It is not true that if you do not diagnose or at least do diagnostic tests and refer out, you will be sued. In fact, it is an absolute lie. You are not sued for failing to diagnose. If you were, no medical doctor would ever be sued! The first prerequisite to medical care is to formulate a diagnosis. Every medical doctor performs a diagnosis on every patient, every time. He or she could not treat the patient without it. In actuality, you are not sued for making an incorrect diagnosis. You are sued because the patient is dissatisfied with your care. When one seeks the care of a medical doctor, he is led to believe that he is going to be given a correct diagnosis. If that does not happen, the patient may be dissatisfied. I say “may” because there have been cases where the physician made an incorrect diagnosis and for some reason, the patient may not be a suing-type person. Or because of the medical doctor’s personality, charm, air of authority or whatever, the patient was still satisfied with care. (While that is the cause of suits, whether one is guilty or not depends upon whether a jury decides the patient had a right to be dissatisfied.) A chiropractor could throw the patient down the cellar steps and break both arms in giving an adjustment and not be sued. But the patient would have to be aware that that was the chiropractor’s procedure and agree to have both arms broken! In other words, if the patient is aware you do not diagnose and agrees to that type of care, there will not be a suit.
Why then do people lie and tell us that we must diagnose. The only reason I can think of is that they want you to practice like they do. The insurance company, for the mixing aspect of the profession, recently sent a letter to graduates of non-CCE schools informing them that they were now eligible to be covered for malpractice. What had the graduates done that all of a sudden made them eligible? Nothing. Apparently the insurance company did some research and found that non-diagnosing chiropractors are not sued any more than those who diagnose and refer. In fact, those of the “straight” persuasion generally have less incidences, despite generally seeing more patients. The straight malpractice carrier charges lower rates to the straights. Perhaps the mixer insurance company was soliciting straights to help bring down their figures! Insurance companies only have one objective in mind, making money. But the real question is, on what basis were they excluding chiropractors in the past and making the statement that chiropractors needed to diagnose? They had no statistics to prove it. Simply because what they were saying was a lie. Let’s put aside statistics, insurance company figures and emotion and look at it rationally. If you diagnose and refer in your practice, what bad things can happen to you? There are at least four.
1. You may fail to make a diagnosis. You can miss something. Medical doctors do it all the time. In fact, our profession never misses an opportunity to note the fact that even the Mayo Clinic has less than a perfect record in the art of diagnosis. We seem to love to criticize medical diagnosis. I find that very humorous. Why would you want to criticize the ability of someone who is much more proficient than yourself? Any negative attention drawn to medicine merely magnifies our own shortcomings in that area. Medical doctors miss things, chiropractors miss things. If you diagnose, you always run the risk of missing something.
2. You may diagnose incorrectly. Most chiropractors have had little training in diagnosis. It is easy to make a mistake, to diagnose low back pain as a lumbo-sacral strain when it is really a herniated disc. That could really make the patient unhappy. If the medics diagnose incorrectly so often, chiropractors have to be guilty of the same crime.
3. You may diagnose correctly but fail to refer. Sometimes chiropractors who are in the disease-treating game think they can cure more than they actually can. This is especially true for those who end up taking care of musculoskeletal type conditions. When you have been limited to doing just one thing, taking care of back problems, you tend to want to take care of all kinds. On occasion you will likely bite off more than you can chew, especially if you have just come back from a weekend seminar where the technique peddler has convinced you that he effectively treats all kinds of medical conditions. So you take on that case and they don’t get well or get worse. There is bound to be a chiropractor who will testify that you should have referred him to a medical doctor. With all the new techniques, procedures and equipment it is easy to get caught up in the enthusiasm of a great new breakthrough. But that in itself is a danger when these new techniques and procedures are not being taught in an “accredited chiropractic college.”
4. You refer the patient to a physician and he performs malpractice. One of the exciting aspects of the diagnostic/refer doctor’s practice is the opportunity to be part of the “team,” to refer a patient to an medical doctor and be kept abreast of his medical care. (It’s about all they have, since they never see the patient again.) However, the medical doctor or surgeon could mess up. We have already said how often they are wrong and how many errors they make. Now we are putting our reputation on the line with them. Sure you may not be guilty of malpractice, you may have done everything correct. But, when the attorney sees your name in the medical doctor’s file, the correspondence between you and him, your diagnosis and your referral, you will likely be sued. You, more than likely, will be exonerated but only after the time, expense and hassle of having to contact your malpractice carrier and perhaps go through depositions. It’s not fun. The threat of a malpractice suit is bad enough based on your actions, who would want to take the chance of being sued based on a someone else’s actions.
While there are four potentially bad things that can happen to you if you diagnose, there is only one that can happen if you choose not to diagnose. Of course, choosing not to diagnose includes explaining the chiropractic objective to the patient and why chiropractic is not a substitution or an alternative to medical care. That done, the only bad thing that can happen to you is that the patient can lie. They can claim that you told them you were treating their medical problems or that you were going to relieve or cure them. Of course, the chiropractor who is doing his job will have an entrance record which the patient signs that says otherwise. He or she will have a sign in the office, information that the patient takes home and videos and pamphlets in the office, all of which explain the chiropractic objective. With all those factors substantiating your position, it is unlikely that you will be sued but if you are, there is assurance you will be vindicated.
There is another version of the lie. This one says that you do not need to diagnose every patient, just the ones that come in the office with severe symptoms, or at least do some diagnostic tests and refer out if they are positive. This lie is popular among faculty at chiropractic colleges, even straight colleges. Malpractice is failing to do something you ordinarily do. There is greater danger in not doing an exam on each patient than on doing it on only a few. It is the one you miss that will cause the trouble. Consistency is the key to a successful practice. Consistency in what you say and what you do. This principle is especially true in risk management. One of the great things about straight chiropractic is that it is consistent. You do the same thing and say the same thing to every patient. An old saying is applicable here, “one good thing about telling the truth is that you never have to remember what you said.” If you always tell the truth, remembering what you said is easy. If you lie, you must remember which lie you used and to whom you lied.
I truly believe that you can judge the veracity of someone by their character, by their standards. If you still wonder whether this diagnosis issue is a lie or not, ask yourself the following questions about the people who are making the statement:
1. Do they want to see chiropractic as a separate and distinct approach to health? Of course they don’t. Their desire is to merge chiropractic with medicine, to become part of the medical community. You cannot be part of the medical community unless you participate in their rituals and unless you perform the procedures which they believe to be essential to their practice, namely diagnosis.
2. Do they want you to have a high volume vertebral subluxation practice? Of course not. That is not what chiropractic is all about to them. If they do not want it for themselves, then why should they want it for you?v12n2