Your patient is still in pain.  They have right arm radiculopathy that has not gotten better with care.  You have been treating this patient for 3 months and there is no significant improvement.  You decide to make an orthopedic consult for your patient. You advise your patient to “find an ortho near you” and wish them the very best, without making any specific ortho referral.

Big Mistake.

I have had this happen several times over the years and I can tell you that you are not providing the best service to your client if you do this generalized referral approach.  Let me show you how this may hurt both YOU and your patient.

A chiropractic physician treats Jimmy following a significant t-bone crash.  Jimmy has significant right arm radiculopathy. Jimmy notes modest improvement with his chiropractor, yet, after 2 months of consistent treatment, Jimmy is still having significant numbness, burning and tingling going down his right arm, which started about 2 – 3 days after the crash happened.  The chiropractor advises Jimmy that he needs to see an orthopedic doctor without making a specific referral. Jimmy does not know who to go see and out of sheer bad luck selects Dr. Aloof N. Haughty out of Franklin to treat him.

Upon setting an appointment and meeting Dr. Haughty, Jimmy provides a history to him.  In that history, Jimmy shares with Dr. haughty that he has been treating you shortly after this wreck and proceeds to tell him about the great chiropractic care you have given him.  Dr. Aloof proceeds to voice his opinion that chiropractic care is not recommended by him and Aloof recommends he stop treating with you immediately. To make matters worse, Dr. Haughty puts in his notes that he does not believe that any of Jimmy’s prior chiropractic care has been helpful, reasonable, or medically necessary to treat Jimmy’s injuries in this instance.  

What a mess he (and you) have now created!  There are orthos and neuros that WILL do this to you.  Now, if I, as your client’s lawyer, take your deposition, you will be emotionally motivated to justify all the good care you provided to Jimmy, and try to prove the ortho wrong.   The ortho will be thoroughly questioned by the defense as to why he said what he did in his notes trashing your care. Jimmy’s two doctors who are supposed to have his back are now at odds with one another, perhaps somewhat interested in justifying their own opinions about another type of treatment rather than what is best for Jimmy.  While you and the ortho spar, it hurts Jimmy’s credibility.

Furthermore, the insurance adjuster and their defense lawyer just love this rift, and they will exploit it.  This will make Jimmy’s case harder to settle, and it will likely delay you getting paid if any of your work is on a lien.  If this case goes to trial, this rift may have a very negative fact on the judgment, or at the very least the bills for treatment of Jimmy by your office.

And YES, I do blame you for this in part. Had you made a referral to a specific doctor that you know and trust, this conflict/rift would have never have occurred.  Instead of verbally sparring and fighting with the ortho, you and he should be affirming one another in perfect harmony for the best care of Jimmy and working together in your common goal.   

You should have a very tight relationship with an orthopedic doctor to whom you transfer any cases that may need a possible surgical consult.  Unless your client has to leave your geographical area, you need to have at least one ortho/neuro referral, within the correct specialty of course.  If you do not yet have a relationship with an ortho, you should. I have seen it work where the ortho was referring the PT back to the chiro and it worked like a symphony for all involved.  

If you need names of good orthopedic doctors in your area, call me.  There are some great ones in our area who are good people, love their job, and love their patients.  They will have their patient’s back, and yours, as long as they are dealt with 100% honestly. If you already have a great relationship with an ortho for your PI cases, then great for you.  If your doctor friend wants to know more about what to expect, charge and wear in a deposition, then have them call me on that as well.


John Griffith

John Griffith
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Nashville Personal Injury Trial Attorney
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