ANATOMY IN ACTION SERIES:TOP 10
Educational articles designed to help CAs understand the underlying anatomy and physiology of conditions presenting to the chiropractic office.
Laurie Mueller
BA, DC, CFMP
Introduction
Since the TAC CA supplement began, we have discussed a variety of topics as they relate to anatomy\ patient care, and physiotherapy modalities. With this issue focusing on risk/ malpractice and social media, we've decided to create a David Letterman-style top 10 list for you (dang, we miss him). We'll get back to anatomy subjects in the next issue, but for now, and with an attempt to mix some good humor with good advice, here are CCCAonline's top 10 no-no's...ahem, risk-reducing reminders.
10 Do not talk to patients regarding anything to do with the current most volatile subject guaranteed to incite disgust and anger in all citizens. Politics. (Cricket noise, cricket noise). Seriously. No good can come from it. It may not be a blatant "risk of malpractice" issue, but it could risk patients becoming so agitated that they find another office for treatment. People are already emotional train wrecks about this past election, and emotional people with back pain are a very scary combination. So remember, even if you are discussing politics with someone of "like mind," a patient of different thinking may be listening and decide the office is not for him or her anymore. Keep office talk professional and maintain a peaceful politics-free zone for all humans to feel welcome and relaxed.
9 Never bring up patients or cases on social media. The big loud red privacy alarm should be going off in your head right now. Do not post, tweet, share, Snapchat, or anything else! "I felt so bad when 'Becky Back Pain' came in today. She could barely walk! Becky, I hope you are feeling better." That is bad. Very, very bad. Even if the patient is your friend and you are posting something nice, you must remember that you are a health professional and bound by HIPAA. Thus, your innocent post could become a HIPAA privacy violation for the office. If you are a per-
sonal friend of "Becky Back Pain," then give her a phone call and ask how she is. No social media. Further, if Becky posts something about her own pain, don't comment on that either. Back away from the smartphone, friends. Our rule of thumb to keep you out of hot water is that there is no office talk outside the office.
8 Hey, baby, do not forget about what you may not see. This means you need to ask all female patients of childbearing years if they are or could be pregnant. Cute little guys and gals in utero can be adversely affected by a variety of office activities, including radiation from imaging and/or performing certain modalities, like electric muscle stimulation, ultrasound, etc. Your doctor will adjust the patient's typical management plan for those types of things if a patient is pregnant. But in general, pregnant women (as if there are pregnant men) very much enjoy the relief that an adjustment can bring to their ever-changing physique and the new stresses they feel on the spine and pelvis. Gitchy-gitchy-goo, chiropractic's good for you!
7 Repeat after me, "If the doctor asks you to come in and 'help' or 'take notes' or 'observe' an adjustment, there is a reason." DCs are fairly independent creatures, but they do need assistance occasionally. Like any good 007 (double-oh! seven), you may be invited into the room to help reduce risk. Particularly, for example, if a male doctor has to work on a female patient in red flag areas like the ribs (around the breasts), thighs, buttocks, or sacrum. You getthe point on how some patients may take this in a way not intended. The same could be true, however, if the doc is trying to be culturally sensitive to a patient's needs, such as when a patient is uncomfortable with being touched or being alone with the caregiver. The doc may also invite you in if he or she is dealing with a weirdly flirtatious or provocative patient to avoid any precarious situation. (Yes, there are some aggressive patients that think
a trip to the office is akin to a nightclub and is part of their potential personal dating pool.) The key to your presence in the room is your eyes. Do not look around at posters, look down at notes, read a People magazine, nap, or shake up a martini for flirty Fiona. Make sure you are watching the entire procedure because if an incident ever became of it, you will be the key witness.
ATTENTION ALL PATIENTS
Tell the doctor/assistant about:
• Recent surgery/medication changes
• Open wounds
• Lack of sensation
6 Records—and this ain't your papa's old album collection. Never. Ever. Skimp on records, falsify records, or make up information for records. "Let's see. What did I do to 'Becky Back Pain' six hours ago?" Remember that these are legal documents. Accurate documentation is critical and there are organizations, such as insurance carriers or Medicare, that can audit the office, and fines or other ramifications could ensue. Less is not more, but more is not better either. Just be concise and, above all, accurate. Medicare needs very specific information included in a certain way. (There are classes for that). When you document
activity, be thorough, date it, and initial it. Our best advice is to take records at the time of service so you don't forget anything. Help your doctor do the same by double-checking files of the day, flagging those needing attention, and hitting him or her over the head with it.
5 Take care not to make bad situations worse. Patients have enough trouble. Remember to ask, and post a sign if you must, but make sure you know if patients have things such as open wounds, lack of sensation, implants or joint replacements, pacemaker or defibrillator, circulatory issues, or other changes, including surgery, medication, or pregnancy. All of these types of conditions can affect their treatment. Ask, ask, and ask.
4 Do not burn your patients or damage their tissues. Simply put, they don't like it. For all modalities, ensure proper settings and that wires leading from the machine to the patient are intact. For EMS pads, you want to ensure proper adhesion to the patient (if a pad is split or cracked, don't be cheap—just throw it away and get a fresh one), do not leave the patient unattended, and ask the patient to tell you immediately if anything hurts or burns during the treatment so that you can shut it off. For ultrasound, ensure that you are using ample
amounts of conductive gel/medium and that you keep the head moving or it can build up excessive heat deep within the tissues. I'm also here to tell you that size does matter (awkward pause)...when it comes to choosing the right EMS pads for your patient's treatment. For best results, choose the pad size to fit the anatomy properly and place pads mindfully to target the specific tissue at hand. A pad too big can extend over unwanted areas and disperse too much current, and a pad too small may not do the job. Fit the pad to the job. Period. (Female joke).
3 Never be dumb! Remember that the only dumb question is the one never asked. So, always leave your ego at the door for the sake of patient safety. Doctors look up information all the time to be sure of things, so there is no need for CAs to be "know-it-alls." The CA training manual does not state, "If you are unsure of something, then just do whatever you want, but make sure you pretend to be confident so that the patient will think you know what you are doing." If you are unsure of something, ask (procedure, palpation, setting, etc.), and if a patient tells you something new, like "I'm pregnant" or "I just got a pacemaker," then please stop, interrupt the doctor, and ask if the doctor is aware of it and wants to proceed as planned. You are a second line of defense and your doc will be very grateful that you double-check!
2 This should not even have to be said, but here I go. One should never use modalities overthe carotid sinus, thyroid gland, eyes, transcerebrally, or overthe gonads. (Really?! Who would even think of doing that? Rhetorical question.) Any of the those could create, well, a detriment to your patient. Eyes and gonads are pretty self-explanatory, and you know where they are and to stay away. If you are working in the neck and are unsure of howto find the thyroid or carotid sinuses, please ask your DC to show you howto palpate them. EMS or ultrasound overthe thyroid can actually stimulate the gland to produce a hormone surge, and if placed by the carotid sinus (on either side of the neck near the carotid pulse), you can actually stimulate baroreceptors (type of nerve) that lead to the brain and help control blood pressure. Fainting patients will not make your day good.
1 Lead-in music for number one and a drumroll, alease. If you ask patients to "gown up" for treatment, we ask you to please, for all of us with eyes and all that is good in the world, remind them to leave the opening at the back and remind them to leave their undies on. Oh, the stories that have been told have been very scary indeed! Communication is key and what seems like an everyday thing to you is not something that the patient is used to or will remember. One CA told an 85-yearold patient to go ahead and remove his clothing and
handed him a gown and closed the door. When the doctor arrived, the man was standing buck naked holding the gown. Don't let this happen to you! Give quick, clear directions to save everyone potential embarrassment, and so that your doctor doesn't walk in the room, open the gown, and have to gaze at a full moon or more. (Gulp) And pay special attention to flirty Fiona if she has to gown up—you better be in the room with the doctor that one. Best case scenario is embarrassment, but worst case is an accusation of sexual harassment. Also, don't forget to tap on the door and wait for a French answer like entrer (recall entree is a food main dish) or an invitation like "come in" or "ready" before entering to ensure the patient is covered and ready for the door to open.
Education Fosters Understanding
An understanding of anatomy and clinical applicability helps CAs better communicate with patients and provide care more safely. Online training programs make high-quality training affordable and convenient and can be taken any time of day. At CCCAonline. com learners can engage in a streamlined, 24-hour training program that meets or exceeds FCLB guidelines in every area of study and fulfills the training requirements needed forthe national examination. DCs will often pay for their employees to train! Full price for this training is an affordable $339 for the entire 24-hour program. CCCAonline.com also has a special discount available for you. If you receive this article through The American Chiropractor magazine use AMCHIRO as your discount code. When you enter the 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. Plus, an extensive note-packet of nearly 200 pages is included and can be downloaded, printed, and studied off-line. Learners work at their own paceand can conveniently take programming around work hours to avoid disruption in the office. Questions? Visit our website or send us an e-mail at [email protected]
Laurie Mueller, BA, DC, CFMP, served in private practice in San Diego, California. She was the postgraduate director at Palmer College from 2000 to 2010; served as the ACC postgraduate subcommittee chair for six years; peer-reviewed for the Research Agenda Conference; and wrote the informal role determination study that aided in the development of FCLB ,’v guidelines for chiropractic assistants (CCCAs). Dr Mueller currently works as a private eLearning consultant with a focus on healthcare topics and functional medicine through her company, Impact Writing Solutions LLC, and the subsidiary, www.CCCAonline. com. She is a clinician, an educator, and an expert in online educational pedagogy.
