Almost all D.C.s will treat a patient for a sports-related injury—whether they have a “sports chiropractic” practice or not.
Posted in Clinical Risks on Monday, June 01, 2015
You might have a golfer come in with a stiff shoulder or a runner with a sprained ankle. Or, you might deal with an old football injury that is now resurfacing. Many times the patient won’t make the connection between the current pain and the earlier injury, so he or she won’t mention it during the initial history. However, by using a clinician’s keen sense of inquiry, the history can elicit valuable information from the patient.
More Knowledge Is Beneficial
Whether you specialize in treating athletes or not, your patients will benefit when you expand your knowledge of sports chiropractic.
I often hear of doctors interested in building a sports chiropractic practice who start out by going to a local gym, giving advice and providing on-the-spot chiropractic manipulations. I wonder if the doctor took a proper history. Performed an examination? Conducted any other diagnostic tests? Acted professionally? Took notes? Recorded the treatments and findings? I seriously doubt it, and if not, it opens a door for the doctor related to liability, a problem supporting an appropriate standard of care and a diminished perception of the value of the service provided.
Always schedule an appointment in the office, explaining to the patient this is where you can do your best work. It’s neither acceptable nor appropriate to do less than your best work. An important component of being successful is keeping good records. In any practice, you should record appropriate information obtained during the interview/exam.
We had one case where the orthopedic surgeon and I were examining a young lady who was a powerlifter. She had back pain and we both suspected a herniated disc. We took the history together and examined the young lady. Following the examination, we advised her she should not compete. We then recorded our findings, including our advice, that she should no longer compete.
The patient continued to lift and her condition deteriorated to the point she ultimately wound up in surgery. Later, she filed suit against our organization, but we obtained a defense verdict largely because our history, examination and records reflected our advice against her competing.
Potential Issues with Sports Physicals
While there is nothing inherently wrong with offering sports physicals, doctors who provide them need to be careful not to lower their standards simply because they expect these children to be healthy. I always advise using the same level of care and documentation with sports physicals that a doctor would use in the office.
A colleague of mine never documented sports physicals and didn’t think he needed parental consent. His philosophy was, “We live in a small community and the parents are all good friends of mine.” My response back to him was, “They’re good friends until something goes wrong with their children.” Often, there are state requirements for parental consent, so check with your state association to verify what is required.
Many doctors are floored when we tell them that their records probably will be projected onto a 10-by-10-foot screen for everyone in the courtroom to scrutinize. A lot of doctors don’t think patient records can be used in a courtroom due to their confidential nature. And, some doctors believe they’ll be able to alter records later, if necessary. However, they soon find out that records can be displayed in the courtroom, and any attempts to change the records after an allegation is made will only jeopardize the doctor’s credibility in court. As often heard: “Bad records can be somewhat defended, altered records cannot.”
When it comes to sports chiropractic, it’s important to ALWAYS take a complete history and perform a thorough examination of the patient’s complaints. Once you have completed the history and examination, you will then assign a working diagnosis to that patient’s condition. At that point, you must determine if you feel the patient in front of you would respond to the treatment you are trained in and if not, you must refer to the appropriate specialist. There are certainly times when it is appropriate to co-manage a patient’s complaints.