Editor’s Note: This is the first article in a series on potential malpractice issues and how to mitigate or avoid them altogether.
Thoracic adjustments are an integral part of care, and while rib injuries are rare, they are not unheard of, particularly in patients with pre-existing conditions or comorbidities. Navigating allegations of causing a rib fracture is tricky, but being willing to communicate directly with patients, having informed consent, and thorough documentation are the foundation to doing so successfully.
In one case, a patient sought care following an auto accident, complaining of stiffness in their neck and back. During a prone adjustment, the doctor applied slightly more pressure than usual (admittedly) due to the patient’s body type.
From the chiropractor’s perspective, the adjustment appeared routine, with no immediate indication of harm. The patient didn’t express discomfort following the adjustment, and the documentation reflected nothing out of the ordinary or abnormal.
However, a few days later, the patient visited the emergency room with rib pain and shortness of breath. X-rays revealed non-displaced fractures on both sides of the rib cage. The patient alleged that the adjustment caused the injuries, although medical records suggested the fractures could have resulted from another event.
The chiropractor’s willingness to engage with the patient and address their concerns directly played a key role in resolving the claim quickly. While this instance escalated to a lawsuit, it’s worth noting that having informed consent, thorough documentation, and a clear, professional explanation of care can significantly reduce exposure and help effectively resolve such situations.
Not all patient complaints escalate into lawsuits, but they still require thoughtful handling to protect the patient relationship and your reputation. Consider another scenario: You reach out to a patient through a re-engagement campaign after they haven’t visited for six months. Out of the blue, the patient responds with a lengthy email stating they stopped coming because you injured them during their last visit.
The patient alleges that you fractured three ribs during the adjustment, causing pain and inability to work, and now they’re seeking compensation, saying your care was negligent.
In a situation like this, it’s important to address the complaint head-on rather than dismissing or avoiding it. Start by reviewing the patient’s records to re-familiarize yourself with their history and care. Was there anything abnormal or unusual noted during their last visit? Was informed consent documented?
Once you’ve reviewed their file, call the patient to address their concerns empathetically and transparently. Explain your findings and offer to review their timeline of care together. Encourage them to share any relevant medical records from providers they’ve seen since their last visit.
This collaborative approach helps demonstrate your commitment to hearing their concerns and addressing their claim while maintaining professionalism.
Empathy is key. Patients who feel heard and respected are far less likely to escalate their concerns into formal claims. Responding promptly, explaining care in accessible terms, and offering a willingness to collaborate can often transform adversarial situations into opportunities for resolution. Asking for supporting documentation, such as medical records, not only informs your response, but can also reinforce your diligence in addressing their concerns.
While no chiropractor can prevent every injury or claim, the combination of diligence, thorough documentation, and effective communication remains the most effective strategy for navigating these challenges.
