Academy of Chiropractic’s
Doctors PI Program
From the Desk of:
Mark Studin DC, FASBE (C), DAAPM, DAAMLP
“THE PI Rules”
There are certain rules in life that are truisms, two examples being, “The early bird gets the worm,” and “Do unto others as you would have them do unto you.” Biblically, there are the Ten Commandments and those are pretty good rules in life to follow. After all, they have been around for quite some time, ever since Charleston Heston brought them down from the mountain. (Just seeing if you are paying attention or if you are much too young to have seen the movie.)
Here is a new twist on some truisms for your entertainment:
- Experience is something you don't get until just after you need it.
- For every action, there is an equal and opposite criticism.
- He who hesitates is probably right.
- Never do card tricks for the group you play poker with.
- No one is listening until you make a mistake.
- Success always occurs in private, and failure in full view.
- The colder the x-ray table, the more of your body is required on it.
- To steal ideas from one person is plagiarism; to steal from many is research.
- To succeed in politics, it is often necessary to rise above your principles.
- Two wrongs are only the beginning.
- You never really learn to swear until you learn to drive.
- The problem with the gene pool is that there is no lifeguard.
- A clear conscience is usually the sign of a bad memory.
- If you must choose, pick the one you've never tried before.
- Don't sweat the petty things and don't pet the sweaty things.
- A fool and his money are soon partying.
- Money can't buy love, but it CAN rent a very close imitation.
- Hell hath no fury like the lawyer scorned.
- Bills travel through the mail at twice the speed of checks.
- Hard work pays off in the future. Laziness pays off now.
- Eagles may soar, but weasels aren't sucked into jet engines.
- Half the people you know are below average.
- 99 percent of lawyers give the rest a bad name, while 50% believe they are in that 1%
In the fun of it all, please pay close attention to number 18, it is a killer. This play on life’s truisms or rules is not far from reality.
Right now, you have read all too many consultations and I agree, it’s a lot of reading and even more work behind them. My goal is to keep you on your toes and at the same time, I understand the rule of the 3 R’s. Repeat and Review with Regularity. The 3 R’s are the key to learning, which is why I tell you the same things in so many different ways. You need to “get it” because this stuff works; we just need to ensure that it will work for you at the next level.
Some of you are getting 0-1 PI cases monthly and others are getting 30-60 PI cases monthly. No matter your level, the goal for everyone is to do better; it's how we are wired and what keeps our competitive juices flowing. The difference between the 0-1 and 30-60 is so simple, it’s glaring; those that follow the rules win. How easy is that?
Just yesterday I read a narrative of a doctor who has been in the program for 2 years and in the diagnosis was “strain/sprain.” The conclusion did not have the entire case synopsized, and this doctor wants to know why he is struggling? Another doctor, for who I reviewed 7 versions of his narrative, continues to add degrees in ranges of motion with no inclinometer study. Another writes the following:
“Ms. Patient has a pre-existing condition of fibromyalgia and has been on disability for approximately the past 10 years due to this condition. This condition is not a result of this injury; however, it does increase the susceptibility of damage with less trauma.”
The problem with the above statement is that this is the degeneration paradigm that has abundant research to justify the statement. Fibromyalgia is not part of any research that I have seen to fit this opinion and, therefore, is an unsubstantiated statement. It is part of the chiropractic 1-step, 2-step bullcrap that has given us the bad reputation we have had in the courts for years. Facts, facts and more facts that are backed with documentation are all that can be included in your paperwork regarding statements at this level. This is non-negotiable!
The result of this untruth is that an average lawyer will look at this and think he/she has gold. He/she will spend $10,000’s to get to trial and will take a loan because you have given him/her the ammunition. In trial, an opposing expert will undo this in a nanosecond because I could and there are a lot of people smarter than me. The end result, the lawyer will lose, you will shrug your shoulders and cash your expert witness check and the lawyer will be left with a loan to repay for the next 5 years.
Henceforth, “Hell hath no fury like a lawyer scorned.” That lawyer will spend the rest of his/her career bashing you and every month, the check he/she has to write to repay the loan will be a reminder of how much he/she hates you. He/she will not be bashful in telling not only everyone he/she knows, but anyone who will listen to him/her.
Whether you are that 0-1 or 30-60 cases per month practitioner, or anywhere in the middle, largely depends on how well you follow the rules you have been taught over the course of the consultations. It is getting much harder for the personal injury lawyer than it is for us to navigate in today’s economy. The lawyer, like us, has to deal with the patient/client and also the insurance carriers, but then he/she has the additional burden of having to navigate the courts.
Can you imagine having to fight an adversary for every bill you submit where the opposition is as knowledgeable as you are and intent on “flat out” proving you wrong in order to deny payment? At least the IME doctor is supposed to report the truth of the patient’s condition to allow fair levels of care and reimbursement. The lawyers live in an adversarial role and the rules of the courts are making the minimum standard to bring an action more stringent daily, nationwide.
This is what I am told from coast-to-coast directly by personal injury lawyers and as a result, they are becoming more critical in who they will work with. This also explains why there are less PI cases to be referred; their case pool is shrinking based on their inability to get many cases to trial compared to years ago when it was easier. As a result, those who know will thrive and those who don’t will no longer even get the crumbs, no matter how many fancy dinners you take them to.
Last week, a lawyer in New York told me that he is now bypassing a local neurosurgeon for a chiropractor because the neurosurgeon refuses to discuss functional loss in the narrative. It is a court requirement to get cases certified for bodily injury under NY statute. The issue, however, isn’t NY statute, it’s that the chiropractor now meets the needs of the lawyer and the standards of the courts if the chiropractor follows the rules and the neurosurgeon doesn’t. Most chiropractors’ work is not admitted. It’s not that most don’t follow the rules, it’s that most don’t even know there are any rules.
When I sat down with this neurosurgeon 5 years ago, as a favor to both the lawyer and the neurosurgeon, I explained in detail that persistent functional loss needs to be added to the report. Simply explain in the examination report what the patient can no longer do as a result of the accident; a 30 second dictation that will open the floodgates for PI referrals for the neurosurgeon. It fell on deaf ears because he is a NEUROSURGEON and, therefore, is above anything other than his needs. Last month this very same neurosurgeon met with me asking for my advice on how to get more PI cases, as his case load is dropping and his malpractice has just topped $300,000 annually and many lawyers are steering their clients away from him.
These rules apply whether you are a chiropractor, neurosurgeon, orthopedist, PMR, etc. The competition is no longer for those with the best degree, it is for those with the best credentials, knowledge base and ADMISSIBLE reports. The rules of success are about admissibility and have little to do with your clinical practice. You can ignore the rules and be like the neurosurgeon and struggle or follow the rules and be like all those getting 30-60 PI cases per month; the choice is yours. It won’t change how you function clinically, it will only fill your clinic.