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 offer 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, and carefully review each patient’s medical history.
• Determine whether gaps exist in the patient’s health information or medical histories that might indicate nonadherence to recommended care and treatment.
• Consider whether the patients’ health records indicate a history of multiple complaints of vague symptoms without clear etiology.
• Discuss the patients’ expectations and assess whether they are realistic based on the standard of care, the patients’ conditions, and other relevant factors.
• Ask patients why they are choosing your chiropractic practice and about their long-term goals. Be mindful of whether the patients seems evasive in answering these questions or questions about previous care.
• Pay attention to whether patients mention dissatisfaction with previous chiropractors, and whether they have a history of chiropractor shopping.
• Determine whether patients have to travel a long distance to get to your office and whether they have transportation issues.

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

When you do decide to accept new patients 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 patients.