Quickie Consults #16-#21

 

From the Desk of:

 

Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues…a larger practice and more family time.

 

Do you know what North American orthopedic surgeons REALLY think about chiropractic care?  Did you know there is a BIG difference in referral patterns between the US and Canada?  How much do you know about the differences in referral patterns between spine and extremity surgeons?  Where should you focus your effort? 

Find out the how to use the MD Relationship Program to effectively and professionally remove the barriers to long term relationships and referrals.  Very few doctors of chiropractic have read this article.  To access the paper and questions, click on e-learning modules on the left hand toolbar.

 

 

From the Desk of:

 

Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues…a larger practice and more family time.

I received this today from Dr. Rich Berkowitz in North Caroliona.  Rich runs two successful practices and makes a consistent effort to promote what he does in the medical community.  As a member of the MD Relationship Program, these practices are now effectively using chiropractic research in their presenations.  I spoke with Dr. Berkowitz and we outlined specific areas of the research that should be presented.  He ha at a large primary care office presentation earlier this week.   I e-mailed him this morning to see how it went.  Here is his response:

 

I think it went pretty good. They had about 30 docs there and they were a very diverse group with some good feedback. I did know a good number of them and there were several I have not EVER been able to get in and do a one on one with, so I was pleased that they asked me to meet with them one on one.  I feel that we definitely raised the bar on perception of what we do as a practice and that there is important research showing that chiropractic WORKS!   The articles were great and I used them as an introduction to the presentation and it really laid the ground work. Thanks so much for your help and insight especially on which areas to highlight.  This helped me keep them engaged since I had the full article as a handout!  I also had another one on one today with a physician assistant in an urgent care center in the community. Always a nice guy although we haven’t really had the opportunity to co-treat any patients yet.  We’ll just stay in-front of him with the research binders and keep the dialog going. 

We will talk soon,

Rich

 

 

From the Desk of:

 

Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues…a larger practice and more family time.

 

Medical Implants and Advanced Imaging

In a recent announcement, “…theFDAapproved the first pacemaker specifically designed to be safe with magnetic resonance imaging scans.  Followingthe unanimous advice of its advisory panel, the agency, yesterday, approved Medtronic’s REVO MRI pacemaker system with CapSureFix MRI SureScan leads, formerly called EnRhythm MRI. Specifically, the REVO MRI SureScan is approved for rate-adaptive pacing and dual-chamber pacing, according to the FDA’s approval letter. Shipments of Revo MRI will begin immediately, according to the company.

The system is designed for patients who may need to undergo an MRI scan. REVO’s SureScan function prepares the device for the MRI environment and the CapSureFix MRI SureScan leads are versions of Medtronic’s CapSureFix Novus active-fixation leads with modified internal wiring to decrease the risk of overheating during an MRI scan. Previously, MRI has been contraindicated for patients with a pacemaker.

The approval is based primarily on the company’s 484-patient trial that randomized patients with the device to undergo or not undergo an MRI. None of the patients scanned with MRI showed any MRI-related complications, confirming the results of animal studies and computer modeling. The study measured changes in the pacemaker’s pacing capture threshold (PCT) as the indicator of myocardial damage associated with lead heating during an MRI.

As a condition of approval, Medtronic has agreed to file annual reports with detailed data on the performance of all implanted REVO MRI SureScan systems. The company has also agreed to conduct a five-year global, nonrandomized cohort study of patients implanted with the device. The study will include a chronic lead performance arm of 1810 patients to characterize the chronic performance of the pacemaker leads. The study will also include an arm with patients undergoing MRI to test whether the MRI-related complication rate is less than 2%” (Miller, 2011, http://www.theheart.org/article/1182875.do).

 

 

From the Desk of:

 

Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues…a larger practice and more family time.

I just received this email from a doctor in the MD Relationship Program on the East Coast.  This PROVES that what we are doing is being done for the right reasons and is targeting the areas that will have the greatest long term benefit for your practice and chiropractic as a whole. 

Hey Dr. Owens,

Here are the main points of discussion with the orthopedist:

Do you prefer the patient worked up before I refer them to you, i.e. x-ray, EMG/NCV, MRI?

He said for me to use my jugdement. They didn’t need MRI’s to be seen at his office.

The difference that the term subluxation means to a medical physician vs chiropractor.

He was under the assumption that it meant hypermobility. When I described it meant hypomobility he understood why to manipulate the spine.  (BIG, BIG, BIG)

Discussion between what would cause him to refer outside of his facility. They have PT and MRI on site.

He felt that chiropractors were more hands on than physical therapists.

What do you think a chiropractor does?

This was more ambiguous outside of that we manipulate the spine. He was genuinely interested in hearing what I had to say.

Where did he get his information from about chiropractic, i.e. from patients, from school, from personal meeting with DC’s?

He was exposed during his residency to chiropractors. He had never seen an adjustment or had one performed on him.

What condition does he think chiropractic care is of benefit to?

He felt that it could be beneficial for many conditions, but had some apprehension when it came to the cervical spine. He brought up the issue of possibly causing a stroke. We spoke about VAD and the hearing in Connecticut and recent literature reviews. He was very comfortable with my explanation.

What is the difference between chiropractic and physical therapy?

He felt that chiropractic mainly used manipulation to treat patients whereas physical therapy used exercise.

What does an adjustment/manipulation do?

He felt it increased range of motion and broke down scar tissue formation.

What surgical procedures does he do?

He is primarily a spine surgeon who prefers to work with the cervical spine. He felt cervical surgeries were more elegant and with cleaner results as compared to the lumbar spine.

What parts of the body/spine does he most prefer to work on?

The cervical spine.

Reviewed many points of the orthopedic survey of 10,000 orthopedists and asked for his feedback.

He found some of the information interesting and generally agreed with all the points.

I looked up his information on his practice workshop and Googled him to see what his interests were.

We discussed our families, hobbies, other personal information. In general, an extremely nice man who appreciated the information

Respectfully,

Rob

 

 

From the Desk of:

 

Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues…a larger practice and more family time.

 

Good afternoon everyone.  I just recevied a report on a patient that underwent a fusion in the lumbar spine.  She was also being treated for injuries to the cervical spine as a result of the same motor vehicle accident.  Building a relationship with the surgeon to effectively manage the patient is critical.  The following is copied from the report that just came to my office.  I should also mention that I received a text from the surgeon after he saw her saying that he was sending her back to me.  This is an important step in justifying care and having future care recommendations documented in the medical records of co-treating doctors.  Once you have built relationships based on sound doctoring and trust with the medical community, this is what you can expect.

She does have residual symptoms related to her cervical spine.  I recommended following up with Dr. Owens for chiropractic treatment.  She is safe to undergo chiropractic treatment to the cervical spine, but I would avoid any maneuvers in the lumbar region.

These types of referrals make practice FUN.  If you are not getting these, PLEASE send me an email so we can talk.  It is easy and I can help…

 

 

From the Desk of:

 

Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues…a larger practice and more family time.

Two research papers have been posted to the MD Relationship Program’s e-learning modules section.  These are “Perceptions of Chiropractic Care – A Survey of 1000 North Amercian Orthopedic Surgeons” and “Chiropractic and Chronic Pain.”  The information in these papers is CRITICAL to growing MD relationships.  The survey of orthopedic surgeons will give you a behind the scenes look at why they like SOME chiropractors and why they DO NOT like some chiropractors.

 

Are you doing the right things in practice or just shooting yourself in the foot?  Some practices thrive with MD referrals on a daily basis while others NEVER see an MD patient.  Why is that?  The simple truth is that doctors that enjoy a steady stream of medical referrals are simply doing what the others are not.

 

Read, Learn and WIN. It is that SIMPLE…