Prognosis and Ongoing Chiropractic Care

The term prognosis is defined by the Merriam-Webster dictionary as:

The prospect of recovery as anticipated from the usual course of disease or peculiarities of the case

Late Latin, from Greek prognōsis, literally, foreknowledge, from progignōskein to know before, from pro- + gignōskeinto know

First known use: 1655

When you are communicating with the medical community, this is where you can really show that you know what you are talking about. If you took a loved one to the emergency room for an evaluation after he/she exhibited stroke symptoms, the first thing you would be looking for would be a detailed prognosis.  Will he/she be okay?  What are the results of treatment?

When we work with patients in our offices, that is what the report of findings includes, but when we are out in the community, chiropractors generally HAVE NO IDEA HOW TO DO A REPORT OF FINDINGS WITH A MEDICAL DOCTOR.  We need to be aware  that our offices are filled with unique individuals and each case has to be handled and communicated based on the merits of a patient’s specific condition. THAT’S WHAT MAKES YOU A DOCTOR and not a technician.

The term co-morbidity is an important part of prognosis and I have found that many chiropractors do not really understand what the term means. Here is the definition:

Co-morbidity

– existing simultaneously with and usually independently of another medical condition

– First Known Use: 1981

Co-morbidity has not been around that long, but is a VERY important term when justifying care to insurance carriers, medical-legal cases, family practitioners and medical specialists.  A recent paper by Farabaugh, Dehen, and Hawk (2010) has a list of “complicating factors that may document the necessity of ongoing care for chronic conditions” in a nice table. This article is reviewed for the Bimonthly MD flier, but I thought it would be useful to include in a consultation as well.  Here is the list (Farabaugh, Dehen, and Hawk, 2010, p. 488)

-Severity of symptoms and objective findings
-Patient compliance and/or non-compliance factors
-Factors related to age
-Severity of initial mechanism of injury
-Number of previous injuries (>3 episodes)
-Number and/or severity of exacerbations
-Psycho-social factors (pre-existing or arising during care)
-Pre-existing pathology or surgical alteration
-Waiting >7 days before seeking some form of treatment
-Ongoing symptoms despite prior treatment
-Nature of employment/ work activities or ergonomics
-History of lost time
-History of prior treatment
-Lifestyle habits
-Congenital anomalies
-Treatment withdrawal fails to sustain MTI (Maximum Therapeutic Improvement)

What is the bottom line?  Examine the patient like a doctor, document the information and report it like a specialist.  SIMPLE and VERY EFFECTIVE!