Case Completion is the Goal
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 implies, it is a clinic case that you have brought to conclusion. Not all completed cases are cured cases or even successful cases. Even with patients that you are not able to help, you owe it them to professionally and ethically see their case through a logical conclusion and insure that they are referred to someone who may be better able to help them. A completed case does not require that you permanently release these 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 are successfully completing cases, your patients will refer and the medical doctors who refer to you will gladly keep sending patients your way. I have found that chiropractors who do not 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 the use of telemarketing schemes.
On the first visits I describe my goals to the patient 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 off and become permanent and stationary; or I treat them and they do not get better…or they get worse. Every patient I have explained these definitions of case completion to has accepted it. I then ask their goals and try to align them with my assessment of their condition. I try to persuade the patient to give me a practical measurement that would define success for them. “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 2/10 [on an analog scale].”
A physical therapist in our spine clinic likes to have his patients write their goals down, date them and sign them. He keeps them in the patient’s record. When those 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 all know your specific definition for case completion.
If you do not use well-defined case completion goals and treatment plans, the patient will feel, possibly justifiably, that you don’t know what you are doing or that you are just stringing them along for pecuniary gain.
Acknowledgement: Dr. J.C. Smith first introduced me to the value of case completion in his book The Path to Mastery in Chiropractic. He is the same J.C. Smith who has become well-known as the opinionated chiropractic blogger with the quirky since of humor. I recommend his book(s).