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Re: What to do?
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Re: What to do? - February 6, 2007 5:42:00 AM
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jbird007
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quote: Would it do much good to talk to the chiro who possibly caused this? What are they going to say, yes I did it? I doubt it.
I think it the professional thing to do. You have already made some huge errors in handling it. Communication amongst other heathcare professionals is often non-existent. Why not change that for all professions and for the sake of the patient.
JBird
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Re: What to do? - February 6, 2007 6:07:00 AM
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Jeep
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Dan states:
[QUOTE] If it is not limiting her function and if her complaints of pain have subsided than why go through the additional cost?[/QUOTE]While I disagree on many levels(see above posts and esp. regarding ortho referral).........If you feel secure and confident in your 3 months handling of this patient.......let's go back in this thread. I am confused/getting mixed messages by your posts. To me it looks like you answered all your own questions.
[QUOTE] My dilemma is what to advise the patient to do or what should I do? Should I continue on my current path of doing nothing, should I inform the patient to file a complaint w/ the state, should I file a complaint on her behalf, or should I contact the chiropractor?[/QUOTE]If it is not limiting her function and if her complaints of pain have subsided than why go through the additional cost?
[QUOTE] Would it do much good to talk to the chiro who possibly caused this? What are they going to say, yes I did it? I doubt it.[/QUOTE] If it is not limiting her function and if her complaints of pain have subsided than why go through the additional cost?
[QUOTE] My main concern was that the chiro was treating her for her back and then without evaluating her shoulder her performed a treatment on the shoulder. That to me seems to be negligence.[/QUOTE]If it is not limiting her function and if her complaints of pain have subsided than why go through the additional cost?
[QUOTE] The one reason I have contemplated for so long on what to do is that I did not want to get into any legalities of it. While the patient did seem concerned and seemed to be aware that she started having problems after the chiropractic manipulation of her shoulder she did not tell me she wanted to file a complaint. On the other hand I am not sure if she is aware that this is an option.[/QUOTE]If it is not limiting her function and if her complaints of pain have subsided than why go through the additional cost?
[QUOTE] I said this because he did not evaluate and examine the shoulder prior to performing a treatment. [/QUOTE]You know this for a fact and can support this with evidence? However, If it is not limiting her function and if her complaints of pain have subsided than why go through the additional cost?
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Re: What to do? - February 6, 2007 6:18:00 AM
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drbuddy
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I think it is in the patient's best interest to be referred to an ortho to get a definitive diagnosis. If there is litigation, that will be important.
After getting the go ahead from the patient, call the chiro and discuss what you've found and suggest the chiro call and discuss things with the patient and make the referral. Make it clear that if they dont make the referral, you will because you are concerned about it. If the chiro is a knucklehead and gets defensive, remain professional and say "thank you for your time". Give it a few days and refer the patient yourself.
As a side note, I never heard of the technique you described above. The patient may be a little off with the explanation, unless the chiro is a really big knucklehead and performing an unsafe procedure.
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Re: What to do? - February 6, 2007 6:38:00 AM
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jbird007
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btw, I must admit I missed that this has been ongoing for 3 months?
Dan, Why did you wait so long??
JBird
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Re: What to do? - February 6, 2007 6:41:00 AM
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ptdan23
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Buddy,
Thank you for your suggestion.
My question is what reason would they have to do a sitting manipulation bringing the UE into flexion and thrusting, almost into an impingmentment position, without first evaluating to see if her mobility was limited?
Thanks, Dan, C. PT MTC.
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Re: What to do? - February 6, 2007 6:41:00 AM
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jbird007
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Jeep makes good points.
..and due to my skeptical nature I beleive this is a fiction story.
J
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Re: What to do? - February 6, 2007 6:44:00 AM
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ptdan23
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You believe I am telling a fictional story? This is a true story, sorry to disappoint your skeptical side. I came on here looking for advice that is all.
Dan
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Re: What to do? - February 6, 2007 6:49:00 AM
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jbird007
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But you waited 3 months?
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Re: What to do? - February 6, 2007 6:51:00 AM
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jbird007
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Dan's quote:I have a patient that was referred to me for L shoulder pain (previous h/o RC repair). She was later referred for L hip pain.
Dan, Did the referring docs have notes about this "injury"?
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Re: What to do? - February 6, 2007 6:55:00 AM
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jbird007
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Dan, Do you have someone in your staff to handle patient concerns? It seems to me you could have confided in a co-worker or superior regarding your story.
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Re: What to do? - February 6, 2007 9:17:00 AM
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ptdan23
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jbird007...Circumstances beyond my control caused this excessive amount of time to pass. I am not going to justify myself, I don't have to. I came here looking for advice not to have to justify my what is going on.
She was referred to me for L shoulder pain/weakness and during my examination is when I noticed the problem on the R. I am not sure if the referring doc was aware of the problem on the R - pt could not remember if she told him or not. I did note it on my evaluation and it was on several progress notes which were sent to the MD for his review so he should be aware of it. Yes I did probably make the mistake of not picking up the phone but it was thoroughly documented.
Dan
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Re: What to do? - February 6, 2007 9:31:00 AM
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jbird007
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quote:Circumstances beyond my control caused this excessive amount of time to pass. I am not going to justify myself, I don't have to. I came here looking for advice not to have to justify my what is going on.
I am just asking questions that I feel are important. You still have avoided some of my questions which are quite relevent to your story. Don't you have a co-worker or superior to discuss these matters with? What was the actual reason for waiting 3 months? I would like to share some wise words of advice to you.
Nothing is "beyond your control" if a patient is injured. You are responsible to report it and handle the matter as soon as it becomes apparent to you. As far as justification goes you will be liable to answer to the legal courts should this take an ugly turn. This is a serious issue and if it did really happen you need to handle it correctly and chaulk it up as a learning experience.
quote I am not sure if the referring doc was aware of the problem on the R - pt could not remember if she told him or not.
Again, Dan, a quick phone call would have been appropriate. When you get referrals do you get or request SOAP notes from the treating folks? If not, you should ALWAYS. A request for the SOAPS and a few phone calls could have solved this dilemma.
If you want to PM me to protect your privacy and discuss this, please do. I sincerely hope you are not pulling chains.
JBird
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Re: What to do? - February 6, 2007 9:54:00 AM
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ptdan23
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JBird,
The circumstances are was basically I was left to run a clinic by myself that previous had 2 other PT's, 2 ATC's and a front desk person. It went from that staff to just me. Unfortunately some things have fallen by the wayside such as a quick communication. I communicated it via my evaluation and the progress notes. By the time the patient go to me I believe (I don't have her chart in front of me) at least a month had passed since the chiropractor manipulated the shoulder.
When I get referrals I do not request office notes unless I find something out of the ordinary or I want to confirm a diagnosis such as osteoporosis. Getting notes from each referral source is just not that feasible. I do not think this is common practice and has never been done in a facility where I have worked. I do call either the MD office or the facility if they have had an x-ray or other radiological testing done to get the reports and/or films.
I still do not understand why you think I am not being truthful. I am not a newbie to the forum nor is it worth going through this just to be lying to everyone. I have no motivation for doing that. Like I said this post was meant to ask for advice not to bash chiros or anything like that.
Dan
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Re: What to do? - February 6, 2007 10:38:00 AM
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Sebastian Asselbergs
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In a case like this - and it happened with a variety of professionals in my 23 years of practice - the first action is to call the alleged culprit of the supposed technique that was the injuring agent. Immediately. All that needs to be said is: "I have this patient who claims such-and-such. I am just letting you know. I am also letting you know that I have informed them of their right to register a complaint with your regulating body"
Of course, you can use much more diplomatic language - but that is the gist.....Even if you know the practitioner well....
IF the alleged culprit was another PT I would add: "And I am letting you know I have passed the complaint as I have heard it on to the College of Physiotherapists ".
Sounds strange? But many PTs in Ontario don't know that it our DUTY to report alleged PT malfeasances to our College, and let them decide whether there is merit to any further investigation and/or action. I don't know how your Florida situation is with Regulating Body and such - but make sure you check. Our Colleges of Physiotherapists in our provinces have guidelines for your type of situation/scenario.
_____________________________
Mundi vult decipi
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Re: What to do? - February 6, 2007 11:09:00 AM
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jbird007
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quote: The circumstances are was basically I was left to run a clinic by myself that previous had 2 other PT's, 2 ATC's and a front desk person.
Are you IC? Who left you in charge to run the clinic? Was there an owner? Why not call your Board and ask for information? There was no one who you could confront on this issue. If this is a true story your performance is inexcusable.
I agree with Sebastian. We all have the responsibily to "take care of business".
JBird
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Re: What to do? - February 6, 2007 11:12:00 AM
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drbuddy
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Dan, as I mentioned, I have never heard of this technique. I do use a technique where I'll place the patient's hand on their ispilateral shoulder (flexing at the elbow and shoulder), stand behind them and reach around to contact the elbow with both of my hands, then thrust in a A to P vector (causing A to P shear). This is a fairly standard manipulation for shoulder joint adhesions. I'm not sure why this chiro would have thrusted further into flexion.
Also, are you sure no exam was performed on the shoulder? Either the patient is a bad historian, or the chiro is a knucklehead.
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Re: What to do? - February 6, 2007 12:26:00 PM
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jbird007
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quote:Also, are you sure no exam was performed on the shoulder? Either the patient is a bad historian, or the chiro is a knucklehead.
Or its a fabrication.
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Re: What to do? - February 6, 2007 1:01:00 PM
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Marc Bronson
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From: Toronto
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[QUOTE]
Hello? Most practitioners (of any stripe) solemnly believe they are treating mesoderm, which mysteriously misbehaves and causes pain, and that their job is to round it up, push it around into some sort of "correct" configuration, and hope it stays put. Attempts to push mesoderm around, no matter how well-intentioned, lead to harm. Inadvertent, but harm nonetheless. Surely no one disagrees that harm can happen from being too forceful. I'm saying the belief system is all wrong in the first place - it's based on ideas about pain that are 400 hundred years old, for pete's sake, and treatment ideas that are older than that, that fossilized about a hundred years ago around the same time chiro did. [/QUOTE]D... I wanted to reply to you in a PM, but you have disabled that feature, so I go public. Sorry guys, please detour this message, as it is off topic.
Listen. I hear where you are coming. I share the same understanding as you regarding WHAT system we are treating. No need to be inflammatory here. That being said, this forum (seems) to be more orthopaedic/mechanical based. This also has its own value. Let me explain.
Correcting aberrant biomechanics (you and I and others will focus on the nervous systems) likely decreases the amount of mechanical deformation that irritates the nervous tissue to begin with. So, perhaps the general UNDERSTANDING of WHY we prescribe corrective movement/exercises hasn't yet been embraced, nonetheless, this forum, or thread at least, is not the place to discuss and promote the ectoderm vs. mesoderm agenda. Nor is it the place for your continuous chiro bashing. You have, and moderate, 2 forums for those needs.
Your silence on a question I asked you (has any DC EVER helped any patient) was expected. It's unfortunate, too. You continuously dismiss anything and everything chiropractic basing your opinion solely on the very worst BELIEFS and practices of the worst DC's. As a health professional who obviously knows EBM, you should know better than to completely ignore the better side of chiropractic, for example the emergence of the scientific DC who's training is non-subluxation based and purely NMSK. It's a new paradigm that is being used in Canada, Europe and most of Australia. But, that would fatally damage your BELIEF system regarding DC's.
It is YOUR ideas and beliefs regarding DC's that are stuck in the 19th century. Although JBird and Buddy T ignore your constant jabs, I personally won't let you off the hook when you cross the line. PM me if you want to further discuss this.
Respectfully,
Marc.
_____________________________
BSc (Hon), DC, Dipl. Med. Ac. CSCS
Integrative Manual Medicine
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Re: What to do? - February 6, 2007 1:03:00 PM
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Marc Bronson
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From: Toronto
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Dan,
Get consent from the patient and do what Sebastian said, although take a more diplomatic tone. Let the patient know her options. Make sure your notes are impeccable as they might be scrutinized by higher ups if this goes to a regulatory board.
Best of luck in this case,
Marc.
_____________________________
BSc (Hon), DC, Dipl. Med. Ac. CSCS
Integrative Manual Medicine
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Re: What to do? - February 6, 2007 1:07:00 PM
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jbird007
Posts: 297
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Nice profesional post Marc. My hats off to you.
What discusson forums does she moderate?
J
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