Academy of Chiropractic’s Lawyers PI Program

Lawyers & Medical Specialists Meetings & Communication #22

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

“Get Lawyers, Medical Specialists and Medical Primary Care Providers to Refer Instantly”

You can be tall or short, fat or skinny, amiable or arrogant, drive a Bentley or take them out to a $1000 dinner and the referral source simply will not care. If you are the reason they either win their case, or be the solution to the case in a medical genre`, then you not only win… you get the referrals… INSTANTLY… and have to work very hard to stop getting future referrals. 

If it seems too good to be true… it isn’t. It has been working for years and now…IT WORKS every time for everyone… provided you have positioned yourself properly through nothing but your clinical excellence. 

The following MRI Report underscores the reason why you will get the referrals. It illuminates why you MUST be the “Primary Spine Care Provider” or the absolute first level of referral for everything spine because you are in everyone’s best interest! I have now shared this with over 1000 lawyers and dozens of both medical specialists and medical primary care providers and once they understand… They all agree… PROVIDED…the chiropractor is appropriately credentialed with the requisite knowledge behind those credentials. 

The doctors who have been following the program have been winning at unprecedented levels provided they have learned how to communicate both the “game plan” and your level of clinical excellence. This consultation is about how to do just that… Communicate at a level to ensure the referral because you are the best option.




The above is a typical MRI report done by a general radiologist. Unfortunately, too many neuroradiologists are doing the EXACT SAME (Dumbass) THING. Read the report carefully, if you cannot pick out the problems, and there are many… then you need to take the MRI courses including the Mini-Fellowship with Dr. Peyster. 


WHY? Because this is what will cause your practice spiral upwards very quickly, if… you position yourself properly. This is applicable to lawyers, medical specialists and medical primary care providers alike. 

NOTE: The above comment isn’t rhetoric or inflammatory… It works all the time, if you work.

FIRST

We understand that across the board, there is a 42.2% error rate in mis-interpreting MRI by general radiologists. Again, not my opinion, but that is significant for all of your referral sources to realize and then remind them you are credentialed and competent in reviewing the images to ensure accuracy. The reference for the 42.2% error rate: 

Lurie, J. D., Doman, D. M., Spratt, K. F., Tosteson, A. N. A., & Weinstein, J. N. (2009). Magnetic resonance imaging interpretation in patients with symptomatic lumbar spine disc herniations. Spine, 34(7), 701-705.  

NOTE: Stick a crow-bar in your wallet and buy the report so you can hand it out if needed without infracting the copyright laws. 


Remind your referral source this isn’t your opinion and the importance is that you will go back to the reading radiologist and have them AMEND their reports based upon the literature and what you both see. Doctors nationally are reporting that radiologists happily amend their report and many are getting 3-4 reports amended per week to reflect an accurate read. 

Is that important to the lawyers, medical specialists and primary care providers? For the lawyers it means lots of money (not that I care), for the providers (including us) it means an accurate diagnosis to create an accurate prognosis and treatment plan. 

The report states that at C3-4, C4-5, C5-6 and C6-7 there are protrusions with C5-6 having a pronounced flattening of the cord. 

According to Fardon et. Al (2014) a protrusion is a herniation, whose base is wider at any point than the apex. This topic is covered at length in all of the MRI courses and is a significant finding for lawyers, medical specialists and primary care providers because it totally changes everything.  

The following citation is the newest research (November 2014) reflecting the most accurate and accepted nomenclature in the industry:

Fardon, D. F., Williams, A. L., Dohring, E. J., Murtagh, F. R., Gabriel Rothman, S. L., & Sze, G. K. (2014). Lumbar disc nomenclature: Version 2.0. Recommendations of the combined task forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology.Spine, 39(24), E1448-E1465.

However, the radiologist often will get lazy, or report in a paradigm that is 10 or 20 years old because they are “used to doing it that way” and not qualify the protrusion as a herniation or bulge. This becomes hugely problematic as it doesn’t tell the provider the entire story how to properly treat and the lawyer will often have to dismiss the case as a result of this now “improperly reported” finding. 

The protrusions listed above, based upon the Fardon article (as well as Fardon’s 2002 article because we are not breaking new ground here) should be “protrusion type herniations,” or simply “herniations.” Without the word “herniation” the entire context of the pathology is mis-reported or simply reported incorrectly. 

The following image is of another case and the radiologist simply reported a disc protrusion and nothing more:



Again, you MUST be able to interpret these images because the radiologist’s report was simply wrong. 

When the patient goes to their primary care medical provider or an anesthesiologist who doesn’t have a grasp on spine MRI, what will they be treating and prescribing for? A bulge, degeneration, trauma?  What will the lawyer argue and how will the defense lawyer twist that incorrect, or severely outdated nomenclature that does not reflect the true condition of the injured? How will you create a prognosis and treatment plan if you do not know how to interpret these images? 

EVERYONE LOSES… Primarily your patient and you put your license at risk by treating blindly. 

SECOND:

You take the above report or image and you go back to the interpreting radiologist and politely INSIST they amend the report based upon the Fardon article I referenced above. Please refrain using phrases like “stupid asshole!” Although in most cases, it is what is deserved. Should the radiologist NOT want to amend the report, then it is your responsibility to make a chart note and diagnose the case independently and NEVER refer to that entity again. But before you do that, you should inform the owner of the facility of your actions. Be clear that your request is purely based upon the most current scientific literature the standards of the American Society of Neuroradiology, the North American Spine Society and the American Society of Spine Radiology. 

THIRD

BE clear with the lawyer and your medical colleagues that you have requested an amendment in the report based upon your training as a trauma trained provider who is credentialed in MRI Spine Interpretation. Do not be disparaging against the radiologist as it will reflect negatively on you. Only use words like “ignorant asshole” under your breath when no one is around… I know I will. 

Be sure to let the referral source know that this is the level you function at and would the lawyer like to have much less herniations or more? Would your medical colleagues like to have more accurate description of the pathology or less? 

This is what you bring to the table for every case and virtually no other providers are taking the time to get credentialed, educated and collaborate with the radiologists to get accurate reports.