10 July 2007

Preceptorship Week 1 of 8, Part II

Independence Day felt like a Saturday in the middle of the week. I liked the break, but it made me want even more time off! Thursday was pretty slow in the clinic. I was left to do a report, and I had plenty of down time to work on a school project.

Friday was another story . . .

Dr. Dennis had me adjust anterior dorsals on several patients. I barely felt anything move on anyone, and I couldn't figure out why. Later that day, a chiropractor was the patient and he gave me some pretty good feedback. Plus, he was the first patient where I actually felt the joints move when I adjusted him. He emphasized using an inferior-superior line of drive. Thus far that day, I had been hit or miss with that aspect, and I had been thrusting more anterior-posterior.

A couple of the staff members also asked me to work on them later that day. They'd never seen me adjust anyone nor had I ever adjusted them. So, in spite of not knowing about how forceful or in fact decent I am at adjusting, they at least felt comfortable enough working with me in the clinic to ask me to work on their spines. Since it was near closing time, I only had time to adjust 1 person. The only catch was that I had to dictate the SOAP notes into a recorder, something I've never done before. Thankfully, there was at least somewhat of a pattern to her SOAP notes. Since the diagnosis hadn't changed, and I was using Pettibon adjusting procedures, I could at least reference similar things that had been recorded in previous adjustment SOAPs. The best part about it was that the patient was easy to adjust, and her legs balanced with a neurological leg check so that I didn't even have to address the upper or lower angles of the atlas.

Also, she gave me feedback that helped me with all the self-doubt I'd accumulated adjusting numerous other patients' thoracics that day. She said she felt her thoracics move in at least 3 places when I adjusted her. I, however, didn't feel ANYTHING move. So, it's possible that I had adjusted some patients throughout the day, but I hadn't felt anything, just like when I adjusted a staff member at the end of the day.

Dictation notes are definitely the way to go. The electronic push-button forms are great, but they don't help much if they don't cover all the stuff that you actually do when you work with a patient. Presently, there aren't any electronic note forms that are compatible with structural correction. Also, dictation is always patient-specific and relevant. Much less likelihood to get in trouble with a malpractice suit for poor note-taking when you have dictation notes. However, I'm a novice at it, and I need practice. I also need to learn the codeword shortforms for standard phrases. I hear Dr. Dennis say "Macro 7" or something similar.

I'll probably develop my own form of code notespeak for the typist once I get settled into my own practice. Once I get that down, I'll be much faster at treating patients for each respective visit.

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