HELP NEEDED--Question... Refer to Orthopedist---she refers to PT

[Guest guest]

It's Tuesday, which is MY Monday. I'm having a brain fxxrt and would appreciate those of you with quick and ready-made responses to help me word a diplomatic reply to a shoulder orthopedist. Something professional, cordial and short and sweet (like moi).Basic info:This is an MVC patient. Rear-ended at approx 50 mph.The orthopedist confirmed my concern regarding an A-C joint sprain (mild) as well as post-traumatic bursitis and rot cuff tendonitis. Duhh.There was also some numbness/tingling and non-radicular pain in the left arm/fingers which I identify as cervical in origin.Orthopedist does the exam, including shoulder X-rays and then proceeds to send my patient for a Cervical MRI. I had already sent her for a 5-view series which revealed a MARKED loss of cervical lordosis and some mild DJD. No obvious antero/retrolisthesis/ligamentous damage.Orthopedist reports back to me that she will be sending my patient for PT for her shoulder AND NECK.First of all, the patient's shoulder pain is quite acute. The PT she could tolerate is what I can do along with Kinesiotape strapping to reduce stress and inflammation.PT rehab would be great down the line. I provide exercises, but I don't provide significant in-house rehab.Regarding the cervical "Strain" she diagnosed my patient with, it is actually a sprain/strain with a marked loss of lordosis.PT will not be of sigificant benefit when compared to chiropractic work and PT modalities that I am already offering.Soooo....What would YOU do?Ann DC

[Guest guest]

Wow. Just goes to show that they have no clue about what we do and don’t care.

I’d respond to the Orthopod by mentioning the fact about what the patient is able to tolerate regarding shoulder PT. If you are uncomfortable with the shoulder, leave it at that. I would then make it clear that you are recommending to the patient that they receive chiropractic care for the cervical spine which will include light physical therapy etc.. Due to your experience in treating spinal conditions versus that of a physical therapist, you feel it would behoove the patient’s recovery to treat the spinal injuries. This is your bread and butter and in the future he should consider chiropractic referrals for spinal injuries that he would normally send for PT. It’s what we see day in and day out. Folks go to PT’s for various different issues. The overwhelming reason for a chiro visit is spinal pain.

ph Medlin D.C.

From: bluepearl2001@...

Sent: Tuesday, March 27, 2012 1:10 PM

To: oregondcs

Subject: HELP NEEDED--Question... Refer to Orthopedist---she refers to PT

It's Tuesday, which is MY Monday. I'm having a brain fxxrt and would appreciate those of you with quick and ready-made responses to help me word a diplomatic reply to a shoulder orthopedist. Something professional, cordial and short and sweet (like moi).Basic info:This is an MVC patient. Rear-ended at approx 50 mph.The orthopedist confirmed my concern regarding an A-C joint sprain (mild) as well as post-traumatic bursitis and rot cuff tendonitis. Duhh.There was also some numbness/tingling and non-radicular pain in the left arm/fingers which I identify as cervical in origin.Orthopedist does the exam, including shoulder X-rays and then proceeds to send my patient for a Cervical MRI. I had already sent her for a 5-view series which revealed a MARKED loss of cervical lordosis and some mild DJD. No obvious antero/retrolisthesis/ligamentous damage.Orthopedist reports back to me that she will be sending my patient for PT for her shoulder AND NECK.First of all, the patient's shoulder pain is quite acute. The PT she could tolerate is what I can do along with Kinesiotape strapping to reduce stress and inflammation.PT rehab would be great down the line. I provide exercises, but I don't provide significant in-house rehab.Regarding the cervical "Strain" she diagnosed my patient with, it is actually a sprain/strain with a marked loss of lordosis.PT will not be of sigificant benefit when compared to chiropractic work and PT modalities that I am already offering.Soooo....What would YOU do?Ann DC

[Guest guest]

Hi Ann

How did the patient get to the ortho? your referral or are you cotreating with an MD PCP? If you referred I would suggest a phone call where you go over the findings and give your reasons for continuing to treat rather then send to PT right now, perhaps including that seeing a DC and PT at the same time will flag this case at the insurance company. At some point in the care you can suggest a visit to the MD office at which point she can see that you don't have fangs and in fact seem to know what you are doing.

If your patient was referred by her PCP it is more complicated as the orthopedist may not want to risk her refferal base by doing something the PCP doesn't understand (read, the othopedist doesn't understand).

I have on ocasion just talked to the patient and asked them if they wanted to go to anaother set of appointments when I can do the same therapy in my office. Just because someone wrote a prescription doesn't mena the patient has to go.

Lonnie DC

To: oregondcs From: bluepearl2001@...Date: Tue, 27 Mar 2012 20:10:54 +0000Subject: HELP NEEDED--Question... Refer to Orthopedist---she refers to PT

It's Tuesday, which is MY Monday. I'm having a brain fxxrt and would appreciate those of you with quick and ready-made responses to help me word a diplomatic reply to a shoulder orthopedist. Something professional, cordial and short and sweet (like moi).Basic info:This is an MVC patient. Rear-ended at approx 50 mph.The orthopedist confirmed my concern regarding an A-C joint sprain (mild) as well as post-traumatic bursitis and rot cuff tendonitis. Duhh.There was also some numbness/tingling and non-radicular pain in the left arm/fingers which I identify as cervical in origin.Orthopedist does the exam, including shoulder X-rays and then proceeds to send my patient for a Cervical MRI. I had already sent her for a 5-view series which revealed a MARKED loss of cervical lordosis and some mild DJD. No obvious antero/retrolisthesis/ligamentous damage.Orthopedist reports back to me that she will be sending my patient for PT for her shoulder AND NECK.First of all, the patient's shoulder pain is quite acute. The PT she could tolerate is what I can do along with Kinesiotape strapping to reduce stress and inflammation.PT rehab would be great down the line. I provide exercises, but I don't provide significant in-house rehab.Regarding the cervical "Strain" she diagnosed my patient with, it is actually a sprain/strain with a marked loss of lordosis.PT will not be of sigificant benefit when compared to chiropractic work and PT modalities that I am already offering.Soooo....What would YOU do?Ann DC