Dynamic Chiropractic - February 28, 1990, Volume 08, Issue 05|
"Doctor's Guidebook -- Personal Injury & Deposition Risk Management"by -- K.S.J. Murkowski, D.C.
Hardcover -- 249 pages
See pages XXXX on how to order.
No one really wants to go to court. At least I find my time more productive working directly with my patients rather than in the courtroom. As things stand today, however, there is every likelihood that the chiropractic physician will be called upon as an expert witness due, in great part, to all the litigation surrounding personal injury cases.
While I might think it's wrong, many of my colleagues have amassed a great deal of money by focusing on personal injury (PI) cases. Regardless of your particular persuasion on this matter, the facts remain that we should all be schooled in the proper way to conduct a PI practice, or just how to effectively handle PI cases when they come into our offices.
The APLC Ltd. has once again addressed an important facet of the modern chiropractic practice with Doctor's Guidebook -- Personal Injury & Deposition Risk Management. It is filled with what I euphemistically call "doctor's goodies."
The text is divided into 15 sections starting with Admitting Patient Information/Classification -- then in order: Case History and Examinations, X-ray Guide & Report, Doctor/Patient Relations & Daily Records, Malingering Test & Non-compliance Letter, Whiplash Symptomatology, Key Points of Evaluation of the Cervical Syndromes, Glossary of Terms/Supporting Tests, Insurance Relations/Component Diagnosis, Insurance Definitions and Procedures, Narrative Reporting, Lawyer Meetings/Deposition and Trial Recommendations, Special Consideration Questions, IME Recommendations,and Sample Letters.
All of the preceding is written in a clear and precise manner. All the excess verbal fat has been trimmed away leaving only a prime cut of information. It's also filled with diagrams, illustrations and a wide assortment of forms.
All of which is almost too good to be true, because on page 68 the author seems impelled to define a chiropractor's relationship to diagnosis. "Although chiropractors are experts on chiropractic analysis, they are not specialists in the field of diagnosis. Internists are medical specialists who are highly qualified to diagnose. Every chiropractic patient should be mindful of his own symptoms and should secure medical opinion if he has any concern as to the nature of his illness or injury. Your doctor of chiropractic may express an opinion as to whether or not you should take this step, but you should take the initiative if in doubt." Later, when discussing chiropractic adjustments, he states "Again, it is the responsibility of the patient to make it known or to learn through medical procedure whether he is suffering from latent pathological defects, illness, or deformity which would otherwise not come to the attention of the chiropractor. The patient should not look to the doctor of chiropractic for indepth diagnostic procedures. The DC provides a specialized health service and does not and should not become involved in the patient's medical regimen."
Upon reading the preceding I can only say that I felt a wave of nausea that hasn't stopped even as I write these words. Aren't most of you a little fed up with colleagues denegating what we do before the public? It is impossible for me to evaluate the author's educational process at the school he graduated from. Some are imbued with the archaic B.J. concept that chiropractors are not taught nor are qualified to diagnose. Well, dear reader, if we call ourselves primary health care providers we'd better be damned sure we know how to find out what's wrong with our patients through the honing of diagnostic skills or place ourselves in the jeopardy of treating someone for a condition that should be referred. Of all the health care providers, chiropractic physicians are the ones, because of the restrictive nature of their practice, who should be the best diagnosticians.
To our shame, however, there are too many who live in dread that they might have to diagnose something and accept responsibility for their patient's welfare, as a primary health care professional is supposed to.
And I'm tired of chiropractors who eagerly place the mantle of diagnostic expertise on the medics. Remember -- most of our patients have unfortunately already been seen and misdiagnosed by the MD before they ever come to us -- or they wouldn't be in our offices. Maybe I was just lucky, but I had a pretty good course in diagnosis at the school I graduated from. Since most of my professional life has been in medical buildings or working directly with MDs, I'm in a pretty good position to give an evaluation of the so-called medical diagnostic expertise and I'm not impressed. Even the AMA admits that in such diagnostic temples as the Mayo and Scripps Clinics, 50% of the working diagnoses are fallacious. Simply put -- ascribing superior diagnostic skills to a medical practitioner is often a form of mythology of virtually heroic dimension.
This doesn't mean that DCs are that much better than their medical counterparts -- although we should strive in that direction. And neither do I ascribe great skills to myself. Rather I plod, push, poke and observe to the best of my ability and am continually working to improve what skills I might have. My only fear is that I might not take the time to properly diagnose my patient's problem. We should never be afraid to do this, for it's our duty. Those who don't have the professional guts or are too lazy to study for the skills they need would be better off selling shoes rather that pretending to be primary physicians.
Yet, with some ambivalence the author states on page 118, "The doctor of chiropractic is trained in physical, clinical and laboratory diagnostic procedures, thus enabling him to responsibly and effectively care for his or her patient in health and disease, to engage in timely consultation with health care professionals, and to refer and accept referrals when it would be in the patient's best interest." Maybe he heard what I said about page 68.
With the exception of the few paragraphs on page 68 (just tear them out) the text is superior to anything I have seen thus far on the subject, and I urge you to get it for your own edification and your patient's welfare.