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Academy of Chiropractic’s

MD Relationship Program

#7 Marketing, Branding and Entrepreneurship

Clinical Decision Making

From:  William J Owens Jr DC DAAMLP

When it comes to your clinical decision-making, all of your focused decision making should be at the initial encounter with the patient.  One of the most common mistakes and time wasters made in practice is doing full assessments at every clinical visit.  As you get busier that gets harder and harder to do and in the end, it is really not necessary and has not been shown to make much of a difference clinically.  It is really your adjustment and your treatment that produces the results, right?  When that patient first comes in, you need to have an idea of what is wrong and an outline of their care plan. It is always an estimate of how long they are going to be under care, which is particularly important relating to the type and degree of the tissue that is injured.  If they have a muscle problem, that is going to be fixed or stabilized the quickest.  If they have a disc herniation sitting on a nerve, that is a different story that is going to be prolonged and involved.  If they have ligamentous laxity, that is going to be even longer, and in most cases, permanent.  So, what you have to think about is; is this a patient that is going to be cured and released from care, or is this a patient that needs to be stabilized and managed for the long term?  All of those decisions really should be made by your first or second reevaluation with a complete E/M evaluation [see the Video Library if you need help] and scientific references to support your decision making.  That way when the patient comes in for return visits, your focus is just on treatment, not clinical decision-making [you will have already done that!].

We spend all of our time with our patients at the initial and re-evals then we are able to stack our treatment visits into shorter blocks of time so that we can move efficiently in practice seeing a significant amount of patients per day.  When you try to do detailed evaluations on everybody all the time, that is what severely limits your ability to see patients and particularly to see volume.  If you need help with that concept, send me an email, but the concept is, you want to define all of the clinical or potential clinical decision-making right up front, and that is ultimately your report of findings with the patient.  That is how the patient understands how long they are going to be with you under care and that the re-evaluations are the time to have in depth discussions on patient care, not at the regularly scheduled treatment visits.  At each reevaluation, you are either modifying or reinforcing those decisions.



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