March 2003
Making sure patients understand you
by Timothy J. Feuling
By now, most doctors of chiropractic
realize the importance of using some type of "terms of
acceptance" form. With it, you have evidence the patient was told
that, as a chiropractor, you do not perform full-body, differential
medical diagnoses nor do you treat specific diseases or conditions. The
form explains clearly and simply that your purpose is to locate and
correct vertebral subluxations.
You present the form to the patient,
who dutifully signs it. You might think that's enough, but it isn't. If
the patient ever sues you, the plaintiff's attorney may argue in court
that the patient signed, but didn't really understand the form.
While you might roll your eyes at this
obvious ploy, it's often true. There are many reasons why the patient may
not have understood the terms of acceptance form, or other material you
provided. Some of the more common reasons are:
***
Illiteracy or low literacy. According to the most recent
National Adult Literacy Survey conducted by the U.S. Department of
Education, 22% of adult Americans are functionally illiterate (they cannot
read the front page of a newspaper).
***
Low health literacy. Often, difficulty in reading or
understanding health instructions is particularly acute. One study of
hospital patients, published in the Journal of the American Medical
Association, found that 26% could not read their appointment slips,
60% did not understand the standard consent form, 47% could not understand
written directions to take medicine on an empty stomach, and 21% could not
understand instructions written at the fourth grade reading level.
***
Hearing or vision impairment. Many people, especially
seniors, may not be able to see well enough to read the form, or hear well
enough to fully comprehend your explanations about the extent of
chiropractic. They have learned to manage sufficiently to perform their
daily routines without letting others know of their limitations, and will
sign where they are told to sign. In court, however, it can be easily
shown that they "miss a lot," and didn't really understand the
terms of acceptance.
***
Non-English speaking. In our increasingly multicultural
society, many patients are foreign-born residents with limited English
reading skills. They often don't admit their language limitations and will
sign the form without understanding it. In court, a lawyer would attempt
to paint you in a bad light asking, in front of the jury, "How is it,
doctor, that you didn't realize your patient didn't speak English?"
***
Nervousness or lack of attention. New patients, especially,
may feel stress over their visit to your office -- distracted by the new
ideas presented to them, even overwhelmed by the amount of patient
education material given to them. They may not be able to absorb the
content and importance of the terms of acceptance form.
What you can do
There are a number of steps you and
your staff can take to make sure patients understand the content of the
terms of acceptance, and cannot later say they didn't know what they were
signing or what chiropractic offered.
The primary step is to be alert to any
reason that they might not understand. Problems speaking English,
difficulty hearing or seeing, failure to read information given to them,
etc. Don't have a
C.A.
shove the form at them and tell them to "sign here." Have staff
members take the extra time to discuss the form with the patient, and go
over the information if there is any question about the patient's
comprehension.
If you have any doubts, try a technique
known as "teach back," where you ask the patient to explain the
form to you in his or her own words. You can ask, "What does that
mean to you?"
Make sure all forms are written in a
fourth to fifth grade level, using simple words and short sentences. When
using difficult or unfamiliar words (such as "subluxation"), be
sure to include a simplified explanation. A staff member can use props,
pictures or demonstrations to aid comprehension. Make it a point to
reinforce the information through repetition, often saying the same thing
in different ways.
If you have a large number of
non-English-speaking patients, try to arrange to have a bi-lingual
C.A.
work at least one day a week, and schedule as many of these patients as
possible on that day. Including this special service in advertising may
help boost your volume.
By ensuring that your patients not only
read and sign your terms of agreement form but understand it fully, you
will be helping them get the most out of chiropractic, and protecting
yourself from future litigation.
SOURCES
"Adult Literacy in
America
: A
First Look at the Findings of the National Adult Literacy Survey."
National
Center
for Education
Statistics
,
U.S.
Dept of Education, 1993.
"Inadequate functional health
literacy among patients at two public hospitals." Williams MV, et al.
Journal of the American Medical Association. 1995; 274:1677-82.
(Timothy J. Feuling is president of
Chiropractic Benefit Services (CBS) and vice president of the World
Chiropractic
Alliance
.
He assists doctors in maximizing their practices through the proper choice
of insurance and related services. Doctors may contact him with questions,
comments, and requests for insurance quotes at
2950
N. Dobson Rd. Ste. 1
,
Chandler
,
AZ
85224
,
by phone at 800-883-0412 or by e-mail: feuling@cbsmalpractice.com).
