The Advocate Update Report --  August 2004
by Dr. Matthew McCoy, Chair – WCA Chiropractic Advocacy Council

Complicated Cases

For most of my clinical career I practiced in South Florida – worlds largest outdoor nursing home. I couldn’t think of a better way to gain clinical experience than dealing with the geriatric population as they generally walk in with a multitude of chronic health problems. Unfortunately the greater the number of health problems in their shopping bag equals the greater the chances that something will go wrong and you’ll get blamed for it.  

Geriatric cases are only one example of the interface with complicated cases. Disc cases are another example - if a patient has sensory and especially motor problems you want, at the very least, to report those unusual findings to the patient.  

Complicated cases are where being clear about your practice objective and having a signed Terms of Acceptance/Informed Consent is crucial. It is also where excellent clinical procedures and documentation skills become extremely important. For example, consider more frequent re-exams in a complicated case and pay more attention to unusual findings. 

Make sure there are no communication barriers between you and the patient and make sure that their spouse or significant other is involved in their care. Many emergency room visits on the night following a visit to your office are made at the insistence of a husband or wife that does not understand what you are doing and has not heard the plan of care. Do not expect the practice member to be able to explain to their partner why they are still in pain after 2 weeks of care.

Consider discussing a referral with the patient if the unusual findings are significant enough or do not show progressive improvement. Better for you to make the referral and tell the neuro what’s been going on then for the patient to end up in his office on his own telling him how you’ve been cracking his back or neck and things are getting worse. This will get written into the record and the seeds of a malpractice accusation are sown.

As always I look forward to your feedback, comments and suggestions. 

Dr. Matthew McCoy, Chair – WCA Council on Chiropractic Advocacy