William E. Morgan, D.C.

Many in chiropractic have selected the wrong measure of a healthy, successful practice: total patient visits, patient visit average or the number of new patients. A better measure of long-term success is your number of completed cases. This is especially true if you have an integrated practice that welcomes medical referrals.

What is a completed case? As the name suggests, it is a clinical case that you have brought to conclusion. Not all completed cases are cured cases or even successful cases. Even with those you are unable to help, you owe it to your patients to professionally and ethically see their cases through to a logical conclusion and refer them to someone who may be better able to help them. A completed case does not require you to permanently release patients from your care. You may complete a case when a condition plateaus but recommend that the patient return on a regular basis for palliative or continuance care. If you feel that a patient has reached a maximum benefit from care, but periodic additional chiropractic care will prevent relapses, complete the case and return the patient to the referring doctor with your recommendations.

If you successfully complete cases, your patients will refer others to you and the medical doctors who refer to you will gladly continue sending patients your way. I have found that doctors of chiropractic who don't pursue case completion are more likely to resort to desperate means of maintaining a flow of new patients, such as giving free spinal examinations or using telemarketing schemes.

During the patient's first visits, I describe my goals in simple terms. I explain that I will treat them until one of three outcomes occurs: They are made well; they get better to a point and then plateau and become permanent and stationary; or they do not get better (or get worse). Every patient I have explained these definitions of case completion to has accepted them. I then ask about the patient's goals and try to align them with my assessment of his or her condition. I try to persuade the patient to give me a practical measurement that would define success-"I would like to pick up my grandson without pain" or "I would consider this treatment successful if I was able to work with pain that is 2 out of 10 [on an analog scale]."

A physical therapist in our spine clinic asks his patients to write down their goals, date them and sign them. He keeps them in the patient's record. When the goals are reached, either the case is completed or new goals are set.

In addition to personal goals to measure case completion, I like to use outcome measurement tools such as the Roland-Morris questionnaire, pain maps and analog pain scales.

You should have a well-defined plan of treatment, evaluation, re-evaluation and conclusion to all of your cases. Your patient, the referring doctor and any third-party payer should know your specific definition for case completion.

If you do not use well-defined case completion goals and treatment plans, patients may feel-perhaps justifiably-that you don't know what you're doing or that you're just stringing them along for pecuniary gain.

Acknowledgement: J.C. Smith, DC, first introduced me to the value of case completion in his book The Path to Mastery in Chiropractic.