Kindness Can Have Unintended Consequences

How often do you have a patient ask you to examine something other than their initial presenting complaint? I would hazard to guess that maybe five times a week a patient might ask you to examine an additional complaint at their request. The dialogue probably goes something like this: "Oh your neck is bothering you too, well let me take a look."

While this type of "on-the-house" doctoring gives you a sense of pride that your patient requested your thoughts on a particular ailment, it also wastes an opportunity to document a complaint, treat it, resolve it and get compensated for your work. It's like basically doing your work for free.

Say a mechanic after running a routine maintenance on your vehicle discovers your transmission is going bad. If you asked them to replace it, would they do it for free? No, they would charge you for the labor, parts and skills necessary to do the job. In chiropractic this is no different. It is important for chiropractors to realize their time, skills and knowledge is valuable and they should be getting compensated for their work.

I would like to show you how you can still be the kind, helpful doctor your patients desire, offer them the best care possible, and best yet, decrease the amount of time, money and effort wasted in the process.

Undocumented Services Can Lead to Disaster
First I would like to challenge your clinic to discover how many "on-the-house" consultations it gives in a week. I want you to keep track of any kind of patient interaction in which you test, assess, recommend and/or treat a patient's compliant outside of their chief complaint. Included in this challenge are modifications of activities of daily living (ADL), whereby you suggest a change to their daily routine as a therapeutic response to their dysfunction. I think you will be strangely intrigued in the amount of times this type of doctoring happens in a week; it's probably far more than you would think.

Five Ways Kindness Equals Disaster:

1. You should never spend your own money on patient care
2. The best way to make money off of your practice is to be compensated for what you are already doing.
3. You're exposing yourself to the possibility that what you might think is a simple musculoskeletal problem of the knee is actually a deep venous problem that should require a medical consultation.
4. You're an expert. Don't give your patient the impression you can only provide a quick analgesic to their aches and pains.
5. Your documentation records become lacking and therefore you are placing yourself at high risk.

So Why Do Chiropractors Keep Doing "On-the-house" Diagnoses
If there are all these high risks to performing "on-the-house" diagnoses, why do health care professionals still perform them? The answer is simple; all this paper documentation takes time. And time is a precious commodity in the chiropractic world. Rather than having to spend more time running a brief, problem-focused exam, complete with differential diagnosis, it is simply faster to do a quick poke, prod and adjust on the area and move the patient into the next room.

There lies another major problem with our current documentation system. Those travel cards we use to indicate our treatment plans and record our patient's visits are too small to contain all of the necessary notes to fully document a patient's visit. If we don't feel comfortable working through a full battery of test, and don't have the prompts to do it, then it simply doesn't get done.  Your goal is to elevate your patient's perception of your knowledge through your interaction and not by performing "down and dirty" diagnoses.

Increase Profits and Increase Patient Satisfaction
However all is not lost. There are two readily available solutions to help you solve this problem.

Solution #1: You don't have to stop being a nice person in order to improve your documentation practices. When you have a patient who indicates a secondary ailment in an exam, you have the option as to whether or not it will be "on-the-house". Instead of allowing the complaint to continue on undocumented, the doctor should have assessed, diagnosed, prescribed, documented and billed the patient. There is still the option of examining a new complaint pro bono; however you should indicate this to the patient. This way you are showing them that your time is serious enough to cost money, even if that fee has been waved.

Solution #2: Transform yourself into a musculoskeletal expert. By knowing more than just one particular area of the body you can impress your patients with a large base of knowledge. This is especially powerful in today's market of health care professionals who only specialize in one area and give ad hoc exams on their way from one patient room to the next.

If you're building practice success on your status as a neuromusculoskeletal expert, it makes no sense to be treating an assessment, mobilization and adjustment of the elbow as less serious than an adjustment of the lumbar spine. Yes, the local neurology is different, and the patient should be aware of that, due to your patient education. However, the impact of elbow dysfunction may be just as detrimental as their lumbar dysfunction in terms of the quality of their daily life. And they deserve to see you take both problems seriously.

Promoting Accuracy, Decreasing Errors
By transforming your paper clinic into a digital, paperless clinic through the implementation of software, like provided by Future Health, doctors can create customizable exam workflow screens allowing their documentation to be completed in mere seconds. In the past world of paper documentation this would have been locating, creating and filing countless exam sheets. Now the digital clinic provides doctors the opportunities to accurately record their patient's new complaints, organize these complaints in a highly systematize fashion and do it all in an extremely timely manner.

With a few simple clicks of the button the software by Future Health will allow doctors to complete a region-centered ortho/neuro exam, complete with differential diagnosis in a meter of seconds to minutes. In the past these examinations would have easily taken 15 - 30 minutes to properly format a high-quality document. Now doctors can make recommendations, suggest a treatment plan, and move on, and still produce two pages of elegant reimbursable quality data. All the while, the patient file is automatically updated to contain this new complaint.

A Better Business Decision
Now you can finally be reimbursed for the time spend with the patient on secondary conditions instead of merely giving your expertise away for free. My years of experience as a chiropractic clinician tell me that most of us aren't going to make the necessary changes to achieve this without the benefits found with digital documentation. This is the quickest way to transform our diagnoses from "quick and dirty" to fully documented professional assessments of health. We can put an end to our poor documentation habits and simultaneously promote our profession. We deserve to be recognized and paid for what we are worth.