Short North Accident Injury Care

Archive for November, 2009

Whiplash Accidents Injuries Treated, Short North Columbus, Ohio Call 614 299 9797 to make an appointment.

In my  Short North, Columbus,this discussion is designed to address the soft tissue personal injury case and to offer what we consider are reasonable points of view which are supportable in the literature when possible.
In our experience, failure to follow a reasonable approach often leads to close scrutiny of the claim. It is our hope this discussion will bring the two different levels of expectation a bit closer and result in a higher level of cooperation between the two sides.
Additionally, if the case you manage as the treating practitioner can pass through the medical/legal system, your relationship with the plaintiff attorney can only flourish.
However, if the attorney representing the patient loses a potential award as a result of many of the topics mentioned in this article, how likely could an expanding relationship be?

Scope of Care in Personal Injury Cases
Obviously, the correct diagnosis is paramount in treating any patient following trauma. We will assume, for the purposes of this discussion, the case being treated represents an uncomplicated soft tissue injury. Specifically, injuries that are absent fractures neurological deficits, dislocations, disc herniations or vascular complications.
Treatment rendered for these injuries should represent the standard of care for the geographic area serviced.
The “scope of practice” or treatment rendered should be designed to make passage through the medical/legal system easier. For example, performing reflexology on a patient’s feet for cervical spine injuries will draw more attention than the well accepted treatment course of manipulation, moist heat, ice, ultrasound, and other therapies.
This is not to say that payment will be denied, but the road to reimbursement and settlement would be much easier if a more traditional approach to care is rendered.

Whiplash Accidents Injuries Treated, Short North Columbus, Ohio

Call 614 299 9797 to make an appointment.

Whiplash Accidents Injuries Treated, Short North Columbus, Ohio Call 614 299 9797 to make an appointment.

An Introduction to Outcome Assessment(Part 3)
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Mark van Hemert, DC, DACS

In my  Short North, Columbus,1992, David Chapman Smith, commission counsel to the Mercy guidelines, stated: “There must be a better method of judging whether a patient’s condition or health status has changed, one that has scientific credibility, can withstand scrutiny by others, and provides strong evidence of good outcomes appropriateness and quality of care.”

The use of outcome assessments is imperative for the practicing clinician. Only by objective documentation of improvement can the attending physician prove that his care was therapeutically necessary; thereby staving off the onslaught of critical opinions by claims adjudicators of third party payers, insurance medical examinations, retroactive governmental utilization reviews and defense attorneys.

The Mercy Conference guidelines defines “outcome assessment” as a procedure or method of measuring a change in patient status over time, primarily to evaluate the effect of the treatment.

The Mercy guidelines go on to list the benefits of implementing outcome assessment into one’s practice procedures for they can:
•    document improvement to the patient, doctor, and third parties;
•    consistently evaluate the effect of care over time;
•    suggest modifications of the goals of treatment if necessary;
•    help indicate the point of maximum therapeutic improvement;
•    justify the type, dose, and duration of care.

(Mercy, chapter 10, page 8.)
This list closely mirrors the points the IME focuses on in delivering his professional opinion. The accumulation of the patient’s objective outcome assessment data during the course of care, will provide the information necessary to make these critical clinical determinations in the medical legal case.

This will individualize you opinion concerning the course of care and the length of care. Treating every patient plan as a continual living, analyzing and ongoing evaluation process.

The RAND study, “Appropriateness of Spinal Manipulation for Low-Back Pain,” makes this statement on treatment duration: “No scientific evidence in the literature supports any of the treatment durations for different indications that have been proposed.”

Using objective outcome assessment data that Mercy rates as established and necessary in your clinical examinations, will result in clinical decisions that are defensible against review professional opinion will determine the therapeutic necessity of care rendered.

My vision is to give the practicing chiropractor the knowledge and expertise to provide to every patient the care they deserve, and to provide objective evidence for every patient and their third-party carrier for reasonable and necessary care; thereby creating an analysis system that is fair to all concerned parties.

In future articles, we will discuss how to use the latest technology to gather objective data. It is important to use the guidelines as an authority not only to guide your practice, but to insist that the IME also follow the same standard.

Mark van Hemert, DC, DACS

Whiplash Accidents Injuries Treated, Short North Columbus, Ohio

Call 614 299 9797 to make an appointment.

Whiplash Accidents Injuries Treated,  Short North, Columbus, Ohio Call 614 299 9797 to make an appointment.

In my  Short North, Columbus,it is reasonable to assume the injured tissues will necessitate a higher frequency of care during the initial stages of injury. This is due to the fact that the patient’s subjective complaints are often at or near their zenith during the first week after the accident.

The injured tissues swell to their greatest degree during this time; thus, the level of the patient’s complaints. As the injuries enter the subacute and chronic stages, it is reasonable to assume the treatment frequency would decrease and correlate with the clinical gains being made.

Since the goal of all treatment is to return the patient to their pre-injury status, a well managed case will include decreased treatment frequency while occupational and daily activities are slowly reintroduced.

In our experience, we have found a constant treatment frequency maintained from the onset of care can lead to problems for the plaintiff attorney as they have to explain this apparent inconsistency.

Consider how they will attempt to explain the following questions: First, how can an accurate prognosis of the patient’s future medical/chiropractic condition be measured if the treatment has remained the same?

Secondly, how could the patient reach their preinjury status if the normal occupational and daily stressors were not introduced while under treatment? An unreasonable approach to treatment frequency complicates settlement.

Whiplash Accidents Injuries Treated, Short North Columbus, Ohio

Call 614 299 9797 to make an appointment.

Whiplash Accidents Injuries Treated, Short North Columbus, Ohio Call 614 299 9797 to make an appointment

In my  Short North, Columbus Office, I see many older (and sometimes younger) patients in who have been diagnosed with osteoporosis.  Osteoporosis is an insidious  disease.

Initially it develops without any clear symptoms, affecting the skeletons’ bone density.  Osteoporosis is usually discovered by special testing or bone weakening that leads to fractures which can result in falls, back pain, neck pain, etc.

I am always surprised that those diagnosed with osteoporosis know so little about it.  I did a search on line and found the following article that is worth reading.

Osteoporosis is a disease of bone leading to an increased risk of fracture. In osteoporosis the bone mineral density (BMD) is reduced, bone microarchitecture is disrupted, and the amount and variety of non-collagenous proteins in bone is altered. Osteoporosis is defined by the World Health Organization (WHO) in women as a bone mineral density 2.5 standard deviations below peak bone mass (20-year-old sex-matched healthy person average) as measured by DXA; the term “established osteoporosis” includes the presence of a fragility fracture.[1] Osteoporosis is most common in women after the menopause, when it is called postmenopausal osteoporosis, but may develop in men and premenopausal women in the presence of particular hormonal disorders and other chronic diseases or as a result of smoking and medications, specifically glucocorticoids, when the disease is called steroid- or glucocorticoid-induced osteoporosis (SIOP or GIOP).

Osteoporosis can be prevented with lifestyle advice and medication, and preventing falls in people with known or suspected osteoporosis is an established way to prevent fractures. Osteoporosis can be treated with bisphosphonates and various other medical treatments.

Osteoporosis itself has no specific symptoms; its main consequence is the increased risk of fracture. Osteoporotic fractures are those that occur in situations where healthy people would not normally break a bone; they are therefore regarded as fragility fractures. Typical fragility fractures occur in the vertebral column, hip and wrist.
The symptoms of a vertebral collapse (”compression fracture”) are acute back pain, often with radiculopathic pain (shooting pain due to compression of a nerve) and rarely with spinal cord compression or cauda equina syndrome. Multiple vertebral fractures lead to a stooped posture, loss of height, and chronic pain with resultant reduction in mobility.

Fractures of the long bones acutely impair mobility and may require surgery. Hip fracture, in particular, usually requires prompt surgery, as there are serious risks associated with a hip fracture, such as deep vein thrombosis and a pulmonary embolism, and increased mortality.

The increased risk of falling associated with aging leads to fractures of the wrist, spine and hip. The risk of falling, in turn, is increased by impaired eyesight due to any cause (e.g. glaucoma, macular degeneration), balance disorder, movement disorders (e.g. Parkinson’s disease), dementia, and sarcopenia (age-related loss of skeletal muscle). Collapse (transient loss of postural tone, with or without loss of consciousness, leads to a significant risk of falls; causes of syncope are manifold but may include cardiac arrhythmias, vasovagal syncope, orthostatic hypotension and seizures. Removal of obstacles and loose carpets in the living environment may substantially reduce falls. Those with previous falls, as well as those with a gait or balance disorder, are most at risk.

Osteoporosis requires special considerations in our office.  Chiropractic techniques involving little or no force have to be utilized to ensure patient safety.  In addition to variations in technique, nutritional suppliments are also encouraged, especially mineral supplimentation.  Osteoporosis treatment requires a multifaceted approach in order to see improvements.  Patients also must show patience with treatment as results are usually only seen with prolonged periods of care.

Whiplash Accidents Injuries Treated, Short North Columbus, Ohio

Call 614 299 9797 to make an appointment.