Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 97 I

From the Desk of Dr. Mark Studin
Academy of Chiropractic
Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time.

"The Most Powerful Lesson Learned in My Neuroradiology Mini-Fellowship Training"

This is going to come as a surprise...because it did to me. While sitting in the room with, literally, some of the best neuroradiologists in the world and struggling to comprehend all that I was being exposed to, I noticed in the background the phones were all in use for the entire time. Being the curious type, during my very long day, I was able to get into earshot of many of the doctors only to realize they were talking to other doctors in the hospital about their cases. When I inquired, after I felt comfortable enough not to be invasive and take them off their job, I asked if they were calling over the results of the images to the ordering doctors. They all answered, "No." They were calling to learn more of the history of the patients so they could make more accurate diagnoses. WOW!!!!

As a whole, they explained the #1 problem facing the neuroradiologist; the lack of knowledge of the history and clinical findings of the patient which often prevents them from getting it right. Therefore, they all call the attending physicians, the emergency room doctors and residents. They don't care who they talk to as long as they get accurate input about the patients' clinical findings.

In one case, they summoned the doctor, a neurologist, who showed up with her 3 residents and had a 30 minute academic conversation about what possibly could be the cause of one 6-year-old child's apparently unidentifiable brain lesions and seizures. The neuroradiologist wanted to know all of the labs, the history, the clinical findings and any other possible co-morbidities and markers in the labs that could lead him to an accurate diagnosis. The neurologist said to the neuroradiologist, "I have been to NYU, Columbia, Mount Sinai and the Mayo clinic with no answers. You are my hope to figure this out. The neuroradiologist replied, "I possibly can if I have all of the information."

The central issue is that all radiologists sit in a dark room with the metaphor of "dark." They are all in the dark and NEED clinical information to help conclude an accurate diagnosis no matter how significant the case.

I have previously suggested that you send your full initial evaluation with a prescription or as your prescription for an MRI to help guide the reading doctor to a more accurate diagnosis. As there needs to be a treatment order for every procedure and test with your clinical rationale, this will serve 2 vital roles. It will ensure compliance as to why you are ordering a test and second, it will ensure the most accurate diagnosis. Therefore, from a posture of clinical excellence, the patient wins and you add another layer of being bulletproof in an audit.

This also (the least important reason by faaaaar) gives you another talking point with the lawyer. NO ONE does this in the medical-legal community and this type of collaboration will often yield more bodily injuries simply because the radiologist is focused on the precise problem area and will be able to more accurately clinically correlate pathology to your findings. Again, another example of winning through clinical excellence!

PLEASE TAKE FURTHER NOTICE: CONFIDENTIALITY AND PROPRIETARY INFORMATION NOTICE:  This email including attachments is covered by the Electronic Communications Privacy Act (18 U.S.C. 2510-2521) and contains confidential information belonging to the sender.  Nothing contained in this message or in any attachment shall constitute an Electronic Signature or be given legal effect under 44 U.S.C. 3504 Sec. 1707.  The information is intended only for the use of the individual or entity to which it is addressed.  If the recipient of this message is not the intended recipient, you are at this moment notified that any unauthorized disclosure, dissemination, distribution or reproduction of this message or any attachments of this communications is strictly prohibited and may be unlawful.  If this communication has been received in error, please notify the sender immediately by return email, and delete or destroy this and all copies of this message and all attachments.