Academy of Chiropractic’s Lawyers PI Program

Lawyers & Medical Specialists Meetings & Communications #21

From the Desk of :
Mark Studin DC, FASBE (C), DAAPM, DAAMLP

“Magic Language for: Medical Specialists”

When dealing with medical specialists it is important to remember that they earn a living in a highly specialized world of procedures inclusive of surgery and testing depending upon the specialty. Based upon extensive market research over the last few years, most specialists find screening cases that fit into their specialty has become more tedious and they would rather focus on only those patients they can help. 

Most specialists embrace chiropractors who are smart, credentialed and “get it,” to act as their screening apparatus so as not to waste time in wading through to get to those they can help. It is this message in part that you need to communicate, provided you are that smart and credentialed chiropractor. The old “chiropractic one-step, two-step” of using rhetoric (or bullcrap as we call it in NY) to succeed in the absence of BOTH the knowledge base and credentials is a formula for failure over (a very short amount) time. 

This is where you need to be the smartest person in the room and if you have followed the program, you will be. The smartest person in the room will win the referral game as your goals is to change the specialist’s referral pattern. 


MAGIC LANGUAGE

First, I am a trauma trained chiropractor and for the balance of my career I will have a lot of procedures to refer to you. My goal is to help keep you in the operating room or preforming procedures, it’s where you belong. 

I was trained by professors at the State University of New York at Buffalo School of Medicine who now recommend that chiropractors should be the first level of referrals for mechanical spine pain vs. PT’s or drugs based on the literature. Frankly, I am looking to both to refer to you and get your referrals

Here is a copy of my CV as there are very few chiropractors with my training in MRI spine and spinal biomechanics and I would be happy to share the published literature with you if you would like as I have it with me and it will take 5 minutes.

The next 5 minutes … discuss each of the following points:

and... Bring a "cheat sheet" with you as this is too much to remeber and do not give them a copy of it!!!!

When I consider ordering advanced imaging, if I have a patient that has significant clinical radiculopathic  or any myelopathic findings I am ordering an immediate “thin sliced” MRI. My protocols also exceed the American College of Radiology Guidelines for slice acquisitions to make sure I miss nothing. 

Here is a copy of my slice acquisition protocols (hand it to them). I use the protocols of the State University of New York at Stony, School of Medicine Department of Neuroradiology. AS a side note, that is also where MRI was invented and I have a relationship with the department chair, who was trained at Harvard and worked with the Nobel Laureate. 

TYPE THE FOLLOWING ON YOUR LETTERHEAD AND HAND IT TO THE MEDICAL SPECIALIST


Cervical

T1 Sagittal 3mm

T2 Sagittal 2.5mm

T2 Axial or gradient 2.5mm

STIR sagittal 2.5 mm


Thoracic

T1 Sagittal 3mm

T2 Sagittal 2.5mm

T2 Axial 2.5mm

STIR sagittal 2.5mm


Lumbar

T1 Sagittal 3mm

T2 Sagittal 3mm

T2 Axial 3mm

STIR sagittal 3mm

Sagittal stacking view 3mm


Note: Fat Saturated T2 can be done in lieu of a STIR view


The following is a sampling of some of the literature that SUNY Buffalo Medical School utilized to help make their determination as chiropractic being the first consideration for referral for mechanical spine pain:


NOTE: Hand them a copy of the research and then explain the synopsis

             You must purchase a copy of the research… It’s the law


a.    Wilkey, A., Gregory M., Byfield, D., & McCarthy, P. W. (2008). A comparison between chiropractic management and pain clinic management for chronic low-back pain in a National Health Service outpatient clinic. The Journal of Alternative and Complementary Medicine, 14(5), 465-473.


Note: Your explanation

                                     i.    Wilkey, ET. Al. in 2008 studied randomized clinical trials comparing chiropractic care to medical care in a pain clinic. "The treatment regimens employed by the pain clinic in this study consisted of standard pharmaceutical therapy (nonsteroidal anti-inflammatory drugs, analgesics, and gabapentin), facet joint injection, and soft-tissue injection. Transcutaneous electrical nerve stimulation (TENS) machines were also employed. These modalities were used in isolation or in combination with any of the other treatments. Chiropractic group subjects followed an equally unrestricted and normal clinical treatment regimens for the treatment of [chronic low back pain] were followed. All techniques that were employed are recognized within the chiropractic profession as methods used for the treatment of [low back pain]. Many of the methods used are common to other manual therapy professions" (p. 466-467).

After 8 weeks of treatment, the 95% confidence intervals based on the raw scores showed improvement was 1.99 for medicine and 9.03 for the chiropractic group. This research indicates that chiropractic is 457% more effective than medicine for chronic low back pain.


NOTE: Hand them a copy of the research and then explain the synopsis


b.    McMorland, G., Suter, E., Casha, S., du Plessis, S. J., & Hurlbert, R. J. (2010). Manipulation or micro-discectomy for sciatica? A prospective randomized clinical study. Journal of Manipulative and Physiological Therapeutics, 33(8), 576-584.

Note: Your explanation

                                i.    Based upon the authors’ review of available MRI studies, the patients participating in the study were all initially considered surgical candidates. Both the surgical and chiropractic groups reported no new neurological problems and had only minor post-treatment soreness. 60% of the patients who underwent chiropractic care reported a successful outcome while 40% required surgery and of those 40%, all reported successful outcomes. This study concluded that 60% of the potential surgical candidates had positive outcomes utilizing chiropractic as the alternative to surgery. 

By using a chiropractor, we can screen those patients to help surgeons wasting time and resources on non-surgical candidates.  


NOTE: Hand them a copy of the research and then explain the synopsis


c.    Cifuentes, M., Willetts, J., & Wasiak, R. (2011). Health maintenance care in work-related low back pain and its association with disability recurrence. Journal of Occupational and Environmental Medicine, 53(4), 396-404.

Note: Your explanation

                                i.    Cifuentes ET. Al. concluded in 2011 that patients with work-related LBP who are treated by chiropractors would have a lower risk of recurrent disability because this specific approach would be used.  Conversely, similar patients treated by other providers would have higher recurrence rates because the general approach did not include maintaining health, which is a key component to prevent recurrence”

3.    There is so much more and if you need anything specifically, I can supply you with it.