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Shaw Chiropractic Who is your Client's Treating Doctor? In this months newsletter I will examine the background, history and credentials of treating doctors. This newsletter topic was prompted by recent inquiries I have been receiving from adjusters, defense and plaintiff council regarding the influx of new physicians and providers from various disciplines who are now attending to injury victims. The new treating doctors range from general practitioner osteopaths and semi-retired orthopedic surgeons to "straight" chiropractors and practitioners of alternative medicine. Since the reputation, background, experience and credentials of the treating doctor directly relate to the credibility of your client=s injuries it is important to know who the players are and where they come from (from both an educational and philosophical backgrounds) There has been a dichotomization of the health profession between those willing to be involved in potential litigation cases and those unwilling. Doctors have been polarized to either managed care practices or personal injury practices with the majority of medical practitioners lining up on the managed care side of the split. The attraction to managed care for medical practitioners is the relatively rapid reimbursements and large influx of new patients when compared with the personal injury practice which can require several years for outstanding balances to be settled. The result is that physician participation in managed care contracts practically precludes management of traumatic injury patients. This is primarily because managed care contractors reward and emphasize minimal care while trauma injured patients almost always require more intensive management with rehabilitation needs. Medical specialists who are not board certified or have questionable malpractice histories tend not to have the option to enter into managed care contracts and have chosen to participate in personal injury cases by default. These doctors with malpractice claims histories and board certification issues may also lack hospital privileges which are necessary for them to function within their specialty. It would be disastrous to have a surgeon who lacks hospital privileges as a result of state licencing and malpractice investigations treating a client. You might as well paint a bulls eye on their forehead during cross examination. As a result, many of the medical practitioners who have chosen to emphasize personal injury case management are either not board certified or have lost hospital privileges or both. It is important to check these points out before you recommend a medical physician to your client. With the previous caveat in mind, lets face it, the gold standard for musculoskeletal injuries has been and will remain the orthopedic surgeon. While I professionally have strong disagreement with this fallacy it is clearly the accepted rule. If you can find an orthopedic surgeon willing to participate in your client=s management it is obviously the path of least resistence so long as none of the previously mentioned land mines exist. Generally, finding the caliper of orthopedist you want will require good insurance coverage, injuries which may require surgical intervention or pre-payment for a one time IME visit. Otherwise, it is unlikely that any good orthopedist is going to waste his or her time on a non-surgical candidate. In fact, busy surgeons often diminish non-surgical connective tissue injuries to let you know that they don=t want your referrals. Alright then, who might the some other new providers be who manage and treat patients? How about the Complimentary and Alternative Medicine (CAM) practitioners? CAM practitioners include a wide range of providers such as acupuncturists, massage therapists, naturopaths, homeopaths, Reikii practitioners, Qi Gong masters, Reflexologists, Craniopaths and Applied Kinesiologists. I personally believe that these providers help many people with a wide variety of conditions. I also believe that their underlying philosophies, while gaining acceptance, are so far from mainstream that they are extraordinarily susceptible to attack by opposing council. Could you imagine a cross examination on a acupuncturist who is testifying that the energy channels of the allegedly injured patient were permanently out of balance? This Achilles heal applies to all CAM practitioners and may also include "straight" chiropractic practitioners and osteopaths who still abide to the original chiropractic and osteopathic philosophies. Who then should be treating your injured
clients? Broadly speaking, any physician
who has the educational background, clinical
experience, reputation and specialization
in the area of injury. For typical neuro-musculo-skeletal
injuries that would include orthopedic
surgeons, neurosurgeons, neurologists,
physiatrists and chiropractors. The physician
should be specialty board certified and
if appropriate hold hospital privileges
for the procedures within their scope
of practice. Their malpractice history
should be reasonable given their specialty
and there should be no state reprimands
or licensing issues. Considering the medicolegal
nature of most of these injuries the doctor
should be sensitive to the documentation
needs of both defense and plaintiff attorneys
and remain objective in their opinions.
Specialized training in trauma management
and biomechanics certainly help when qualifying
the physician as an expert. Of course,
a desire and will to treat injured patients
involved in litigation is fundamental
and should be discussed with the doctor
before your client seeks consultation.
This could avoid conflicts which unnecessarily
sabotage your client's case. |
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