Who are your patients?

If you had to compile a list of all your patients, you’d no doubt record the names of everyone who comes in for care and pays you for their visits.

But what about the friend who works down the street and drops by now and then for a quick adjustment? What about your neighbor, who phones you at home for health care advice? What about your C.A., who receives chiropractic adjustments as a fringe benefit of employment? What about your sister who needs a few adjustments while in town for a visit?

Are these people considered patients?

The question is important, since under established legal principles, malpractice charges can only be filed by an individual who was in a doctor-patient relationship with you.

For most of your patients, the answer is straight forward. You provided a consultation, examination or adjustment, were paid for your services, and kept proper records for each visit. They’re definitely patients!

But there are many other people who aren’t so easy to categorize since, according to the courts, a doctor-patient relationship doesn't require a formal setting or arrangement. EVERYONE you adjust is legally considered a patient, including friends, employees and even family members. Furthermore, you don’t have to even provide hands-on care -- even a seemingly casual conversation can be construed as establishing a "doctor-patient relationship" if the person asks for advice or assistance specifically because you are a chiropractor. Establishing a doctor-patient relationship can take as little as a single conversation.

According to attorney Lynne Dakers, doctors “can no longer expect that direct face-to-face contact or a formal consultation is required to form the basis of a physician-patient relationship ... courts are increasingly broadening the definition of the doctor-patient relationship, sometimes finding a relationship in situations where traditionally none existed.”

Although there are, so far, few legal cases on the topic, the rise of telemedicine has prompted many legal advisors to suggest that an e-mail may establish a doctor-patient relationship if the message sent by the doctor is asked for or gives health care advice.

In informal settings, a plaintiff can argue that he or she asked for help with the expectation of receiving appropriate advice from a doctor of chiropractic, not merely a friend or acquaintance. If the person can show that a doctor-patient relationship was created, you will be held to a "reasonable standard of care" in the case. That is, the court will decide whether the action you took was one that most doctors of chiropractic in your community would have taken under the same circumstances.

In order to protect yourself from this kind of lawsuit, you need to be just as careful about providing advice and care in an informal setting as you would in your office. Giving friends and neighbors a "quick adjustment" without examining them for subluxations or providing medical advice that is beyond the scope of chiropractic practice, can expose you to the risk of malpractice charges. In addition, you need to keep records for every patient (including family members!).

You may have limited office hours, but you're a doctor of chiropractic 24-hours every day, and you need to protect yourself at all times.

SOURCES: “Establishing the physician-patient relationship,” by Lynne Dakers, JD,  “The Reporter” Texas Medical Liability Trust, July/August 2000.