Scope of practice and treatment boundaries, including referral and co-management
This domain tests the limits of chiropractic treatment and the licensee’s duty to refer when a patient’s condition exceeds those limits. Exam questions often present a clinical scenario and ask whether adjustment, continued care, or referral is appropriate.
Scope boundaries
Ohio chiropractic practice is drugless and non-surgical. It includes adjustment and manipulation of the spine and other articulations, adjunctive procedures such as physiotherapy modalities, therapeutic exercise, and nutritional counseling, and the use of diagnostic imaging and tests. It does not include prescribing drugs, performing surgery, or treating conditions beyond the chiropractor’s training and competence.
Referral and co-management
A chiropractor must refer when findings suggest a condition requiring medical, surgical, or other specialized care. Red flags include unexplained weight loss, fever, night pain, neurological deficits, bowel or bladder changes, and a history of cancer or significant trauma. Referral should be documented, and co-management with the patient’s physician is appropriate when care is shared. The chiropractor remains responsible for the chiropractic portion of care and must not delay necessary referral.
Worked example
A 58-year-old presents with mid-back pain, fever, and night sweats. Spinal manipulation is not appropriate until infection or malignancy is ruled out. The chiropractor should refer promptly to the patient’s primary care physician or emergency department, document the red flags and referral, and avoid manipulation in the febrile patient.
Traps
Do not treat outside scope because a patient requests it. Do not assume a normal x-ray excludes serious pathology. Do not fail to document a referral or co-management plan. Do not continue a trial of care when red flags are present.