Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 69

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.

"Functional Loss & Pain"

Over the last few months there has been a recurring error noticed regarding functional loss and pain. Doctors are writing the following in the narrative:


Personal Functional Loss: “I am having difficulty in doing household chores, such as dishes and vacuuming, due to the pain. It requires me to stop from time to time and rest until the pain goes away, so I can finish my chores.”


Work Functional Loss:  I am a copyright artist and that requires me to sit at a computer for hours at a time. As a result of the pain, I have to stand every hour or so until the pain subsides to complete my tasks at work.”


Here is the crux of the issue…In both of these examples, the patient can do their tasks and it is not a functional loss, it only requires them to modify their lifestyle. This is important, marginally. What is impactful, is that the loss is present and clinical correlation confirms the complaint. THEY CAN NO LONGER DO VS. WHAT THEY COULD DO BEFORE THE ACCIDENT. This is the single biggest issue in a report to the medical-legal community and needs to be clearly articulated in your report.


Dr. Dean Robinson of California writes, “You stated that in both of these examples that since they can do their tasks, the loss is not functional.  However, the necessity to modify their lifestyle is by definition a functional loss (AMA Guides 5th edition).” 


Dr. Robinson is correct and I minimized the alteration of lifestyle too much. The point is, it is more impactful if a patient can no longer do a task, but it is still an impairment if they have to alter their lifestyle. The 6th Edition, however, has different guidelines, but comes to the same conclusion.

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