Academy of Chiropractic’s Lawyers PI Program
From the Desk of :
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
"Reporting Active vs. Passive Care"
A common belief of health care professionals is that it is better to use active therapy rather than passive therapy when treating musculoskeletal injuries. (DR. STUDIN'S NOTE: This is why physical therapists are secondary providers and should stay that way and why for spine, chiropractic has proven through the scientific literature to be far more effective)
Passive therapy is when something is done to you. Passive treatmentimplies lack of participation. Examples of this form of treatment include massage, manipulation, ultrasound, electrical nerve stimulation, laser, ice packs, and hot packs. Passive therapy always requires another person to apply the treatment. Passive therapies usually demand more resources in terms of time and money. Passive therapy can foster dependence.
Active therapy means the patient is actively involved in the treatment. Exercise is the most obvious example. At specific points in the healing process rest could be considered appropriate active therapy as it requires the patient to actively choose to modify the amount and manner of exercise or activity. Learning to do sport/work activity in the correct manner is an example of active therapy. Self applying passive therapies could be considered active therapies. Developing a heightened awareness of the subtle changes in the intensity, frequency, and duration of the symptoms allows improved communication with the health care professional in order to determine future direction of treatment.
The patient’s role is to actively participate in the treatment process by integrating information and modifying activities with respect to the symptoms. The clinicians role is assisting the patient in determining the parameters of the symptoms and in recognizing the parameters that exacerbate the symptoms. The clinician is the director, and instructor of the treatment process and the patient is the student, analyst, and assistant.
As you can see by the above explanation, active care means that which is done by the patient independently and passive care means that which a Doctor does. In our often "demented chiropractic world" we think that active care is with an adjustment performed by us and passive care is by using various modalities. As you now understand that is not accurate.
Many patients have actively made decisions to participate in their recovery prior to seeking your care, which can be construed by many as an unacceptable gap in care prior to initiating passive care directly with the doctor. Therefore, it is important to document what the patient did prior to seeking your care. It is important on your intake history to document what they attempted to do to hasten their recovery both prior to seeing you and during your passive (doctor initiated) care. If the patient has taken independent "active steps" in the middle of your care that needs to be documented as well.
The following is a list to consider as possible questions to ask your patients to determine if they have participated in the recovery prior to seeing you and then be documented on your initial history:
- They have reduced their work schedule
- They have stayed in bed longer than usual
- They are sleeping longer
- They are taking over-the-counter medication
- They are taking prescription medicine for a previous injury
- They are taking prescription medication from a friend or family member who have had similar problems
- They have worn a cervical, lumbar or other type of brace
- They had instituted a stretching or exercise program for specific body parts to relieve the pain or instability
- The have limited their daily activities such as shopping or housework
- They have limited, reduced or eliminated recreational activities such as walking, dancing, sports, etc...
- They have received massages from either their significant other, spouse, friend or a licensed massage therapist to relieve the pain
- They were hoping that time would allow the problem to heal on its own and they did not want to incur any unnecessary expenses for medical care that in the end wouldn't have mattered.
ACTIVE CARE IN THE MIDST OF DOCTORS TREATMENT
I am of the belief that all patients should be prescribed both a home exercise program and have clearly defined activities and/or limits based on their physical condition of what they can and cannot do.
Should a patient be prescribed a home exercise program it must be clearly defined in your treatment orders and in your treatment SOAP notes you must, on a daily basis document what the patient did at home between each visit. This is also inclusive of utilizing any canes or walking supports, TENS devices, cervical collars, lumbar supports, cervical pillows and anything else he patient did or utilize towards helping themselves get well at home (away from your office). This then becomes part of their permanent treatment record.