Since I was a kid, too many years ago, every time I visited a doctor, they started with my blood pressure and pulse.
In chiropractic college in the 1970s, taking vitals was one of the first things we learned. As you know, the purpose is simple: monitor cardiovascular health, detect hypertension, assess physical fitness and evaluate the circulatory system. However, you might not realize this simple practice can significantly impact your marketing efforts, confirming you prioritize patient safety as a healthcare professional.
From my experience
In the early 1980s, a patient called me and said they had terrible neck pain, difficulty breathing and felt very “clammy.” I instructed her to go directly to the emergency room (ER). As I treated her and her family members for neck pain and asthma in the past, she wanted to start with me. I insisted on a trip to the ER first. She didn’t listen. She pulled up to my home office and I met her in the driveway, where she took one step, collapsed and died in my arms of a dissecting aneurysm.
During that phase of my 43-year career, I treated 650 patients per week, armed with a chiropractic spinal adjustment and an X-ray machine. I didn’t do a complete examination. I skipped cranial nerves, review of systems, height, weight, blood pressure, pulse and prior treatment. All of the things that made a DC a “doctor.”
The afternoon after the passing of my patient, the medical examiner (ME) called me and wanted all my records and asked why I treated her. I told the ME I directed her to go directly to the ER, and she never set foot in my office. He said he would get back to me, but have my records prepared. During that conversation, he was quite aggressive and met the sentiment of the mid-1980s of a strong dislike with no respect for DCs by the medical community. Having omitted vitals, review of systems and all the other things I was taught in my training, I had a very sleepless night. The next day, the ME called and shared with me that if my records didn’t match what I told him transpired and I omitted safeguards for my patient’s safety, he was considering charging me with the wrongful death of my patient. However, he interviewed the friend who was with her and reported I strongly urged her to go directly to the ER. As a result, he dropped the entire case, and I didn’t have to produce any records.
Does taking vitals help your marketing efforts?
Beyond the health implications, let’s look at the marketing up and downside of taking vitals. The marketing upside is small, as you did what every doctor should do. If your patient has a blood pressure of 220/180, immediate medical collaboration is warranted and should be done. At the very least, refer your patient to their medical primary care provider and send your report. This puts you “on their radar.” Also, you must determine whether the patient is undergoing a vascular accident and needs urgent care to prevent a full vascular dissection. This requires a complete neurological examination, a detailed history, a review of systems and taking vitals. This is all before you treat your patient to triage effectively and help prevent a catastrophe in the patient’s life.
However, if you’re not used to taking vitals and the patient has an issue, licensure boards, malpractice defense lawyers or MEs (like the one I spoke to) will want to know why. That is the hard downside beyond the patient’s well-being.
With marketing, many of your reports are read by the outside world, specifically by lawyers and MDs, where the absence of simple vitals already confirms the “disrespect” for chiropractic that many have. Too many consider DCs below a physical therapist and above a massage therapist. You don’t have to like or agree with it, but it is a persistent belief in the marketplace, and the absence of what are considered “pro forma vitals” confirms the belief.
Final thoughts
The presence of vitals typically doesn’t add much to your reputation; however, the absence of vitals will erode your reputation and the profession’s reputation. In medicine, if a specific doctor does something bad, that doctor gets blamed. In chiropractic, when a single DC does something bad, it is held against the entire profession.
MARK STUDIN, DC, FPSC, FASBE(C), DAAPM, is an adjunct assistant professor at the University of Bridgeport, School of Chiropractic and an adjunct postdoctoral professor at Cleveland University-Kansas City, College of Chiropractic. He is a clinical instructor at The State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Office of Continuing Medical Education. He earned his Fellowship in Primary Spine Care certified in joint providership from The State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Office of Continuing Medical Education, and Cleveland University Kansas City, College of Chiropractic. He also runs the Academy of Chiropractic’s Personal Injury Program. He can be reached at 631-786-4253 or DrMark@AcademyOfChiropractic.com.
