We cannot escape regulation. Whatever we do in our practices requires that we learn our rights, scope of practice, standards of practice, and choice of therapies and modalities. Virtually no activity in clinical practice escapes regulation. However, all too often, practitioners employ a "shoot-from-the-hip" approach to case manageinent, where the doctor or therapist applies his or her own individualistic methodology, on a case-by-case basis, using the patient as a guinea pig. But things are changing. A highly significant trend in healthcare has been the development of utilization guidelines. Evidence-based healthcare is driving the need for guidelines and, increasingly, the evidence exists to support (or refute) the use of various treatments for commonly encountered conditions. Guidelines are framed as recommendations for best practices in prevention, diagnosis, and the treatment of common conditions. Essentially, utilization guidelines recommend initial treatment for anticipated clinical situations and then attempt to answer the question, "What next?", if a patient doesn't respond as expected. Guidelines are not meant to replace a practitioner's judgment or expertise, but provide a ready reference for case management. Additionally, patients benefit from knowing where they stand in the treatment process and why. Despite their shortcomings, utilization guidelines represent a welcome new era of rationality to what has traditionally been perceived as the least scientific of disciplines— manual medicine. In the future, they may serve to displace the HMO-imposed six or less visit "screens" that dominate case management today (having gone largely unchallenged from a scientific standpoint). Ultimately, guidelines may serve to reduce the lack of standardization in case management between individual practitioners and may standardize the outcomes expected from therapeutic intervention. Dr. Mark Sanna is the CEO of Breakthrough Coaching, LLC, a leading resource for personal coaching to chiropractic and multi- disciplinary practices throughout the country. He can be reached at Breakthrough Coaching. LLC. by calling 1-H00-7-ADVICE.
