Screening New Patients for Potentially Problematic Behavior

Managing patients who have difficult behaviors or who are nonadherent with their care plans is a persistent issue that chiropractors face. If a patient who has these issues is already under your care, various risk management strategies can help you manage the situation. However, difficult patient behavior and nonadherence still can be frustrating, stressful, and time-consuming.

Initial consultations with new patients present chiropractors with a unique opportunity to identify potential signs of difficult or nonadherent behavior. By proactively screening for such issues, you might determine that some patients are not a good fit for your practice before establishing a duty to care.

Below are some considerations for screening new patients for potentially difficult or nonadherent behavior:

• Obtain the patient’s health records in advance, if possible.
• Determine whether gaps exist in the patient’s health information might indicate nonadherence to recommended care and treatment.
• Consider whether the patient’s health record indicates a history of multiple complaints of vague symptoms without clear etiology.
• Discuss the patient’s expectations and assess whether they are realistic based on the standard of care, the patient’s condition, and other relevant factors.
• Ask the patient why he/she is choosing your chiropractic practice and about his/her long-term goals. Be mindful of whether the patient seems evasive in answering these questions or questions about previous care.
• Pay attention to whether the patient mentions dissatisfaction with previous chiropractors.
• Consider whether the patient has a history of chiropractor shopping.
• Determine whether the patient has to travel a long distance to get to your office and whether he/she has transportation issues.

If you decide that the patient is not a good fit for your practice, do not charge the patient for the initial visit. Tell the patient that you cannot meet his/her needs, and advise the patient to find another chiropractor.

If you decide to accept the patient into the practice, clarifying boundaries, limitations, and expectations is essential. A thorough informed consent process can help establish expectations related to treatment and procedures. Documentation of the  informed consent  process and all patient education will help reinforce your efforts to clearly and thoroughly communicate with the patient.