Discharge within the context of the ICBC Flat Fee Program

The College has written to ICBC to express its concern over use of the word “discharge” in the context of the ICBC Chiropractic Flat Fee Program (the “Program”). The College is now writing to registrants to explain the concern communicated to ICBC and to confirm that chiropractic doctors participating in the Program remain ultimately responsible for the continuing care of their patients.

In chiropractic, as in other forms of health care, “discharge” of a patient typically refers to a discontinuation of care that may bring the doctor-patient relationship to an end. The decision to discharge lies with the treating practitioner and involves the professional determination, made in consultation with the patient, that further care is not necessary.

Under the terms of the Program, a treating chiropractor may be required to submit a “discharge” report to ICBC when treatment reaches an end (either at 14 weeks after the initial visit, or if a treatment extension request is approved, at 19 weeks), even though, in the chiropractors’ opinion, the patient would benefit from additional chiropractic care.

The College’s concern is that, in this context, submission of a “discharge” report might be interpreted to mean that the chiropractor must stop all treatment of the patient and that the doctor-patient relationship has come to an end. However, this would be a misunderstanding of where the responsibility for continuing care lies.

Chiropractors have an ongoing duty to ensure that patients have sufficient knowledge of their health condition to make an informed decision on the need for additional treatment. Where a chiropractor’s opinion is that there is likely no need for, or benefit to, further treatment, the chiropractor may discharge the patient from care upon explaining the clinical basis for that determination. At the time of discharge, the chiropractor may invite the patient to return in the future for assessment and further treatment as needed. In all cases, the decision on whether or not to proceed with chiropractic treatment must be made by the chiropractor and the patient in consultation with each other.

Where a patient is receiving treatment through the Program, a chiropractor’s responsibility to keep the patient advised of any need for continuing chiropractic care may require the chiropractor to explain why a “discharge report” is being submitted to ICBC and to make clear that submission of the report does not require the chiropractor to stop treating the patient. More specifically, if a chiropractor is of the view that, despite submission of a “discharge” report, the patient would benefit from additional chiropractic treatment, the chiropractor should ensure the patient is aware of that recommendation and the clinical basis for that recommendation.

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