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doctor patient relationship issue

Can I be "Too Friendly" as a DC?

QUESTION: I'm a chiropractor with a friendly, easy-going nature that at times has been misconstrued by my patients as flirtatious. What are some tips that might help me avoid an allegation of a boundary violation?

ANSWER: Though your personable nature is generally a positive for your practice’s risk management, you are on the right track to keep it on a professional level. Here are some tips:

Know your patient. While many patients will appreciate your casual demeanor, others will prefer a more serious approach. This doesn’t mean you need to completely change your personality, but instead modify your approach based on what you observe in your patient’s body language. Most patients will react when their personal space is violated.

The best surprise is no surprise.Whether in examinations or treatments, always tell the patient in advance what you are going to do and why. A patient’s first visit to your office is an especially critical time for clearly and effectively communicating and establishing expectations. It is also important to explain the specific types of treatments performed. For example, explain to someone with low back pain that you are moving down the waistline of his or her pants to apply electronic stimulation therapy.

Along these same lines, explain all tests and obtain patients’ permission before performing them. This usually requires explaining the clinical necessity of examinations. A patient’s consent and permission is especially important for exams involving any private areas.

Give explicit instructions regarding any articles of clothing to be removed. Example: “Please remove your shoes, socks, pants, and shirt, but do not remove any of your undergarments. Wear the gown with the opening in the back. Be sure and close the gown using the Velcro or ties on the back.” The patient should then be instructed to slightly open the examination room door when they are finished gowning. By opening the door, the patient initiates the examination process and maintains more control.

Avoid “off-the-cuff” comments. For example, what you perceive as an innocent remark about a patient’s undergarment could be misconstrued.

Be cautious when texting, blogging and posting to social networks as comments made on social media may be more apt to be misconstrued due to their casual nature. (You must also protect patient confidentiality on social media to avoid a HIPAA violation.)

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