep accurate records of your initial findings, patient history, and medications they may be on as well as reevaluations you have performed.
2. Always document each visit including how the patient is responding as well as your findings on that day. Indicate how your adjustment was performed including segment, contact, line of drive, type of thrust and any other details you use for your analysis and correction. Indicate any additional specifics about the procedures your performed that day.
3. If the patient indicates that the treatment was tolerated poorly or caused any adverse reaction, make sure you document that in the notes as well as what you communicated back to the patient and what you will change going forward. This would apply to the patient reporting this while they’re still in your office or maybe the called you up, or emailed you, or even told you on the next visit.
4. Inform your staff that if the patient indicates any adverse reaction for them to immediately notify you. This should be included in the patient charts.
5. If the patient indicates there was a problem with your adjustment, this may warrant a reexamination including new imaging, if necessary, to make sure you’re treatment correlates with your original findings and diagnosis. You would then want to make any changes appropriate.
6. A patient indicating that they need a little bit more here or there after you’ve already adjusted them, that does not mean that you should continue to readjust them over and over and over again on the same visit. Follow your instincts and proper guidelines.
7. Never continue to perform the same treatment to a patient that is responding poorly.
8. If a patient responds poorly, regardless of how you have adjusted them, that is an indication that the patient may be considered for referral out for a second opinion whether to another chiropractor or to another health care professional.
I’ll see you back again soon for some more great tips from ChiroSecure. Please like us on Facebook and have a great day.