Academy of Chiropractic
Quickie Consult 1155
Infrastructure 240 I
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
"Speaking the Language of the Lawyer & Take a Quiz"
Dr Studin: So, start from the beginning. What do you got?
Guest Doctor: So I've been having PI patients come in after a few years, post collision in which MRIs are indicated and there's paresthesia and indication for neurological deficits. But no one, no one has ordered these. Now my question and confusion is what is my role here? it's not life threatening.
Dr. Studin: But here's the thing, you're in the state of Washington. you're a duty of care state, meaning, do you understand the duty of care stuff?
Guest Doctor: Yes.
Dr. Studin: Okay. So, for those who don't, duty of care means that you have a responsibility illegally. A plumber has a duty of care to do plumbing and electrician to do electrical work. Now in Alaska, that was a landmark duty of care case that an occupational assessment doctor for employment, physical on an x ray saw a spot on. This guy loved working with silicon factory. Those are the little, how chose or that they put in like electronics to keep dry. So, we breathe it in and he had lung cancer and he died. So the estate sued this doctor for malpractice, the state of Alaska rule that there is no duty of care for a third party evaluator ordered by a third party that the patient did directly go to act as a doctor and, and they left the Dr. Ross. It's disgusting. But unfortunately, there's many states in the country that agree with that. But in the state you're in, thankfully for the people of the state in Washington, you have a duty of care to treat every patient the same, whether they're third party report it or your patient. So, you have to practice to the standard of your license and, and there's my strongest suggestion that everyone, no matter what state you were in, practices the standard of your license. You evaluated patients and there's paresthesia’s and other things. What would you normally do?
Guest Doctor: Yeah, get an MRI.
Dr. Studin: Yeah. So, if this is the case in ordered by a lawyer, and also is a matter of good business, as a courtesy cause he referred the patients. Do you want to let them know, listen, this patient has, you know, paresthesia there's a lot of things going on even though it's a year or two or three years old, they're still diagnostics dilemmas that haven't been answered. So, this is what's needed. Now the other thing is also it's got to be paid for and you might not find that MRI company to do that or a patient willing to do that. And if they choose not to, you can't do anything about that. It's not prison. You can't make them go. But at least you'll have let all the parties’ zone, including the patient that this is what's going on.
And this is what is strongly suggested. Did I answer your question?
Guest Doctor: Yes. Part two is, so what I've done in the past was because I didn't understand this fully was I mentioned that one way to order the MRI would be to have me be a treating doctor and not an expert..
Dr. Studin: Well, once you evaluate that patient, physically you're a treating doctor, he gets the forget the patient IME designation, your billing that is a 99204/205 whatever, ability enough. That's a new patient evaluation. The only time you're a non-treating doctor if you do a peer review off of records.
Guest Doctor: Okay. So, in the reports that we write, I would just basically put that I evaluated the patient on this day, and I recommend advanced imaging due to this everything else taught us. And then later they get the report and then I put an addendum in like I've reviewed the MRI report and this is what are images and this is what I've come up with.
Dr. Studin: that the past medical records, just like you wrote it, that any new patients.
Guest Doctor: but the MRIs coming after the evaluation
Dr. Studin: then yeah, you could write a subsequent report. Yes. You don't do an addendum, you do a subsequent report and there's a code for that. Review of outside records when the patient's not in front of you. It's like nine, three, eight, six one some. I don't know if that's the right number. I mean I actually, I'm certainly, it's not, but it's review of patient records of patients last with you. Now here's the thing. You know, us demented chiropractors think that if we don't adjust patients, we're not treating them. I mean, if a surgeon sees a patient that doesn't operate on the machine, treating them, yeah, he's managing their case. You become a treating doctor when you manage a case, not when you just adjust the cases when you manage it. So, if you're doing an eval or re-eval or any kind of encounter, you're a treating doctor because you're managing this case.
Dr. Studin: Got It?
Guest Doctor: Yup.
Dr Studin: And that's a biggie. What else? Is there a third question to it?
Guest Doctor: Okay. So yeah, well, I mean this is, this is a completely different question. It has to do with, sending out, patients to pain management and neurosurgeons and not getting any referrals back.
Dr. Studin: you have to channel, you're in a market, be a little of a dick. Okay? Be somewhat arrogant. Make believe your firm, your Jew from New York. Okay? So, here's the deal. I refer a lot of cases to you. You know, and I'm very happy to work with you, but the only commodity I have to my practice is by referrals. So, if I'm referring patients to you, I need to see referrals back. Not one for one, not even one for two. But for every four or five patients I send I need to see at least the patient back. I do really good work. I managed spine cases and perhaps we need to chat with that a little bit, but if you can handle that, great. If not, I understand. I'm just going to go someplace else. It doesn't get any easier than that. Very forward, very direct with a little bit of an arrogant edge. Make believe you're me.
Guest Doctor: Yeah, no problem. Thank you.