Academy of Chiropractic Personal Injury & Primary Spine Care Program
Quickie Consult 126
"The Lack of Clinical Excellence & How it Will Destroy Your Practice"
A doctor sends his narrative for critique today and writes:
“An MRI of the cervical spine on 05-12-09 reveals some early degenerative changes present on the right at C4-5 with asymmetric foraminal narrowing and at C5-6 without foraminal narrowing.
An MRI of the lumbar spine on 05-12-09 reveals the following impression:
1) Early degenerative and/or transitional intervertebral disc space changes seen at L5-S1 with intervertebral herniation of the L5-S1 disc into the S1 vertebral body.
2) 1 mm of subtle broad based disc bulging at L5-S1 beneath an intact posterior longitudinal ligament without significant deformity of the adjacent thecal sac or subjacent nerve roots.”
First, who interpreted this MRI? It must be the doctor because he does not cite anyone else and signed his name to the bottom of the report. However, the doctor was referring to another doctor’s read and that is fraud. You must state who read the film if it was not you.
Then the doctor continues and uses the following diagnosis:
“722.10 L5-S1 lumbar disc herniation with impingement of the left L5 nerve root.”
The question I asked the doctor is, “Where did this come from?” Do you see this in the above MRI interpretation? I don’t! Is that pandering to the lawyer for personal gain? I am sure the defense lawyer will bring that up at the first opportunity they can get and perhaps report that to the licensure board in order to discredit the doctor and win an extra $5,000. That little bit of money can cost the doctor his license. I am not exaggerating.
Then, it gets better…The doctor writes in his conclusion:
“The mechanism of his accident where he was a driver of an automobile that was struck from behind while stopped at a stop light clinically correlates to the MRI findings of cervical encroachment and lumbar disc herniation and x-ray findings of degenerative disc disease…”
Again, referencing a disc herniation that is apparently fictitious and correlating the degenerative disc disease to the accident. I don’t think so!!! That is not true! Disc degeneration is not from the trauma and you should know this as much as the doctor who wrote this should. You have to.
There is so much more wrong with what was written, such as the broad based bulge. That is the wrong nomenclature and you should know that, too. However, I am going to focus on the most obvious inconsistencies in what was written.
This doctor, through lack of understanding what resulted from trauma and what was degenerative, planned on reporting this to the lawyer tomorrow, but decided to run it by me first. The good news is this doctor did not send it to the lawyer and the doctor did sign up for the Super Conference and will take the MRI Spine Interpretation Course online…BECAUSE it is this type of a lack of clinical skills that will destroy your practice, give you a greater opportunity to hurt your patients and become the poster child for the “ONE-AND-DONE!”
When I discuss clinical excellence, I mean you have to be the real deal and truly understand this stuff. Wake up folks…The lawyers know this material better than most of the profession because this is their bread and butter. Arguing disc is how they make money!
This doctor wrote a very articulate narrative, got everything right, but the physiology and inconsistency in reporting. It only takes a little bit to get a bad reputation. I continue to remind you at every level and every opportunity that the best practice builder is YOU. Take the MRI Spine Interpretation Course, go to the Super Conference on Clinical Excellence and know this material…Your success depends upon it.