T he importance of observation is ironically often "overlooked" in the office setting as we go about daily business. This article is intended to open your eyes to the importance of what CAs see, hear, and document in the realm of patient presentation, patient feedback, and as a witness for your DC, as well as what can happen when a CA makes discoveries that the doctor may not have seen yet Patient Presentation and Feedback As the first line of defense in an office, the front desk CA is typically the first health professional to see patients when they walk through the door. Sure, the patient fills out paperwork, but you can provide the doctor with additional intangible clues that could be very beneficial to patient outcomes. Let's look at a couple of scenarios: The patient in the lobby may write "neck pain" or "headache" on the intake form, but perhaps you overhear the patient tell a family member about having trouble speaking. This would be an important detail to add to the record. It also happens to be a warning sign of possible stroke. Double check with the patient and ask, "Did I just hear you say that you are having trouble forming your words?" Then let the doctor know immediately because this patient may need a 9-1-1 call. If it is a stroke, you could save that patient from lasting damage by acting quickly; they are clearly in the wrong office and need emergency care. For low back pain patients, your observations can also be of service. You would certainly notice if the patient arrived with a walker or wheelchair. Some patients arrive lying down in the back or front seat of a car. If you see that happen, jot down a note for the doctor and let him or her know you made a note. Did you notice if the patient took great care when sitting or standing? Or had difficulty? Did the patient need help to sit or stand? These could be helpful side notes for your doctor. On another note, let's say you have a patient claiming personal injury damage and deficit (I can't walk, I can't bend, etc.), but you clearly observe him or her in the parking lot doing backflips. Perhaps you also observe patients change posture or demeanor when they know they are being observed by office staff. Tickle your doctor's ear with this kind of information, but do so privately and with much discretion. Hopefully, those types of cases will be few and far between. Observing High-Risk Patients During an Adjustment Your doctor may occasionally ask you to come into the treatment room and observe high-risk encounters. What is "high risk"? It would be any situation in which the doctor feels a witness may be prudent. "Danger" areas of the body might include those around the breast/ribs, flank, buttocks/sacrum, or pelvic girdle. Some patients could perceive being touched in these areas as flirtatious or harassing. As you know, however, DCs often do need contact in these areas to issue an adjustment. Certainly, the DC should always explain this before touching the patient. However, in many instances, the patient will feel more comfortable if a CA is the room too. So your presence is two-fold because you put the patient more at ease and you serve as a witness for the doctor should the patient ever decide to make an accusation. If the DC calls you into an exam room, make sure you greet the patient and then watch the adjustment. To be a good witness, you shouldn't be looking at the patient's chart or be taking notes; you need to visually witness the encounter. On a similar note, there may be a situation with a flirtatious patient. Sometimes patients have crushes on doctors, but usually they don't act on it. However, if you hear a patient talking flirtatiously about the doctor, you may want to the let the DC know and offer to step into the room during the adjustment. No one likes an uncomfortable situation. There have been patients who would go so far as to bring nude photographs into the office or even purposefully disrobe rather than putting on a gown when trying to get this type of attention. In the most severe cases, the doctor will transfer care of the patient to another office to alleviate the situation. If you are in the room and keep an eye and ear out for warning signs, it can reduce risky situations for the office and unjust accusations against your doctor. Making Discoveries Unseen by the Doctor The doctor is in charge of the exam and treatment, but there may be times when you see the patient first. Perhaps this occurs when taking a measurement or blood pressure, or maybe during a visit when the patient didn't put on a gown until physiotherapy, so the DC may not have seen the patient's skin. If you ever note a rash, lesion, or suspicious mole on a patient, please let your doctor know, particularly if it's on the back or any other region the patient can't readily see. The patient could be having an allergic reaction or need to have a dermatologist look at a mole. If the patient can't see it, the visit to your office may be the only place it is noticed. You will recognize a red blotchy rash easily. It's important for the DC to determine the cause. If the patient is reacting to a medication, a phone call to the patient's MD will be prudent so that the medication can be stopped and changed immediately before an anaphylactic reaction could occur. A suspicious mole could be another story. The signs of a suspicious spot include asymmetry from side to side, varying levels, varying pigmentation, bleeding, itchiness, or excessive size. The doctor may take measurements and monitor it for changes, or may send these directly to a dermatologist. Training is Key Baseline knowledge is always beneficial to have if you work in a healthcare profession. Tell your DC that you'd like to go through training. Online training programs in particular make high-quality training affordable and convenient, and can be done outside ofofficetime.Atwww.CCCAonline.com, learners can engage in a streamlined 24-hour training program that meets or exceeds FCLB guidelines in every area of study. DCs will often pay for their employees to train. Full price for training is an affordable $339 for the entire 24-hour program. However, www.CCCAonline. com also has special discount programs available for COCSA state association members, participating colleges, and other organizations. Ask your state association for your specific discount code. Not a member? If you are reading this article in The American Chiropractor magazine, you can still enjoy a discount by using AMCHIRO as your discount code. When you enter this code during the registration process, it automatically provides a $15 discount off the regular price of the program. This is the program that gives back to the profession. Learners can expect text, images/schematics, dynamic video lectures, and robust customized experiential inter-activities in a thorough 19-module program. There is also an extensive note-packet of nearly 200 pages included that can be downloaded, printed, and studied off-line. Learners work at their own pace and can conveniently take programming around work hours to avoid disruption in the office. Questions? Visit our website or send us an email at [email protected] Laurie Mueller, DC served in private practice in San Diego, California. She was the post-graduate director at Palmer College from 2000-2010; served as the ACC Post Graduate subcommittee chair for 6 years; peer reviewed for the Research Agenda C onference, and wrote the informal role determination study that aided in the development ofFCLB's guidelines for chiropractic assistants. Dr. Mueller currently works as a private eLearning consultant with a focus on healthcare topics and functional medicine through her company, Impact Writing Solution and subsidiary www.CCCAonline.com. She is a clinician, an educator and an expert in online educational pedagogy.
