Most practice management groups and veteran practitioners will advise other DCs (especially new graduates) of the importance of calling patients at home to check on their condition and progress. This is also true in relation to their response to treatment. Not only is this good from a "practice management" perspective, it is also simply good clinical care. Naturally, the patient's response (or lack thereof) to treatment may have significant implications in terms of the recommendations for future care, even including very acute care needs.
An oft-overlooked aspect of this service is the importance of documenting the patient's response to the care provided. I will often make either written and/or dictated entries into my notes about a patient's condition and treatment, followed by two or three entries on the patient's subsequent response based on our conversations. The patients sometimes initiate these conversations.
I was recently asked to provide an "expert opinion" on a chiropractic malpractice case. The DC failed to diagnose an acute cardiogenic pain syndrome (it was also missed at the hospital emergency room). The DC gave the patient a midthoracic adjustment and then left him on a table under the care of a nonchiropractic assistant for a heat treatment. However, the DC shortly thereafter left for vacation and did not check on the patient's response to the treatment.
While I can understand that the doctor may not have sufficient ability to differentiate midthoracic pain from cardiogenic pain, had the doctor waited a few minutes more and checked the patient post-treatment, he could have easily determined that the patient had not responded to the manipulation and concluded that further investigation was needed. Had the doctor called from his car on the way to the airport or checked in some other manner, he could have made the same determination. It is not only important to follow up, but to document such an evaluation. The patient died about 12 hours after leaving the emergency room.
I would not think of this as something to be done so you "won't get sued." You still might get sued, although it may help your malpractice company and attorney in mounting a sufficient defense on your behalf. I would rather think of it as "proper patient care" that wins the admiration of your fellow DCs (and MDs and other health care providers in your community) and the affection of your patients. Should a "standard of care" question arise, you will have the documentation to show that not only did you function in a proper professional manner, but that you did so with kindness and consideration for the patient's concern about the symptoms. From my experience, the doctor who emphasizes this latter aspect of his practice is far less likely to ever get sued in the first place.
David Hepler,DC,DABCI
Lincoln, Illinois
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