My best advice
Beware of the dangers lurking at the gym
By Donald J. Lawlor, MS, DC

It didn’t seem so disturbing at first. Many young chiropractors were using the gym as a place to build a reputation and find patients. This seemed ideal since people who frequent the gym are already tuned in to physical fitness, but this behavior can result in serious consequences.

Here are examples — more serious than most — of behavior I’ve become aware of.

HELP GONE AWRY

A doctor offered to provide chiropractic treatment to a man who complained about a sore shoulder after playing a game of racquetball. Though a little skeptical about receiving chiropractic treatment, the man agreed to the offer. The DC only provided heat therapy and a massage treatment, since the man seemed apprehensive and tensed up during treatment. Only a cursory physical exam was conducted.

When the man was in the locker room a few minutes later, the chiropractor approached him from behind and performed a cervical adjustment as he stood there unaware. The chiropractor wanted to catch the man by surprise so he wouldn’t be as tense as he had been earlier.

Unfortunately, the man ended up with neck discomfort, which ultimately resulted in an allegation of trauma to the neck and failure to provide informed consent. Though the patient’s condition improved and the case was settled out of court for a nominal amount, it was reported to the National Practitioners Data Bank (www.npdb-hipdb.com) and resulted in negative publicity. (Any time a settlement is reached, a case must be disclosed to the data bank.) This may have caused the chiropractor problems with his networks and licensing boards.

RISKY TREATMENT

During a friendly game of pick-up basketball, one of the players fell to the floor and grabbed his knee. A chiropractor participating in the game jumped in to assist the injured player.

With no examination whatsoever, the chiropractor told the injured man that his kneecap was dislocated. He then attempted to put the kneecap back in place.

After several days, the injured player sought medical care and underwent an MRI, which revealed significant ligament damage to the knee. Later, the man claimed the DC’s adjustment caused this damage.

Of course, in these instances, the doctors should have examined the men and obtained their consent before treating them.

Though performed with the best of intentions, this widespread practice can be risky. If a malpractice allegation results, a plaintiff’s attorney most likely would contend services were compromised because no records had been kept, no case history had been taken, no exam had been performed (or just an “inadequate” cursory exam), and proper equipment had not been available.

Without evidence from the defense to prove otherwise, the plaintiff’s attorney would be in a prime position to demonstrate that the doctor violated the state’s standard of care. Substantial awards could result, putting a chiropractor’s assets and career in jeopardy.

FRIENDLY SUGGESTION

Taken a step further, you can put yourself at risk simply by providing a “friendly suggestion.” Consider this example:

Two men were in the locker room after an intense workout with weights. After showering, one of the men said he felt dizzy and nauseated. The other man, who was a chiro-practor, told his friend he should drink some water and go home and rest since he was probably dehydrated.

The man did just that. When he still felt “funny” the next day, the man went to the emergency room with symptoms of a full-blown cerebral vascular accident (CVA). He later blamed the chiropractor for providing him with improper advice.

Why was the chiropractor’s casual remark so risky when his friend wasn’t even his patient? A doctor’s comments carry considerably more weight than two friends in a casual conversation.

This particular case met the legal definition of “providing a professional service and establishing a doctor-patient relationship” because the friend followed the chiropractor’s comments. Once a doctor-patient relationship is established, a patient can initiate a malpractice action if something goes wrong.

When it comes to building your professional strength, strive to maintain the strongest standards possible. You’ll portray a positive image of chiropractic and may avoid the “dangers lurking at the gym” that can put your practice at risk.

WHAT CAN YOU DO?

Opportunities arise to provide on-the-spot advice and treatments to people who are not your patients. By being prepared, you can avoid some potentially awkward — and perilous — situations.

The best way to begin is to always remember to represent chiropractic as the highly skilled healthcare that it is. Doctors who provide on-the-spot treatment and advice aren’t cultivating professional relationships. By approaching chiropractic care so casually, these doctors set the stage for their current and prospective patients to do the same.

Since you know you will face situations where you’re asked for advice or treatment, you can be ready by developing a few diplomatic responses in advance. Here’s an example:

“I’d love to answer your question/treat you today, but I don’t have the proper information and equipment at hand to give you the best advice/care possible.

“I want to give you top-notch care, and I can’t do it at the gym. Please give me your phone number, and I’ll have my staff squeeze you in for an appointment at your earliest convenience. If you need immediate help, I’d suggest you visit the emergency room, where they specialize in urgent care treatment.”

If the response from your friend regarding an office visit is that “you just want to charge him,” consider offering the first session at no charge — if that approach fits your office style and personality. You’ll uphold your professional status and be much more likely to win a patient long term.

Donald J. Lawlor, MS, DC, recently retired from practice in Norwalk, Conn. This article was submitted at the request of NCMIC (www.ncmic.com, 800-769-2000), a malpractice insurer.

Disclaimer: This article is offered solely for general information and educational purposes. It is not intended as legal advice or opinion. You should not act or rely upon this information without seeking the advice of an attorney.