Advice

[Guest guest]

I sent this email to a friend of mine - I would like to get your input on this. I am scheduled to fill-in at this office again on Friday which would be my last day.

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 I am substituting at an office today. This week in fact. Its an auto accident type of franchise, called F*** Chiropractic owned by a Dr.P****. Several problems - first of all all the notes were pre-written when I came in - the treaetment etc was there - I was just to add an orthopedic test etc if I did one, and then write an assessment that comes from a prescripted set of about 20 sayings that are devided into 3 categories based on their anticipated progress - sayings like : stage 1 "Feels same but likes treatment", stage 2 "slowly progressing", stage 3 "almost done".  I won't do it - I am kind of marking through it as a see it - if an orthopedic test is now negative, even if they are in what he has as stage 1 (he wants an average of 25 visits per patient regardless) I mark the test as negative or normal. I am actually writing negative because I don't trust this guy not to take a " (-)" finding and change it to a " (+) " by marking vertically through the (-).

 

A patient was better today and I recommend to the CA's that his treatment plan be reduced - he reported no pain and had no positive ortho findings and the CA's told me - he is still 3 X week for X number of weeks. It does not matter what the patient is really like, they just create it for insurance. Their notes are good - too good in fact - as they do notactually do what charting is supposed to do : acurately reflect what the patient felt, what was observed, what the assessment was and what was done. Today I noted one patient record in which someone added notes after I was completely done stating that "the patient noted increased stiffness after therapy" - that was not there the day I treated the patient and for some reason (added reason to continue treatment on a patient who in reality is asymptomatic?) was added later, however who added it is unkown to me.

 

Tell me what you think of this - a patient was in a car wreck a month ago, her neck is much better she says, her low back is much worse.  On the first visit her only positive ortho finding was a positive Kemps on the left. Today she had a positive SLR at 90 degrees on the right, Positive braggards on the right, positive gaesnlens on the right, positive yeomans on the right and her complaint was of right sides lowback pain. Valsalvas and dejerines were negative. Muscle strength testing was normal 5+, tenderness around her right SI. No bowel changes or leg weakness noted.

 

Accident was 10/16/06. her signs and syumptoms werre progressing  up to 10/30. up to this point they were doing ice on the lowback with EMS. They are no longer using Ice.

 

I recommended the use ice again and consider altering treatment (it has just been lumbar rolls). Pain was rated a 9 on the initial visit 10/16/06 and is roughly that now.

 

The CA's say it is from an epidural from childbirth (youngest child is now 5 years of age). They would not follow my advice to alter her treatment.

 

I left a note for the doctor - any other suggestions? I am not comfortable with notes that are 80% done before I do anything - in advance, and CA's that won't consider my suggestions.