“The Power of the Chiropractor Over the Medical Specialist”
The # 1 issue-fear-complaint-concern (blah-blah-blah) I get nationwide is that the chiropractic profession believes the legal profession wants a medical specialist over a chiropractor when considering referrals for their clients. In the soft tissue injury, there are more chiropractors treating the clients of these lawyers than non-chiropractors. This is from an informal survey taken from the last 2-3,000 personal injury lawyers I have lectured to. Therefore, injured patients are getting into the offices of chiropractors over the medical specialists, and you have to understand why that is of a greater benefit to both the legal profession and the injured patient. With that understanding, it will become abundantly clear as to how this benefits the medical-legal community in an ethical relationship.
First and foremost, in the soft tissue injured patients, there is no better healing discipline then chiropractic. After co-treating 1000’s of accident victims for decades with medical specialists, physical therapists, acupuncturists, osteopaths and biofeedback providers the results of chiropractic are far superior in spinal related conditions then any other healing discipline. I am not saying that chiropractic treats all problems. There is a place for all healing disciplines, but for spinal related trauma of soft tissue, chiropractic is usually the treatment of choice.
With that said, the problem in the medical community is that their focus is on bodily injury and they are very good at documenting those injuries. After reading 100’s of narratives across the country, we as a profession are not very good at documenting anything in comparison to the medical community, therefore creating the bias within the legal community. I do not blame them; both you and I would want the same if our businesses depended upon the quality of the paperwork. This is a bias that needs to be overcome and it becomes more acute if you have been circulating poor paperwork over the years to the same population of lawyers that you now want to refer to you.
The problem that the medical specialist has is they usually focus on just the bodily injury, ignoring either causality or functional loss, and rarely, if ever, discuss persistent functional loss. This is where the chiropractor has leverage over the medical specialist because unlike the medical specialist that sees the patient one, two or three times, the chiropractor has their hands on their patient on an ongoing basis and understands the persistent functional loss of their patient as a result of the bodily injury. This has been told to me by numerous lawyers nationwide and it would be the choice of the lawyer to have the chiropractor over the medical specialist because the bodily injury is historically documented in an imaging or testing report by the medical specialist while the functional loss is more opinion than a radiographic or neurodiagnostic fact. The problem the lawyers have with the chiropractors again, is the documentation and/or the in-depth knowledge of the bodily injuries as evidenced in test results.
THE SOLUTIONS LEAD TO REFERRALS
Solution #1 – Examinations & Diagnostics:
Bodily injury is about understanding diagnostics test results that clinically correlate to findings in a physical examination. You must perform an in-depth examination of all body parts that have any potential injuries; no different than what you were taught in professional school. The only problem is that many have gotten lazy and cut corners on the examination. This will be a sure way for a lawyer to not want to work with you and worse, it will leave your license exposed to disciplinary action if looked at by your state board for any reason.
As a side note: Insurance companies are rendering complaints to state disciplinary boards regarding deficient documentation in an effort to not pay claims.
The diagnostics you need to understand are centered on the spine:
- X-Rays: Ordering the correct sequence for a trauma patient and understanding how to interpret the film and be an expert on the results
- MRI: Ordering a timely MRI and understanding how to interpret the film and be an expert on the results
- EMG/NCV: Ordering a timely test and being an expert on the results
- Bone Scan: Ordering a timely test and being an expert on the results
These are the basics in trauma diagnostics. If you have met the above criteria, then the rest is simply logistics. If you are deficient in your abilities as a diagnostician, then you must take additional coursework.
If you need additional work I would suggest starting with an online course to get an overview and understanding. (Go to www.lawyerspiprogram.com and click on Continuing Education Courses. This was created at the request of doctors nationwide to create a solution for this very problem.) A course of this type will give you a good understanding of what’s needed in the medical-legal community. However, it is recommended that additional coursework is taken to become more proficient. Knowledge is the key when dealing with lawyers on bodily injury.
Solution #2 – Ortho’s - Neuro’s
When the lawyer says to you, “I would rather deal with a medical specialist,” your answer is that you agree. If a patient has a radiculopathy, myelopathy or a significant herniated disc, you are going to refer the patient to the medical specialist for a second opinion anyhow. It is usual and customary for the chiropractor to get a second opinion for their patients with these conditions and you follow this responsible and conservative approach to care. Therefore, when a patient is under your care, you are going to refer them to the specialist anyhow and by your state’s education law, the specialist has to send you a copy of their examination findings on your patient. Inform the lawyer that as a courtesy, you will be attaching their report to yours at no charge, giving them the medical specialist that they want. However, you are doing all of the work and the lawyer does not have to pay for the additional paperwork.
Solution #3 - Documentation
By now your CV and narrative should have been critiqued and approved by me so that it now exceeds the expectations of the lawyers. After showing the narrative template to 1000’s of lawyers nationwide, the response is always the same, “Can I have a copy?” My answer is always, "No!" You can have a copy when I care for your client. The point is that they want this level of documentation because it meets their needs of clinically correlating causality to bodily injury and persistent functional loss in 1 document which most have not seen before. If you have not sent me your narrative to critique, you must do so. No matter what your marketing effort is or how good a doctor you are, poor documentation will be the end to any relationships with the legal profession.
Putting it all together…
Once you have shown the lawyer your narrative, explain that by working with you they will be getting the same specialists that they wanted initially, only now you are the quarterback of the patient. Include that you will also be working with an MRI company that renders thin slices to find all of the herniations. You will be getting the specialists reports to them at no cost and giving them the quality of report for your patient they have seen and should now want.
By being an expert at the diagnostics, lawyers now have a resource of an accessible doctor. One of the 3 main complaints lawyers have about doctors is they can never get a doctor on the phone when they need one. By being an expert in diagnostics, you can now let the lawyer know you are available to them at any time, and give them your cell number, even for a client that isn't your patient. One bonus to you is that for any question they might have that you can’t answer, you can call me (even if they are in front of you) and I will be able to answer most of the questions on the spot. The lawyer doesn’t expect you to have all of the answers, but they do expect you to be able to get them the answer to any medical question asked.
By having control over the referrals, you also create leverage with the specialists to get referrals in return, as we discussed in a much earlier consultation.