I have been conducting CCE lectures for the last 8 years all over the country. One of the aspects that I think has been lost in our profession over the last 20 years is the sense of community. This meaning, we are all Chiropractors with one goal, treating patients to the best of our clinical ability. I always have three goals when I speak to doctors in our profession. My goals are; increase the credibility of our profession by serving our patients with the utmost concern, decrease the liability in OUR offices, and to increase our revenue to provide for our families.
Over the last 20 years of active practice I have seen a lot of scary case scenarios regarding signs, symptoms, and patient presentations in my office. These presentations scream, “this patient is going through an event”, or “this patient does not need chiropractic care, they need emergency care.” It is our job and our insight to know these symptoms, and emergency signs to veer the patient to the proper clinical setting and/or diagnostic imaging ASAP. I am in the clinical trenches like all of you. I have been lecturing over the last 7 years for CCE in Florida and all over the country on risk management, medical errors, medical necessity, and record keeping/documentation. I have been hired to review chiropractors files that have been sued for the inability or failure to navigate the above scenarios.
I have approximately 250 hours of case review under my belt dealing with malpractice claims. The attorney attached to the case ALWAYS asks me one simple question, “Did the Chiropractor deviate from the standard of care with this patient?” It is apparent by the time this attorney firm asks me the above question, another D.C. for the other side has already answered, “YES!”. This is sometimes a hard question to answer. We are aware that there is no cookbook answer for every case scenario. We must consider patient’s age, medical history, past traumas, occupational physical repetitive stress, past imaging, past types of treatments (results), and patient’s current/past signs, symptoms, and presentation.
Physicians can and should utilize their clinical judgement based upon these unique factors for each individual patient’s scenario. Now MY investigation of the patient’s file begins. The only aspect of this investigation that benefits you, YOUR practice, and OUR profession is that I get to see all doctor’s files, SOAP notes, ER notes, imaging studies, doctor’s deposition transcripts, what type of presentation the patient was experiencing and the DC’s mindset before moving forward in the patient’s care. Remember the definition of Deadman notes? These are SOAP notes that if the treating Physician dropped dead, any similarly trained doctor should understand the thought process of the doctor writing the notes. Remember, our patient exam consists of three components; patient history, time, and decision making.
I have noticed patterns in over 90% of the claims I review. The top two reasons for malpractice claims against Chiropractors are 1.) The lack of initial imaging (X-rays) with the possible recommendation of advanced imaging (MRI). Then, 2.) the lack of second opinion referrals (MD, DO, and/or surgeon) based upon those imaging findings with the correlation of symptoms. These deficits should be avoided and the doctor should be thinking ahead by at least 2-6 weeks in regards to possible advanced imaging, possible second opinion orthopedic evaluations, and possible second opinion surgical consults. These “possible” recommendations are based upon the lack of clinical results, lack of decrease in the intensity, duration or frequency of the patient’s initial symptoms.
Now is the time for the Chiropractic Profession to increase our credibility, serve our patients, and be an active member in our communities. We can do that by supporting each other’s mission by respecting each other, communicating with each other, and, above all, competently treating our patients.
Dr. Todd Cielo
Graduated Life College 1998
Active Practice Tampa, Florida Todd@cielochiropractic.com