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Dynamic Chiropractic Canada – January 1, 2009, Vol. 02, Issue 01
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Donít Worry, Be Happy

By Allan Freedman, LLB

Why is it that newspapers don't report planes that land? Why is it that the million chiropractic adjustments that go exactly as planned are unreported? Simply, good news doesn't sell as well as bad news. Nevertheless, let's deal with the good news.

First, a report that dealt with professional discipline in the '90s indicated that more than 92 percent of all complaints concerning professionals did not deal with core competency. So, where did the complaints come from? Inappropriate billings, sexual abuse and communication. It is the responsibility of every chiropractor to ensure that the bylaws, standards, guidelines and policies of the profession in their jurisdiction be examined, reviewed and memorized. What is the moral of the story? If you practice what you have been taught, do what the rules say you can do and what you ought to do, and meet the minimum standards for a chiropractic practice, you will likely go through life not having to look over your shoulder.

Second, the scope of chiropractic practice provides for extremely beneficial care for patients. Through the use of legislation, chiropractic, over a millennium, has established its effectiveness and validated the necessity and need for governance and regulation synonymous with other health care providers. But with every right and privilege comes a duty and an obligation. Legislation that establishes a profession in effect establishes a monopoly which requires education and licensing for the purposes of becoming a member of the profession. A failure to live up to the standards of a professional practice may well amount to a breach of public trust - if not actionable, at least in the moral arena.

Third, the practice of chiropractic can exist within a multidisciplinary practice. There is great opportunity for chiropractors to participate in a practice in which the services provided to patients involve not only chiropractic care, but also massage therapy, kinesiology and conventional medicine. The chiropractor may be an associate in the practice, but they may just as likely be the owner of the practice.

However (and I expect that by now the reader is expecting a however), there are matters that must be dealt with so that a practitioner does not have to look over their shoulder. Namely, make sure the practitioners enter into a written agreement that deals with all contingencies; make sure that if the practitioners are expected to be independent contractors (maintain their own business status as far as expenses and taxes are concerned); enter into proper documentation to ensure the validity of the relationship; ensure that signage is proper; ensure that the practitioners comply with appropriate regulations and statutory obligations; etc., etc. Do not attempt to traverse the mine fields without professional assistance.

Fourth, a chiropractor has the privilege of establishing a primary health care practice. There is no necessity for a reference from another practitioner. However (again, the however), be wary about stepping from the customary and usual practices and, as a result, gaining an additional and possibly unnecessary risk. It is important to ensure that when undertaking a particular mode of practice, the practitioner complies with the legislation, regulations, standards, policies and guidelines of the applicable jurisdiction, whether that relates to issues of educational compliance, consent to treatment, experimentation or billing matters. Keep in mind that when dealing with professional standards and practices, willful blindness to legislation is no defence.

Fifth, a chiropractor may dispense orthotics. However, given the ability to prescribe orthotics for patients, a practitioner must ensure that their practice passes what might be described as the "stink test." Namely, the practitioner must do all things that would be required for them to provide an adjustment (i.e., history, examination, diagnosis and plan of management).

The practitioner must not be in the business of selling shoes; the dispensing of the orthotics must not be based upon insurance coverage; there must be justification for the prescribing of the orthotic; and there must be follow-up visits to deal with the dispensing of the orthotic, as there would be in dealing with any health care issue.

Sixth, a chiropractic practice allows for a transition from one practitioner to another practitioner. It is almost inevitable that, while the practitioner has enjoyed a long, healthy and happy professional life, the time will come when they will voluntarily or involuntarily resign from the trials and tribulations of practice. If the practice was created and maintained in a professional manner that provided proper business protocols and applied the best tools for the operation of a chiropractic practice then, at that time, a chiropractor may well have a professional practice which is suitable for transfer to another chiropractor and has monetary value.

If so, it is imperative that the transfer of the practice be done in a professional fashion that benefits the seller and the buyer. A proper transfer of a professional practice is not only beneficial to the parties of the agreement, but also of great importance to patients and the profession.

So, in the daily grind, when reading the reports of bad news and worse news, keep in mind that the good news is it is a pleasure and privilege to be a chiropractor. Becoming a chiropractor took many, many years; a great deal of effort; a great deal of resources; and the help of many people. In short, it is a privilege afforded to the very few. The good news may not be reported each day, if at all, but as professionals, we know that we are given the right to provide services few others can. It is truly a privilege that should not be abused.

Be well and be good!


Allan M. Freedman graduated in 1974 with a law degree from the University of Western Ontario and has been an instructor at the Canadian Memorial Chiropractic College since 1976. He can be contacted with questions and comments at www.allanfreedman.blogspot.com.

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