this summer and 28 years ago this summer, a chiropractor was smuggled into the neonatal nursery at Northside Hospital in Atlanta, Georgia, the fellow that gave me my first adjustment and adjusted her and she is alive today because of that adjustment. I am not an anti-adjustment guy, quite the contrary, I am a pro-adjustment guy, but I am also aware of the fact, that there are times when discretion is the better part of valor. At this point, where this patient may have developed a dissection, I don't know of any type of adjustment, any type of thrust that will cause the swelling in the wall of that artery or the tear in the flap of that artery to reduce or heal spontaneously. That is a matter that is going to take time. That doesn't mean never adjust the patient again, it means at that time be discrete, be reserved, and be cautious. If the symptoms persist, or if the symptoms worsen seek emergency support services. I'm not talking about over hours here, I'm talking about over minutes. Monitor the patient while you call support services. Put the patient in a recovery position and be prepared to answer the questions for the group that shows up to take care of that patient. Let me say it one more time, do not adjust that patient again at that time. Why do I say that? I've said this twice before, let me say it one more time. If the patient is experiencing a dissection, I don't know of any form of adjustment that will minimize the consequences of that dissection. I do appreciate the fact that the introduction of another force into that area of injury may cause greater swelling or greater emboli generation than if we had left the area alone. When your patient seems unstable or in a fragile state after an adjustment because you think that they had a negative response like we've been talking about, never ever let them leave on their own. First of all, you should only let them leave if they have someone to be with them and someone driving them. Second, if you're going to be the doctor call 911. Sometimes doctors have told me, "Patients don't want me to call 911, so I tried not to do that." Well, when it's an emergency situation and sometimes these become emergencies, you don't use the patient's judgment at that point in time. You make sure you do, not only what you're responsible to do but what's right. What's right is getting someone first, medical first aid as soon as physically possible, because that will absolutely affect an outcome. The worst case scenario is you call 911 and there is nothing wrong. So what? At least you did what was right and being proactive for your patient. How do you limit your professional liability outcome in this environment? What can you and I do in this environment to minimize the complications for the patient, for ourselves and for the liability picture? Well, the first and most important thing is that we have to recognize what's going on. Our failure to recognize the developing constellation of symptoms in retrospect will be held against us and quite possibly as it should be. To write off what's going on as a normal reaction to an adjustment or a typical reaction to an adjustment is a mistake in our part.
Dr. Stu Hoffman:
Dr. Gerry Clum:
At this point when we're talking about neurological sequelae secondary to an
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