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Introduction
Recently, New Jersey legislation codified a broader range of healthcare services that may be offered by chiropractic physicians with the requisite training and experience (formerly A2029, now P.L.2009, c.322).
These changes to the statutory scope of practice – in tandem with the acceptance of chiropractic as an effective alternative to some allopathic treatments – may place greater responsibility on the chiropractic physician to be transparent with patients about the scope of services provided and what specifically the patient can expect or should not expect from your practice.
As healthcare risk professionals, we do not endeavor to address every aspect of those services permitted by chiropractic physicians under the NJ regulations, but rather, we will look at a few of the ramifications and potential exposures to risk that may confront chiropractors as a result of this expanded scope of practice, particularly as these relate to the prescribing, administering and dispensing of nutritional supplements and providing nutritional counseling.
Specifically, we will look at the patients to whom you provide healthcare services, the issues to consider when providing nutritional supplementation for patients taking prescription medications, and continuing education requirements under the revised regulations, particularly as these requirements apply to documentation.
Get to know your patient
Why is your patient your patient? Find out. Learn about (and document) the patient’s objectives: does s/he see you as a member of the healthcare team or does the patient perceive you as his/her primary care provider (PCP)? If you are a member of the team, document the contact information of the primary care provider and encourage the patient to be forthcoming with the PCP about the services and nutritional supplements you provide. TIP: Be mindful that your patients may fail to disclose complementary treatments and supplements to their PCPs, often due to fear of physician condemnation. The trend regarding a lack of physician acceptance of alternative therapies, however, is changing as more medical schools incorporate courses in complementary and alternative medicines.
If, on the other hand, in the patient’s mind, you are the PCP, or the patient does not have a PCP that they see regularly, there is greater responsibility to fully understand the patient’s goals and to have a thorough working knowledge of current/past medical and familial histories. And you need to proceed cautiously!
You, as the chiropractic physician, must go to the lengths necessary to ensure that your patients understand the scope (and limitations) of your services. Be proactive in addressing any misperception the patient may have about your capability to substitute for other care providers (such as an MD or DO). Remind your patient that, as a chiropractic physician, you are trained to provide services to complement traditional medicine. Failure to make this distinction creates a greater exposure to undesirable liability (For example, consider those patients who need colonoscopies, mammographies, and so forth).