Managing difficult chiropractic situations

Chiropractors regularly deal with challenging situations and are continually required to make difficult decisions.  However, these decisions don’t always relate solely to the clinical care they’re providing their patients.  Unfortunately, sometimes chiropractors will face other difficult situations with their patients and knowing how to manage these isn’t always easy or obvious.

The information below highlights three challenging scenarios, which are not uncommon in chiropractic, with tips on how they could be managed.

Patient requesting specific treatment

Some patients will attend their chiropractic appointment with what they believe is an understanding of their condition and how they should be treated.  These patients will often request, maybe even demand, a particular type of treatment.  This information may be based on how they’ve been treated by a chiropractor in the past.  Sometimes it will be based on information non-clinically trained people, such as friends, have shared with them or even information they’ve read online.

Chiropractors must be sure all patients are assessed thoroughly regardless of what the patient tells them about their condition; the chiropractor as the health professional needs to be sure.  Following the assessment, the chiropractor may determine that the treatment being requested isn’t appropriate for that patient based on their current clinical situation. 

When the treatment the patient has requested isn’t ideal for them, they may not be happy with the decision to not provide this.  This requires the chiropractor to explain to the patient what treatment is recommended and why.  Chiropractors must be sure they don’t allow themselves to be coerced into providing treatment against their better judgement and they need to be sure all treatment they provide is clinically justified.  If there is a poor outcome following treatment and the choice of treatment is questioned, stating that the patient demanded that treatment isn’t a justification for it being provided.

In many cases, the patient will accept the chiropractor’s treatment recommendation.  However, chiropractors need to be prepared for the possibility that some patients won’t agree with this recommendation and may leave the appointment disappointed.  Unfortunately, it’s not possible to please all patients. 

If the situation above occurs, it’s vital that the patient’s request is noted in the clinical record so there is a full history not just of what treatment was provided but of all conversations regarding the treatment.

Patients seeing multiple practitioners

Some patients will choose to visit multiple practitioners for the one condition.  A common reason for this that they aren’t satisfied with the treatment outcome from one practitioner, so they try others hoping for a different result.  They may choose to see different chiropractors, or they might see different types of practitioners such as osteopaths and physiotherapists as well as a chiropractor.

In most cases, a patient seeking a different opinion shouldn’t be cause for concern.  However sometimes a patient who has seen numerous practitioners and has been unhappy with them all may be a patient who’s difficult to please and chiropractors should be mindful of how they manage this situation.

In cases where a patient presents criticising the treatment provided by another practitioner, it’s important that chiropractor doesn’t also criticise this treatment.  The chiropractor doesn’t have the full story of how the patient presented to the other practitioners, what treatment was provided and why.  Criticising the work of other practitioners is not only unprofessional, it can also encourage, even if unintended, the patient to make a formal complaint about that practitioner.

Quite often patients are unhappy with their treatment outcome due to them having unrealistic expectations.  Assisting a patient to form realistic expectations about treatment requires effective communication before treatment starts.  Therefore, be sure that with all patients the likely and realistic treatment outcomes are discussed with them prior to any treatment being performed.  And this conversation needs to be had using language they’ll understand so avoid clinical jargon.

If a chiropractor has a very uneasy feeling about a patient due to it appearing difficult to meet their needs, the chiropractor can decline to provide treatment.  However, the chiropractor needs to acknowledge that not providing treatment could upset the patient.  Therefore, this discussion needs to be planned and worded in a way unlikely to cause offence.  Exactly what is said will vary depending on the situation, however it would be reasonable to let the patient know that due to the patient not getting benefit from previous treatment similar to what would be provided, the chiropractor may not be the most appropriate person to provide further treatment.  The patient could be advised to see another health professional such as a medical practitioner.

Blurred boundaries

The relationship between a patient and chiropractor is a professional relationship.  However, at times the behaviour of patients and chiropractors can blur the boundaries of this relationship and it can start to seem more of a personal relationship which isn’t appropriate.

Chiropractors need to remember that their patients are just that, patients.  They aren’t friends and shouldn’t become friends.  There are a couple of simple rules to follow to avoid this change of relationship.

Chiropractors should avoid socialising with patients.  Sometimes a chiropractor will treat a patient and their family for many years which leads to them getting to know each other quite well.  This can lead to chiropractors being invited to family birthdays and other events.  While it may seem impolite to decline these invitations, accepting them can complicate the professional relationship. 

With the continually increasing use of social media, there can be a temptation to connect on social media with a large number of people.  If a chiropractor has a professional social media account, only used for professional communications, it’s okay to connect with patients through this account.  However, chiropractors shouldn’t connect with patients on a personal social media account.

Chatting to patients during consultations is a great way to seem more personable and make patients feel relaxed.  However, if there is too much personal chatting the chiropractor is possibly not spending enough time discussing the treatment being provided.  Also, there have been occasions when personal conversations have been misinterpreted by the patient and they’ve felt uncomfortable with the chiropractor discussing information not related to treatment.

Unfortunately, keeping clear boundaries can be a little challenging for those chiropractors practicing and living in small towns or communities where many people know each other.  In these situations, the chiropractor needs to ensure that if they are treating someone they know, they maintain their professional standards during consultations and not treat these patients differently to others. 

Managing difficult chiropractic situations

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