Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 4

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.


I have spoken to over a dozen doctors nationwide over the last week and there is a common pattern that is preventing almost every doctor I spoke with from getting PI patients referred from the legal community: Narratives!
The legal profession, unlike the chiropractic profession, is one exclusively of paperwork. We can have a poor note, or a poor report, but the patient still gets well and they are happy. Henceforth, the formula for many successful practices. In law, if your documentation is poor, be prepared to fail in business. There is no middle of the road. Good paperwork = success, bad paperwork = failure.
In spite of the heated arguments I got this past week where doctors told me, “My state’s requirements are much different from those any other place in the country,” there is only 1 standard that holds true nationally. Clinically correlate causality to bodily injury and persistent functional loss. I have spoken to 1000’s of lawyers nationally, in dozens of states, and I would be happy to speak to lawyers in your state if I haven’t, but should your paperwork accurately reflect the above statement, then you will have the PI practice you want.
It’s that easy and at the same time, it’s not that easy. The paperwork should reflect the true condition of your patient and at the same time, through clinical excellence, your patient should be accurately diagnosed. You need to understand all of the diagnostic modalities along with how to interpret the MRI’s, x-rays, EMG/NCV reports, etc… It never fails to amaze me how many doctors don’t remember how to read x-ray film.
This brings up another critical point. If you refer to a radiologist for x-rays, most if not all state licensure boards still hold the doctor responsible for treating their patients based upon the pathology found on the film. Should a radiologist miss pathology, then you will be held responsible for hurting your patient. The solution is simple; make sure you get the film as well as the report and look at it, as we have all been trained in reading x-ray.
The next issue is reading MRI’s. To have a successful PI practice it is extremely important to know how to read MRI’s. This is a very big issue with admissibility in most states and a very big deal with lawyers. I have created a course online (at the request of many of you) to teach you how to read MRI films and as importantly, give you credentials to read MRI (go to and click on “Continuing Education Courses”). It’s a great place to start and you would need to follow up on your training. I have many suggestions for that. However, that’s for a different forum.
As a note, should you already know how to read MRI and have no formal training, your opinion will usually not be admissible, as you have had no formal training. Once the formal training is in your credentials, then it becomes admissible. Which brings us to credentials; your CV must be powerful.
As a note, if you hire doctors to work for you, you are liable for everything they do. Therefore, it becomes more critical for those associate doctors to practice within your standard of care with a very high level of clinical excellence. This is evident in the lack of understanding in what films to take or order in both trauma and non-trauma patients. 
Finally, there are narratives. Most narratives that I have critiqued are extremely deficient in what is necessary to meet the needs of the lawyers and the court. Even those doctors whose narratives I have critiqued previously, when sending me an actual report to review, still are missing most points. If you would like me to review a narrative for you prior to sending it to a lawyer (before you shoot yourself in the feet with bad paperwork), send me a copy of the report and I will look at it for you. It is more important to create a good reputation then fix a bad one!
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