adjustment, normal an typical aren't part of the discussion. Our failure to monitor the patient, our failure to document what's going on, our failure to stay with the patient and our failure to develop a thought process about what's going on will accrue to our detriment and to the patient's detriment over time. Our failure to manage this thing properly and to be responsive to the best interest of the patient, because we don't want an ambulance coming to the office or we don't want a gurney coming to the waiting room when it's crowded, whatever consideration maybe offered, it is absolutely no defense. The best interest of the patient has to be served at this moment. Readjusting the patient at that time. This is the single most common complicating factor that takes an unfortunate situation to a bad situation or a bad situation to a disaster situation. If we will stop what we're doing at that point, not introduce another thrust until this situation is evaluated and calms down, we will see a significant percentage of this problem go away. If you appreciate the fact that up to 50% of this problem could be identified on the front end to recognition of the phrase "a pain unlike anything I've ever had before in my life," and another significant percentage of this problem can be minimized by not delivering that second adjustment or that third adjustment. We now have a situation that is way more manageable, and maybe we're talking 66% to 75% of this problem is behind us, and is never realized because we understood those two factors. If the patient is in a compromised neurological state or moving in that direction and you take the perspective that you're going to send them home to rest and send them home to relax, and so on, very unwise decision. If they're neurologically compromised they belong in an emergency room. They don't belong in their living room. They don't belong under the care of their spouse, they belong in an emergency room. If you take a casual approach to this situation, "You know. Mrs. Smith, you might want to see a neurologist. You might want to stop by the emergency room." This is not a might-want-to environment or might-want-to moment. This is, we're-going- to-see-that-you-get-to-the-emergency-room moment. Failing to document what you did, what you were thinking, being less than honest and explicit in the record. I've been involved as an expert witness on a number of professional liability cases in defense of chiropractors. Once a chiropractor fails to be honest in the record or misleads anything to do with the record all bets are off. That cannot be rehabilitated. When you're involved in this situation, be honest, be truthful, be forthright. If you're less than honest, if you disclosed less than all you should, then down the road if that information comes forward you cannot recover from that. You should always have an action plan in your office. As I've discussed earlier, if your staff isn't watching this with you, you certainly should have meetings about what happens in your office if an emergency takes place. Do you have an action plan? Does your front desk have emergency numbers at their disposal? Do you go through possible scenarios that could happen with patients coming in to your office
Dr. Stu Hoffman:
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