Small Mistakes, Huge Disasters

"Mistakes are the portal to discovery." — James Joyce

Profound words of wisdom indeed. You will also find that learning from other people's mistakes saves a lot of time in the discov-ery process. Making mistakes is how we gain experience. Typically, the most successful people have made the most mistakes.

In today's economy you can't afford to make careless mistakes. As a doctor, mistakes can make you liable for malpractice. As an entrepreneur, mistakes make you vulnerable to decreased profits. Oftentimes, it is the mistakes you make out of complacency in poli-cies and procedures that come back to haunt you. Be painstaking in your quest to be the best and stay true to a system of professional standards.

A hammer in the hands of someone without the skills to use it properly can be a dangerous tool. Even a skilled craftsman can get hurt if they are careless in the application of their craft. It only takes a split second for things to go wrong. Just because something seems simple and easy, doesn't mean it can't be harmful. Taking routine treatment procedures for granted will make you susceptible to costly mistakes. Unattended or improp-erly used medical equipment can be dangerous. Follow the suggestions below along with the safety checklist for common equipment found in practices, and you will be on the fast track to discovery.

Powered Treatment Tables

Things can go horribly wrong when curious patients start touching the table and pushing buttons. Even worse, children might be in the room and accidents inherently happen. All you need is for a table to come crashing down on a child [as recently happened in a chiropractic practice, causing the child's death]. There are dangers of pinching fingers or even severed limbs.

Do not drop your guard for a single moment. Put the safety switch on when you are not in the room. Many doctors have tables in an upright position ready for the patients to stand on and then lower for treatment. If so, make the safety lock mechanism an absolute priority.

Stick a Post-It note or reminder somewhere in the room to always remind you to engage the safety switch. On busy office days, it can get chaotic and you might forget. Post a professionally-made sign inside each room warning patients not to touch the medical equipment. This is a great secondary back-up reminder for you, and in the event of a liability claim, you have proof that you took the time and energy to engage preventative risk procedures.

Electrical Muscle Stimulation

Check your pads on a regular basis to ensure proper contact. Do not exceed the life of the pads beyond recommended applications or you risk a painful electrical arc. EMS is most often an unattended modality and you do not want an electrical arc to occur when patients are alone and vulnerable. Don't be so gung-ho to crank up the power on the device. More is not always better. Better is better. If using EMS in conjunction with heat or ice modalities, ensure there is proper padding to prevent skin damage. Blistering or ice burns often occur when combined with electrical muscle stimulation due to the inherent superficial analgesic effects of the modal-ity. Stay with the patient for a moment before you leave the room unattended to make sure they are comfortable. This helps establish the trust relationship when the patient gets a true sense of how much you care.

In addition, document instrument settings so you are not haphazardly administering therapy, and so you have benchmarks for im-provement.

Ointments and Gels

Many people are hypersensitive or allergic to pain relieving ointments. Always ask the patient if they have allergies or sensitivities to creams, gels or ointments. Massage and man-ual therapy creams should also be evaluated for potential allergic ingredients. Read application directions carefully on any topical treatment modality. Applying pain-relief modalities in conjunction with heat or ice might be contraindicated due to increased skin sensitivity. Never assume you can apply the same therapy or treatment to each patient.

Explain to each patient what you want to apply, the reasoning behind it and what they should expect. Note resultant skin irritations and patient response to any topical application. You might find that some patients do not like to have gels or ointments applied during therapy. If so, respect their wishes.

There is a fine line between giving patients what they want and giving them what they need. This is where your expertise comes into play in balancing this variable for patients to reach their end goal.

Heat Packs and Ice

When using heat or ice, ensure there is an adequate buffer zone between skin and modality. Seems simple enough, right? Wrong. It's often the simplest of procedures that cause the biggest problems. It is very easy to get an ice or heat burn if applied improperly. Put a timer in each room as backup to assure the modality is not on for too long. Patients will often not say anything if a treatment is uncomfortable or even painful, thinking that some discomfort is normal if they want to get better. So, always ask the patient if they are uncomfortable.

When giving instructions for using heat or ice at home, walk the patient through the process step-by-step. Never presume they know how to apply ice or heat correctly. You might be held liable for what a patient does improperly at home with this simple mo-dality if you did not take the necessary time to review application procedures.

Patients often fall into the, "more is better" category in regards to heat and ice. How many times have you heard patients ask what they should use first, heat or ice? It's never a bad time to review the 72-hour rule of ice and heat application.

[pb]Rehab Exercise: They Will Do It Wrong

Rule number one in corrective exercise: Patients will do an exercise incorrectly. They will sacrifice quality of movement for quan-tity every time. People who are in pain or recovering from pain have poor motor control and dysfunctional movement patterns. Their nervous system is unable to coordinate movement patterns correctly due to underlying compensation mechanisms. In-office rehabilita-tion exercises must be monitored at all times.

Patients must "own" the movements and exercises before progressing. Simply going through the motions is not an option. When giving your patients home exercises, use the show, teach and do system. Even if you are giving them a handout with pictures and instructions of simple movements, you must always assume they will do it wrong.

The show, teach and do system is as follows: show them the exercise you want them to do by demonstrating it yourself; teach the cueing of movements and actions; and then have them do the exercise in front of you. Only then are they cleared to do the exercise unsupervised.

Does this seem like overkill? Maybe, but I can tell you patients love it when you do this system because it shows them how much you really care. Plus, from a rehabilitation standpoint, any exercise done incorrectly will set a patient up for re-injury.

Policy Procedures

You must have a system in place for office procedures and policies that are customer-service focused. The biggest mistake I see in practice is the complacency of mastering customer service procedures centered on adding value and appreciation.

People don't care how much you know until they know how much you care. This is the golden rule of success in life. Remember what you are there to do: help people! You just happen to use the tool of chiropractic to do it. Here is a list of what I like to call "The Favorite Eight" – eight people-centered actions and procedures that are musts in practice:

1. Call all new patients personally after their first session, and call all existing patients whenever they have a change in their symptoms or exacerbations. Patients love this and are usually dumbstruck that a doctor actually took the time to call!
2. Send a handwritten thank-you note to new patients welcoming them to the office. No e-mails!
3. Send a handwritten thank-you note and a phone call to all patients who refer. Everyone wants to be valued and appreci-ated. Referrals are the lifeblood of a professional service business.
4. Take time to learn about each patient's life and loved ones. Write down important facts in their chart and talk to them about things outside of the office. They are more than just a patient.
5. Address concerns, conflicts or complaints immediately yourself. Do not delegate this to a staff member. The number-one factor that invites a malpractice suit is a feeling of dissatisfaction with regards to service or financial complaints.
6. Have a written policy procedure that you give to each new patient so they understand the process. There should be no sur-prises. Show them each step of the way a detailed road map for getting them to their final destination of feeling better.
7. Use their names often and greet them with positive energy from the first moment they walk in your door. You only have one chance to make a good first impression. Your front-desk staff must be top caliber. Hire for personality first! Personality wins every time. You can teach technical job responsibilities; you can't teach a vibrant personality.
8. Don't be afraid to adapt your program to the individual. There should be no cookie-cutter care program in your office. You are not treating pain. You are treating a person. There are many factors that cause pain and they are not all the same. Listen to what your patients are telling you and adapt your program to their circumstances.

Communication

Reality is all perception. What does that mean? Simply stated, we see the world not as it is, but as we are! We often make the mistake of thinking that everyone knows what we know. In the world of health care this is often called, "The Curse of Knowledge." When we know something, it becomes hard for us to imagine not knowing it. As a result, we become lousy communicators. Our knowledge and experience can render us unable to fathom how little other people know. We are in our own domain of expertise.

Here's the great dichotomy of the Curse of Knowledge: The better we get in our field of expertise, the more unnatural it becomes for us to communicate those ideas clearly. That's why knowledge is a curse. You just need to devote a little time to applying the basic principles of communication so your patients and staff truly understand what you mean. What's the easiest way to ensure someone un-derstood you? That's easy, just ask! When communicating with patients and staff, take time to ensure everyone is on the same page. Use stories and analogies to help communicate complex or detailed topics.

Human imperfection ensures that none of us will ever be free from error. If you do make a mistake, a patient will tend to value your rela-tionship more when you admit error. One of the best things to do with patients if you make a mistake is openly say: "I'm really sorry. I goofed there." Patients are far more forgiving than you can imagine. They not only forgive mistakes if we are open and genuinely apologetic about them; but the admission also helps to humanize the doctor/patient relationship. Always be diligent and work hard to minimize mis-takes. No one is going to be (or should they be) accepting of incompetence!