November 2002

The best way to avoid malpractice lawsuits may be to drink a cup of chamomile tea and do some deep breathing exercises. At least that's what many risk management experts are saying after discovering that stressed doctors are more likely to be sued for malpractice than their calm colleagues.

"When a doctor is under a lot of stress, or burnt out, he or she is more likely to make mistakes, forget to make patient record entries, or fail to establish a good rapport with patients," states Timothy Feuling, vice president of Chiropractic Benefit Services (CBS) Malpractice Program.

It's not just chiropractors who face this problem. Medical doctors are prone to it as well.

Theodore L. Passineau, senior health care adviser for PICOM Insurance Co., which covers approximately 5,500 medical physicians in the Midwest, noted: "There's a link between stress and liability. Calmer, rested doctors are more careful, and therefore get sued less."

The situation has gotten so bad among the medical community that some professional liability insurance companies are offering stress management courses to their policy holders.

In an article for Medical Economics, Edward E. Bartlett, a risk management consultant in Rockville, MD, who conducts stress-reduction seminars for medical-malpractice carriers, stated: "Stressed-out doctors are emotionally exhausted and may just be going through the motions, not completely attuned to their patients' physical or emotional needs."

Luckily, most doctors of chiropractic don't have the same level of stress since they're not dealing with the dangers of drugs or invasive procedures that can jeopardize their patients. The fact that chiropractic has been shown to be extremely safe helps eliminate much of the stress triggered by putting a patient at risk.

"There are many other stressors in a chiropractic practice, however," Feuling explains. He notes that the challenge of attracting and educating new patients -- particularly in cities with a large number of competing chiropractic offices -- is a common cause of stress. The economic downturn has hurt as well, not only affecting doctors' own financial picture but decreasing the number of patients willing to pay for chiropractic care if they don't have sufficient insurance coverage.

"In a better economy, patients are more willing to pay out of their own pocket for chiropractic wellness care," Feuling notes. "But when things get rough, they often sacrifice that care unless they truly understand the role of chiropractic in health." Feuling adds that incorporating a good patient education program is an essential step in ensuring that patients realize the dangers of vertebral subluxation and the need to incorporate chiropractic care into their health regimen -- even it they have to pay for it themselves.

David Singer, D.C., a premier chiropractic practice consultant, once noted: "The most stressful point in almost any practice is trying to sell chiropractic care. During my early years, I'd try to convince patients they needed corrective care. But despite my heart-felt efforts, patients still wouldn't comply. This was very stressful to me. I didn't like them not getting the care they needed, and I didn't like being rejected."

Dr. Singer's solution was to increase patient education and use a "four-day report of findings technique."

Ironically, having too many patients can cause stress as well, although this is not a critical problem in many subluxation-based wellness practices. In these offices, the doctor focuses solely on the detection and correction of subluxation rather than devoting time to non-chiropractic procedures. Many doctors manage to adjust more than 100 patients in a day and maintain a happy, upbeat practice.

C.J. Mertz, D.C., founder and head coach of the Waiting List Practice, advises establishing a few carefully chosen house rules such as, "All patients must attend a course of workshops concurrent to their care." These rules help you take back control of your practice, and sets parameters for your patients. "House rules are part of every happy, successful, growing, stress-free, principled practice," Dr. Mertz says.

Here are a few other steps you can take to reduce stress, and along with it, your chances of being charged with malpractice:

*** Take a stress-management course or read a book on the topic and practice some of the proven stress-reduction techniques (deep breathing, meditation, etc.).

*** If you can't avoid the stress on certain days, use checklists and cue cards to make sure you don't miss important tasks such as updating patient notes or having new patients read and sign a "Terms of Acceptance" form.

*** Keep motivated and excited about chiropractic. Talk to other doctors who share your enthusiasm about the benefits of chiropractic subluxation correction and wellness care. Join the World Chiropractic Alliance to establish contact with other like-minded D.C.s. Attend philosophy seminars. Re-read B.J.'s books.

*** Assess your office environment. Has it gotten boring to you? Invest in new patient education posters and books, or even new furniture, to give you and your practice a "rededication" boost.

*** Get regular adjustments! Stress can cause vertebral subluxation, which causes more stress, which ... the cycle can go on and on. Don't neglect your own health while helping patients to maintain theirs.