Duration of Care
The scientific literature indicates the vast majority of healing will take place during the first three weeks following the traumatic event. In addition, the majority of the injuries seen are limited to muscular injuries and treatment of patients over 90 days, in our experience, often hinders the solving of the legal matters. This is not to say that all soft tissue injuries need 90 days of care. Care, like the patient's injuries, are individual. But, if treatment is longer than 90 days, it should be stressed that the clinical necessity for care should be justified even more. It is the doctors responsibility to prove the care is needed, not the insurance company's responsibility to prove it's not needed. In our experience and opinion, documenting only the patient's subjective complaints, is insufficient criteria for the continuation of care. To support the need for continued care, the documentation within the file should show timely re-examinations which demonstrate objective physical examination findings. In addition, these objective signs would need to be reasonably "weighed" against the clinical potential for further healing.
Orthopedic Supports
The use of orthopedic supports, such as a cervical collar, during the acute states of the injury, is a common clinical practice in both the medical and chiropractic communities. It is, however, a double-edged sword. The most reasonable approach would entail use of these supports during the functional instability phase of injury, followed by removal as prolonged use can lead to dependency. Typically, the support is most beneficial during the ten days following the trauma. Prolonged use would support the need for additional investigation, which must include consideration of a psychological component.
X-rays
The initial use of x-rays in the well managed soft tissue injury is well supported in the scientific literature. The use of "follow-up" series of x-rays is, however, debated. We have found the use of serial x-ray studies is usually unwarranted, absent the clinical management of clear osseous injuries or delayed instability. The prudent use of x-rays should always consider the potential harm from radiation exposure. This is especially true in patients of child bearing years. The use of repeat plain film radiographs will often bring the case under immediate scrutiny, thus, complicating the settlement process.
Writers Bio
Dr. Steven R. Jones is a licensed Chiropractor in the state of California. He received his doctorate from Palmer College of Chiropractic-West in Sunnyvale, California. Dr. Jones has treated his patients for over 15 years at his own San Diego Chiropractic practice.
Dr. Jones is accepting new patients and would be happy to consult with you regarding your chiropractic needs.
Call Steve Jones at
(619) 280 0554
San Diego Chiropractic
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