Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 268

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.

"The Neurosurgeon Standard"

Yesterday, I had a conference call with a doctor who connected a lawyer in on the conversation regarding a "disconnect" in communication about documentation that precluded the lawyer from referring to the doctor. The disconnect was that the doctor did not have typed reports for the evaluations and the physiatrist the doctor was referring to also did not have typed reports. The lawyer could barely read the findings in the evaluation and the conclusions were too cryptic as a result of everything being handwritten.
This is a topic I have discussed in the past. "Real doctors" type their reports. Anything that goes to a lawyer should be typed vs. anything that goes to an insurance company...Who cares?!
Neurosurgeons are the pinnacle of specialists. They are considered the best-of-the-best at what they do by both the medical and legal communities. You will NEVER see a handwritten report from a neurosurgeon. You will get a dictated report that is concise, perfectly articulated and considered by many to be the standard of the medical-legal profession.
Am I saying you should become a neurosurgeon? No! BUT...the entire legal community already accepts that as the highest standard of professionalism and to be considered THE EXPERT, you must look the part on paper.
RULE: Any report, whether it an evaluation, re-evaluation or narrative, should be typed to go to the lawyer. I always felt that dictating reports was the most efficient and non "cookie cutter" versus the case in most computer reports. Computer reports also take too long. My dictation took 3-4 minutes with a review after it came in that took another 2-3 minutes. That allowed me to do volume and not take time.
I spoke to 3 doctors this past week on the same issue. They all complained that the reports, both evaluations and narratives, take too long to have typed out. Dictation is one solution, but what you are dictating is another solution to expedite the process.
When in practice, I came across the same issue. Therefore, I created an examination template that many of you already have that forces you to do a "5" level examination. This protects you against a retrospective audit from YOU NOT DOING WHAT IS NECESSARY and getting a demand letter for repayment or getting sued by the carriers. This examination template is also designed to be dictated in an orderly, succinct and expedited format so that every facet needed is covered. As I have said previously, this document took 3 years to create and came from the collaborative effort of 2 chiropractors, an internist, a neurologist, a physiatrist, an orthopedic surgeon and a lawyer. The end result was a template for any provider working in a chiropractic, physical medicine, neurology, orthopedic or physical therapy office because we all deal with neuromuscular issues and a reflex, foraminal compression test or range of motion are universal. Each area of the evaluation is customizable, specific for any technique requirement, making this document flexible for any practice. That is the type of document you need to utilize when creating your reports so that you can create a professional report in a very SHORT amount of time. As for narratives, the biggest complaint is creating them, again, in a short amount of time.
Next week (9-20-2011), I will be having a seminar in New Jersey and I will be covering how to complete narratives with you spending less than 3 minutes of your time. I "pumped out" 7-10 narratives and countless evaluation reports weekly and it took me literally 2-3 minutes per report without a computer narrative writing program and some help from my staff. This is waaaaay easy and I will be recording and posting the process. If you are reading this after that date, please go to the audio/video section as we are instituting video consultations to review the procedure.
If you want to be considered an expert, you have to look the part in person by dressing the part in person and on paper in your documentation. There are rules of success in creating perception effectuating the type of reputation you deserve.
The lawyer on the phone yesterday said to the doctor, "With this type of handwritten document, I will never send you a patient." The lawyer was also referring to the physiatrist the doctor was referring to. The MD-PMR also had a handwritten evaluation. The standard is not prejudicial to chiropractors. It is a universal standard in law. If you are working with a specialist, no matter if he/she refers to you or pays you rent, a substandard practice of handwritten evaluation reports will cost you relationships and poorly reflect on who you choose to work with.
In the end, the specialist, as your team member, will damage your reputation by your associating with them. Be the best-of-the-best and only work with the best-of-the-best. Your reputation depends on it as do your referrals.

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