Chiropractic + Naturopathic Doctor

Are you placing your practice at risk?

By Drew Stevens   

Features Business Management

August 12, 2014 – Many chiropractors will tell you that operating a practice is risky. The implication revolves around patient acquisition, money management and even staff development. Yet, one of the riskiest aspects of chiropractic practice growth involves risk management.

Managing risk not only involves proper patient treatment protocols but
also the many nuances of ethical care, proper communication and paper
management. These issues are especially important since the slightest
issue will bring about patient complaints or, quite possibly, audits.
From the beginning chiropractor to the more experienced, risk management
must not be overlooked.

Defining risk and ethics
as business owners or even associates engage frequently in risk. There
is prudent risk whereby doctors might engage in business alliances that
possibly aid practice growth. There are investments that aid savings or
even retirement. And then there is risk that is considered cautionary
such as words, phrases and jokes that place the practice in jeopardy.
The latter relates to ethics, in other words, those principles that
society, the community and the practice culture consider wrong. Ethics
are those standards established by society to delineate right from
wrong. One of the first principles is patient communication.


Doctor-patient relationship
are individuals first, but unfortunately, from time to time they get
cornered at parties, gatherings and even during family events. Once
identified as a health professional, many that suffer immediately desire
“advice”. Yet, chiropractors must realize that the moment they engage
in remedies, they enter into a doctor–patient relationship that can
immediately place the practice at risk. After all, the recipient trusts
you, believes in you and may take your advice – without an evaluation.
Therefore, every chiropractor must ensure that advice is only dispensed
in the office, with a thorough examination and with proper

Secondly, individuals engage in camaraderie by
telling stories and sometimes jokes. Yet, what is interesting and funny
to one person may be seen as offensive to another. Unfortunately, we
live in a reality-infested and litigious world. First and foremost, what
you offensively say can be sent to YouTube, Facebook, Instagram,
Twitter or other social media sites, and what may not live there will
reside in an attorney’s office. Be cautious and be conservative without
being colourful.

Thirdly, we live in a globalized economy that we
have not experienced since the early 1900’s. We now do business with
communities and nations that we never heard of 10 years ago. We had
trouble spelling them and pronouncing them. Today, we must be cautious
about words, dress, linguistics and even electronic communication.
Anything we say or write can be misinterpreted.  Cultural understanding
is paramount with operating a risk-free practice.

And just as
important as culture is generational communication. Younger doctors now
treat older patients. With five generations comingled in present
society, doctors must ensure that message delivered is message received.
For example, younger generations text and email whereas baby boomers
and veterans desire personal interaction – so ensure that words and
phrases match the demographic group.

Patient documentation
the chiropractic world, similar to any health-care practice, notes must
be written that describe symptoms as well as desired treatment. SOAP
notes are the standard used, however, there are many chiropractors that
become lackadaisical. Many doctors, especially those that see over 80
patients per day, will claim there is no time, note taking slows them
down or simply, doctors don’t like writing notes. I know of one
chiropractor that was behind in notes by more than three months.

major concern here is that practices can get audited and when
regulators discover poor documentation, penalties arrive. Further, all
appointments must have proper documentation so that the doctor
understands anomalies, issues and trends that make for better treatment.
Laziness makes for poorer treatment.

Should doctors decide that
documentation slows them down or is cumbersome, there are numerous
methods to resolve the issue. There are many practice management systems
available that use electronic SOAP notes. The software includes
dropdown windows and preprogrammed information that provide
documentation in less time than physical writing.

There are also
many doctors that use travel cards but they lack the time in completing
them. The easiest method is to use either a smart phone or purchase a
digital recorder, as these systems allow information to not be forgotten
and then content can be transcribed from electronic to written form.

is also the availability of using dictation software that enables the
doctor to speak into a computer and the software automatically
transcribes the voice to text. This then enables electronic
transcription to become immediately copied and pasted into a document or
the practice management software for easier inclusion. These systems
decrease labour and increases your compliance.

Managing risk is
just as important as managing people. There are numerous sensitivities,
nuances and implications that if not reviewed will implicate the
practice into compliance issues. The best run practices are compliant.
And the most compliant practices are the busiest and most profitable.
Remaining compliant makes the practice sustainable, lowers costs and
eliminates the possibility of getting sued. Remaining within the
boundaries ensure success, improves the patient experience and lessens
stress for the doctor.

Take some time to review your risk
management; your next few minutes will save you hours in paperwork,
productivity and profitability.

Drew Stevens, PhD, is a
chiropractic coach and author of the best selling book Practice
Acceleration. He is a frequent guest lecturer at Logan College of
Chiropractic and can be reached at or


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