Patients are important for chiropractors. They allow the chiropractor to keep a steady stream of new patients and inject meaning into their practice as they help relieve symptoms for individuals in their community. Of course, patients also keep the clinic running profitably and allow the clinic to expand patient services. Retaining patients is important, too, for gauging success metrics like patient satisfaction and referral sources.

Chiropractors – unlike other healthcare providers like ER physicians – have the luxury of selecting patients. This means they can usually turn down patients and refer them to other providers even without providing treatment first. Patient selection is an important part of the chiropractor’s toolkit when evaluating patients new and old. This article examines two situations when chiropractors should evaluate patient selection: referring out existing patients and the “unhappy” new patient.

Referring Existing Patients
This scenario involves the longtime patient who nearly every chiropractor has treated. This patient has sought chiropractic treatment for years and receives regular adjustments for conditions like back or neck pain, often with some temporary relief. But when does that patient transition from a solid candidate for treatment to a liability?

Once a series of treatments does not render long-term relief from symptoms, or something that is successfully managed with less frequent maintenance care, that patient should be referred to another provider.

Many malpractice cases involve patients who feel they were treated for too long with minimal to no lasting results. In nearly all of these cases, the patient realized this when they sought treatment with another provider outside the chiropractic profession who politely told them that they had been “wasting money” for years on treatment that the non-chiropractor knows nothing about. It is also common to see a claim regarding continuing to treat a patient without results go hand in hand with a claim for failure to properly diagnose a condition.

Regardless, you can avoid this scenario altogether. If you are treating a patient for a long period of time and not seeing lasting results, consider doing the following:

• Have a conversation with the patient regarding their progress. Do they feel like the treatment is providing relief? Is it worth the money they are spending?
• Ask the patient if they want a referral for a second opinion and provide them with options.
• Send the patient out for advanced imaging, if not already done recently and if appropriate. This will allow you new insight into their condition, determine whether the condition has changed or progressed, and provide you with a specialized set of eyes on the patient from a new perspective.

Document your questions and the patient’s responses in detail. Without documentation, you and the patient are relying on memories, which become unreliable as months and years pass. And documentation holds up in court much better than someone’s memory.

Handling the “Unhappy” New Patient
The second scenario involves new patients who are unhappy with a prior chiropractor’s treatment. The patient might speak negatively of the prior chiropractor and appeal to you to provide them with the correct treatment. This patient might say that your “glowing reviews” and “excellent reputation” brought them to your office, and they wish that they had seen you “in the first place” rather than going to another chiropractor. You have likely seen this type of patient in the past. Be wary of this patient.

When presented with this situation, documentation is your best friend. Ask detailed questions in your initial evaluation. For example:

• What type of treatment did you receive that you were unhappy with?
• Did you suffer from any injury?
• Did you ever discuss this with your chiropractor? What was said?

All of this information can substantially assist the other chiropractor and you if the patient turns to litigation. Be careful about saying anything negative about the other chiropractor until you have seen their records. Many years of litigation have been spent on one chiropractor speaking negatively about another – and they both end up sitting through a deposition.

Patient Selection is Important for Your Practice
These are only two considerations when evaluating your patient population. There are many other factors when determining patient selection, include patient demographics, cultural differences, insurance v. non-insurance, marketing/social media, and your skillsets. Generally, it is usually desirable to have some diversity among your patients relative to each of these considerations.

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Disclaimer: “OUM” and “OUM Chiropractor Program” do not refer to a legal entity or insurance company but to a program or symbol of a program underwritten, insured, and administered by ProAssurance Insurance Company of America. The information contained on the OUM Chiropractor Blog does not establish a standard of care, nor does it constitute legal advice. The information is for general informational purposes only. We encourage all blog visitors to consult with their personal attorneys for legal advice, as specific legal requirements may vary from state to state. Links or references to organizations, websites, or other information is for reference use only and do not constitute the rendering of legal, financial, or other professional advice or recommendations. In the event any of the information presented conflicts with the terms and conditions of any policy of insurance offered by ProAssurance Insurance Company of America, the terms and conditions of the actual policy will apply. All information contained on the blog is subject to change.