Academy of Chiropractic

Quickie Podcast 1281
Narratives 101 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

Diagnosing Accurately

Dr. Studin:  What's your question again?

Guest Dr: I have two questions. First one, diagnosis, kind of knowing the difference between some of them, the weight is the same.

Dr. Studin: Let's slow down. Let's talk about relative weights. Okay. Do you know what a relative weight is for?

Guest Dr: just the strength of the diagnosis.

Dr. Studin: Okay. Now what happens is if the world health organization, when it created the IC day needed to create statistics, and give algorithms for length of stays in hospitals, and the seriousness of illnesses to determine population demographics and epidemiological stuff. And in today's environment, like COVID-19 would have a high weight because it's a big epidemic epidemiological issue. So, what they do is that if someone, for instance, has cancer, like breast cancer or lung cancer, it is going to be a higher weight than a stubborn toenail. You know what I mean? So, and that's it. And that gives algorithms to length of stays on hospitals, etc, somewhere along the way, insurance companies weight then. And they decided to use that for how long is it going to be until we IME somebody? How long is it going to be until this or until that, etc. So, what you want to do is when you, as a doctor, have a choice of picking a diagnosis and you always listen, neck pain, cervicalgia injured, nerve root. I mean, depending upon the specifics, you've got a lot of choices, strain, sprain, you have a lot of choices. So what you want to do strategically is pick the one that's the most accurate. What if you have choices, why would you not want to pick the one with a higher relative weight? Okay. Does that answer your question?

Guest Dr: That does make sense. So just to kind of go a little bit further with that, you know, for instance, you know, cervicalgia an injury to the nerve root, they based on what I'm looking at here, carry the same weight. So I want to make sure that's accurate and kind of where you go, but I look at it this way, if someone's post-traumatic, which one is more and I've got nerve root, clinical findings, such as weakness, motor loss, they reflect SIA or abnormal reflects SIA, which one would I want to use?

Dr. Studin: Enter it in Nirvana, just cervicalgia, because cervicalgia me just tells me neck pain. It doesn't really tell me. And I might want to use both.

Guest Dr: Okay. because you had said in a lot of cases don't feel like you're going to over diagnose. Like sometimes you might have like what 20 diagnoses.

Dr. Studin: Correct. But there's another wrinkle here. Having with the lawyers for the carriers and have a really strong relationship with them, you know, with one specific attorney and looking at lawsuits that have been rendered against some of our doctor's Rico suits that are being defended and I have four Rico suits being defended at the moment, you know, that can change at any time. It could be zero, it could be 10, but right now it's for one of them specifically the carrier claims. And it doesn't mean that's true that the doctor uses the same number of high diagnoses in every patient and the same diagnoses in every patient. Okay. So, you have to be careful because the carriers are reverse engineering, creative lawsuits, the days of someone staging an accident with a bus with 30 people on and they all get treated for gazillion dollars. Those days are pretty much over. So now the carriers are looking for fraud in a creative fashion.

Guest Dr: Okay. That answer question number one, number two. I guess it's kind of along the same lines, but when you have a patient come in and you know, they don't have … clinically, they're not showing all of these, these fancy diagnosis, they’re pretty routine. How does it change your, I mean, as a clinician, obviously it's going to change your treatment plan, but does that hurt you? Does that hurt you with it?

Dr. Studin: Well, it's funny you say that because I know you're relatively new in practice compared to me and you know, it's funny when I was in practice, I love taking care of asthmatic. So they all got better. I was able to get them to throw their drugs away and you know, breeze and, you know, have their life back. And then what, like that was the first hundred, second hundred. It was okay. By the third hundred, you know, it's pretty routine, that's a standard routine patient. Yeah. They're going to throw their drugs away. But if you're that one patient who's been addicted to these puffers, whatever they're called and the steroids, then your parents had to sell their house or remortgaged to pay for your drugs. It's not routine, it's not a routine patient just because it's the typical patient. You know, it's like the cancer doctor who says, Oh, only colon cancer, stage four. It's pretty routine. So, you help a lot of people that for them to come to you, it's not because they're a hypochondriac. If they've got a problem. Now, the other side of the coin is, is that you're going to see a specific musculoskeletal sect of patients and your diagnoses are not going to vary beyond maybe 20 or 30 or 40 at the most, every single patient. Okay. I mean, you know, cervical, thoracic, lumbar headaches, migraines, back pain, radiating to the arm or legs reflections down sensory, down, motor down what I miss.

Guest Dr: Okay. Yeah. That makes sense.

Dr. Studin: Yeah, but it might be sleep aberration. It might be concussion. You know, it might be variations that you have to put based upon what the patient says, but you're not going to have 7,000 ICDs to choose from. It's going to be a very finite setting. You're going to work off of that finite set. Okay. Which is why I gave you, you called it a cheat sheet before we got on this recording. It's not really a cheat sheet. It's just the most common ones out there. And you'll be hard pressed to diverse from those common ones out there because we do see a finite amount of a patient.

Guest Dr: Now we're not, when I had a conversation with the attorneys, for the carriers, he says, well, all you guys, you always put the same diagnoses on. He says, well, we see musculoskeletal patients related to the spine. How much variation is there?

Dr. Studin: Right. We want them to see you , but I left that out. But, but we were for lunch. I said, you're paying for lunch. That's a whole, I did get him at the very end. There we go.

Guest Dr: All right. That's it. That answers it.


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