Save 1-5 minutes per visit with this physical rehabilitation addition to service with a properly-trained tableside assistant
YOU DON’T HAVE TO WORRY ABOUT CHIROPRACTIC BEING OUTSOURCED OVERSEAS. The patient needs to be seen by the doctor to receive their adjustment and both modalities and initial physical rehabilitation exercises need to be performed in person. This major benefit also brings a significant liability — we can only treat a limited number of patients a day. The answer is to increase your productivity and capacity to treat more patients with a table-side assistant.
The goal is to save at least one minute on every routine office visit and a minimum savings of five minutes for a new or returning patient with a new condition. Now do the math, multiply the time saved by your patient visits for the day, and that is the amount of extra time you now have in your schedule. Extra time to see more patients, to do marketing, to get to the gym, or to just get home earlier.
Training and time saving
A properly-trained tableside assistant can make this happen. Let’s be clear: This is your tableside assistant, not your front desk or insurance staff that slides in to help you when you are backed up. They follow you to ensure you only diagnose and treat the patient. Yes, they can bring patients into the room and facilitate patient flow, but the real savings in time is during the treatment.
Let’s look at some of the areas where they save time:
- Obtain and record the subjective complaint/change from the last visit.
- Record your dictation of the daily SOAP note. Both subjective and objective findings: subluxations, muscle tonicity, levels adjusted, direction adjusted, any ortho/neuro test. Dictating your findings in front of the patient is also a great practice-building tool.
- Retrieve prior notes, outcomes, test results or X-rays you want to review.
- Hand you everything you need — tape, scissors, SOT blocks, reflex hammer, IASTM tools, paper towels, activator, topicals, emollient, MRI reports, etc. — especially if it is in the next room.
- Write excuse notes — you just sign them.
- Get supplements/products from the display case or out of the supply closet.
- Communicate to the front desk or insurance staff for you so you can continue to treat the patient.
- Keep you on schedule — you will talk less about non-clinical issues when there is another person in the room.
- “Throw the block” for the patient who is finished with the adjustment but now just wants to talk about issues outside of care.
- Review informed consent.
- Record your exam findings and recommendations for new and returning new-condition patients.
- Make EHR entries that can be dictated or delegated.
The time savings can add up to 1-2 hours a day depending on your office flow and your treatment style. However, check with your state licensing board on the legality of using a tableside assistant. Most states allow for a medical scribe to take dictation and enter EHR information. Some states, like New Jersey, have a Licensed Chiropractic Assistant professional degree that can really open up the doctor’s time.
Get in the physical rehabilitation flow
The documentation requirements to substantiate care continually rise and we can meet those requirements with less doctor time by using an assistant.
This would be a typical visit flow:
1. You greet the patient, confirm any changes since their last visit, and then get your hands to work.
2. While your hands are working, you dictate your findings to your assistant, interjecting a few statements to the patient about their condition and personal interests.
3. Then go right back to the dictation of the note, ask your assistant to get your exercise sheet for their condition, review the physical rehabilitation exercises given, give the patient any final instructions and tell your assistant to close the note and prepare the next patient for you.
Not only have you finished your treatment encounter, you have finished the daily SOAP note and avoided talking about the weather and sports.
Using a tableside assistant is great for you, your patients, physical rehabilitation and your office. After you check your state laws to determine the procedures an unlicensed assistant can perform beyond transcribing notes, simply assign those tasks to your tableside assistant. Perhaps your state law allows a tableside assistant to take vitals, a history, a foot scan or surface EMG. Now you can focus on the job of diagnosing and treating patients — not staying after-hours doing SOAP notes.
Donald Defabio, DC, DACRB, DACBSP, DABCO, teaches Relevant Rehab hands-on seminars, and his e-book, “The Six Keys to In Office Rehab” is available free on his website at DeFabioDifference.com. His exercise protocols can be found on his YouTube channel, which has more than 28,000 subscribers. He can be reached at DeFabioChiropractic@gmail.com.
