The Art of Referrals: Put Your Name and Face in the Mind of the Doctor
I had a recent experience in my office that I thought was worthy of a letter. For many years I have had an ear, nose and throat doctor refer me patients with jaw or facial pain, sinus problems, or ear problems. He is quite aware of the work I do at the C1 and C2 level.
I am now in my 29th year of practice. Early in my career, I noticed that when I would refer a patient to a medical specialist, I always got a report from them. It struck me that I should be doing the same thing. So, for the majority of my career, whenever I receive a referral from a medical doctor, I always, always send them a report.
Very briefly, I say thank you for referring this patient, I tell them what my thoughts are on what the patient's problem is, and how I can help them. It's never a long letter. I don't bore the doctor with patient history or exam findings. It's simply a communication letting them know my thoughts on what's going on and what I can do to help.
In the past 10-15 years in particular, there has been an increased number of new patients have told me that when they went to their family doctor, the emergency room, or were seen by some medical doctor somewhere, the provider mentioned that they might want to see a chiropractor. Even if that doctor didn't refer the patient to me specifically, I still send them a short report.
In this case, I'll make mention of the fact that the patient saw this particular doctor, who suggested that they might want to see a chiropractor, and they ended up in my office. I always receive permission from the patient to send the report.
I have oftentimes dropped by these doctors' offices and introduced myself, just so that they can associate a name with a face. The net result of all this is that I am quite well-known within the local medical community and I receive a lot of medical referrals.
With all this in mind, I would strongly urge anyone in the profession, especially a young chiropractor just starting out who is planning on living in their community for a long time, to send a brief report to any and every medical practitioner who either directly or indirectly refers them a patient. Then, make the effort at some point to meet them so that, as I noted, they can associate a name with a face. Believe me, it will pay off in the long run.
Stuart Pardee, DC
An Open Letter to the Leaders of the Chiropractic Profession
A recent article written by Drs. K. Jeffrey Miller and Ray Tuck appeared in the March 2012 issue of Dynamic Chiropractic Practice INSIGHTS. In the article, titled "Weighing Your Medicare Options,"the authors bring to light a great concern of mine which I have shared with numerous "leaders" in our profession: With regards to Medicare, chiropractors are considered "Physicians," along with MDs, DOs, and DPMs. Yet out of all the named "physicians," only chiropractors are not permitted to opt out of Medicare.
As the authors correctly point out, "If a medical doctor chooses to opt out of the Medicare program, they sign an affidavit saying they choose to opt out. From that point, the doctor must notify their patients that they are not participating in Medicare and work out payment arrangements with those patients who choose to continue or initiate care. The doctor is given the opportunity to opt back in later if they so choose. However, doctors of chiropractic cannot opt out of Medicare. Opting out is illegal for doctors of chiropractic. A chiropractor's only legal (emphasis added) way out of the Medicare system is to simply never see any Medicare qualified patients. It is an all-or-nothing deal."
This is discrimination at its best! DCs should be entitled to the same rights as other Medicare "physicians." They say that the optimist sees the glass as half full while the pessimist sees the glass as half empty. I say the realist sees half a glass of water! Our leaders need to get real with what is going on in Medicare. The 27 percent decrease in providers' fees may be postponed for now, but I'm willing to bet not forever. I wouldn't be surprised to see this postponement curtailed shortly, especially after the November elections.
Sure, everyone would like to see us get reimbursed for exams, X-rays, etc., but wake up folks – it just isn't going to happen. They want to decrease what they already cover you for by 27 percent, and you think you are going to get the government to increase payments for additional services? Get real!
It's time for the leaders in this profession to step up and lead! I don't care what your brand of chiropractic is; this isn't an ICA, ACA, IFCO or WCA issue, it's a chiropractic issue! Leaders, remember us guys and gals in the trenches who daily have to do battle with all this nonsense?
How about all the national organizations unite on an issue that affects all DCs? How difficult would it be for these groups to form a coalition and introduce bipartisan-sponsored legislation, with companion bills in both the Senate and House of Representatives, that would allow doctors of chiropractic the same rights as other Medicare physicians: the right to opt out of Medicare?
I would even add that the two-year waiting period (I understand that to opt out of Medicare, you cannot accept a Medicare patient for a period of two years before you sign the affidavit to opt out) be waived since we have been discriminated against for so long. Given the current economic climate, I would think the Medicare folks would welcome anything that would help lessen the financial pressures on an already overstressed system.
Of course, we could always suggest that the other Medicare physicians instead be held to the same restrictions that we have had to contend with, but you can believe the AMA, AOA, and the podiatrists would never stand for that. In fact, the head of the company that does our billing told me that the MDs are already dropping out of Medicare in droves, especially gastroenterologists and gynecologists. These people aren't stupid; they see the handwriting on the wall.
So, chiropractic leaders, are you going to be proactive and help out "us" rank-and-file chiropractors, or are you just going to wait to see when the other shoe drops and then tell us there isn't anything you can do to abate the situation? We will all be eagerly waiting and watching.
Anthony J. DeCosta, DC
South Plainfield, N.J.
Let's Not Be Bamboozled
Recently, it seems we have been bombarded with influences that would like our profession to begin to prescribe medication. With this letter, I would like to tell a story with the hope of defacing what is, in my opinion, a ridiculous thought.
This past year I received a referral from an orthopedist. In this case, the orthopedist is one of the most highly respected spinal specialists in the medically conservative Tri-State (New York, New Jersey, Connecticut) Area. ( While this may sound like bragging, it also illustrates the point that "chiropractic cultural authority" does exist.)
This patient, a 67-year-old male, had been through it all, including NSAIDS and stronger, multiple rounds of physical therapy and courses of epidurals. He was to the point that he broke down crying twice during our initial consultation. His life was ruined by his pain and his wife was very distraught, fatigued and depressed as well.
In treatment, I mixed and matched, utilizing the teachings of some of our profession's best: Cox with an assist by Nicche, DeJarnette, Fuhr and Colocca, Faye and Koren. Over time, the patient responded beautifully and his life was restored.
But this is just half the story. This patient's son is a cardiologist in Philadelphia. This cardiologist knew little to nothing about chiropractic and had originally begged his father not to see a chiropractor, urging him instead to get more surgical opinions.
After learning of his father's seemingly miraculous (not to us chiropractors) results, the cardiologist started seeing a chiropractor in Philadelphia, two hours from my office. Clearly, our colleague in Philly knew his trade, because the cardiologist was ecstatic about his own results and referred his wife and children to the chiropractor to get checked. His direct quote to his father was, "These chiropractors also know a lot about wellness."
So, I ask, how many human lives were changed for the positive? And how many more will be changed because of referral? The two chiropractors involved in this instance clearly were initially taught properly and continued to learn more and more about their wonderful profession after graduation.
These patients would never have benefited had I or our colleague in Philly been prescribing medication. Our world of chiropractic has such rich lineages of healers, from the gentleman I mentioned above to the Palmers, Gonstead, Harrison, and so many others. I advise all of us to continue to learn, to dive in and immerse ourselves to make ourselves the best that we can be. It does not matter what "brand" or "brands" of chiropractic any individual gravitates toward. It only matters how well we perform them.
The masters got the ball rolling. Chester Wilk, George McAndrews and the Chicago 7 paved the way. The younger generation of medical doctors don't know a gosh-dang thing about the past politics of the AMA, nor do they care. They are trying to do their best in their paradigm. But both they and the world needs us now – and needs us more than ever.
Let's not be bamboozled by the seduction of prescription drugs and the illusion of cultural authority. Let us all continue to dive into our profession to be the best we can be. I guarantee we will all be rewarded for it.
John T. Cece, DC, CCRD