#11 Clinical Information, Diagnosis, and MRI

#9 MDs as Patients

Having an MD present as a patient is a golden opportunity that if handled properly will generate thousands of patients over the life of your practice.  This will happen for a variety of reasons, but generally it is due to a personal relationship with the MD.  When you have an MD coming into the office it is often difficult to know how to behave, sometimes we second guess ourselves and wonder if the MD will be watching you or critiquing your examination.  I will tell you from experience and from consulting with chiropractors from all over the country that they are NOT critiquing you, they have plenty to do with their time instead of making an appointment at your office just to “evaluate you”.  They are coming because they need to be a patient.  I have treated MDs in primary care doctors, pain management, OB/GYN and Cardiology…They are no different than any other patient EXCEPT they understand medical pathology and the vocabulary that goes with it…the worst thing you can do is not talk to them as a Peer.  Be a doctor and evaluate them as you normally would, but also be able to discuss the medical side of the physical examination, radiographic interpretation, MRI studies etc.  The biggest disconnect between the MD and the DC is when the MD assumes that the DC has skipped the fundamentals of patient assessment and is only looking at ONE thing, the subluxation.  When you communicate with chiropractic FIRST the MD things that you skipped assessing for pathology and contraindications to care.  So make sure you set them at ease First by making sure they understand the underlying medical pathology if present, THEN talk about the chiropractic side.  Lead with what they know first….that is how you build the relationship.  So this is how I would start it out…

Review MRI first if there is one present – go to the most important and revealing tests first don’t dilly dally.  Then question him/her based on the objective findings on the MRI.   If there no x-rays or MRI then go right into regional specific questions, remember if you follow the CPT coding manual for level 3 or 4 evaluations you will be fine.  Those levels include past medical history, allergies, medications etc., that is what the MD is used to and that is the minimum of what they expect. 

Physical examination and discussion of any objective findings on exam, basic explanation of orthopedic tests.  I would focus on the specific ones that outline medical pathology such as nerve root tension signed, joint dysfunction etc.  Explain what the medical pathology is (herniated disc, annular tear, and degenerative disc disease) then talk about what chiropractic is looking for and “teach” them that biomechanical problems are the most common reason for spine pain.  Talk about uncorrected biomechanical problems will accelerate the degenerative process. 

That’s IT!  


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