Re: Puziss Orthopedic Referrals

[Guest guest]

,

Would you please post his contact info?

Thanks,

, DC, DABCO

>

> I just got off the phone with Puziss office, and was told that

for

> months he was completely unaware (and rather loudly angry when he

found

> out) that one of his office workers had been telling chiropractic

> physicians, patients, and attorneys that he would not take mva and

> chiropractic referrals even if the referral was made early on (when

PIP

> benefits were still amply available), and that he would only take

> patients, regardless of cause, if the patient produced proof of

current

> private health insurance before even scheduling the appointment.

That

> was incorrect, and his office would like to correct that.

>

> I know that many of you expressed some understandable dismay after

> trying unsuccessfully to refer patients to him in need of orthopedic

> consultation. I know that when I heard that he wasn't taking

referrals,

> I personally called his office and spoke with the " gatekeeper " and

was

> also told in no uncertain terms that regardless of what Dr. Puziss

may

> have said when he spoke at the 2007 CAO Convention or elsewhere, he

> wasn't taking mva referrals, period, end of story. Dr. Puziss was

> apparently unaware that his scope of practice had been limited by

his

> staff. He is accepting and will welcome your referrals.

>

> So, I again throw Dr. Puziss name out there to all for

consideration for

> orthopedic consults, second opinions, etc. He is a very good Board

> Certified orthopedist, and while he was known for years as the go-

to guy

> when all else failed with shoulder injuries (I had patients with

frozen

> shoulder and botched surgeries routinely drive up to Portland to get

> fixed by him from Coos Bay, Eugene, and elsewhere), he is also a

very

> capable general orthopedist for neck/back, knees, etc. Do to

personal

> medical reasons, he apparently is no longer doing surgeries, so if a

> patient ultimately needs surgicial intervention, he will refer them

on

> and grease the path with other surgeons in Portland.

>

> I know that some of you also expressed some concern that in years

past,

> whenever you referred a patient to him, the patient seemed to

disappear

> and ended up doing physical therapy with Bonino or elsewhere and the

> patient tended to not find their way back to your clinic. Dr.

Puziss

> has assured me (and all the doctors he spoke to at the CAO

Convention)

> that regardless of whether that was a right or wrong perception in

the

> past, that you need not worry about that at this time or into the

> future. He is well aware that Chiropractic Physicians are licensed

to

> perform physical therapy.

>

> Now that doesn't mean that he will necessarily automatically refer

the

> patient back for ongoing multi-weekly chiropractic treatments, if

that

> is not what he believes the patient needs. While he is and will be

> supportive of chiropractic, he will of course be exercising his own

> independent medical judgment about what the patient's needs are.

He may

> send the patient back with specific treatment recommendations, he

may

> concur in your treatment plan, or he may recommend a new approach

in a

> case that appears to have plateaued. Also, with respect to

insurance,

> you've heard me ad-nauseum stress the importance of making early

> referrals in personal injury cases. If I were a neurologist,

> orthopedist, neurosurgeon, or other specialist, at some point I

would

> certainly tire of only seeing patients from certain chiropractic

clinics

> after IME cut-offs, after 10 months and $ 15,000 worth of

chiropractic

> treatment had been paid by the PIP carrier, etc. A compassionate

> person's willingness to engage in pro-bono " maybe I'll get paid a

year

> from now, maybe I won't " services has understandable limits. Also,

most

> board certified medical specialists are fairly intelligent: they

know

> when someone is asking them to be a rubber stamp.

>

> I would also think that if I were going to make a referral, I'd

forward

> to the specialist actual MRI films and reports, xray films and

reports,

> enough of the chart to show the doctor where the patient's care has

been

> and where it's going well in advance of the appointment. I probably

> would even call his/her office to confirm/inquire what they wanted

sent

> prior to the appointment. I've seen many cases where an

appointment is

> set three weeks out, and when the patient shows up, the specialist

has

> to rely solely on the patients verbal history, and a thorough

evaluation

> of the case cannot be made right then and there, because the

specialist

> needs to order the films and reports that have already been done or

> order his/her own. So then the specialist has to set another

> appointment out another 3-4 weeks so he/she can review that which

could

> have been made available on day 1.

>

> In listening to some of Tyrone Wei's presentations (and frankly I

think

> is among the best of the best radiologists in this state--medical or

> otherwise), it seems that with the increased accessibility and

> usefulness of MRI films, the clinically accepted trend is to request

> such studies in more, as opposed to less, cases. Even if there's

not a

> blown disk or severed rotator cuff requiring surgery, those films

> document a whole bunch of stuff about what is going on in a joint,

> evidence of edema and high signal intensity will be documented (at

least

> if Tyrone is reading the films), and even pre-existing degenerative

> conditions can go a long ways toward explaining why a particular

> individual patient is not recovering as fast as American Family

> Insurance would like. Those conditions are not visualized as well

on

> plain films. As a lawyer, I don't think I've ever seen an MRI

report

> that did not in some way help a client's case and help get

outstanding

> medical bills paid (help that exceeds the cost of the MRI).

>

> Also, I've heard from several specialists (and Dr. Puziss is one of

> them) who indicate that many times they take chiropractic referrals

and

> when the patient comes in, the specialist is not really sure why the

> patient has been referred, and the specialist doesn't have a clear

> concise picture of where the patient has been or where their

treatment

> is heading. Many times the specialist doesn't even know precisely

who

> made the referral, and they are completely unaware that the

referral was

> made by the treating chirpractic physician (you). I notice that

when an

> M.D. general practitioner (and certainly when many of you) make

> referrals, an introductory letter is almost always sent to the

> specialist explaining the reason for the referral and some of the

> specific concerns and questions the referring doctor has. It seems

in

> almost every case, the specialist sends a nice letter back to the

> referring doctor thanking for the referral and explaining the

> specialist's findings and recommendations. As a trial lawyer, those

> inter-profession letters are dynamite, and are worth much more than

most

> closing narrative reports (heck, they usually make the time and

expense

> of a closing narrative report unnecessary). If I were a treating

> physician, I would think those types of introductory letters would

also

> go along ways toward building my own individual credibility and

rapore

> with the medical specialist.

>

> Anyway, back to Puziss. I would encourage you to consider him

when

> making orthopedic referrals. He's worth the drive.

>

> Best Regards, G. , Gatti, Gatti, et. al.

>