We see it often.  D.C.s who think they'll never be sued.  Or they think they'll only be sued if there's some huge mistake made.

The reality is quite different. 

Many lawsuits result from simple oversights, poor communication with the patient, or other little things that you never think twice about in daily practice.

So how do you protect yourself from a lawsuit?  NCMIC has many resources available to policyholders, including an 8-point practice saving checklist.  Here are the highlights:

1. Do you have a standard procedure for evaluating new patients?
2. Do you use written letters of notification when deciding NOT to treat a patient?
3. Do you consistently create patient records at the time of treatment?
4. Do you review patient records before treatment?
5. Do you regularly use informed consent forms?
6. Are new techniques closely monitored when implemented in your practice?
7. Does your bedside manner put patients at ease?
8. Do you have a standard procedure for billing - including standard collection letters?

Policyholders can get the complete checklist which includes the rationale for evaluating each of these areas and a section on what to do if a patient sues you. 

Click here to log in and access the checklist!

A new patient came to my office this morning. He had received sporadic chiropractic care for episodic back pain for years in another community which had been beneficial. His wife was also with him during his visit as she was considering care, but wanted to be familiar with the doctors and our procedures.

After obtaining a history which for the most part was unremarkable for a 55 year old male, a physical examination was performed. As with all new patients, we obtained his height, weight, blood pressure, pulse and temperature - these being standard screening tools in our office. Mr. Jones then underwent a routine physical examination [orthopedic and neurologic] which I would venture most chiropractors perform.

We discussed his findings, options and made recommendations for further care. During his report, he related that while very happy with the prior chiropractor and the results obtained, he felt that in comparison to our procedures, "he had been treated previously by a horse doctor."

Mr. Jones was impressed by the completeness of our evaluation noting that his prior D.C. had never taken his blood pressure or obtained vital signs. And while he was pleased with his prior chiropractic results, he had had a "different" experience in the other office.

I assured the patient that I was quite familiar with his previous chiropractor, having know him for several years and indicated that he was an excellent practitioner.

That being said, and while each circumstance and individual has different needs, patients are not only impressed by demeanor and results, but also by procedures and completeness.

Whether a new or returning patient.... periodically update your assessments as it's easy to become complacent with patients who've been seen several times over many years.

And by the way, Mr. Jones' wife did schedule a future appointment. Happy days!

OK.  I'm done beating up on social networking sites such as Facebook. 

I've blogged several times now about the risks involved and the threats to the doctor/patient relationship inherent in "friending."

I hope you've listened.

Now I want to share the up side of social networking.  This medium is really a great marketing tool for your practice!

If done correctly.

I read an article in Chiropractic Economics on how to effectively use social networking in your practice.  In a nutshell it comes down to setting up a "practice page" and using that to interact with your patients and community.

It is super easy to set up and maintain a professional page and Google really likes them when searching.  You can use the page to promote your practice, educate your patients and interact with your community.

As with any advertising, I just urge you to apply the following filters to anything you post:

• How does this reflect on me as a professional?
• How does this reflect on the chiropractic profession?
• How would my state board view the posting?

Simple as that and you are hopefully already doing that with your other marketing strategies. 

OK, so I lied.  I do have to raise a caution associated with a professional page.  If there is controversy, people can use your page to air their grievances and in extreme cases, cause a PR nightmare.  Read this blog about an unfortunate situation playing out in Suburban Des Moines.  The blog offers some good ideas about policies to prevent and manage bad situations.

So have at it!  Happy Facebooking! (Is that a word?!)

Very soon, doctors will be graduating from chiropractic colleges throughout the United States.  It is truly an exciting time in your career. But if you do not proceed with caution, it could ruin your chances for a successful start.

The contract is a legally binding contract between you and another party.  That other party may be an employer, a business partner, a practice management company or an insurance company as in the case of a PPO.  Whichever it may be, it is your responsibility to thoroughly read the contracts, ask questions and in most cases, seek guidance from family, peers and/or legal counsel.

Recently, a soon-to-be-graduate, asked me about an associate contract. The pay was not bad, but I noticed that the contract had a 50-mile non-compete clause. 

Isn't that too excessive? 

Maybe not in the tundra of Alaska, but in a metro area, it may not hold up in court.  Time to talk to an attorney.

Are you going to be an independent contractor?  You must make yourself aware of the IRS rules as an independent contractor.  Are your hours being set?   Will the other party involved schedule patients for you?  Will they collect for you?  Will they provide equipment for you?  If you answered yes to any of these questions, then you most probably will be deemed an employee and not an independent contractor.

When getting into a Preferred Provider Organization (PPO)  you must carefully read the contract.  Once you sign the contract, you are legally bound to follow all the PPO rules and regulations. 

The reimbursement rates are not the only criteria to consider.  As an example, some Blue Cross PPO plans also control what services are billable and, as in the case of physical therapy codes, who can perform the services.  One recent case with a Blue Cross Federal PPO plan stipulated that trigger point therapy had to be done by the chiropractor and could not be delegated to staff, such as a massage therapist.  Since the doctor had several massage therapists performing this service on his orders, it led to a demand of repayment by Blue Cross of several hundred thousands of dollars.

You made an informed decision when you decided to become a chiropractic physician.  Using that same investigative attitude may pay off huge in future dividends, a successful career and multitudes of patients benefiting from your care. 

A news headline caught my attention today, “Woman Wins $2.3m From Former Employer.”  The story goes on to explain that the verdict was issued by a jury for alleged sexual discrimination in the workplace.

Do you currently have your own practice or are you planning to have one in the future? 

Do you, or will you, have employees? 

If you said yes to both questions, please take a moment and read further.

If you have, or are going to have, staff employed at your practice, you may want to consider purchasing Employment Practices Liability Insurance (EPLI).  EPLI is meant to protect against claims arising out of discrimination in the workplace, wrongful termination, sexual harassment in the workplace, and other potential employment related exposures. 

Here are a few reasons why it is important to discuss EPLI with your insurance agent:

• Not covered by your other insurance policies:  Your commercial general liability, malpractice, and workers compensation insurance policies do not cover this type of claim.
• Upward trend in claims:  Claims involving employment related practices are increasing year over year – an assumption can be made that the increase is due in part to our ever increasing litigious  society coupled with poor economic conditions and higher unemployment.  I read an insurance publication that stated you are now statistically as likely (or perhaps more likely  depending on how the numbers are interpreted) to have an EPLI claim rather than a general liability claim.
• You don’t have to do anything wrong to be sued:  An employer that has excellent internal controls and written procedures/handbook in place can still be sued!  You might be surprised to know that you don’t have to do anything wrong to be on the other end of an employment practices claim.  Assuming you’ve done nothing wrong, you won’t be faced with compensatory damages, but you will incur the  cost for your defense.  Defense costs, which can be significant, will be at your expense if you do not have EPLI coverage.

I’d encourage you to discuss EPLI insurance with your insurance agent.  Several companies offer EPLI and policies may differ with respect to the exposures they protect against.  There are other factors to look for such as whether defense costs are in or outside the limit of liability, if it includes third party coverage, whether there is a deductible, and, of course, premium cost. 

(NOTE: Did you know that NCMIC Insurance Services can help you with an EPLI policy? Our experienced agents work with a variety of leading carriers to provide both business and personal insurance to D.C.s.)

I am sure that I am not the only one who has treated someone who "was unable to get the bone to move" either by themselves or with a sibling walking on their back!

It is difficult to hold back my desired initial reaction but really...what should we do about these patients? 

In my practice, I make sure I do the following:

1. Make note in the progress sheet or Initial consultation, that they are a proclaimed self adjuster.
2. If applicable, note the amount of times that they adjust their own necks in the course of a day...most can not even count the number of times they do this.
3. Explain to the patient that they are encouraged not to "crack their own necks" and possibly educate them as to the complexity of manipulative therapy so they can appreciate the treatment.

So another question is this: why do they think so little of manipulative therapy that they presume it can be done by anyone?

Maybe it is our marketing techniques, spinal screeings at the fairs and in some cases having DC's treat patients in inappropriate and unprofessional settings. My other favorite is watching DC's adjust their own necks. 

I was just at an Starting into Practice workshop and students in the lecture were adjusting their own necks!  Even if you are a proficient self adjuster, if such a term exists, please practice self control in public and call a colleague for an appointment.

So how do others treat or not treat the self adjuster?  On a malpractice basis, are their higher risks or less if documented correctly?

Gail Martin is a friend of mine and an author who wrote a comedic novel about a small-town opera guild. Up until the book, she had never been very knowledgeable about opera, and found herself having to really research the ins and outs of the business to make sure the novel's characters, places and opera jargon were accurate.

When the book was done, she decided to utilize all of her research material to do a blog. For some reason, Gail  hit a niche market that took off. Inside of no time, she had a couple hundred followers. Now its well over a thousand!

She has international opera stars calling her out of the blue to give interviews AND the Metropolitan Opera has asked her to be a reviewer for the New York opera scene! That was just over six months ago!

On the other side, I've seen where some people utilize social networking to give information on their lifestyle, their partying and their everyday activities. Do we really care that you just had a cup of coffee?

So why do I mention any of this? Two reasons, one cautionary.

1. As a Doctor, social media should be used to inform and educate patients and attract new business! It makes sense to use the tools of this generation to reach as many people as possible about the benefits of chiropractic!
2. But social media (along with cell phone records) are routinely used by investigators and attorneys to discover "lies" when evidence is needed in court trials. Everything you put out on the world wide web can be used against you in a court of law.

The world of Facebook, Twitter, Linkedin, etc., can be valuable to growing your career if utilized to its full potential. But remember, ANY information, claims that you make or titles you give yourself can also be used to discredit you should you ever be called into court.

So are you "singing" the right tune? Are you thinking about the identity you are building as you text, blog and "friend" others?  Do you have any experiences, good or bad, that might give a fellow doctor a "heads up" on an issue you've encountered?