Doctors of Chiropractic know that before performing an adjustment on a patient, they must take a history, elicit subjective complaints, perform an exam, render findings, perhaps take X-rays, obtain informed consent, develop a treatment plan and record all pertinent information in the form of SOAP notes. Most D.C.s would never do a “quick adjustment” on someone who walks into their office who they have never examined or treated before.
Posted in Clinical Risks on Monday, March 06, 2017
Yet, time and again, D.C.s do not hesitate to do a “quick adjustment" on a friend or relative without following the protocol they would if that person were a new patient. Many do not realize this is probably not a good idea, even though they have the best of intentions.
Once a D.C. provides treatment, such as performing an adjustment, a doctor/patient relationship is created. This means that if the friend or relative who was adjusted believes that the D.C. has caused an injury, there is a legal basis for a medical malpractice lawsuit. And yes, friends and relatives have been known to sue one another.
Unsolvable Problems in the Event of a Suit
When a D.C. does a “quick adjustment” outside the office, there is no paper or electronic record of the treatment, and the D.C. has not followed preadjustment protocol. In such a case, a lawsuit is nearly impossible to successfully defend. The plaintiff’s attorney will easily establish that the standard of care was breached because:
- A complete history was not taken. One of the problems with treating friends or relatives is that they may not want to reveal private clinical information they would share with a doctor with whom they do not have a personal relationship.
- A complete chiropractic exam was not performed. The environment or social setting is generally not conducive to what D.C.s can do in their office.
- A formal, definitive diagnosis was not rendered, which, in any event, is not recorded.
- Informed consent was not obtained. When adjusting a friend or relative, it is very unlikely the D.C. will discuss risks or potential adverse outcomes.
- A treatment plan was not determined. The “quick adjustment” is invariably a one-time thing, with no thought given to follow-up.
- There are no SOAP notes. Without charting, a D.C. could very well have examined the patient, asked about his or her history, and discussed risks. However, without a contemporaneously made record, there is no proof of anything—and make no mistake, people remember things differently.
Avoiding a Suit or Being Able to Defend It
A D.C. should never initiate treatment by offering a “quick adjustment” to friends or family members who complain of pain. If they ask for an adjustment, and the D.C. has never examined or treated them before, they should be considered like a new patient and the same protocol should be followed.
Taking a history, performing an exam, rendering a diagnosis, obtaining informed consent and developing a treatment plan significantly lessens the chance of injury and a potential lawsuit. And, by recording all that has been done, the D.C. is able to show that he or she met the preadjustment standard of care. Knowing that the D.C. has acted professionally, potential plaintiffs are less likely to file suit. Moreover, an injury alleged to have been caused by a “quick adjustment” for which there is no chart creates a field day for a plaintiff’s attorney.
It is normal for a D.C. to want to help friends and family by providing free and convenient treatment. But, for everyone’s sake, the D.C. should tell them to come to his or her office, where he or she will adjust them free of charge, and if further treatment is warranted, begin to bill the health insurance carrier, if there is one. Seeing a friend or family member in the office also allows for the use of other modalities not otherwise available.
A Final Note on Adjusting Colleagues
While D.C.s commonly adjust colleagues at conventions and conferences without following a preadjustment protocol, they should do some things before adjusting. While it is implausible to create a chart for each colleague the D.C. adjusts and it can reasonably be assumed that the colleague is aware of the risks of treatment, the treating D.C. should at least ask about medical history, do whatever testing is possible in that environment and discuss the likely diagnosis. A D.C. must be mindful, however, that a “quick adjustment” to an anonymous convention-goer can set the stage for a malpractice lawsuit.
Most importantly, a D.C. should never adjust an attendee who is not a chiropractor (e.g., a vendor or a doctor’s family member). The reason for this is that non-D.C.s don’t understand the conditions and risks as a D.C. would and any resulting injury would likely be viewed with a more critical eye.