Triaging Patients – Chiropractic…WE HAVE A PROBLEM
Published in 2017
I spend time on the phone with doctors across the country daily discussing many things including marketing concepts, imaging reviews, compliance issues and patient management. I am very familiar with the current research and coordinating of care expectations with a proper and successful interprofessional practice. There is an old saying that “No Person is an Island” and that is certainly true in the daily care of spine patients. The three items that set you up for failure in practice are, missing a contraindication to chiropractic treatment [fracture, tumor, stroke etc.], producing non-compliant notes [billing for not documented services] and failure to co-manage patient care. The first two are obviously a nail in your coffin, however although less ominous and often overlooked, number three is just as bad. I call it the “silent practice killer”.
I was on the phone the other day with a doctor who was about to examine a patient for a final Personal Injury Narrative. This patient was given a deliberate gap in care after reaching maximum improvement with chiropractic treatment. This patient was being evaluated for residual functional losses, duties under duress and loss of enjoyment of life. If those issues were persistent they would be documented and the patient would be put on a chiropractic health maintenance program causally related to their injury.
When I reviewed the patient’s MRI with the doctor, we had discussed the usual items. We talked about imaging [both plain film and advanced imaging], start date of treatment, course of care, response to care and final opinion as to the true NATURE of the injury. The patient had been treated since mid-fall of 2016 and was coming back in for re-evaluation. When I asked about the “other doctors” that the patient had seen, the doctor on the other end said “none”. This patient with multiple disc injuries, several levels of pre-existing injuries, a prior diagnosis of cervical radiculopathy and a long term non-response to care [meaning there would be the need for long term care] was only examined by the chiropractor, no one else. I use this example not to bust the chops of the doctor I was on the phone with, but to illustrate an extremely common issue with chiropractors across the United States. That is a general lack of building a “Team” to manage the patient.
In my experience, there are two reasons for this issue being as large as it is, the first is lack of clinical expertise by the treating chiropractor. They have difficulty in understanding the objectification of serious injury and how or when to refer for imaging or a medical specialist referral. The second is a lack of a network of credentialed and clinically excellent medical and imaging providers that will help the doctor of chiropractic build a solid reputation as a comprehensive clinician. That is the BAD news, the GOOD news is the MD Referral Program is designed to overcome BOTH of those obstacles easily. Remember, one of the best parts of the program is having ME, just like this doctor did that I had on the phone. The only thing I wish was that this doctor had called me in November 2016!
So why is this the “Silent Practice Killer”? It is silent because most offices do not see it coming before it’s too late. Your inability to work together with the medical and the legal communities is the backbone of short and long term referrals into your practice and is the foundation of your reputation as a clinician. The most common misconception when referring into your network of providers is that you are referring to them for TREATMENT. When you refer for an x-ray, EMG/NCV, MRI, CT or bone scan, you are the EXPERT and you are referring for a specific task to be completed, in this example it is imaging. When you are referring to a surgeon, neurologist, or pain management doctor you are NOT referring for TREATMENT, you are referring for ASSESSMENET, a second set of eyes to validate what you are doing. It is a much better situation when the doctor above sees the patient and based on residual functional losses recommend lifetime supportive care at a frequency of 2-4 times per month for the rest of the patient’s life WHEN that patient has also seen a surgeon and a pain management provider BOTH who opine that the patient has hit an endpoint in care and the residual injuries will have to be managed with medication or chiropractic. The chiropractic patient chooses CHIROPRACTIC.
When you and a team are ALL SAYING THE SAME THING, that is power and that power will grow your reputation. Don’t do it alone, if you CHOOSE to practice that way eventually medical providers and lawyers will steer patients away from you.