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Shaw Chiropractic Primary Care Physicians: Training Inadequate I’ve always been concerned when an attorney encourages their client to seek medical care from their primary care physician (PCP). My concerns have been both clinical as well as medical/legal. I am of the belief that PCPs are trained to be the first line of defense for infectious disease and many of the more "routine" health condition. However, when it comes to the management of musculoskeletal complaints my experience has been that many are inadequately prepared to assess and manage care. A recent study in the Joural of Bone and Joint Surgery confirmed my experience. The paper titled The Adequacy of medical school education in musculoskeletal medicine was published in the most recent issue by Freedman and Bernstein. The study included a population of 85 recent medical school graduates in their first year of residency. The research design was developed to determine the level of competency in the management of common musculoskeletal health issues as well as gain deeper understanding of the types of training received in medical schools in this specific area. The results were somewhat frightening. First year residents were asked to complete an examination written by a general orthopedist. The types of questions were specifically directed towards the types of conditions that a PCP would encounter in practice. Conditions such as simple fractures, various types of arthritis and sprains and strains were used as examples. The exam questions were sent to a panel of 124 orthopedic residency department heads in order to grade the importance of each clinically oriented question. The residency chairpersons were also asked to make recommendations regarding a passing score. The authors make the following conclusions: "The current study clearly documents the inadequacy of medical school education with regard to musculoskeletal medicine. The duration of the resident’s preparation in this area was inadequate. For the study population as a whole, the mean duration of instruction in orthopedics was only 2.1 weeks. In addition, twenty-eight residents (33%) had graduated from medical school with no rotation, required or elective, in orthopedics surgery; These residents had the mean score (59%) on the examination and the highest rate of failure." Some of the sample schools included University of Chiacago, Cornell, John Hopkins, Harvard and NYU. What does this mean to the lawyer involved in a personal injury matter? First, your client may not receive the care necessary to obtain optimal clinical results. This means that with inappropriate care your clients injuries may be compounded. Further, with improper care goes inadequate documentation which makes the trial lawyers job that much more difficult. Add to this the disincentives and other influences on PCPs by managed care carriers and the scenario worsens. What can you do? Tell your clients that
they need to see a specialist who understands
their health care and legal needs (Perhaps
Shaw Chiropractic). If they do see their
PCP make sure that the care and documentation
are what you would expect given the case
and injury dynamics. Regular communication
by the PCP to your office will assure
that your client has been treated in the
manner required to regain their health
or document their residuals if problems
persist. If medical management is inappropriate
as this recent study suggests may be the
case you may need to challenge the comfortable
boundaries and make the referral your
self. When this happens we hope you will
keep us in mind. |
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