Academy of Chiropractic Personal Injury & Primary Spine Care Program
Quickie Consult 1170
Infrastructure 248 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
"Managing Clueless MD Primary Care Providers"
Dr. Studin: So you just shared with me that you have a patient that's got a potential disc problem with pain radiating down their leg, numbness, all the classic ridiculous symptoms. And their primary care provider only wants to give a Medrol Dosepak prednisone, correct?
Guest Doctor: That is correct.
Dr Studin: So initially the patient came to you stating what, could you just say again what their primary care doc said?
Guest Dr: Stating that he heard his low back exercising. He has radiating pain down the right leg, and pain when he coughs. Sneezes, it's been going on for about 10 days, And he went to his primary care doctor, primary care doctor prescribed prednisone, and the patient said: I don't want to take drugs. He found me because of my office location was close to his mom's house. Patient is about 45 years old. Very physically fit and active, during the examination we found he had a sensory deprivation along the L 5 nerve roots development, he has hyperreflexia at L5 and S1, but the muscle strength tests for all within normal limits 5 by 5 and x-rays revealed a very thin L5 S1 disc, because of the neurological involvement, MRI was indicated. So we called up his primary care cause he's in HMO how policy holder. And as much as I don't work with HMOC, I told the primary care, I said, we got a positive neurological findings at 4 L5 disc issues here and he needs to get an MRI and Can you write the script for him? And the doctor said I need to see him back in my office. So today the patient went back to the primary care and the primary care said, why didn't you take the medicine and we're not following my orders? I thought you needed an MRI. I was sending you out for one right away. In the meantime, we contacted the HMO company and got the MRI actually recruits And so we called the patient, said your MRIs all preapproved. We got the approval number imaging companies are going to be calling you to schedule an appointment. So he schedule the appointment and then after he saw his primary care, he canceled the MRI appointment, came back my office paid his balance and said I'm at a really awkward moment with my primary care doctor and I'm going to follow his directions and if I don’t get better in 10 days I will come back and see it.
Dr Studin: So my answer is call the patient back and I went through this a little bit before with you and say, I'm not asking you to go against your primary care doctor, what he's ordered for you. I'm not changing your treatment but right now nobody knows what's wrong with you, nobody. And you're looking to delay another 10 days. The conclusive diagnosis, That's all I'm looking for is to know what's wrong with you. And your insurance company agrees with me, not your primary care provider because they approved it and they're not easy to get approvals from. But once I gave the clinical presentation, they understand and they said, yes, you need an MRI. So it's my strongest suggestion that you listened to both people. I'm not going to comment on your primary care treatment. But this is what I do every day. And you've got to have a conclusive diagnosis because if the nerve is being irritated, putting it out another 10 days at another 10 days, you could do damage to the nerve and sometimes that damages are irreversible. So we need to know what's wrong with you. So it's my strongest urgent to do an MRI Now, do whatever your primary care wants. He's out of the loop right now with the insurance company who thinks you need one also. So that's my strongest suggestion. And when the MRI comes back positive, then you could share with the primary care, also the primary care take this guy out of work? Did he modify anything? Did he know anything?
Guest Dr: Nothing.
Dr Studin: So there's a lot of things here which the primary care actually could border on malpractice as far as I'm concerned. And again, you can't have a pharmacological solution to a mechanical problem. You just can't. I would couch it that way to the patients and see if you can get them to do the MRI and then find a very polite way to deal with primary care provider, And I'm understanding that the patient has a mechanical problem which is far out of his purview of what he could treat and get rid of his bias and prejudice. I'm sure also that his primary care provider was an older guy, not a younger guy because it sounds like he's living in yesterday.
Guest Dr: He's actually younger guy, we have half a dozen patients who have him as a primary care doc and he's probably mid to late forties.
Dr Studin: So we need to just change just thinking a little, but my first, and you got to do it with this patient. So just tell the patient again, I'm not telling you to change anything the primary care wants you to do for this, even though the literature shows that won't help. But who knows? Maybe it will help. I don't know. But we still don't know what's wrong with you and by delaying necessary care, it could really, if the nerve is being irritated, it can cause some damage. And I'm just looking to prevent that. So I'm not saying to treat differently. I'm just saying, figure out what's wrong with you. And the insurance company agrees with me and that's how I would go after it.