Malpractice lawsuits are frequently filed because patients don't understand what chiropractors really do.

For instance, a patient comes to your office saying she has a backache and feels tired all the time. You examine and X-ray her, take her vital signs and complete health history, ask her questions about her general health, and talk to her about other symptoms she might be displaying. Finally, you determine she has several subluxations. You start her on a regular program of adjustments and, after a few visits she's feeling better so she leaves your care.

A month later, you're notified that she's suing you. It turns out she went to her medical doctor shortly after receiving your care and discovered she is a diabetic. She and her lawyer argue that, since you were her "primary care physician" and gave her a complete examination, you should have been able to detect her diabetes. Your failure to do so was a sign of your incompetence and, thus, cause for a charge of malpractice.

This scenario is becoming quite common. Patients who do not understand about chiropractic have no way of knowing that we focus our practice on vertebral subluxations. They pass billboards touting the local "Chiropractic Medicine Clinic" and assume we are another type of medical doctor, like osteopathic physicians. Or, they read ads implying chiropractic can "cure" everything from sinus headaches to bed wetting, without even a mention of subluxations.

Also, if you project a medical image -- white lab coat, stethoscope, etc. -- you reinforce the notion that chiropractic is a medical discipline. So can your examination if it includes medical procedures (such as taking vital signs) or a discussion of symptoms that are irrelevant to a diagnosis of vertebral subluxations.

To avoid this kind of lawsuit, you must prevent the confusion that could give rise to it. You need to:

*** Provide patient education material about the vertebral subluxation, and explain the role of chiropractic in health to patients before you even begin an exam. Your patients must understand that you are not a medical physician and do not perform physical and clinical examinations or use diagnostic X-rays EXCEPT for the detection and analysis of vertebral subluxations. Do not assume your patients understand the scope of chiropractic, even if they have attended a health talk.

*** Make sure your actions are consistent with your stated purpose. If you are a subluxation-based doctor who focuses on the detection and correction of vertebral subluxations, you have no reason to perform medical tasks such as taking vital signs (which cannot possibly aid in the detection of subluxations). In addition, your office and personal attire should not include any "props" that might be confusing, such as lab coats, stethoscopes, etc.

*** Use a "Terms of Acceptance" form that spells out in plain language what you, as a chiropractor, will and will not do. If you're a subluxation-based doctor, you need to let patients know that you will be focusing on the detection, analysis and correction of vertebral subluxations and will not be looking for or diagnosing medical diseases or conditions.

Each patient should be required to read the form, and you or your C.A. should be available to explain it in more detail if necessary. He or she should then sign the form and receive a copy of it. The original should be kept with the patient's records. With this signed document in your files, you can easily show that the person was fully aware of the purpose and scope of your care and that it was unreasonable for him or her to expect a medical examination or treatment.

If you do not follow these steps, you may be suggesting that you are offering medical services to your patients and you could be held to a medical standard if you fail to do so properly. You run the risk of exposing yourself to a malpractice claim which could be successful in court. Considering the huge amounts being awarded in malpractice cases today, it's a risk you can't afford to take.