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Look Closer: The Answer May Not Be Obvious
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Written by Kirk Lee, D.C.   
Tuesday, 01 May 2012 17:10
E
ven with everything we do in the evaluation process of our patients, sometimes outside forces like activities of daily living, job, family and financial stress can complicate the presenting vertebral subluxation complexes and its resulting signs and symptoms. Sometimes even the littlest postural changes can affect our outcomes.
 
gaitcycleWhen we conduct our evaluation and management of a patient, we benefit from a thorough history based on a review of the patient’s case history or other admitting information that we request the patient to fill out. This is followed with a one-on-one consultation to review the case history where we ask additional questions to further assist our decision making. This history covers the requirements of chief complaint, history of present illness, review of the symptoms and past family and social history. 
 
Then we perform the appropriate examination that we feel clinically is necessary to provide us with needed information in evaluating posture, ranges of motion, functional movement patterns, palpation findings, orthopedic and neurological findings. We also have to take into consideration that documented information is required to meet the billing requirements for the level of E&M that we feel is appropriate for billing purposes.
 
Using a digital foot scanner to evaluate the three arches of the feet to establish the patient’s pronation index will determine if he/she may benefit from the recommendations of stabilizing orthotics. Evaluation of the patient’s gait cycle using a system of analysis provides us a baseline of the different phases of the gait cycle to compare both the right and left sides. If the patient is a runner, we should conduct the analysis in both the walking and running phases. We may go as far as asking our patients about activities of daily living or a description of their job duties. How much information you feel you need to obtain through the evaluation and management process to help you with your level of medical decision making is totally based on your clinical judgment. Just keep in mind that you must always obtain enough patient data to support the level of E&M for which you are billing.
 
Ms. W. is a 28-year-old runner who runs an average of five miles, four to five times a week. She has been under our office’s care for the majority of her adult life. She first consulted our office with complaints of low back pain and chronic Iliotibial Band Syndrome. Following a treatment plan of chiropractic adjustments, core strengthening exercises, and stabilizing orthotics, Ms.W. responded very well and now enjoys the benefits of a wellness lifestyle. Recently, she began experiencing pain in the right shoulder area which was about three to four weeks in duration. Pain is more pronounced on the posterior side. She describes the pain as a 5-6 on a scale of 10. She also notes it develops during her run and is usually gone the following morning. 
 
There is no history of trauma or other known reasons for the pain. We conducted a re-evaluation of Ms. W., which included a new digital foot scan (it had been three years since her last pair of new stabilizing orthotics) and a new gait analysis for both walking and running since the pain comes on while she is running. Nothing major is derived from our re-evaluation, but we begin adjusting the right shoulder. After several weeks of treatment, no noticeable changes have been noticed within the shoulder. It has improved slightly, but the pain still flares up each time she runs.

I asked her how long she had been carrying the water bottle while she was running.


One evening after work I drove over to see my good friend Dr. Knight, who practices 12 miles west of me, for an adjustment. I notice my patient, Ms W., is out ahead of me on this country road. Realizing it is her, I stay some distance back to see if I notice any asymmetry in her gait that we did not pick up on the treadmill. What I did notice was how she was flaring her right elbow and how she was holding it in an abducted posture. I then noticed the culprit that was causing this abnormal posturing. It was a water bottle! When I finally pulled up beside her I asked how her shoulder was feeling and she mentioned it had been getting tighter and sorer over the last mile. 
 
I asked her how long she had been carrying the water bottle while she was running. She told me she had been doing it for about a month since her belt she normally wore that carried her water had broken. As she was explaining it to me you could see a quizzical look come over her face. She asked me, “Do you think my shoulder pain is caused from me carrying the water bottle?” I smiled and said, “Let me have your bottle, finish your run and I will see you tomorrow!”
 
We all know that ADLs and prolonged postures can be major causes that slow the healing powers of the body. As our patients enjoy the great benefits of a chiropractic lifestyle, through the many services that we can provide them, we must always consider the not so obvious when it comes to our patients!

A 1980 graduate of Palmer College of Chiropractic, Dr. Kirk Lee is a member of the Palmer College of Chiropractic Post Graduate Faculty and Parker College of Chiropractic Post Graduate Faculty. He has lectured nationwide on sports injuries and the adolescent athlete, and currently practices in Albion, Michigan.
 
Create Your Own Stimulus Plan
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Written by Claude Cote   
Tuesday, 01 May 2012 17:04
T
here is no doubt that obtaining $44,000.00 from the government is very enticing. In this hard economy, who would say “No” to such a gift? A gift? Well, not exactly. If you are interested in Electronic Health Record software programs, you already know that doctors will need to meet all the necessary meaningful use objectives in order to receive any incentive payments. On the Center of Medicare and Medicaid Service (CMS) website (www.cms.gov), there is a section called "Attestation".
 
officeorganizationUnder that section, the CMS answers a few potential questions you may have. One of them is: "Will CMS conduct audits?" The answer is clear: "Any provider attesting to receive an EHR incentive payment for either the Medicare EHR Incentive Program or the Medicaid EHR Incentive Program may potentially be subject to an audit." And then they explain how to be prepared for an audit. In the best case scenario, where you do your very best to meet all the conditions, where you keep your documentation at the best of your knowledge and where you keep your office legally crystal clear, an audit is never fun. 
 
And if the auditor finds something wrong, you are the responsible person, not your software provider. You might not be very excited to do all the necessary work to meet all the meaningful use objectives and you probably do not wish to get an audit either. If this is the case, why don't you create and implement your own stimulus plan? If you decide to compete with the government by creating your own stimulus plan, not only will you not have the hassle of implementing a fully certified software and showing all the meaningful use objectives that the government is imposing, but you may be able to receive substantially more than $44,000.00 over a 5-year period and have much more free time for yourself and your family. One size does not fit all. Many chiropractic doctors do not want to do their stimulus certification and do not want to go through unnecessary audits. Right now, it is only a very small percentage of eligible providers who are registered to do their stimulus certification. But don’t worry, there are some good alternatives for all other doctors. There are many recipes to create your own stimulus package. Planning, organization and perseverance are the keys to success. 
 
Planning
In all new projects, good planning is mandatory. What do you want to achieve? How much revenue increase would you like to get? How much growth are you looking for? The $44,000.00 payment the government is offering over 5 years represents only 3.5 adjustments per week (at $50.00 each). This is not much. Don’t you think you may increase your office by 4 visits per week if you are serious about it? I am sure you can. Let’s say, as an example, that you see 100 patients per week. You may set up a goal where you will see an average of 125 patients per week within 3 months from now. Let’s beat the stimulus package by 21 visits per week. Is this realistic? Absolutely. 
 
Not only are these achievable numbers but this will probably be easier than you think to achieve. As a second goal, would you like to spend more time with your patients on each visit? And, as a last goal, recoup 4 hours per week and spend that time with your family. This does not seem to make sense, right? How can you see 25% more patient visits, spend more time with your family and spend more time with your patients? The answer is Organization. By the way, 21 visits per week at $50.00 each, 50 weeks per year for 5 years amounts to $262,500.00. This is almost 6 times the entire government stimulus package.
 
Organizing

You don’t need to use a certified software program to implement all the meaningful use objectives.


In many chiropractic offices, organization is the weakest part of the entire business. This is where information technology will be your best friend. The best and easiest patient growth is through the actual active patients referral. If you spend less time in administrative tasks and use that valuable time educating your patients, you will definitely increase referrals. Increasing referrals means more patient visits. A full automated system will reduce your administrative tasks, will speed up all your processes and will provide, at a glance, all the necessary information needed to provide the greatest care to your patients, in less time. 
 
Searching for a paper patient health file does not help any patient in his care. If the system you are presently using has a good statistic module, use it. Find out how many patients have left your office without any other appointment and have a list of who they are. Are they really done with their care or are they just on the edge of dropping chiropractic? These are only a few very simple examples of how good organization, using great information technology, will make it easy for you to reach your goal.
 
Persevering
There is no use putting anything new in place if you do not persevere. If you implement a new procedure, believe in it and be patient. Success comes over time. Just keep doing it and you will see results. Perseverance is probably the hardest thing to achieve. Implementing something new takes you out of your comfort zone. If you keep persevering, your new procedures will eventually become your comfort zone.
 
This is a brief description of how to create your own stimulus package and how to succeed with it. You don’t need to use a certified software program to implement all the meaningful use objectives. As an example, you can record your patient smoking status in almost any software program if you think this information is useful to treat and help your patients. 
 
Creating your own stimulus package may have many advantages over the government incentive program. You may be able to generate much more income, without having to go through the CMS registration process, or through any CMS audit, etc. As far as health benefit for the patients, you may exceed the government requirements if you want to. It’s your call!

Claude Cote  is an expert in EHR systems, insurance billing and chiropractic clinic management for 22 years.  He has installed EHR system in 18 countries over 5 continents and nationwide in USA.  He is the President and Founder of Platinum System C.R. Corp (www.platinumsystem.com).  For comments or questions, please email to This e-mail address is being protected from spambots. You need JavaScript enabled to view it
 
In Loving Memory: The American Chiropractor Celebrates the Life of Editor, Wife & Mother, Jean Marie Irelan Busch
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Written by TAC Staff   
Tuesday, 01 May 2012 03:05
jeanbuschAfter 34 years of consistent service to the chiropractic profession through her work here at the magazine, on March 29th, 2012, TAC Editor Jean Marie Irelan Busch made the transition leaving us with the honor of carrying on her legacy. 
 
Jean, or “Jeanie” as she was called by friends and loved ones, was the loving wife of the founding publisher, Dr. Richard E. Busch, Jr. They were married 45 years, and she is survived by her six children, 14 grandchildren, and her husband. Several of her children and grandchildren continue to work at the magazine that Jeanie helped found.  
 
buschfamilyJeanie graduated from South Whitley High School, achieving the high scholastic rank of Salutatorian of her class and went on to graduate from Indiana University in 1966 with a Bachelor of Arts degree in Grammar and Theater. While at Indiana University Jeanie was a member of the Delta Gamma Sorority, was captain of the pom pom cheerleaders, taught for the National Cheerleaders Association, and was on various Indiana University steering committees, including Little 500 etc. and the I.U. Foundation. Many who have known Jeanie remember her boisterous laugh, beautiful smile, positive love of life and comforting, silent strength that those around her could sense whenever she was present.  
 
Upon graduation from college, she traveled to Davenport, Iowa to support her husband Richard's pursuit of his chiropractic degree at Palmer College. While there, Jeanie taught English to students at Sudlow High School. Jeanie didn't teach school long, however, because her first child, Tracy, was soon conceived.  
 
Jeanie returned to Fort Wayne, Indiana following the graduation of her husband from Palmer College. Before her husband, the now Dr. Busch, established the Busch Clinics, Jeanie worked as a C.A. with him at the Goeble Chiropractic Clinic in Fort Wayne, Indiana. This only lasted 2 weeks while Dr. Goeble was on vacation, and then Jeanie was blessed with another child on the way. Their first son, Rick, now Dr. Richard E. Busch III, furthered the Busch chiropractic tradition. Jeanie came on strong as a leading homemaker and mother fostering four more children: Tunde, Jaclyn, Joseph and James. Joseph, Jaclyn and Tracy are also graduates of Indiana University, with Joe furthering his education at the National Chiropractic College. Her children continue to present strong leadership for The American Chiropractor Magazine, a trait learned from their Mother.
 
buschfamily2Jeanie was also active in civic and sorority matters. In Fort Wayne, Indiana, Jeanie was active in Career Day for kids and established the category Homemaker, which was previously missing from the choices. Also, at one time she was the leader of four Brownie Troops. She was instrumental in leadership and giving her time to help her family and others with continued support for her husband in his many endeavors.
 
jeanbusch2In 1978, Jeanie was called on to sell advertising in The American Chiropractor. She did so under the pseudonym Tracy Leigh. She sold an ad over the telephone on her first call! She was also one of the original editors for The American Chiropractor Magazine, with a meticulous eye for grammatical mistakes and a passion for commas, as her family liked to joke. When not editing, she was also selling advertising to many of the same companies that have become prominent supporters of the profession. From that point in 1978, Jeanie was never far away from all aspects of The American Chiropractor Magazine. When not directly involved in the delivery of the content, you could find her working on some other aspect of the magazine.
 
The traits that were most respected by those that knew Jeanie were her compassionate heart and tireless work ethic. Those who were around her felt blessed to have shared in her time, and those who loved her will carry her memory in their hearts.
 
The Safest & Quickest Way to Become Debt-Free
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Written by Garrett B. Gunderson   
Saturday, 17 December 2011 22:40
The Counterintuitive Formula Your Financial Advisor Doesn’t Know

H
int: It’s not about your loan interest rates. As a financial advocate to Chiropractors, I deal with this issue frequently with my clients. You want to get out of debt so you can reduce your risk, increase your cash flow, and have greater peace of mind, right? Here’s the fastest, safest, and most sustainable way to do it:
 
financesclaculatorbankstatement1. Roll Non-Deductible Loan Interest into Deductible Loans
Assuming you have enough home equity and good enough credit, refinance your mortgage and roll as much of your non-deductible loans (credit cards, auto loans, etc.) into it as possible. The tax deduction will increase your cash flow.
 
2. Roll Short-Term, High-Interest Loans into Long-Term, Low-Interest Loans
Again, the goal is to minimize your interest payments and maximize your cash flow. Then, you can attack your remaining debt strategically, using your increased cash flow to eliminate one loan at a time.
 
CAUTION: Do NOT do this if you’re undisciplined and your spending is out of control. If you’re just going to charge your credit cards back up again, you’ll just sink deeper into debt.
 
3. Improve Your Credit Score
There’s a smorgasbord of companies and resources to help you do this. By increasing your credit score you get better loan interest rates, which lowers your payments and puts more money in your pocket.
 
4. The Secret Sauce: Cash Flow Index
Here’s where the rubber hits the road. After minimizing your payments and maximizing your cash flow, you’re now prepared to focus on one loan at a time, thus creating the “snowball effect” until you’re completely debt-free.
 
Most financial advisors and pundits will tell you to pay off your loans with the highest interest rates first. My advice is to ignore the interest rate and use my Cash Flow Index to determine which debt to pay off first. 
 
To determine your Cash Flow Index, take all your various loan balances and divide each of them by their respective payments. Whichever one has the lowest number is the one you should pay off first. 
 
For example:
Home Loan Balance: $228,000
Interest Rate: 7%
Monthly Payment: $1,665
Cash Flow Index: 137 
($228,000 ÷ $1,665)
Credit Card Balance: $13,000
Interest Rate: 12%
Monthly Payment: $260
Cash Flow Index: 50
Auto Loan Balance: $16,500
Interest Rate: 8%
Monthly Payment: $450
Cash Flow Index: 37
Student Loan: $107,000
Interest Rate: 3.9%
Monthly Payment: $650
Cash Flow Index: 165
 

In this example, it seems to make sense to pay off the credit card first because it has the highest interest rate. But the Cash Flow Index reveals that the auto loan should be paid off first. 
 
The trick is to pay off debt that gives you the greatest cash flow with the least investment. A high Cash Flow Index means your loan balance is high relative to the payment, while a low Cash Flow Index means your balance is low but with a high payment. Knock out those high payments first and you free up cash to work on other debts. 
 
In this case, by paying off the auto loan first, you free up more monthly cash, which can then be applied toward the credit card balance. Paying off the auto loan first means you can pay off both faster than if you started with the credit card. 

5. Address the Risk Factor
This strategy isn’t just about paying off debt faster—it’s also about reducing your risk. Banks and other financial institutions tell you to pay off debts that lessen their risk while increasing yours. For instance, if you put more equity into your home, you are still at risk for being foreclosed on if you can’t make a payment. In fact, they may be more willing to foreclose if you have more equity in your home. 
 
The rule here is to not directly pay down loans that keep you in the same payment (as opposed to loans for which the payment reduces as you pay them down). Rather, save the money that you would have paid on the loan balance in a separate account until you have enough to pay off the loan in full.
 
In those types of loans, you’re worsening your Cash Flow Index with every payment. It doesn’t give you immediate benefit, and it increases your risk by reducing your liquidity.
 
6. Get to the Roots
As I explain in my book, Killing Sacred Cows, without a fundamental change in consciousness regarding debt, none of these strategies will work long-term. You need to identify and solve the root causes of debt, rather than hacking at the byproducts (interest and bondage) with nothing but techniques.

Before you employ these techniques, ask yourself questions like these:
  • Why did I incur each of my debts? What was the purpose? Was my desire to consume or to produce?
  • When I incurred debt, how did I justify it?
  • Do I seek consolation in material things? If so, what could replace the feelings I receive from borrowing to purchase material things?
  • Was my debt caused by gambling—putting money into things I didn’t understand and couldn’t control? If so, what can I learn from this and how can I be wiser in the future?
Getting—and staying—out of debt requires a fundamental shift in outlook and behavior. You must change who you are, then what you do flows from that change. If you’re struggling with debt, focus on increasing your knowledge, improving your mindset, and developing your character. The practical solutions to your debt problem will naturally follow.

Garrett Gunderson is a financial advocate and the author of the New York Times, Wall Street Journal, USA Today, and Amazon bestseller Killing Sacred Cows: Overcoming the Financial Myths that are Destroying Your Prosperity.
 
Peer Review Abuse: A Plan for an End
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Written by Mark Studin, D.C., F.A.S.B.E.(C), D.A.A.P.M., D.A.A.P.L.M.   
Saturday, 19 November 2011 04:15
M
edical peer review is a process whereby doctors evaluate the quality of work done by their colleagues, in order to determine compliance with accepted health care standards. This self-regulatory procedure provides quality assurance for the medical community by fostering standardization of appropriate medical procedures and by policing caregivers who could pose risks to patients. The rationale for the process is efficiency: working doctors are best situated to judge the competence of other working doctors because they regularly see each others’ work and possess the relevant expertise to evaluate it" (New Jersey Law Revision Commission, 2004, http://www.lawrev.state.nj.us/medicalpeerreview/mprM083004.pdf).1 
 
peerreviewabuseIn a perfect world, the peer review doctor would render an opinion on the paperwork that certifies necessary care and covered issues for injured patients. Peer review differs from an IME in that there is no face-to-face meeting with the patient and no examination. The peer review doctor reviews the paperwork of the treating doctor to see if that doctor practiced within the standards of his/her license and renders an opinion about the necessity for care.  
 
Like IME abuse, peer review abuse has gone relatively unchecked for decades, as doctors and lawyers have not focused on the solution to neutralize those reports that border on fraud or licensure misconduct language. To render a fair and balanced opinion, there are many doctors nationally who conduct very fair and ethical IMEs and peer reviews. This article is not focused on those ethical doctors who perform a necessary function in the healthcare environment.   
 
In August of 2011, I was given a peer review report written by a chiropractor in New York who was hired by Alternative Consulting & Examination located in Fulton, New York to render an opinion on the immediate ordering of an MRI by a chiropractor, although the MRI wasn't performed until 9 weeks post-care. The lawyer representing his client wanted my opinion on the report. The peer review doctor stated, "Because MRI's reveal so many herniations in pain-free people, and HNP's respond to most conservative treatments anyway, MRI findings have little if any use in determining early therapy options." He quotes this snippet from The Journal of Family Practice. He then goes on to take various quotes from various other research journals. First, he uses The Journal of Family Practice for his lead quote in his opinion. He cites 2 authors incorrectly, as there is only one author with another rendering a commentary. The peer review doctor uses that "very limited" 1 & 1/2 page study and quotes one person's opinion, but conveniently omits the following from the same author in the same paper: "Unfortunately there are too few studies to guide clinicians in the appropriate use of MRI in the evaluation of low back pain. Higher quality evidence is needed before firm guidance can be made for the use of MRI in the evaluation of low back pain" (Grover, 2003, p. 232).2
 
The same paper offers a clinical commentary by a family practitioner that states, "I find MRI useful to help tailor therapy and make decisions regarding appropriate referrals" (Grover, 2003, p. 232). The peer review doctor also omitted this in order to make one believe that his conclusion was a supported standard of care. This irresponsible type of action reminds me of the tobacco companies who attempted to defend themselves in lawsuits by quoting snippets from research and attempting to produce a global decision that cigarette smoking was safe. Although irresponsible and bordering on misconduct, it is easy for anyone to "dig up" snippets from various research articles to win an argument using limited portions of the scientific research data. The peer review doctor went on to quote many research articles of disc findings in asymptomatic patients, none of which had any bearing on the case at hand, but were all just "fluff" in an attempt to misdirect the reader. In spite of the peer review doctor's attempt to discredit the treating doctor, this issue is a standard of care issue and goes well beyond the necessity of one patient.
 
The standard of care currently taught at the doctoral and post-doctoral levels is with the presence of significant radicular or myelopathic findings that corroborate with the patient's clinical presentation of signs and symptoms, an immediate MRI is warranted in order to determine an accurate diagnosis. In the absence of either, conservative care is warranted for 6-8 weeks. Should the pain pattern persist in the absence of either a radiculopathic or myelopathic presentation, then an MRI could be considered to determine the etiology of the unexplained persistent pain. A radiculopathic or myelopathic finding may indicate a significant space occupying lesion that could signify disc issues, tumors, varices, tethered cord issues and many more co-morbidities. Without advanced imaging, the practitioner is treating an undiagnosed condition blindly in the presence of positive clinical findings and treatment may end up with the opposite effect, hurting the patient, in many cases, irreparably. 
 
It was reported by Fish, Hisashi, Chang and Pham (2009) that "Perhaps the more meaningful portion of our study was the one in which we limited positive-MRI findings to those with major severity because lower-grade radiologic findings can be common and clinically insignificant. Disk protrusions are particularly common findings in cervical MRIs of asymptomatic patients. Mild cervical stenosis are very common, as well. Also, only significant nerve root compromises are generally expected to exert associated symptoms. It has been reported in a lumbar study that a mere contact of nerve root by disk material is usually not associated with neurogenic symptoms, whereas a compression does seem to be important in this regard. To evaluate MRIs ability to predict treatment outcome, it would be more valid to limit positive MRI findings to only those that will likely have symptomatic effects" (p. 243).3  This statement reflects the clinical standard stated previously, which is to limit an immediate MRI to a significant radiculopathy or a myelopathy.
 
The peer review doctor further went on to discuss studies of disappearing herniations with language that is very misleading. It is a physiological "truism" that discs shrink over time in a process called desiccation and a physiological phenomenon that begins as soon as 2-3 days post trauma. The peer review doctor's statement, a form of misdirection and misuse of physiological facts, still does not answer the direct question clinicians have to answer, "What is the underlying pathology (co-morbidity) creating the clinical signs and symptoms?" A practitioner will not be able to conclude an accurate diagnosis, prognosis and treatment plan without an MRI in the presence of significant radiculopathic or myelopathic findings. The peer review doctor's opinion, should it be adhered to by practitioners, will be the cause of many innocent injured patients being hurt further and possibly experiencing a delay in necessary proper treatment, surgery or proper and timely triaging in potential cancer patients. In addition, should his opinion be adhered to, it could be the cause of many doctors facing licensure misconduct issues. 
 
Although this doctor is entitled to his opinion as a peer reviewer, his "blanket statements" are not in the best interest of the public's health. Peer reviewers get tremendous latitude at the expense of patients and often at the expense of the doctors in trying to create standards where they have no right. Chiropractors have additional issues regarding "risk factors" that are not shared with their medical counterparts. In some of the medical literature, it clearly states that immediate MRIs are not warranted for various reasons. However, most of those authors have no training or knowledge of chiropractic care. Chiropractors usually deliver high velocity thrusts into the spine, a very safe form of care unless a risk factor is present. Although in certain tumors or central canal stenosis immediate MRIs are warranted with overt symptomatology, it would not be considered the standard of care to use MRIs as a screening process to look for possible tumors without those overt signs and symptoms, as the cost factor far outweighs the benefits. However, with the clinical presence of significant radicular or myelopathic findings, it is a current standard of care for the chiropractor to determine the etiology as the risks significantly increase with co-morbidities by delivering high velocity thrusts without first having an accurate diagnosis. 

In considering the cost vs. benefit when ordering MRIs, chiropractic offers a savings of $5.74 billion over medicine and physical therapy4  for low back conditions alone, thereby validating the benefit of immediate MRIs with chiropractic care when clinically indicated. Should a chiropractor deliver a high velocity thrust into a patient with co-morbidities, including, but not limited to, the cause of radiculopathy or myelopathy and hurts the patient or delays necessary surgery or medical care in the case of tumors, that chiropractor would be subject to licensure misconduct by his/her state board for not following the standard of care. 
 
Peer reviewers realize that doctors and lawyers often do not have the ability to understand how to use research and more often lack the ability to look up citations. This peer review doctor's actions of partially quoting a published "opinion article" is problematic and common among unethical peer reviewers. According to a chiropractic board member in the State of New York, this peer review doctor's lack of full disclosure is a potential licensure misconduct issue and should be reported in a complaint to the state's disciplinary board. Unless treating doctors take the time to read all of the research quoted in the peer review reports and IME reports, this abuse will continue unnecessarily.  By refuting inaccurate peer review reports with additional facts from the same research paper(s) originally used, identifying misquoted information and using research to support your care, the truth will prevail in court because of the presentation of the complete set of facts. If you add the licensure complaints to root out the "unethical doctors," the goal of rendering and being compensated for necessary care can be achieved. In the end, the real winners are the patients being afforded necessary care to get well.

REFERENCE:
  1. New Jersey Law Revision Commission (2004). Medical peer review. Retrieved from http://www.lawrev.state.nj.us/medicalpeerreview/mprM083004.pdf
  2. Grover, F., (2003). Is MRI useful for evaluation of acute low back pain? Journal of Family Practice, 52(3), 231-232.
  3. Fish, D., Kobayashi, H., & Pham, Q. (2009). MRI prediction of therapeutic response to epidural steroid injection in patients with cervical radiculopathy. American Journal of Physical Medicine & Rehabilitation 88(3), 239-246.
  4. Studin, M. (2011). The chiropractic solution for work related injuries, Recurring LBP and chronic care. Dynamic Chiropractic, 29(18), 13, 29, 34.
 
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