Far too often, we read or hear about inappropriate sexual activity and encounters between a doctor and patient. We've all read and heard the horror stories in which a psychiatrist has over stepped boundaries or a dentist has taken advantage of an individual while that person was sedated. While it has happened in all types of practices, chiropractors are particularly exposed as our care is "hands on."

While being a member of my state licensing board, I unfortunately saw too many cases in which allegations were made against a chiropractor - some with merit and others without. Regardless, in each case, despair occurred.

The physician/patient relationship is founded on trust and confidence and rules and regulations are generally promulgated to prevent a physician from taking advantage of that trust.

Florida rules regarding sexual misconduct (which mimic many other jurisdictions) include "Any direct or indirect physical contact by any persons or between persons which is intended or which is likely to cause  either person stimulation of a sexual nature" would be a violation. Additionally, a doctor is precluded from having a relationship with a patient for a period of one year following the last treatment encounter with that individual.

I've heard doctors say and testify that a relationship was innocent and consensual. But whatever the case, it is inappropriate and may put your license in jeopardy.

Just a few suggestions - as in all relationships, choose your words and actions carefully and always advise a patient of what you are going to do and why, prior to examination and treatment.

Happy days!  

Nothing gets your name around more than participating in (notice I did not say joining) a civic group and becoming active. 

Hospital groups are particularly good groups to participate in because they provide an introduction for you in an arena where you are not seeking or soliciting patients but rather are delivering and participating in service to others. 

Many will recognize your service and word will soon get around town that you are a willing participant in the community.  There are simply a thousand ways to give back a little to your community from groups that want to preserve historic sites to civic groups and little league sports. 

Giving back is just something you do because it is the right thing to do. Funny how things just seem to come back tenfold.

In the last 12 years that I have been involved with Medicare, I have always said that nothing ever stays the same in Medicare. I believe that every doctor and appropriate staff should attend at least one Medicare class per year. 2012 is no exception!

In addition to the ABN form changes that went into effect on January 1, 2012, here are just a few more changes on the way.

Each year, a physician can decide to change their status with Medicare. Usually the period of open enrollment is from November 15 until December 31. In the 2011-2012 status alteration period, CMS has extended the period until February 14, 2012.

CMS wants to better allow physicians to manage the uncertainty of threatened Medicare fee reductions. The current Medicare Fee Schedule is only until March 1, 2012. Congress will decide if they will institute the proposed fee reduction for 2012.

If you have not already enrolled in PECOS, this would be a great time. The Physician  Enrollment Chain of Ownership System (PECOS) is an online service for enrollment changes in the Medicare system. The 855i form is for the individual, the 855B is for a corporation and the 855R is to reassign benefits.

Eventually everyone will have to be on PECOS.

Now is the time to make a decision about those old balances you have been ignoring in the hopes that they would "go away."  It's time to clean them up and make stronger policies to avoid it happening again.

Medicare deductibles - The first of the year means every Medicare eligible patient must start paying their deductible again.  Don't forget to remind the patient that you accept credit cards!  Statistics show that seniors manage their expenses by charging to one credit card and paying one monthly bill.

Clear out accounts that are more than 90 days past due.  Address the outstanding balance with the patient in writing and also advise that they can use their credit card.  Attach a credit card approval sheet so they can either mail a check or the info on their credit card to process.

If you decide to write off an account, you should also notify the patient in writing of your action.

Review current insurance coverage.  The first of the year brings changes in coverage, new options for higher deductibles or change of carriers for many people.  Be sure the front desk person asks for a card and re-verifies every patient's coverage.

If you have not done a year-end aging of your accounts receivable, do it now!  It is impossible to see and decide on a plan of action without hard data. 

Do it now!

A number of years ago Psychology Today ran an article about a man who committed three hours a day for 10 years to complaining.  Each day he would call, write or talk to someone about what he thought was "wrong" with the world. 

Rather than changing anything, the only result was that it made the man incrediably miserable. 

Complaining is a habit that is highly contagious, especially when people work together in an office.  When you are surrounded by complainers it's easy to become one yourself!

Here are four types of complainers:

1. The Whiner.  This person wakes up negative.  Morning is a time to "rise and whine."  The whiner's favorite phrase is "it's not fair!"  He/she feels that everyone else gets the breaks in life.
2. The Martyr.  This person's favorite phrase is "no one appreciates me."  The martyr is a pro at hosting pity parties.  When they are under pressure or don't feel well, they let EVERYONE know it.
3. The Cynic.  Sarcasm is his/her most common form of communicating.  "Nothing will ever change, so what's the use of making the effort."  They seldom make a difference and often pretend they are somehow morally or intellectually superior to everyone else.
4. The Perfectionist.  This person is hard to please. Nothing is ever good enough. Their favorite phrase is usually "is that the best you can do?"

If you or your staff go home from the office totally exhausted every day, it may be because you have spent more time complaining than using your energy in a productive way.  It's time to make changes in a positive direction...for yourself, your family, your office and your profession. 

Start TODAY!

Not long ago I watched a movie starring Channing Tatum as Tyler, a roughneck with soul, and Jenna Dewan, as Nora,  an aspiring ballerina from a wealthy family. They both learn lessons about dancing and life in this teen drama. One of the biggest lessons they learned was that you've got to shed old habits (and maybe even old friends) to succeed.

You can't be afraid to ask for help and can't be discouraged if someone tells you "NO." 

In other words, you've got to "step up" to the challenges facing you right now as you get ready or have just opened your practice!  

When Mike, Dan, Anna and I conduct Starting into Practice and Risk Management programs at the colleges, we are all delighted when we meet the students who "step up" to ask questions. It's amazing how that works.

In fact, I'm just back from a college program. In the classes I teach I often ask the students, "Where do you plan on practicing?" A young woman in the back of the class answered, "I'm planning on going to Orlando. Do you know any doctors there that might be willing to tell me what it's like to practice there?"

It took me by surprise, as most students (and unfortunately I mean "most") don't think they need anyone's help. I told her, "Yes. See me after class." We had a nice conversation and I was able to refer her to a very reputable D.C. in Orlando who I know will be delighted to answer her questions.

That's what good doctors do.

So before you strike out on your own, or maybe even after, and you find yourself wondering "Where do I turn next?" try sending your questions to "Ask the Expert" or ask one of us, or your favorite professor, or a successful business person to help you with advice, give you encouragement or suggest a referral.

You may walk away with just what you needed!

You can't do it alone so it's time for you to "Step Up" and ask for a little help!

Can you share with us anyone who made a difference in your school life or your business success when you "stepped up" to ask for help?

As we start up the practice, our main focus is largely on the big things that have to happen.  Getting the build-out done, paying your loans, building your practice, managing your overhead, managing and trainging your staff, etc.  

It is very easy to let a lot of little things pass you by.  I have found that over the years, what has really helped my office, and made my life a lot more enjoyable, is to focus on the little things.  

For example, a friend of mine works for a chiropractor near where we live.  It is a small office in a small town, and it is just the two of them in the office.  She recently had a major surgery to correct a problem she let go for a few years.  The recovery is slow and she can't be in the office for a while.  

I gave her a call about a week after the surgery to see how she was doing.  Man, she was irate!  The doc she works fo, hadn't called, texted, emailed, facebooked, or anything to see how she was!  The lack of contact truly upset my friend and significantly altered her view of her boss.  

A simple phone call would have prevented serious damage to their working relationship.  Five minutes.  A little thing.

Patients will bring in food, or a letter, or some other gesture to show their appreciation for you.  What will you do in return?  What ways are you showing your appreciation for them?  

When a business contact sends you a referral, what is your process to show appreciation?  Is there a process? 

These little things add up to have a dramatic effect on the overall opinion people will have of you.  Here are some suggestions on things to consider.

• Never underestimate the power of flowers or a plant.  When someone has a family member pass, a surgical procedure, an end to a relationship, and so on; a small investment will not only bring a smile to their face but will pay back tenfold in the future.  
• Handwritten thank you notes are also quite effective, and simply cost a stamp!  These can go to your staff, your banker, your accountant, someone who grabbed your lunch, clients that helped you out, and so on.

Yes, the big things are important, but don't forget the little things!  Not only will they help your business grow, they will also help you fall to sleep with a smile on your face.

Whether you are a new graduate or an experienced practitioner, think about this question.

If a loved one called you from across the country to seek a referral for a neurosurgeon what would you do? 

Even if you did not personally know a neurosurgeon you could safely rely on certain criteria. 

Look up their CV, find out the medical school they graduated from, see which accredited hospitals they are affiliated with and chances are you would have a good idea based on credentials that this individual would be a rather safe referral. 

What about referral to a chiropractic colleague?  How do you go about making that referral with any degree of confidence? 

This is not an indictment of all the D.C.s but rather of our lack of “third party credentialing” to provide at least a sense of confidence.

So how do D.C.s get their name and reputation “out there” so when others are looking for a D.C. your name will make the list. 

Participation in your state and national association is a good start.  While participation does not guarantee competence it demonstrates professional responsibility. 

Additional certification, ongoing post graduate training, published articles, website that outlines your mission for your office, community involvement and civic contribution all go to help form the impression that provides confidence in making a referral. 

It is important to start early to help build that reputation so when the need arises for a “referral you can trust” it will be obvious that you are a good choice.