The Smell Test - an editorial

The Smell Test

The issue concerning when actions and conduct do not meet the “smell test” can be summed up much like in the trial in which the judge was asked to define pornography. His answer was: “I can’t define it, but I know it when I see it.”

From the moment that we each were able to communicate with the world, we had an innate appreciation of what was inherently right and what was wrong. Unfortunately it did not take too long for that understanding to be skewed by our interaction with other human beings. It starts at the television set, moves on to the computer and computer games and becomes entrenched once we are foisted upon the educational system starting at day care, kindergarten or grade one. It seems that simple things like the use of appropriate language, sharing and being polite fly out the window as soon we start interacting with others.

The relationship of individuals and communication between persons becomes even more of an ordeal when an individual enters into a profession. Unlike occupations which may allow for solitude and the ability to act without interaction and communication, most professions, as in the chiropractic profession, require the ability or, at a minimum, the necessity of being able to rationally, reasonably and politely communicate with patients.

We all appreciate our patients or clients. We appreciate their trust and their willingness to place their health, body and soul in our custody. But alas, not every interaction is going to be so pleasurable that the patient’s trust overcomes the “literal pain” that a practitioner has to experience in order to comply with their professional responsibilities. Having to “endure” a patient may well bring to mind that age old adage that “the key to success is sincerity and when you can fake sincerity you have it made”.

Patients are an interesting flock of individuals made up of all kinds of different characteristics, quirks and habits. Some may have chronic problems. Some have acute problems. Each one requires care. However, when in your office they are patients, not friends, not family, not customers, not anything other than patients. And that puts the doctor and the patient in an interesting venue.

The doctor will use of his or her education, experience and repertoire to illicit from the patient all of the information that is required to arrive at a conclusion as to what is required for the patient’s best interests. Of course, depending on what brought the patient into the doctor’s office, the patient may well desire a conclusion that is not supported by the objective testing of the doctor.

If a practitioner has not had a patient in his or her office that has no objective symptomotology; been treated for a complain that should have been resolved months ago; has changed doctors a multitude of times; or is on a disability claim for which the patient is in a state of non-compliance, then the practitioner has not been in practice long enough or is just plain lucky -- and none of us can be that lucky.

A chiropractor cannot become a party to a patient’s economic, social or litigious environment any more than he or she can become sexually involved with the patient. It is an inappropriate relationship that allows for an abuse of the doctor-patient relationship whether in the office or involving third parties such as insurance carriers. The fact that a patient seeks health care is not an excuse to provide care if none is warranted. While at the time of the “visit” it may seem reasonable to provide the care, and whether there is billing for such treatment or no billing, imagine having to review your patient’s file some 2 years hence and in hindsight indicate the necessity, and therefore the validity, of providing that treatment. If it was not justified when provided, it will seem even more inappropriate when looked at by third parties many years later.

A chiropractor is more than a technician. A chiropractor is required by law to assess, diagnosis, create a plan of management, obtain informed consent, refer when necessary, etc., etc., etc. I have no idea of the length, width, breadth or volume of tests that are associated with the profession of chiropractic and health care in general. They must obviously be extensive, and in some cases, are required as a minimum guide to the therapeutic necessity for treatment or non-treatment of a patient’s condition.

I have seen, heard and defended chiropractors who have dealt with patients who desire treatment, beg for treatment; pray for treatment and are grateful for the treatment. But in hindsight when revisited years later, the 160 treatments given without a reassessment; the 10 treatments of a patient over 6 weeks with a cost into the many thousands of dollars; the patient who sought out 6 doctors before finding one who would justify his complaint; or the doctor who had sex with the patient because the patient was lonely and wanted the comfort just don’t satisfy the definition of what a reasonable chiropractor would do in the circumstances. In other words the justification for the treatment does not satisfy the professional standards notwithstanding what the patient may want – whatever the reason for the treatment -- it just doesn’t pass the “smell test”.