By Christina Acampora, DC
FACT: PATIENTS YOU THOUGHT WERE BETTER have actually left your care to seek medical opinions and consultations for continued pain.
This does not mean you didn’t do a quality job of managing this patient. In fact, you probably still are a top choice treatment option. The problem is, unless you are communicating with physicians, they have no idea just how outstanding your care is, and all of your communication is being done on your behalf by the patient. Do you want a patient who thinks he or she failed chiropractic care communicating to an MD for you?
When a patient seeks a medical consult, typical comments are: “I saw a chiropractor over the last few months and it helped for a little bit, but the pain is back,” or worse, “I’ve been seeing a chiropractor this past year, but the pain is the same.” Both of these statements leave out some vital information. What the MD hears is – absent any other information – is that your care didn’t work; the MD rarely questions the patient about the details of your care; he or she doesn’t ask who the patient saw; and most likely the MD isn’ t going to pick up the phone and call you.
A patient may choose to switch course of care without informing you for any of several reasons. Perhaps a friend raves about a particular MD’s care of back pain; maybe the patient is frustrated that pain keeps returning and needs reassurance that it’s not something frightening or disabling. Whatever the case, their motivation is irrelevant; it’s what is communicated to the MD that matters, and you have a choice and some control as to how the message is relayed.
A Typical Patient
Let’s look at a common situation. You have been treating a 45-year-old male patient who presented with four months of chronic, nontraumatic mild to moderate back pain. There were no red flag warnings and no neurological findings, but he travels a lot for work, lives a high-stress life and is overweight. You address all of the modifiable factors such as ergonomics, eating, exercise, smoking and so on. You provide patient-specific exercises, ones that seek out weak muscles from hypertonic ones versus those often prescribed from a generic sheet, and you make sure he knows how to do them correctly. Within a few visits of typical care, the patient feels better, the pain is gone or significantly diminished and he is off on another business trip, having done no active care at home. You don’t send a summary report to his or her MD.
A couple of months later, the patient is back with similar but more acute pain. A fresh exam and review illustrates similar findings from the first episode. You reinforce previous recommendations and care. The patient is treated and responds similarly but perhaps a little slower this time, typical of what you might expect after a second recurrence and no home care. Once the patient is discharged, you assume the patient is fine and you’ll hear back the next time there is an episode, hoping the patient understood your message about home care and its role in prevention. Again, no summary report is shared with the MD.
What you don’t know is that a few months later the patient lifted a bag into the overhead bin in the plane on yet another business trip and had sudden but similar pain, again with no red flag warnings. It was just more painful and more acute, it scared the patient, and he determined it was time to seek care from his MD. The patient reports to the MD that he has “seen a chiropractor for the past few months, but the pain is getting worse.” The MD doesn’t question much about previous care and doesn’t reach out to you for comment or records. The MD has no records or correspondence in the file from you illustrating your care and thus no collaboration and no presumed working relationship. This patient will likely be prescribed medication, perhaps receive a physical therapy (PT) referral and start a long cycle of bouncing from one provider to another despite recommended treatment guidelines.
Summary of Care
Now imagine that you had sent a one-page simple summary of care that reflected the patient’s busy schedule, history and the timeline of his condition, and complete exams and treatments that addressed thoroughness of care for both episodes. Isn’t it likely that you would leave a more explanatory and positive impression of your care and also reinforce your care to the patient? Wouldn’t it be a truly collaborative approach if the MD also reinforced the importance of actually doing those exercises you laid out, thereby pushing some responsibility back on the patient? A simple report can convey your clinical excellence and has the power to speak on your behalf and possibly save a patient from being put on medication or being referred to another provider or specialist.
Consent to Share Records
When patients present for care, you must gain consent to share medical records with other providers. This request helps patients realize that there is value in communication about care and perhaps will help them speak more openly with you about a referral. At the very least, it provides an open door to be part of the process and have your clinical opinion and treatment history communicated properly, and it most certainly provides necessary information on future care recommendations.
When the simple task of providing a report is not done, negative consequences can occur:
• Patients state they have been seeing a chiropractor for months. The physician hears “endless treatment plan.”
• Physicians won’t research your care. They won’t know the expert, patient-specific care that you delivered. They won’t know that it worked despite non-compliance with home exercises and recommendations.
• Lack of communication resets the patient back to zero and potentially sets the patient up for a long cycle of staggered and inconsistent care that won’t include you unless the patient self-refers back to you.
• For those DCs who want to be part of the integrated approach, failing to attempt to collaborate is essentially supporting continued non-integration.
This lack of communication is, in fact, communicating the worst possible message.
When we do communicate, whether or not it is initially welcomed by the MD, there are benefits:
• Proven efficacy and communication of appropriate care, leaving no room for assumptions;
• Demonstration of clinical proficiency and expertise;
• Patient retention;
• Even if an MD refers out, patients will still fail traditional care. If the MD has your reports, illustrating your care to be effective after all those other failures, a clear message is sent.
It is frustrating to see the trend of integrative care centers that focus on spinal pain that don’t include chiropractors among the professional staff. We can look at these exclusions as a collective community of professionals and shake our heads wondering how a clinic can call itself integrative, evidence-based and forward-thinking and not include chiropractic care, or we can communicate with MDs about the care and value we provide.
Don’t wait to be invited into the medical arena. Leverage patient reports, and force open a door to make collaborative contact with MDs whether they want it or not. At the very least, do it to control the impression of your care through your own words.
Dr. Christina Acampora is the founder of Aligned Methods, which offers online medical marketing courses and resources, and is the author of Marketing Chiropractic to Medical Practices, a 2007 Jones and Bartlett publication. She speaks for chiropractic and university organizations and is a consistent contributor for ACA News. She can be reached at www.alignedmethods.com.