TEACHING through REPORTING
I know that I have learned a lot about medical specialties by reading the reports that get faxed to my office after a referral. These specialists include orthopedic surgeons, pain management doctors, electrodiagnositic, orofacial pain centers, and the list goes on. Most of the relationships that I have built started with learning how a doctor operates by reading reports and actually seeing who the best-of-the-best is. Whether they realized it or not, they were TEACHING me about their specialties and their particular practice styles by sending reports. What I realized over the years was that reports are not just for documenting care, getting paid or preventing an audit. What they also do is educate doctors on each other’s practices. Chiropractic has been missing this simple fact for a long time. We make the effort to spend the time doing reports of findings with our patients and scheduling them into new patient seminars in the office, so why do we fall short communicating with the medical community?
When I speak with chiropractors that have healthy MD referral based practices, there are 2 major points that always come up in conversation. First, communicate and second, teach…All communication should take on a teaching format; you do it every day and hundreds of times per month on your patients! When you look back on your educational career, think about the good teachers and the bad teachers. How do you remember them and how does that make you feel? Who would you like to run into them at the mall? That is exactly what this consultation is about; teaching medical doctors about what chiropractic does!
In a recent survey of 1,000 orthopedic surgeons, 72.7% agreed that chiropractors promote unnecessary treatment plans! This is not the truth, but what are we “teaching” them? Just yesterday, I spoke with a group of doctors that all admitted they send out great reports on the first visit, 2/3 confessed they do not report re-examination and NONE reported that they have EVER written a release from care report to a medical doctor! Now, let’s examine the release from care documentation. The problems lie with the “perception” of prolonged care. This occurs when Ms. Smith sees her primary care doctor and discusses with him that she is under your care. The MD looks in the chart and there it is, a nice initial report with examination, diagnosis and treatment plan, including long and short term goals for the patient. Huh, nice. He is now wondering who this doctor is…Seems to be thorough…Ms. Smith leaves the MD’s office and schedules her follow up with her MD in 6 months. She comes back into the primary care office and consults with her MD. The MD is looking through her chart and there are no other notes or reports on chiropractic care and he asks her if she is still “seeing the chiropractor?” The answer is yes. What do you think the MD thinks? The first thought is, “Wow, chiropractic takes an awfully long time to fix this problem,” followed up by his thinking the initial report was garbage.
Patients come into our offices for a variety of reasons and when communicating (TEACHING) the MD what we do, we must look to defining what TYPE of care the patient is under. Why is this important? The MD will automatically assume that he/she is under corrective care! There are other types of care, such as supportive, rehabilitative, pain management, preventive care, etc. You get the point. Teaching the MD that these types of care exist, showing him/her RESEARCH that proves it works and reporting (TEACHING) that to him/her is the most significant part of this entire program.
I have patients that have injuries that I have been treating for years…My communication to the primary care doctor is, “Mr. Jones is presently under conservative pain management for the injuries sustained following a work related accident in 2001. Mr. Jones has been able to maintain his daily activities and overall has decreased his need for pain medication. I have found that though my experience with these types of injuries, intimate knowledge of the research literature and Mr. Jones’ response to chiropractic care, a frequency of 2-4 visits per month, based on his symptoms, is appropriate. I will keep you updated of any changes in this plan.”
He is not RELEASED from care; his care type just changed. This can be done for all types of care, BUT IT MUST BE COMMUNICATED SO THE MD LEARNS WHAT WE DO…”