Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 1168
Narratives 94 N

From the Desk of Dr. Mark Studin
Academy of Chiropractic

Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time. -Mark Studin 2006

"How not to lose your license with documentation"


 Dr Studin: I just did a compliance review with the doctor in practice about 6 years and if I was a judge and listening to him, I would instantly have questions about best this guy being a doctor. But here's what he did on the witness stand. And the compliance, the mock witness stands with me as the judge and etc. But here's what he wrote in his report. I'll give you two paragraphs, just we'll do one at a time. She is complaining of neck pain, headaches, back pain, left shoulder pain, leg pain, and stomach pain. She is also complaining of bladder weakness due to the impact from the airbag. Her bladder drops. She's also complaining of muscular pain, coarser chest and having trouble breathing. So let's just take that paragraph as it is. So I said, doctor, did you get a copy of the other reports from the other doctors? He Says No, but the lawyer sent me a lot of records, but they were too much to read. So what would be your reaction to a doctor if they said, if someone said that a bladder dropped but they're coming in for your care and she was complaining of chest pains and trouble breathing and they didn't bother reading the record or doing anything.

Guest Doctor: number one is yes, you're certainly records review is important, but then immediately I would be looking at, were you assessing this patient or emergent type of conditions, You know, how many research articles that we read, where people have gone in and gotten hit in a motor vehicle accident and had a suburb a aorta, or a pulmonary embolism, I'm missing enough in your training to realize that hey, spine, a secondary at this point from a chiropractic perspective, primary is that you take a blood pressure, Did you look at a pulse?

Dr Studin: that was my first question. He did the blood pressure but didn't do pulse. He got halfway there.

Guest Doctor: That's like checking out just the right-side joints, you're only evaluating a portion of assistance, particularly in a traumatic.

Dr Studin: if you have a dissecting aneurysm, how important is blood pressure for this second compared to the next minute?

Guest Doctor: That's the point, you have to assess the entire situation.

Dr Studin: what's good is fixing a spine if the patient's already dead.

Guest Doctor: Yeah, In your office, we talk about this and let's just look even globally at this process. That's the difference between being a doctor and a therapist. And when I talk to people all the time and I'm like, listen, if you're being confused with a physical therapist, it's because you're not being a doctor. That's why MDs thinks they have to overstate chiropractors need oversight because of things like that.

Dr Studin: if you're on the witness stand with this and you said that on transcript, what do you think the judge would do? or the defense lawyer.

Guest Doctor: I think they would just move to exclude you as an expert because you're not.

Dr Studin: and I think beyond that, I think the judge hearing that my independently say doctor or if the defense lawyer comes up and says, your honor, because the defense lawyer doesn't care about your license, they just want to win their case. But there's also a public health risk issue here. You know, your honor, this doctor has a patient with chest pains and can't breathe and was too lazy to read the records. I'd like to make a motion to have this remanded over to the licensure board for a hearing. The judge might say, I'm going a step further. I'm going to do a temporary restraining order from you practicing chiropractic until your licensure board reviews this on the spot. Because the judge also has a public interest responsibility for protecting the public. I don't know what precedence there is for. But if I was the judge, I'd make precedent instantly.

Guest Doctor: And even more importantly, if I was the defense attorney, my first question would be, isn't that part of your training? And from a defense perspective, I would look down stream as well. what I would love is I would love to have a transcript of 20 or 30 pages of this doctor just fumbling through what he did and what he didn't do. Because pretty much after 6 years in practice, his career in the personal injury world would be completely done because that transcript would be handed by every single attorney with every single case in this community. Cause that's on record permanently.

Dr Studin: Yeah. Now Let's get to the next paragraph. And this is on the new patient first evaluation. She has cervical Kyphosis, lumbar kyphosis, instability, spinal discs, injuries, spinal facet injuries. She has abnormal spinal structure and stability. Please see attached x-rays and separately attach x-ray reports that will show evidence.

Guest Doctor: I don't even understand what that means.

Dr Studin: first it says, please see attached X-ray, he has no orders for his x rays. He just takes them. There are no x-ray orders Or who took them or when they were taken, etc. But in questioning him, he said she had the loss of the cervical and lumbar curve, which indicates instability, disc injuries and fossette injuries.

Guest Doctor: Yeah, that's not true. That's not what it indicates. Number one. Number two is those are all separate assessments in and of themselves. I just think about how much work we do with surgeons, if a surgeon read that doesn't make any rational sense compared to how a patient is worked up, even to this point, regardless of the patient being at risk, it doesn't appear that this doctor's following any sort of rational timeline or protocol in evaluating a patient and then using evidence to determine a diagnosis. To me, it just seems like he's throwing out whatever is out there just to, for whatever reason.

Dr Studin: His answer was based upon my understanding and chiropractic training, that when you have loss of a cervical curve, it causes a herniated disc.

Guest Doctor: Well that's great for our profession then because if that's what chiropractors are being trained to do, you might as well and your license up and go get a landscaping job, here's the problem and here's the issue, for 150 years or whatever it was, chiropractic has been clamoring to get recognized and we've complained that we get pushed to the outside. Everybody understands what we do and nobody takes us serious, I'm not treated as a real doctor. I want to be paid what I'm worth. But the perception in our profession at times is exactly what this doctor is providing. So how can you blame all of these other entities for feeling the way they do when this is what's out there?

Dr Studin: Here are the solutions. Very simple compliance review read all the consultations, trauma team, ENM qualified, primary spy care, qualify of hospital qualified and then fellowship. That's the solution. That's the career path. And it's not a short-term game. It's a career path. Listen, I just hung up with head neck surgeon it took him years after medical school to get a specialty training, he had to go through medical school. Then he had to go through residency, then he had to go through a fellowship program. Then he had to go to a subspecialty program. You probably talk in 6/7/8 years of training after medical school.

Guest Doctor: how old is the neurosurgeon typically before they're allowed to practice on their own? they are 36, 38, depending on what they get into, sometimes a little older, the idea that are three and a half years of chiropractic education, sitting in a classroom, being lectured to by somebody that doesn't practice, the idea that that's giving you enough training to operate in today's world is nonsense.

Dr Studin: let me just put this in different terms our Chiropractic education is incredible. They do exactly what it's supposed to do, give you the minimal amounts of knowledge to pass your state and national boards. That's the purpose of, nothing more. And the boards are set up so that you have a minimal amount of knowledge to be competent to go out and treat people without hurting them. But that's a starting place is with the minimal amount. And that's all their schools are supposed to do. And medicine does the same thing. It doesn't give you more of, the only advantage in medicine is when you're going through your internship, you're doing rotations with real life patients, and you're working with attendings and residents and fellows. You're getting all of this type of exposure that we usually don't get in Chiropractic, that we're now offering, um even in the fellowship, but still you're not sitting with 50 hot low back patients and learning how to treat them. 

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