More so today, than ever before, the chiropractic profession enjoys visibility and integration within the mainstream of healthcare delivery. Long regarded as an adjunctive therapeutic modality, many patients are seeking chiropractic care as a first line of treatment for a broader spectrum of health and pain control issues. Mainstream acceptance, however, invites scrutiny as demands for use of techniques and equipment increase. This scrutiny can lay the foundation for allegations of malpractice heretofore aimed primarily at medical and osteopathic healthcare professionals.
Not every chiropractor offers the same spectrum of services and the employment of any technique or equipment assumes appropriate patient selection, adherence to governing and licensing regulations, and that the provider has been fully trained, proctored (as required by a specific procedure or piece of equipment) and regularly participates in continuing education activities. Risk management and patient safety models further assume that recommended routine maintenance is performed to assure the public and oversight authorities that the services provided are safe to a very high degree of reliability.
This article addresses two therapeutic modalities about which our Risk Services Department has received questions. We will discuss potential risk issues for each, as well as examine the means to mitigate liability or exposure to risk while increasing and enhancing patient safety.
Laser therapy
Lower level laser therapy (LLLT) produced by Class III lasers and, more recently, Class IV, or high level, lasers have been used to treat musculoskeletal disorders, arthritis, reduce inflammation, speed the healing process, as well as being effective in the management of pain.
Optimum therapeutic benefit appears to be influenced by the ability of a laser to penetrate layers of skin, fat, muscle, etc. It is reasoned that the higher the power of the laser, the deeper the penetration and, therefore, the better the therapeutic result.
Every treatment has its potential risks and laser therapy is no exception. To be risk proactive, you consider the following when using or intending to use laser therapy:
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The patient meets established criteria to ensure the best possible outcome, such as adherence to instructions, proper weight control, appropriate and reasonable activity levels, proper nutritional status and intake and s/he provides an accurate, complete list of medications to review for photosensitivity.
Patient circumstances, such as pregnancy (for laser treatments of abdominal and lumbrosacral areas), pacemakers (for laser treatment around the thorax), meds (as noted above predisposing a patient to photosensitivity), protective eyewear for the patient and other health concerns such as cancer, anticoagulation and immunosuppressive conditions, and so forth.
As a laser operator, you are fully trained by the manufacturer or its certified representative to use the equipment, a state-licensed professional, taking and reviewing a thorough medical history to identify any potential contraindication, taking and reviewing a complete medication inventory, maintaining a routine and current maintenance schedule, properly documented, as recommended by the manufacturer, documenting a thorough informed consent discussion with the patient prior to any laser intervention, addressing possible sensations, increased heat, post-treatment effects, etc. and providing periodic progress reports to the referring physician as the individual patient situation warrants
Manipulation Under Anesthesia
Manipulation using twilight sedation has been utilized for decades in treating chronic pain in the neck, back and joints, as well as treating pain from long-term disabilities, accidents and injuries that have responded poorly to other conventional treatments.