A patient suffers cardiac arrest while waiting in the exam room. An elderly visitor falls in the waiting room, is complaining of leg pain and is unable to get up. A diabetic staff member passes out from hypoglycemia. These are just a few examples of unexpected medical emergencies that could happen in a medical office.

A new patient comes to you for an initial visit. You perform a chiropractic adjustment based upon the patient’s complaints and much to your surprise, the patient develops increased pain or has an adverse reaction to treatment and must be referred to another provider for further workup and treatment. While this scenario doesn’t happen often, it can and does happen. And when it does, it can lead to a lawsuit against the chiropractor.

As a practitioner, you have most likely experienced an unexpected outcome in your care and treatment of a patient. It does not mean you are a bad doctor. It happens even with the most experienced doctor, but it can be very distressing for you and your patient. How can you protect yourself from risk and maintain a healthy doctor-patient relationship in the event of an unexpected outcome?

Start at the Beginning
First, prepare your patients for the possibility of an unexpected outcome. At the beginning when you’re developing a treatment plan with your patient, discuss the risks and benefits of your plan, including the most likely complications or side effects. Include a discussion of any risk factors that the patient may have that might affect the success of your plan. With medically complex patients, discuss the treatment challenges and the fact that they may require treatment from a team of specialists/healthcare professionals.

The use of marijuana (cannabis) for medical purposes has been steadily increasing over the past few years and is becoming more widely accepted in the medical community. Polls show the public is largely accepting of marijuana use and research studies indicate that it has potential medical benefit.

Start with Informed Consent
As a practitioner, you use your knowledge, experience, and medical judgment to determine the best course of treatment for your patient. However, adult patients (and those having decision-making authority for others) have the right to choose to follow or refuse to follow your treatment plan. When a patient refuses a necessary treatment, what can practitioners do to protect themselves and their patients?

If you’re thinking about retirement, it’s prudent to start planning well in advance. If you are a solo practitioner, will you sell or wind down your practice? If you are in a group practice or employed, what are your obligations regarding providing notice of retirement? What are your state licensing board’s requirements regarding retirement? How will you retain your medical and business records? How will you notify your staff and patients of your plan to retire? What do your contracts with health insurers require when you retire from practice? Do you need to purchase professional liability insurance “tail coverage”? 

Review all contracts pertaining to your practice and consider seeking the advice of an attorney who specializes in business and/or healthcare law, your professional liability insurance carrier, your state board, and your state association for advice regarding these questions and the many other issues that arise in the retirement process. 

Here, we will discuss a few issues related to retirement from a risk management perspective.

All physicians know a medical record must be maintained on each patient. Why? Medical record documentation is required by state and federal laws. Proper documentation is important for continuity of patient care and necessary to receive reimbursement for services rendered. The patient’s medical record is a legal record of the care you provide to the patient and is a valuable tool in your defense should a medical malpractice lawsuit be brought against you.

Introduction to Integrative Medicine
Integrative medicine is an approach to wellness that is growing in popularity in the United States. It is patient-centered and combines conventional medicine and complementary medicine to treat the person as a whole. It addresses many factors, including the physical, emotional, social, spiritual, and environmental influences on a person’s health status. Integrative medicine focuses on the broader concepts of health that promote a person’s overall health and future well-being. Reviews and clinical studies have shown positive outcomes for patients and providers who participate in integrative medicine programs. 

Benefits of Integrative Medicine
Complementary therapies are not used to replace conventional treatments. They are used in conjunction with conventional medicine to enhance and complement treatment. Complementary therapies include diet therapy, herbal supplements, probiotics and vitamins, biofeedback, hypnotherapy, meditation, yoga, acupuncture, chiropractic, reflexology, and therapeutic massage. Integrative medicine practitioners include professionals of many disciplines, including medical doctors, nurse practitioners, doctors of osteopathic medicine, naturopaths, chiropractors, mental health professionals, mind-body specialists, massage therapists, and acupuncturists.
Many patients can benefit from integrative medicine, especially patients with chronic or complex medical conditions such as cancer, chronic pain, depression, diabetes, hypertension, fibromyalgia, and many other conditions. Complementary therapies may help people living with such conditions to achieve better appetite, improved cognitive functioning, pain relief, reduced anxiety, and improved sleep.

Risks and Challenges Related to Integrative Medicine
While there are many benefits to integrative medicine, there are some risks to be aware of. Integrative medicine often involves care from multiple practitioners. This may involve multiple appointments for the patient to keep. Providers may disagree on the plan of care since complementary therapies and traditional Western medicine have different philosophies. Some complementary therapies have side effects or interact negatively with conventional treatments.
As a medical provider, it’s important for you to be aware of the benefits and risks of any complementary or conventional therapies a patient is receiving. Complementary therapies should only be used if proven to be effective, safe, and appropriate for a person’s individual health status. Open communication with your patients and their providers is crucial to optimize patient outcomes and maintain a good physician-patient relationship. 

Get More Resources and Information to Stay Educated
It is critical to educate yourself on the various integrative medicine options. The National Center for Complementary and Integrative Health website has resources for healthcare providers that includes an A-Z listing of various health products and practices, including information about the safety and effectiveness of the products and practices. It also includes evidence-based resources, such as research results and clinical practice guidelines, which will help prepare you to discuss complementary health approaches with your patients. 

If you are not insured with OUM, fill out our online form to get a no-obligation quote.

“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. 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. All information contained on the blog is subject to change.

Understanding What Leads to Common Malpractice Claims
The most common allegations in chiropractic malpractice claims are related to these three things:

While most healthcare providers are compassionate and want to provide optimal care to their patients, everyone has biases and knowledge gaps that may hinder the provision of quality healthcare. These biases and knowledge gaps can lead to:

• Barriers to care
• Miscommunications
• Misdiagnosis
• Lack of trust