Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 134

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.

“That’s Clinical Excellence”

I have received 3 communications in the past 2 days that underscore 3 doctors commitment to clinical excellence and they are not what you think. The first was an e-mail from Dr. Sadowski in Massachusetts asking about a certain test he wanted clarification on. My reaction was, “I don’t know the answer,” so I put it out to you to help me find the right definition and utilization of this test. I then forwarded every response to Dr. Sadowski who is compiling a brief paper on the results and utilization and I will publish his paper on the Web site, so that he can cite that in his CV.


The second was an e-mail to call the doctor on the correct slice thicknesses on the MRI in the cervical spine and any other necessary views. This doctor is relatively new to the program and after reading the consultations, realized he needs to take the MRI Spine Interpretation Course and learn the protocols. He knows enough from the basic reading to not accept an inferior scan for his patient. I called him back within a few minutes, as that is the usual response time for an e-mail request for call back, and he got his answer and ordered the appropriate protocols for his patient.


The third doctor had the MRI representative in his office and he, too, had not taken the MRI Spine Interpretation Course yet, but knew from the consultations that he needed to know the protocols for slice thicknesses and STIR views to set up his patients for every scan in the future. He called me directly, I was able to take his call and I talked directly to the MRI representative and gave him the parameters for every one of the doctor’s future patients.


Both of these doctors understood, but do more so now, the importance of the knowledge in the MRI coursework. However, they wouldn’t accept lowering their standards because they hadn’t yet taken the course. In all three cases, these doctors recognized that they will not accept inferior standards of care for their patients and have taken the steps to ensure clinical excellence. You are not expected to know everything, but you are expected to know what you need to learn and not wait for answers when a patient needs care now.


These doctors are using their resources; in these cases, I was their resource. In others, it’s the courses online or through seminars. I have outlined in the consultations finite areas of expertise that you need to attain. Do not procrastinate and do not accept your former standard of care if it does not reflect what you now know.


In talking to many of you, I have discovered that a good percentage have not read every consultation. Therefore, you are missing clinical protocols that I share in the later consultations. It cannot be business as usual and this has less to do with your medical-legal practice (although it will greatly enhance your relationship with lawyers) and everything to do with being the best-of-the-best in rendering patient care.


This is one area where I do have an issue with our formal education. We all get a very in-depth education on clinical evaluation, x-ray interpretation and corrective care (adjusting), but fall significantly short on a thorough education in diagnostic testing and triaging the patient. As a result, the post doctoral courses available online help fill that void, as I know that I was very inadequate in my diagnostic skills beyond a clinical examination for my first 15 years in practice. That inadequacy left me feeling very insecure in caring for many patients, as the longer I was in practice, the more I was guessing.


That is the WORST place for a practitioner and your patients to be. As a result, I then turned every decision over to the medical specialists and my practice and patients suffered because very few medical specialists recommended a given patient stay under my care. Along the way, the medical specialist took whatever liberties with my patient in “trashing me” and damaging my reputation. In retrospect, they were right…I should have known better or not accepted the patient for care. It was when I took control of my practice through knowledge of the diagnostic process and every diagnostic modality available to me, as well as the rest of medicine, that I regained control over my patients, practice and reputation.


The 3 doctors initially discussed in this consultation have taken a major step in that direction and should serve as an example to all. I must say that many of you have already taken those steps and for that I am very happy, proud and encouraged for the chiropractic profession. That is the only way we are going to lead into the next millennium and this message needs to be shared.

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