Academy of Chiropractic

Quickie Podcast 1340

Narratives 113 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

Apportionment

 

 

Dr. Studin: Good morning. What's going on?

Guest: Good morning. So I have a patient that just recently started with me, who just moved here from California. And when she lived in California, going back to last summer, summer of 2020 she had different traumas within a very short amount of times, the first one was late July of 2020. That was a rear impact car accident. And literally just a few days after that she had a fall at a retail store. And what she is claiming is injuries from both sending after the car wreck that happened first, she had Lou pain and increase in old pain and then after.

Dr. Studin: Okay, so, new, old, all that stuff doesn't mean anything. So we're looking at a portion that correct?

Guest: I believe so.

Dr. Studin: Okay. So what you're doing, it's simple. You're only two accidents. You take a blank piece of paper. You draw a line down the middle, you put the symptoms and clinical findings from accident. One on the left side, you put the symptoms and clinical findings from accident. Number two on the right side of the piece of paper. And now you play connect the dots. Anything from accident one that moved over to accident. Two is from accident one. Now, if the anything that's on accident, two, that wasn't on accident. One is from accident two. And with me so far?

Guest: yes.

Dr. Studin: Now you're also going to put pain scales down any on accident to any consistent pain from accident. One or finding if it's more pain, you have two choices, exacerbation or aggravation. If it's exacerbation, you treat that on accident too, until the pain scales go back to what it was on accident one. And then you're going to go back to treating on accident. When you're going to run two charts, if you have more pain, do you know the difference between exacerbation and aggravation?

Guest: Yes. Exacerbation is just symptoms. Aggravation is actual structural changes, correct?

Dr. Studin: More bodily injury. If you have aggravation that stays on accident. Number two, because it's a new injury. So action two is either exacerbations of accident. One when those actions act, when those exacerbations abate, you go back to the chart on accident one and any aggravation or new injury stays on accident too, in a new chart. Now here's the kicker do not treat the patient for both charts on the same day and tell the patient. Unfortunately, you're going to have to get a wing in my office with your name on it. We might even have a, you know, put a bed in there for you, but you're going to have to live here for quite some time, because I cannot treat you on the same day for both two accidents. It gets confusing. It gets muddled. The arguments come out that, Oh, you just treated everything the same. You're just double billing. There are two different charts. Do you understand how it works?

Guest: I believe so. I do have a question about the clinical stuff though. So clinical findings on accident one and accident two, if I didn't see her until after both of them had already transpired, uh, is that basically just her subjective symptomatology?

Dr. Studin: There was no. Um, what, how far apart in time was it a few days? Oh yeah. You're then the exacerbate issue comes off the table. Okay. Since we don't have any imaging, this is the third time in the past week. I've had two accidents a few days apart. If it's a few days apart that you can't determine that aggravation, it's not possible. So if she said she complained that she was in a car accident, her neck hurt and it was killing her and then she was in a slip and fall landed on her. And now our low back is hurting her. You know, that's clear, that's easy, but if it's lazy, you might have to make a clinical decision and put it all to one accident. It's going to be challenging. And I think that was the clinical decisions.  What I want you to do is I want you to write the write it up and send me your conclusion and rationale, but you have best have an airtight rationale to start two charts if you these apart, because it gets clear as mud.

Guest: Yeah.

Dr. Studin: That will be tough, but I love to see your feedback on it.

Guest: But that's you know, if it's a few days apart, rarely, can you create two charts from that?

Dr. Studin: Unless it's an easy, you know, like a car accident with lash in the neck and then fall on your. Right. Unless it's something as crystal clear as that you're going to have a hard plug delineating between accident one accident. Two sounds like it.

Guest: Yeah, it does.

Dr. Studin: It does certainly sound like there's going to be overlap, but he's got to make a decision. And the decision is whether there's the correct, where the most damage of the car was, or, you know, some, uh, and this is not that type of scenario, but you're going to have to come up with what was the most causative factor logically if there's no clear cut and of course you'd get some big pre-existing injuries that C5 to C7 fusion, couple of big work injuries that happened way before this. No one said it was easy.

Guest: No, no. It's a good experience though, for sure. Thank you for your help.

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