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How Should I Handle Incidental Findings?

QUESTION: I noticed an unusual growth on my patient's arm the other day as I was providing an adjustment. Should I have advised her about the potential health issue and referred her to another healthcare provider?

ANSWER: Yes. Although you may see patients specifically for chiropractic care, you have initiated a doctor/patient relationship with them. As such, you have a duty to promote their health and welfare.

Therefore, if you encounter a situation that you reasonably believe may adversely affect a patient’s health, you should advise the patient and document the records accordingly. This includes conditions that may not require immediate attention, but could worsen over time and result in adverse patient outcomes.

Additionally, it is advisable to:

  • Conduct a full physical during the first visit, which includes the patient’s chief complaint, past clinical history and any incidental findings.
  • Inquire whether the patient is seeing other healthcare providers—including dermatologists and dentists—while taking the initial case history or during the physical examination.
  • Obtain the patient’s consent to communicate with these other providers, giving your ability to communicate with them about potential issues.
  • Document the fact that the patient is presenting only for a specific treatment or service and, therefore, a complete exam may not be performed on subsequent visits.
  • Refer the patient as needed and document whether the patient complied. If you have reason to believe the patient is not being forthcoming, contact the referral doctor, documenting the conversation in the patient’s healthcare record.
  • Discuss during the informed consent process (and include language in the informed consent form) that treatment is limited to relief of the specific condition and a referral may be needed for additional treatment or evaluation.

As a Doctor of Chiropractic, you have a unique opportunity to observe your patients closely over time. Therefore, if you note anything unusual at any point during the treatment process, you owe it to your patients to address the issue and/or refer them accordingly.

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