Practice Issue: Partner with Different Philosophy

Different practice situations can place a D.C. at risk for a malpractice allegation or board action. Consider how a difference in practice philosophy created problems for these doctors.

Jared Smithly, D.C., age 33, was interested in buying a chiropractic practice from 62-year-old Donald Jakeson, D.C., who wanted to phase into retirement.

Dr. Jakeson had a sizeable and loyal patient base in large part because he and his staff had always focused on patient satisfaction. Dr. Jakeson prided himself on providing conservative chiropractic care, primarily spinal adjustments, without many additional modalities or undue diagnostic intervention.

In contrast, Dr. Smithly, while limited in experience, was trained in integrated care and a host of therapeutic modalities. He believed that early intervention and coordination with specialists was the best approach.

As Dr. Smithly began to take on more of Dr. Jakeson’s patients, the senior D.C. pared back his schedule. Some patients did not understand Dr. Smithly’s different philosophy, and they began to ask him why they needed referrals to specialists when Dr. Jakeson just “did it all.” Dr. Smithly simply avoided these questions.

Dr. Smithly eventually referred a patient with a herniated disc to Dr. Roberts, an orthopedic surgeon. Dr. Jakeson had been treating this patient with conservative care for several months before the patient saw Dr. Smithly. After examining the patient, Dr. Roberts criticized the fact that the patient had not been referred sooner. He recommended immediate spinal surgery. Though the surgery was successful, the patient ended up with chronic tingling in his hands bilaterally.

In a case like this, a patient may be likely to file a lawsuit against both D.C.s for failure to refer to a specialist sooner. How the case would resolve would depend on a number of factors, such as whether the care provided was supported by experts and whether the standard of care was breached.

What Can We Learn?

The most important thing the D.C.s should have done was to work together to provide a thoughtful approach and response before potential patient problems escalated.

The orthopedic surgeon expressly criticized the prior care, likely triggering a claim. Before that, Drs. Smithly and Jakeson should have figured out the best way to address their philosophical and patient management style differences.

Both doctors needed to provide a united front in explaining to patients that they would see differences in how each D.C. approached their care. In cases where Dr. Smithly believed the patient required an immediate referral, both D.C.s should have directly expressed to the patient their support of the decision to refer.

What’s more, Dr. Smithly should have continued to build upon and learn from Dr. Jakeson’s method to successfully retain patients. It was equally important for Dr. Jakeson to understand that, while Dr. Smithly’s methods were different than his, they were not necessarily wrong. Instead, they reflected a different practice style to which Dr. Jakeson’s patients had become accustomed.

Any change—for better or worse—is always met with resistance and opposition. These issues should have been resolved long before the discussion to enter into a combined practice.

Additionally, if Dr. Smithly would have spoken to the orthopedic surgeon before Dr. Roberts saw the patient, he could have explained the background and the nature of the referral. Dr. Roberts’ criticism may have stemmed from not knowing all of the relevant facts of the case.

A referral with an accompanying letter indicating the diagnostic impressions will go a long way with specialists. It lets them know that the referring D.C. knew what the patient was suffering from and that a failure to diagnose was not the issue.

In turn, Dr. Roberts could have easily spoken to Dr. Smithly or Dr. Jakeson before he criticized their care directly in front of the patient. Any practitioner who condemns another’s care in front of a patient is asking to be a part of the litigation process.

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