Doctors Personal Injury Program

Narratives #10 

Lawyers PI Program


#111


From the Desk of:

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


“Gaps in Care”


In previous consultations I recommend that you handle in your narrative why the patient had a gap in care. Most courts can interpret as a result of the gap, all of the care wasn’t necessary and the patient was malingering. In addition, Colossus views gaps in care as a significant downgrade in the case and will handle the case accordingly both with the lawyer and the amount of care allotted to you. 

First, there should never be a gap in care. We have previously discussed “active vs. passive care” with passive being whatever you the doctor performs and active, whatever the patient does on their own. It is a “hard clinical (Studin) rule” that you should NEVER treat a patient without ordering a course of home self-care. The orders can ranged from bed-rest to walking to stretching to getting a massage from a significant other. 

With these orders, a patient will still be under a doctor’s orders should they miss a few visits and truthfully still being treated. It is the responsibility of the doctor to document the active care both in the narrative and on every SOAP note for each visit. 

At the end of passive care, when you want an ordered gap in passive care, order a course of home exercise and have the patient return in 4-6 weeks to assess their condition. At that time you can either MMI the patient, continue to treat or order another course of active care. 

However, if the patient has not done any of the ordered care and missed more than 2 weeks of care, you need to document why. An unexplained gap in care can be catastrophic to your patient and the lawyer arguing real injuries. Be very specific and accurate about why there has been a gap in care with no active or passive treatment. 

Accepted non-treatment gaps are bereavement, elder care or REAL financial hardship. Travel and work do not count. People can seek care anywhere in the world and must document it via either a doctor’s note or receipt. Everything must be documented and verifiable.