Academy of Chiropractic

Quickie Podcast 1283
Narratives 103 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

Using Oswestry and Indexes

Dr. Studin: What's your question again?

Guest: The question was about when you list the things that you need for new patient personal injury reports, is this for the lawyer or is this my initial visit for your initial, but nothing to do with the attorney?

Dr. Studin: everything for your patients.

Guest: Okay. And then the next question you mentioned about not using us history and Nick disability questionnaire forms.

Dr. Studin: If you look at all of these indexes and it's something that I've studied extensively, I've been published about  and I've looked at them as well as the history of them, indexes Oswestry neck index, back index. All of these indexes are population based studies designed usually for occupational issues. In other words, um, worker's comp issues, employment issues. So what they're doing is looking at a population based outcome. So if they're studying a million people, they're trying to standardize where you should be, but in those millions of people, if a half, a million or to the left and a half a million to the right, you're going to get a meme, what does that have to do with your patient? Who's either all the way to the left or all the way to the right. The answer was nothing. Now, some carriers mandate that you use this type of study. Now, why would a carrier mandate that? Because it's good for you or it's good for them? That's the question. And the answer always is it's good for them. In addition, should this be a personal injury case and you go to court and you're Oswestry is 23 out of 50 and the lawyer. So you're on the witness stand now. Okay. Doctor on your documentation. So there's a mass West street corner where the patient fills out the paperwork.

Guest: And doctor is that, and please answer this question. You're on the witness stand doctor.

Dr. Studin: Is that the patient's handwriting? Your handwriting?

Guest: Yes. It's a patient's handwriting. And then doctor, is there a score at the bottom, is that correct? Yes. And that score says 23 out of 50. Is that correct doctor? Yes. Doctor. Did you score that or did the patient score that I scored that. And doctor, is that your signature on the bottom where you put your name on the bottom? Yes or no? No. Okay. Well, the doctors, did you look at this form? Yes. Did you sign off on it? Yes. Okay. So there is a signature on the bottom, which you are your name? The patient's name is there, but yours as well. Okay. That doctor, you scored a 23 out of 50. Could you please tell me what your patient can do? How a 24 to that they cannot do what? A 23 out of 50? Yes or no. Could you could you repeat the question please? Could you please tell me what your patient can do with a 24 hour versus the 23 out of 50 that's there now it would be irrelevant. It would be relevant. Can you tell me yes, it's a yes or a no. Can you tell me what they can do? My answer was it was irrelevant and it would be no. So the answer is no. So you see, regardless, regardless of how you answer the question, regardless of how you try to explain it away, the answer is no, you can't, it's absurd.

Dr. Studin: And in summation, lawyer's going to say, even the doctor said in his own words, that he's basing his, his opinion on an index, which he doesn't even know how it changes over time or how it would change with higher or lower score. So the point is is that these indexes really don't work, but here's what works. And I've been to court so many times, and here's what judges and I've read thousands of case of case, um, uh, rulings from judges. Here's what the judge has ruled. This is Jones. Before the accident could carry her baby for an hour. After the accident, she can only carry her baby for five minutes. Keep it real, just keep all ADL's just keep them real and get real life scenarios, because those indexes are designed to screw you. No matter what anyone says, they're not designed to help you.

They're designed to help the carrier. Hey, you can certify what a higher or lower number means because it's too not theoretical, but too general. Keep it real. So in your reports, um, you, you go to school and now I have to carry, I can't carry a backpack. I need a rolling suitcase. I can't lean over and do the dishes. I can't carry my baby. I used to be a mechanic. Now I can't do that anymore because I can't pull the wrench. It hurts too much. So I'm now a service rider and I reduced my pay as a result of that. So the more you keep it real, the more that a judge and a jury will understand that. But if you're dealing in the world of personal injury, the lawyer who's working with, you will now look at those words and say, this is something I could really sink my teeth into.


And this is a doctor who fully understands my needs, because all that matters. Let me just finish this last statement, then I'll, then I'll move on. All of that matters at the end of the day, as what has persisted after a reasonable course of care is concluded. And you want to do a comparative study baseline before you start your care, then asking your care what functional losses have persisted after your care is concluded because that's what every lawyer in this country is going to base a case on, which is substantial. Now I'm done with that. So that's where I would say clinically clearly causality and bodily injury and permanent or persistent functional loss. Let's add one. That's perfect, but let's add one word, causality, demonstrably, bodily injury, and persistent functional was, um, have you been on any of the, the, the weekly seminars that we've been doing for lawyers?

Guest: The webinars? No.

Dr. Studin: Okay. So we, we spent over the last two years, I deal with, um, one of the nation's leading, uh, attorneys on personal injury. He's a former president of the New Jersey trial lawyers, and now he lectures nationally for the national trial lawyers association called the American association for justice. And the big buzzword in the courts and New Jersey is the bellwether state, uh, for the entire country, because everything bad starts in New Jersey. Then it goes around the country. Um, it's just, just the way it happens. Um, it's demonstrably Realty. And if you go and I've lectured in so many bar association meetings and trial or meetings, and I've lectured in bench bars, which were the, all the judges go through, I've lectured in so many Around the controversy Or exhibit hall or these demonstrable companies. They'll, they'll blow up pictures of a herniated desk. They'll blow up pictures of accident, scenes, um, they'll draw things and recreate things because it's gotta be demonstrably because people have to understand that and see it. So what our job is, we spent an exquisite amount of time detailing is how for you to make that bodily injury demonstrative, meaning if you have like an MRI where to put arrows and how to blow things up and how to explain it. So we've spent the last two years, um, not only doing coursework with the attorneys, that's available to you on testifying and, um, educating the attorney, but also how to show it. So this way, when you're reporting your injuries, even to insurance carriers, here's, what's wrong. Look at the red arrow is pointing to it. Here it is. This is why care is taking so long. And here's the literature, which says why. Then there's connective tissue pathology, that this patient is taking longer than usual. And they're a diabetic, which is a comorbidity, meaning that they're going to healing processes taking longer. And here's biomechanical failure studies, which then further corroborate all of those things. Now, a carrier will be very hard pressed to say, Oh, strain, sprain, resolved, eight visits. You're done. Unless they're a total fours. In which case, it gives you a legally defensible position to get paid.


Everything that you finish and everything. But I have not been to court in years and market penetration, but I don't get the results in terms of, I know everybody, everybody knows me, but there's only I've been here for so long that there's a limited gene pool. So to speak, to draw from, and you're always talking about going to court and, but, but here, but here's the thing he goes to court here. No, no, no people go to court there. And I know, and I know your area well, okay. I know your area very well. Your area is no different than anyone else's area in this country. Yes, it is.

Your area is really, it's really not. Everyone thinks my area is different. No, I said, it's not. I said, it's not, Oh, okay. I'm sorry. Oh, so, but here's the thing. You're not going to go to court. That's not going to change what the lawyers have to know. You can go to court, but they're still not going to take you because they're going to want to settle almost everything. And they're going to put it into suit and they're going to settle like the week before the court date, right? That's what's going to happen. That that happens. But the only difference is your reputation. And that changes based upon the documentation that the attorney seek. And that changes upon how you, how you tee up your triage and how you communicate and, and, and the test you order and what you tell your patient. And then the reports the lawyers say, and you're going to force feed reports of your reports.


Not only down their throat, we have wait and put, it starts. It starts with your ENM, your evaluation and management, your initial evaluation. That's where it starts because you know, like computers garbage in, garbage out. So it's all going to start and change. They have to see something different. You know, I have a lot of people look, I'm 64 years old. They've been around and I'm married 40 years. Oh, actually that's not true. No, no, no, no, no, no, no, no, no, no, no. It's nothing to do with that. I'm married 44 years to be precise. Um, but there's nothing to do with that. When I get people, a lot of younger people on the phone, as you know, um, and sometimes I feel like I'm their rabbi or their priest, dr. Mark. And I have the problems. I'm having problems with my wife, with my girlfriend.


This maybe you could help me because they're comfortable. They have no one else to talk to. Here's what I tell them. And it's a very, very big, uh, parallel to practice. You can change how your partner feels about you, because that's how they feel. You could change what they see. So ask them what they see that bothers you. And if you can change what they see, they'll change how they feel about you, which is your reputation. Or if they feel it's the same thing with lawyers, medical, primaries, medical specialists, how they feel, how they feel that you change that, but you can change what they say. And what they think is, is they'll see documentation different. They'll get different feedback from their patients and over time, and it's a process will change how they feel about you, which is your reputation. And that's where the referral process starts.


Okay, fair enough. I will send the stuff out. So another question is West street, so that you, you would continue doing them for work comp or not. I would do it for only the carriers that mandated. And clearly there are certain cars you have to ask them. And workers' comp is a state by state issue because there's 50 States and 50 sets of rules. And those rules change literally every day based upon the last court rulings. So you have to find in your state of workers' comp lawyer and say, is the us Western mandatory or any type of index mandatory? Or you can't just ask that question because they're going to say, well, yeah, you should get it because they're thinking, Oh crap, this guy ain't getting anything else. So I'm screwed or can I keep it real? And just say that the patient used to be able to lift their kid, carry a backpack, do dishes have sex?


And they can't do that. Now, which one do you want? Or can I do that? Okay. And they'll say, you know what, almost every lawyer in the country I've worked with and I've worked with hundreds of, thousands of them turned around and said to me a lot of these words, but keep it real, who cares about the index? Okay. So that's the thing that you would have the patient on their own words, the paragraph or so that it could do this and now I can't et cetera, et cetera. Correct. Uh, there's, there's a functional loss form. It's actually, um, uh, for sale on the, on the site, uh, because to cost me a whole bunch and you gotta print it up, but I have a sneaking suspicion. If you just send me a request for it, it might just find its way back to your inbox. Okay. Okay. Well, I'm, am I send that out by text, email? Not text, email? No, I can't because I have to be able to attach things real quick. Um, I had that surgery a week ago tomorrow. We're done with this conversation. Um, I'm going to hang up and call you back. Okay. Okay. Okay. I'll call you right back later, alligator.



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