Academy of Chiropractic
Quickie Podcast 1226
Narratives 96 N
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
"Documenting Persistent Functional Loss"
Dr Studin: I want to talk about documenting persistent functional losses, but really putting it in the context of the entire case. And I know you've got a vast experience, which is why I'm reaching out to you. It's a 32 year old male status post a car accident. He was rear-ended a while stop sitting in a compact car. He was rear ended by a cement truck fully loaded with cement, the car didn't come out so well, Neither did he. He needed shoulder surgery, cervical surgery of which they did not perfomed so well. He has fragments in there and he went almost three years with fragments cause everyone was saying was nothing wrong with them until some smart surgeon came along and post-surgery he still has issues and problems. So let me read what I wrote now that we've done the setup. Is there anything else you need to know?
Guest Dr: No, I think that's good, just a quick reminder on that MRI doesn't show everything no matter how good it is and what the surgeon finds is often more than what the MRI shows.
Dr Studin: And MRI company at the time, three years ago only did a T1 way that axial image, not T2, which is why it was missed. Mr. Smith, prior to his accident on September 14th, 2016 was pain-free and working full time and a mostly manual labor position , post-accident under the advice of the doctor, the patient is working at buy buy baby, his job included sales, stocking ,furniture assembly and carry out services for furniture due to the lifting and bending of his job, he terminated the position. He acknowledged that regardless of the advice he was in too much pain to consider working, at the time he was living in his mother's home with his wife and children because he was saving to afford an apartment for his family. from September 14th, 2016 through the cervical surgery on February 5th, 2019 he was always in significant pain and was under constant care, his neck pain and other post-accident injuries. He reported that there were many days he could barely get out of bed without significant pain and working was not possible. Also, his desire was to enroll in college as his goal is to be an engineer, but the pain of sitting at a computer was too difficult for more than a short amount of time that varied depending upon the pain intensity. Additionally, he had no funds for tuition. So college was not possible. just before his cervical surgery, his wife and children who the financial issues moved to a family shelter in the Bronx, New York where they currently live. The patient lives with his mother who's being treated in a hospitalized for throat cancer. He is the caretaker. His role is limited to like grocery shopping and preparing food with her not needing any support for getting around as she uses a Walker and he would not be able to help her at that level due to his pain. Over the last few months, the patient has attempted to find employment and has completed applications but as not sound employment in his limited status with no college education, no vocational education and still in pain upon lifting or sitting for more than an hour while using a computer. Currently, his primary role is acting of caretaker for his mother while relying on family to help support his wife and children for additional needs beyond housing. He is still looking for employment but as counting on funds from either a settlement or verdict to return to college or vocational program to find a career that fits his permanent cervical disability.
Guest Dr: that is really solid and depending on how busy everybody is, that arguably is a much better job than a narrative format than even we put more bullet points that was very good. If I'm being a the only four things, I was just writing quick notes and some of this doesn't tie into even how you reported it, but I really hung up on the word accident. So I would just say don't use the word accident. Spilling waters and accident use motor vehicle crash or collision just cause that's really what it is, did he take himself off work?
Dr Studin: No, Doctor took him out.
Guest Dr: I would just say that and use that. Just as a real quick note, I had this come up in trial the other day. Is there a specific doc at some point that specifically told the patient to stop working if a patient stops work on their own? I know a lot of attorneys in Denver have problems with that counting for anything and the insurance companies say we're not going to give any value unless they doctor wrote that note to stop work, the overall narrative I thought was great, it might help to note if it's the spine versus extremity.
Dr Studin: This report is limited to the cause of relationship demonstrable body injuries only at C4 and C5.
Guest Dr: The only other thing I would say is that the very end, and this is just thinking deposition and trial and the unbelievable spin that the defense puts on stuff. I think you use the words counting on the funds. He'll go back to school. I would wonder if there's a different word. I would use something more like relying on I think counting on…
Dr Studin: hoping for?
Guest Dr: even that my concern is that hoping or relying could get spun around.
Dr Studin: what would you consider?
Guest Dr: I like the idea of due to his financial limitations, He does not have the ability to go back to school and I would let the legal community argue about the obvious fact that he will use funds to go back to school. I'm not sure that doctor necessarily, we want to put that into the report.
Dr Studin: but reported that he is hopeful of.
Guest Dr: I would be concerned about using that to at some point say that he could be exaggerating symptoms or complaints because he is hoping on and relying on this financial verdict. And while we know that's true and appropriate, the defense companies nowadays, they'll take one word and they'll spin it a little bit.
Dr Studin: he is still looking for employment and cannot afford to return to college. A vocational programs to find a career that fits his permanent cervical disability.
Guest Dr: Yes, Because of his pain and lack of money And then it's the attorney's job to think the patient actually can use this money to go back to school, but let's them do that. That'd be my only real comment. Good report man.
Dr Studin: It's not my patient. I'm doing this as a peer review for an attorney actually as a favor, I've logged 20 hours into this case already and the reason I'm doing it actually is to see what can I learn to pass on to our members like you and have conversations with people like you, who are very experienced from an educational perspective to constantly make everyone better, but you really have to have patience to know how to ask the right questions and then it helps to be able to write.
Guest Dr: You have to be able to communicate effectively, I think it also helps to remember, if you can know the patient, is it a patient who just is, not overreaching Our patients are injured, but I had a patient in the other day and he is your classic machismo tough guy to the point that he had gone to the work comp doctor and said, Hey, I'm not even injured cause he was afraid he was going to get fired. So the point just being that, when one patients describes their situation, like you just said, it can be helpful to price sometimes and you might need to dig a little bit deeper to really elicit those functional losses and put it into real life terms that people might not know how to express.
Dr Studin:. I'm not saying he's having difficulties bending, stretching, I'm keeping it real. And I always believe you look for a tail in the story. And for me the tail in this story his wife and children live at a homeless shelter in the Bronx. They are living in extremely difficult situation and it's not pleasant. And so for him to have to move his family out and his mom has throat cancer and he's the caretaker, there are so many real life things that come here and life happens and you as a doctor to get the empathy part, you've got to make their life real in words so that someone can feel the pain of their life as a result of what the accident has done.
Guest Dr: I remember the claims adjuster might not know the Bronx, just like the attorneys at the beginning always prepped for trial. we're so involved on the depo and trial side, the district member, the details matter. And when you're in front of a jury in New York, if it did get to that point, they would know the Bronx. So those extra little details can pay off, even if it's only every 20 or every 30 cases when you're sitting in depo and trial.
Dr Studin: Every word you write matters.