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
Five Ways Kindness Equals Disaster:
So Why Do Chiropractors Keep Doing "On-the-house" Diagnoses
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
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
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