Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 182

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.

“Medical Specialists Wear Underwear Just Like Us”

While writing the title, I realized that some of you many of you do not wear underwear and “combat” is the style of choice. However, for this article, please make believe that you do!
Over the summer, I have spent a significant amount of time at the beach with two prominent surgeons, a spinal orthopedist and a neurosurgeon and based upon their attire and their lack of suspenders, I can attest unequivocally that they all wear underwear just like we do. The point, other than grossing you out, is they are just like us, yet some many of you feel intimidated about talking to these people. Yes, they are people and guess what? They know as much as you do, perhaps more about surgery, but no more than you should know about the spine. The key word is “should.”
If you are feeling inferior in knowledge base, fix it! Take courses, ask questions and learn. My education, as I have previously stated, started with the neurosurgeon, with my not being bashful about what I didn’t know. I still ask some stupid questions and based on our relationship, he doesn’t care. In the beginning, he really could care less as long as I sent him patients. You have to start somewhere and having a neurosurgeon is critical to YOUR TEAM. 
These specialists are very quirky. They have little competition and have strange nuances. With all of them, you have to let them know that they cannot write in their notes, “There is no surgical lesion,” and nothing else. Neurosurgeons are focused on surgery and if the patient has no surgical lesion, they often document in their reports that fact alone and that can be very problematic to the necessity of your care and the medical-legal community you work with. Request that they document what is there and not limit it to a comment on the presence or absence of a surgical disc. 
In addition, ask them to write in their recommendations that if there is no surgical disc, then conservative care is indicated. This will open the doors of necessity on your part and give you a level of insulation if there is something wrong with the patient and it is missed. It is not reasonable to ask them to recommend chiropractic care because chiropractic to a neurosurgeon is only one tool in the mix of “conservative care.” 
Neurosurgeons, as a rule, will support chiropractic, but bed rest, drugs, physical therapy and acupuncture, to name a few, are also part of their conservative care options and that is fair. We all know that chiropractic is powerful, yet there are times when patients do not respond to our care and they have to seek alternative care. Whether that is 1 out of 1,000,000 or 1 out of 10, the metric is not important to the neurosurgeons because those who do not respond are the ones who see them. They are at the top of the food chain of problematic cases and they see them all. The good news is that neurosurgeons do see it all and do see how many patients respond well to chiropractic care. They also see the opposite.
Every neurosurgeon I have met with, taught and worked with has always said the same thing to me, “I appreciate the benefits of chiropractic care and will work with and refer [when I have a chance] to chiropractic, BUT when I read the doctor's notes or talk to the chiropractor, I will know in a “heartbeat” if this doctor is someone who I feel comfortable working with.” That is almost a direct quote. 
Neurosurgeons will tell their patients not to go to you if they feel that you are not going to help them and that is based solely upon what you know. We all work on the same conditions, but use different modalities to get there, so if you are the “real deal” and the “best-of-the-best” at what you do, there will be no problems.

In fact, last year I lectured to 85 lawyers in Saddle Brook, New Jersey and after the meeting, the sponsoring group of 6 doctors was coordinating the schedules of who was going to visit the attending lawyers as there were too many for an individual doctor to meet with. One of the sponsors was a neurosurgeon and he approached us to ask us a clinical question based upon what he had heard in the presentation. To reiterate, a board certified neurosurgeon asked a chiropractor a clinical question. Truthfully, that happens not only to me often, but to every chiropractor who is at the top of his/her game.
The neurosurgeon, because of what he/she sees, is consistently the only part of the medical community who will condemn the individual practitioner and not the whole profession. Neurosurgeons have the same level of complaints against everyone in the healthcare community, MD and DC alike. You are either good at what you do or they want nothing to do with you.
As for referrals, neurosurgeons are obligated to send patients back to the referral sources as they are a 95% referral practice, with emergency rooms as exceptions. Those exceptions, however, are usually catastrophic and will not end up in your office. As a result, this is not the place to expect many referrals. Over time, perhaps there will be a few, but again, not many. This is the relationship where you have an “ace in the hole” to render the very best of care and help guide your patiens to the very best.
Another note is that neurosurgeons malpractice insurance is roughly $300,000-$350,000 yearly. They need your referrals to survive. In essence, they need you more than you need them! Create the relationship and learn from the best, but remember that they all wear underwear just like you.
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