Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 936
Narratives 69N

From the Desk of Dr. Mark Studin
Academy of Chiropractic
Preamble: many of these issues are small, yet each issue is just that… an issue. If you take care of the small issues, then the larger issues often take care of themselves and you can focus on the larger issues… a larger, more profitable practice and more family time.

“Research: E&M vs. Narrative”

What goes where?  

 “Everyone has an opinion… but are they right?” Mark Studin 2018

 

Too many self-proclaimed have an opinion on how to use research in practice. This holds true more so in a personal injury case than a non-personal injury case and here is what you go through:

 
Is research necessary?
When do I use it?
Where do I find the research?
What do I need to know?
How do I prepare it?
What do I use?

 
And… a million (at least) other questions…

 
Regardless of the opinions of every guru (too many are dangerous, inexperienced and inflammatory) in the industry… research SHOULD be used liberally in your E&M and SOAP notes. You need to quote research to ensure compliance and reimbursement certifying that you are functioning in a “Usual and Customary” manner within industry standards as evidenced by indexed, peer-reviewed scientific literature. It is for that reason we created the “EMR Macros Program.” 

 
You will notice we didn’t call the program the “Narrative Macros Program” because narratives serve an entirely different purpose. A narrative is for court proceedings and not insurance purposes and in the courts, all the lawyer wants is YOUR opinion, not a researcher that cannot be subpoenaed to be cross examined making their opinion hearsay. In addition, should you use research in a narrative, you are exposed to every word on every research page in cross examination and I can certify with a great degree of certainty that there are many passages I have to read 5 times to even understand them and on the witness stand, that will be the “kiss of death” to any testimony. You will look the fool and the lawyer does not want the research… they hired you and want ONLY YOUR OPINION!!!!!

 
It is a VERY BAD place to NOT have a “robust” amount of research in your E&M and SOAP notes, it is the opposite with narratives.

 
In addition, how will you answer this question if asked on the witness stand, “Doctor, where did you get the research?” If it is from open access (FREE in Google), you are good if you remember. However, most articles are not free, and you have to buy them for $35 on average (at Google Scholar) and if you cannot prove you purchased them, you will be exposed to a $100,000 statutory fine (the courts have already decided that amount for copyright violation) for ever article you used and did not pay for. 

 
The defense lawyers can use this tactic to discredit you as an expert and it is within their legal right to do so. Do not think for one nano-second they will not use any and all means to prevail. That is their living. In addition, you do not need fear court; just be prepared and although you will rarely get there, you always need to be prepared because that is how you are being judged by EVERY plaintiff’s lawyer who has cases to refer.  They judge you on their “end-game,” which is how well will you do in court?

 
This falls back to the 6 P’s!!!!


 
Respectfully,

 
 
Mark Studin DC, FASBE(C), DAAPM, DAAMLP

Adjunct Associate Professor of Chiropractic, University of Bridgeport, College of Chiropractic
Adjunct Post Graduate Faculty, Cleveland University-Kansas City, College of Chiropractic
Adjunct Professor, Division of Clinical Sciences, Texas Chiropractic College
Graduate Medical Educational Presenter, Accreditation Council for Continuing Medical Education Joint Partnership with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences 

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