Risk Management Considerations in Chiropractic

This article stresses the criticality of accurate charting in chiropractic risk management, particularly focusing on the clinical discussion that links findings to recommended treatment. The author advises that while Electronic Health Record (EHR) templates are useful for recording factual exam findings, the DC’s professional opinion and ethical obligations should be documented in a separate, dedicated, non-templated section labeled "Discussion". This addresses risks identified by the U.S. Office of Inspector General (OIG), such as inaccuracies arising from improper copy-pasting or auto-population in EHR systems. A detailed medicolegal case study of a 44-year-old delivery carrier is presented, suffering from chronic lower extremity pain attributed to work injury, along with plantar fasciitis history. The examination revealed specific issues like an antalgic limp, a proprioceptive disorder (inability to single-leg stance without assistance), and pain inconsistent with a simple lumbar dermatomal pattern. The clinical discussion identified a potential Baxter’s nerve entrapment—a key differential diagnosis often misdiagnosed as plantar fasciitis. The proper documentation justifies chiropractic manipulation to break up adhesions alongside essential referrals for potential surgical consult, MRI (to evaluate nerve entrapment), and ankle X-rays (to measure degenerative joint disease), thereby supporting medical necessity and mitigating legal risk.