In the old movie, Cool Hand Luke, the Captain said to Luke, “What we’ve got here is failure to communicate.”
This has been a major problem with the chiropractic profession since our inception. So many people who’ve never been to a chiropractor have simply no idea what it is that we do and why we do it. In fact, the rest of what I like to refer to as the “Health Care Universe”, which includes other health care providers and payers, has very little understanding of what we do or why we do it. Why not?
It’s because of our documentation. How do I put this gently? You see, as a profession, our documentation, um, sucks.
I’m a 2nd generation chiropractor and I’ve been treating patients for more than 31 years. I’ve also been reviewing LOTS of records and performing IMEs for quite awhile. If you could see what I see…you might have a better understanding of what I’m talking about. We seem to have little to no standardization of how to perform a history and exam. One patient can go to 10 different chiropractors, and that one patient will likely get 10 different exams, all kinds of different diagnoses and 10 completely different treatment recommendations – some for 2 visits, some for 6 visits and some for a pre-paid package of 53 visits. We’re all over the place, and it makes us, as a profession, look ridiculous.
Many chiropractors ask me if they should be sending their patients’ primary care doctor their notes. My answer is always…”NOT IF THEY SUCK.” But, if you document properly, using the “universal” language of healthcare, not language that only chiropractors understand, then, by all means, send the notes.
Many chiropractors tend to have a love/hate relationship – hmmm, check that – a hate/despise relationship - with Medicare. What has been our biggest problem with Medicare over the years? Yep – our documentation. Personal Injury? Yeah, the documentation. Blue Cross Blue Shield and other payers? More and more of them are producing guidelines that are putting chiropractors into a full blown panic attack. Why do they keep doing this to us? I suspect it’s because we, as a profession, have done such a poor job of documenting what it is that we do and why we do it. At least that’s a big part of it.
So how do we fix it? I can just say “document better,” but that’s too ambiguous. We need to standardize our exams more. We need to address BOTH pain and function, not just pain.
Let’s start with the History. Too many chiropractors are taking shortcuts on the history. The standard in the Health Care Universe is the OPQRST method, but we’ve got to ask and document ALL of those letters, and we need to document them for EACH condition that we’ll be treating.
We need to understand what the ortho/neuro exam is actually for, and what it’s NOT for. We need to understand how to document the findings of the exam. If I see one more time a chiropractor’s records for a non-radicular patient in which the chiropractor notes Grade 2 muscle weakness, I’m going to spit.
We need to wrap our head around using outcome assessments for ALL of our patients. This is not a Medicare thing or a PI thing – it’s a DOCTOR thing. But we need to figure out which outcome assessments are more powerful, take less time and are most cost-effective.
We need to accept and embrace some guidelines (I know, a four-letter word, so to speak) that actually HELP us help our patients. The CCGPP Guidelines are an EXCELLENT place to start.
We need to know exactly WHEN to re-assess the patient and HOW to determine if our treatment has been effective or not and if we’re justified to continue treating the patient – or not. We need to know exactly when ACTIVE care ends and MAINTENANCE care begins. And, here’s the big one – we need to be able to do ALL of this in the LEAST amount of time, with the LEAST amount of effort (documentation, not the exam or treatment) and, yes, the LEAST amount of cost.
Is all of this even possible? You bet it is. But only if we stop failing to communicate.
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