Academy of Chiropractic’s
MD Relationship Program
#11 – Clinical Information, Diagnosis and MRI
From: William J Owens Jr DC DAAMLP
Triaging Patients – Chiropractic…WE HAVE A PROBLEM
I spend time on the phone with doctors across the country daily discussing many things including marketing concepts, imaging reviews, compliance issues and patient management. I am very familiar with the current research and coordinating of care expectations with a proper and successful interprofessional practice. There is an old saying that “No Person is an Island” and that is certainly true in the daily care of spine patients. The three items that set you up for failure in practice are, missing a contraindication to chiropractic treatment [fracture, tumor, stroke etc.], producing non-compliant notes [billing for not documented services] and failure to co-manage patient care. The first two are obviously a nail in your coffin, however although less ominous and often overlooked, number three is just as bad. I call it the “silent practice killer”.
I was on the phone the other day with a doctor who was about to examine a patient for a final Personal Injury Narrative. This patient was given a deliberate gap in care after reaching maximum improvement with chiropractic treatment. This patient was being evaluated for residual functional losses, duties under duress and loss of enjoyment of life. If those issues were persistent they would be documented and the patient would be put on a chiropractic health maintenance program causally related to their injury.
When I reviewed the patient’s MRI with the doctor, we had discussed the usual items. We talked about imaging [both plain film and advanced imaging], start date of treatment, course of care, response to care and final opinion as to the true NATURE of the injury. The patient had been treated since mid-fall of 2016 and was coming back in for re-evaluation. When I asked about the “other doctors” that the patient had seen, the doctor on the other end said “none”. This patient with multiple disc injuries, several levels of pre-existing injuries, a prior diagnosis of cervical radiculopathy and a long term non-response to care [meaning there would be the need for long term care] was only examined by the chiropractor, no one else. I use this example not to bust the chops of the doctor I was on the phone with, but to illustrate an extremely common issue with chiropractors across the United States. That is a general lack of building a “Team” to manage the patient.
In my experience, there are two reasons for this issue being as large as it is, the first is lack of clinical expertise by the treating chiropractor. They have difficulty in understanding the objectification of serious injury and how or when to refer for imaging or a medical specialist referral. The second is a lack of a network of credentialed and clinically excellent medical and imaging providers that will help the doctor of chiropractic build a solid reputation as a comprehensive clinician. That is the BAD news, the GOOD news is the MD Referral Program is designed to overcome BOTH of those obstacles easily. Remember, one of the best parts of the program is having ME, just like this doctor did that I had on the phone. The only thing I wish was that this doctor had called me in November 2016!
When you a team ALL SAYING THE SAME THING, that is power and that power will grow your reputation. Don’t do it alone, if you CHOOSE to practice that way eventually medical providers and lawyers will steer patients away from you. If you need more help on this, visit the MD Referral Program site and watch #14 Video Library – Case Management – talk with the MD and the Patient as well as #14 Video Library – The POWER of a Referral. These were topics presented at the Tuesday Webinar.