Lawyers PI Program
From the Desk of:
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
“Going the Extra Mile = Referrals”
I had a very pleasant phone call today from a doctor that has been part of the program for well over a year and consistently gets 24-26 new PI cases per month in an office with 3 staff members. He shared that he regularly goes the extra mile with the lawyers and it reminded me of something I did in practice for years. As I have shared with you previously, you should be packaging all of your paperwork in a bundle and meeting with the lawyer or paralegal at the 6-8 week mark in care. The package should include all of your reports, the test results and the results of any specialists. What this doctor does is he goes the extra mile and gets the hospital records as well and then calls the lawyer or paralegal and explains all of the findings, not just his.
WOW! This extra step has earned him a place at the top of many lawyers' referral lists by being so user friendly and knowledgeable. The level of professional service then becomes unsurpassed, as no one gets hospital records for anyone…and then deciphers and explains them. Now…regarding hospital records, here is how to explain them because they are the bane of the lawyer’s existence and often destroy cases because no one really knows how to understand their context. Let’s explore what happens in a hospital emergency room.
The ER is a very hectic place and the key word is triage; that is the process that takes the most critical first and leaves the less critical getting much less attention, as it should be to save lives. On a typical day in the ER, the attending physician is overburdened due to the insurance companies not paying the hospital’s claims, just like they don’t pay you. Therefore, the doctor has to be in too many places at once and something has to give.
Your patient, who has been in a car accident and has significant neck pain, shows up in the ER. The triage nurse has him wait and the ER doc comes flying into the room after attending to 3 heart attacks, a bleeding carotid and a motorcycle crash that resulted in a crushed skull. He asks your patient what is wrong. Your patient says that his neck is killing him from a car accident and nothing else. The ER doc does a brief exam to ensure there are no head or spinal cord injuries and orders an x-ray to rule out fracture. From there, the nurse handles the rest. After the x-rays are taken and come back negative, the patient is released with a pain killer and told to go to his family doctor. On the notes, it simply says neck pain and nothing else with cryptic notes of an examination. No ancillary information is taken regarding other problems.
The patient comes into your office and has a slew of other problems. The pressing question is, "Why does he have these problems which he didn’t report to the ER doc?" There are 2 reasons. First, the ER doc didn’t ask the questions because he didn’t have the time, as it wasn’t critical at the moment…and he shouldn’t take the time because there are others that are critical. The second reason is the gating phenomenon. That is the process where the body “gates off” physiologically the pain of all secondary issues because the primary area is firing off messages to the brain at an alarming rate preventing the other messages from getting through. Over time, those secondary messages get through, allowing the brain to sense them. It doesn’t mean those secondary issues are minor or less egregious than the primary issues, just that they didn’t fire as many neurons compared to the primary site.
It is your responsibility to elicit an entire history so that all primary and secondary issues can be exposed and evaluated for bodily injury in order to help your patient. Sound like chiropractic school? It should because this is something we were all taught and is usual and customary. The ER process and the primary and secondary complaints need to be explained to the lawyers so they can position each complaint from their clients properly and understand why there are symptoms that the ER doctor didn’t document. In fact, you need to explain why ER records are so cryptic.