Anthony B. Morovati, DC, DAAPM
Last month (DC PracticeInsights, June 2010), I described how to build a network of physicians who will refer to you. This month, we'll take a look at how this has worked out in practice.
A 67-year-old female, with a chief complaint of right knee pain, was seen in my office. There was no history of trauma or injury. Her symptoms had persisted for several months, and her condition was worsening. After obtaining x-rays of her knee, I reviewed my findings with the patient. She had moderate to severe osteoarthritis with osteophytes along the medial tibial plateau. Her range of motion was quite compromised in flexion and extension, and there was marked subpatellar swelling. There was jenu valgus deformity of the right knee as compared to the left knee. She walked using a cane. Incidentally she has developed right scacroiliac pain as a result of her altered gait.
I explained to the patient that I would try to help her in resolving some of the pain due to myofascitis and myofascial trigger points and edema. However, I wanted to also follow up with an MRI to rule out internal derangement of the knee. She agreed with the plan and was treated four times with the acuscope and myopulse with some improvement in her range of motion and pain. Manipulation of the sacroiliac joint offered her much relief. Her MRI results revealed severe osteoarthritis with degenerative joint disease. At this point, I told the patient that my treatments may offer some relief for the time being, but she needed to see an orthopedic surgeon.
Working Together
I called the orthopedic surgeon and informed him of my referral and mentioned to him that this would be a consult. I followed up with a SOAP note similar to the description noted in my previous article.
The patient was pleased with her visit and commented that the orthopedic surgeon had nothing but good things to say about me. He had told her that he appreciated referrals from me because all patients referred by me have been worked up with all the necessary diagnostic tests. This allows him to give the patient a decisive diagnosis and plan on the same consult day. I received a letter from the orthopedic surgeon informing me of his findings. He also noted that the patient had requested that I be present during her surgery and that she trusted my judgment. Therefore, he asked if I would be interested in observing the total knee replacement surgery. I agreed. His staff had obtained temporary privileges for me, which is not an easy task.
Referral Power
On the day of surgery I met with him and we scrubbed in. Along the way from the changing room to the operating room, the orthopedic surgeon introduced me to every staff person we encountered. Every nurse to scrub tech to physician whom I met asked me for a business card and commented that if I was good enough for the orthopedic surgeon, they would want to see me as a patient. That afternoon I had four new patients from the hospital. Those patients also referred another four to six people each.
Building the Cycle of Credibility
The reality is that if a nurse, physician or other health care professional recommends you as a DC, all of a sudden you have a lot more credibility and respect. One of the patients was a family physician who told me that he gets a lot of patients who have been in a motor vehicle accident and seek chiropractic care. He asked if I would see them if he referred them to me? I said yes and that if they needed a specialist consult, I would like to refer to someone he works with. He agreed. This is how the cycle begins.
Educate patients, so that they don't have to go to overpopulated ERs for simple sprains and strains. Let them know that you are well-trained and versed in handling such cases.
By the way, the orthopedic surgeon came in for his "lateral epicondylitis" from repetitive trauma of pronation and supination. NSAIDs and analgesics, as well as a cortisone injection, did not help. So I educated him about biomechanics, myofascial pain and nutritional deficiencies that were the perpetuating factors of his pain. He was treated three times with the acuscope and myopulse, followed by flurimethane spray, and stretch and manipulation of the neck, shoulder and elbow. He is pain free and has referred many patients to date.
So don't corner yourself as only a spine doctor, because you will miss out on a diverse number of musculoskeletal conditions for which you are well trained to help.
