COLUMN THE BIG IDEA Desegregating chiropractic D Making collaborative care happen BY DAWN ARMSTRONG o you wish that the Chiro-practic profession in Canada could be less marginalized; that we could all be a more integral part of the main-stream of our health-care system? For our patients’ sake, I believe that would be a good thing – but what will it take to make that happen? How can we change the system? We can change it by changing what we are doing every day in our own practices. No doubt our patients like us. We’re good listeners, we have great hands and we work very hard to educate our pa-tients about the magnificent integrating power of the nervous system and how our particular brand of hands-on health care can help them in so many ways. For the benefit of our patients, we could do a much better job of integrating our skills and knowledge with that of other health professionals. Perhaps you’ve tried a collaborative approach to patient care. You have reached out to a few of the GPs in the neighbourhood, but not much came of it. You recommended that some of your new patients consult with a personal trainer or a massage therapist. You pass out business cards. You hope for co-operation on the case but you almost never hear back from the trainer or the RMT about what their plan is for the patient, or ever receive any referrals from them in return. Your front desk person seems to be dropping the ball; they’re not always on-board with the patient’s treat-ment plan. Patients disappear – maybe it’s because they are so much better. It can be very discouraging and it doesn’t seem fair. We want to be a more recognized and respected part of the patient’s health-care team – and we be-lieve we deserve to be included. Now would be a good time for a reality check. The patient’s family doctor has never consulted with you or referred anyone for care. They don’t seem to ap-preciate your particular expertise so you choose not to share it with them. They remain in the dark on the specific details of this patient’s chiropractic care. And, what about the patient? Are they really better? Or have they become lost to other health-care providers – who are giving them a different message – be-cause they were unclear on what’s really wrong with them and how you can help? The truth of it is they’ve wandered off and fallen between the cracks of a frag-mented system, and it didn’t have to happen. A second reality check – if we want to be “in-the-loop,” we have to be prepared to make our own loop. We are not likely to be invited to be part of the system’s team – we need to step up to the plate and become the leader of our own pa-tient’s team. Integrated patient care is all about re-lationships and the best relationships are based on clear communications, both in person and in writing. The three keys to effective integration of services are using the right paperwork, finding the right people, and establishing the right proto-cols. DOCUMENTATION In a nutshell, if you want to integrate your patient care with other health pro-fessionals, you must commit to keeping good clinical records. A collaborative approach requires the sharing of all sorts of information – facts that have been DR. DAWN ARMSTRONG is a graduate of CMCC and has been in practice for nearly 30 years. She is currently focused on promoting life-long learning and professional development and has created a continuing education course – Clinical Record Keeping: A Hands-On Approach. Learn more at http://www.auroraeducationservices.ca. 12 Canadian Chiropractor December 2017 collected from the patient, decisions that have been made about them and details of what they have been told – are only the start. A clear record of the treatment provided and the response to care are also important points to be shared, so are the specialist reports you requested and any correspondence you’ve sent or re-ceived on behalf of the patient. The best way to do this is to start with the right forms. Whether you use elec-tronic health records or pen and paper, the right templates with diagrams, charts and blanks to be filled in will facilitate quick documentation of all the impor-tant facts. The most useful form in a patient’s file is a simple Report of Findings form – a point by point summary of their problem, your findings, your diagnosis and your recommendations for care (i.e. the treat-ment plan). The patient gets a copy of it on their second visit – your message is clear, in black and white. You heard them, you examined them, you know what’s wrong and you know how to help them. www.canadianchiropractor.ca
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