As field doctors, we know of this question all too well, and for good reason. We either have a personal experience with it or we know of some one who has. We may also know that there are many anecdotal answers to this question ranging from "undo the problem," "call an attorney," "pray," "call a colleague" or "call an expert." Of course, there are other authoritative answers addressing the issue of suspected iatrogenic (doctor caused) injuries which are available to the chiropractor through a variety of seminars and textbooks.
Like many of our readers, I've heard and read a lot of advice on the subject of suspected iatrogenic injury. However, unlike many of our readers, I am often asked to give advice to doctors who believe they may have created a problem. Herewith are a few important pearls of wisdom you probably won't find in any textbook or seminar.
Doctor, Don't Make It Worse.
Curiously, among all the advice I've ever read or heard on the subject of suspected iatrogenic injury, I've never seen a warning given to the chiropractor about the risks of getting advice from another health care provider who is not a chiropractor. Think about it.
If I was a betting man, I'd wager a month's income that most readers see the risk of getting advice from a non-DC is about prejudice against chiropractors. I can almost hear the words from our readers: "The first thing the MD will say is that I'm wrong, and a chiropractor (i.e., me) has no business doing whatever it was I was doing." How about this one? "It certainly sounds like you hurt the patient. My advice is to refer the patient to whoever and tell the patient you'll cover the costs."
If you were thinking along these lines, you probably missed the boat. Your fear of prejudice against chiropractic, while an important consideration, should not be your biggest concern. It is not your biggest problem.
It is unlikely that it is the main cause of a very typical situation which one doctor described best when he said: "I thought it was an easy situation to deal with, but now it's out of control."
It is even more unlikely that it is the main cause of the worst possible situation which is described best when the doctor says: "I thought it was an easy situation to deal with, but now it's out of control and I'm being sued."
The message so far is, don't make your situation worse by focusing on the wrong side of the problem.
Doctor, Make Your Situation Better -- Step #1
How? First, remind yourself that your being careful about the management of your patients because, in part, you want to assure success and prevent unwanted outcomes. Second, remind yourself that even perfectly designed therapy can't prevent the odd, the weird, the once-in-a-blue-moon type of occurrences. Try as we may, as field doctors we can't foresee every conceivable reaction to our therapy. We can, however, successfully remedy most of our patient's unplanned reactions. But once in a while we get stuck with what we perceive to be a "problem that won't go away."
So what do we do? More often than not, we seek advice. We'll read, search the literature or talk to another DC in the hopes of recalling similar experiences where they have been successful. Usually, this strategy works quite well so the message up to this point: seek clinical advice.
An example will serve us well to illustrate the points we've made. I recall talking to one of my DC colleagues who was stumped by a "left lower rib subluxation that would not go away." No matter what he tried, the pain just below the heart on the anterior chest persisted.
It also turns out that during the course of care, he had told his patient to purchase some supplements to enhance the healing process for a strain injury caused by a minor lifting accident. The doctor said, "Things were going well, but then all of a sudden the chest pain got much worse. The first thing that ran through my mind was some kind of heart problem."
He continues by saying, "Right away I called a DC friend of mine and talked the case over with her. Sure enough, we pinpointed (with the help of the supplement manufacturer) the cause to the patient taking expired supplements." It turns out that the patient did not purchase the supplements as directed. Apparently, the patient discovered he already had a bottle that he purchased quite some time ago, which he left in the bottom drawer of his office desk. So, he took them instead.
Finally, armed with the advice from his colleague, he ordered the patient to dispose of the expired supplements and he cleansed the GI tract. "Within an hour or two," he adds, "the problem that would not go away had disappeared."
Doctor, Make Your Situation Better -- Step #2
Next month we'll finish our discussion and talk about a very important, but least known risk surrounding the subject of suspected iatrogenic injury and how to remove this risk when getting advice from another health care provider who is not a chiropractor.
With each article I encourage you to write the questions you may have or thoughts to share with your colleagues, to me:
Darryl Curl, DDS, DC
2330 Golden West Lane
Norco, California 91760
Please enclose your return, self-addressed, stamped envelope.
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